Canadian Social Work Travail social canadien

Canadian Social Work Travail social canadien Volume 16 (1) Autumn/Automne 2014

The official publication of the Canadian Association of Social Workers Publication officielle de l’Association canadienne des travailleuses et travailleurs sociaux

Canadian Social Work Travail social canadien Volume 16 (1) Autumn/Automne 2014

Co-Editors/Co-Éditrice Karen Schwartz & Elizabeth Sheppard Hewitt Editorial Board/Comité de rédaction Michael Crawford, Caroline Corbin, Ian Rice, Donna Ronan, Isabel Lanteigne, Morel Caissie, CASW President, ex-officio/président de l’ACTS, ex-officio; Fred Phelps, CASW Executive Director, ex-officio/directeur général de l’ACTS, ex-officio. Project Manager/Cheffe de projet France Audet French Copy Editor/Révision du français Gaston St-Jean Graphic Design/Conception graphique Jeff Dumas Cover Design/Graphisme de la couverture Jeff Dumas Canadian Social Work/Travail social canadien 383 avenue Parkdale Avenue, Suite/bureau 402, Ottawa, Ontario K1Y 4R4 Tel./Tél. : (613) 729-6668 Fax/Téléc. : (613) 729-9608 E-mail: [email protected]/Courriel : [email protected] Published by the Canadian Association of Social Workers/ Publié par l’Association canadienne des travailleuses et travailleurs sociaux ISSN 1488-0318

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Notice/Avis Canadian Social Work, the official journal of the Canadian Association of Social Workers (CASW), reaches social workers throughout Canada and beyond. The journal is published online annually in the Fall. Where appropriate a special issue or an additional issue is published. Canadian Social Work is indexed with Social Work Abstracts and Social Services Abstracts CBCA Complete and CBCA Reference also supported by Ebsco Host. Le Travail social canadien, revue officielle de l’Association canadienne des travailleuses et travailleurs sociaux (ACTS), est lu par des travailleurs sociaux de tout le Canada et même de l’étranger. Il est publié en direct, chaque année, au mois d’octobre. S’il y a lieu, on publie un numéro spéciale ou additionnel. Travail social canadien est indexé dans Social Work Abstracts et Social Services Abstracts, CBCA Complete et CBCA Reference également pris en charge par l’hôte Ebsco. IP Access Subscriptions/Abonnement avec Adresse IP et Archives Year 2015 subscription rates for Canadian Social Work IP Access including rolling year privileges: $233 + HST in Canada and $292.00 (US) funds for the US and overseas. Le prix de l’abonnement pour l’an 2014 au Travail social canadien pour les adresses IP & archives : 233 $ + T.V.H. pour le Canada, 292 $ (devises américaines) pour les États-Unis et outremer. Individual Subscriptions/Abonnement individuel 2015 subscription rates for Canadian Social Work for non-members: $52.00 + HST in Canada and $64.00 (US) funds for the US and overseas. Le prix de l’abonnement pour l’an 2014 au Travail social canadien pour les non-membres : 52 $ + T.V.H. pour le Canada, 64 $ (devises américaines) pour les États-Unis et outremer.


Cover The cover art, entitled “Morning Train,” is an early morning view of the outskirts of Gastown, the original settlement and heart of what is now Vancouver. To the left is the modern day Port Metro Vancouver. Visually dividing and linking the two is the expansive rail yard, the same one that has brought goods and people to Canada since the early days of Gastown, and which continues to be a vital link to our modern society. Brian Ball is a Newfoundland-born artist currently living and working in Vancouver. His work spans both the east and west coasts of Canada. www.bgballdesign.com Couverture En couverture : une peinture, intitulée Morning Train, présente une vue au petit matin de la périphérie de Gastown, le site original et le cœur de ce qui est maintenant Vancouver. On voit à la gauche le Port Metro Vancouver, comme il se présente de nos jours. La vaste gare de triage divise visuellement les deux et les lie à la fois. Il s’agit de la même gare de triage par où les marchandises et les personnes sont arrivées au Canada depuis les premiers jours de Gastown. Celle-ci demeure un lien vital à notre société moderne. L’artiste, Brian Ball, est originaire de Terre-Neuve; il vit et travaille aujourd’hui à Vancouver. Ses œuvres dépeignent tant la côte est que la côte ouest du Canada. www.bgballdesign.com


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CONTENU VERBALISÉ PAR L’ENFANT VICTIME D’AGRESSION SEXUELLE LORS DE LA THÉRAPIE (TF-CBT) ET DIMINUTION DES SYMPTÔMES VALÉRIE MERCIER, MIREILLE CYR AND MARTINE HÉBERT

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“I LOVE MY JOB, BUT . . .”: A PORTRAIT OF CANADIAN SOCIAL WORKERS’ OCCUPATIONAL CONDITIONS RALUCA BEJAN, SHELLEY CRAIG AND MICHAEL SAINI

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BOOK REVIEWS/CHRONIQUE LITTÉRAIRE

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PROVIDING CARE FOLLOWING SUDDEN DEATH: THE PRACTICE OF VIEWING CHRISTINA HARRINGTON AND BETHANY SPROWL

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VOICES FROM THE COMMUNITY: BARRIERS AND RECOMMENDATIONS FOR DOMESTIC VIOLENCE SERVICES FOR SOUTH ASIAN WOMEN IN THE GTA, PURNIMA GEORGE AND MARIAM RASHID

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REDEFINING CHILD PROTECTION CULTURE: RELATIONAL NARRATIVE PRACTICE DOUG EGAN AND JOHN YAKIELASHEK

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REPORTS/RAPPORTS PROMOTING EQUITY FOR A STRONGER CANADA: THE FUTURE OF CANADIAN SOCIAL POLICY PROMOUVOIR L’ÉQUITÉ POUR UN CANADA PLUS FORT: L’AVENIR DE LA POLITIQUE SOCIALE CANADIENNE

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RESOURCES/RESSOURCES: LIST OF READERS/LISTE DES LECTEURS AN INVITATION

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EDITORIAL POLICY OF THE CASW JOURNAL

POLITIQUE ÉDITORIALE DE LA REVUE DE L’ACTS

Canadian Social Work, (CSW) the official journal of the Canadian Association of Social Workers (CASW), it is published electronically by the Canadian Association of Social Workers in October of each year.

La revue officielle de l’Association canadienne des travailleuses et travailleurs sociaux (ACTS), le Travail social canadien, est publiée électroniquement par l’ACTS tous les ans, au mois d’octobre. Les articles (2 500 à 5000 mots) présentés pour publication sont évalués de façon anonyme par des membres du comité de rédaction et d’autres personnes compétentes. Les points de vue exprimés dans les articles et les annonces ne sont pas forcément ceux de l’ACTS ou du comité de rédaction.

Articles (2500 to 5000 words) submitted for publication in the Journal are anonymously peer reviewed by Editorial Board members and other selected reviewers. The viewpoints of authors or advertisers are not necessarily those of CASW or the Editorial Board. The goals of the journal are:

Les objectifs de la revue sont les suivants :

1. To provide a national forum in which Canadian social workers can share practice knowledge, research and skills, and debate contemporary social work concerns.

1. constituer une tribune où les travailleurs sociaux canadiens pourront échanger des connaissances pratiques, des résultats de recherche et des compétences, et débattre de sujets intéressant le service social;

2. To stimulate discussion of national and regional social policy issues.

2. stimuler la discussion sur des questions nationales et régionales de politique sociale;

3. To promote exchange between: social workers in different regions and language groups in Canada, the CASW and its Member Organizations, and Canadian and international social work communities.

3. encourager les échanges entre les travailleurs sociaux de différentes régions et de différents groupes linguistiques au Canada, l’ACTS et ses associations affiliées, et les groupes et organismes canadiens et internationaux oeuvrant en service social;

4. To share information about social work educational resources—books, films, videos, conferences and workshops. Submissions Articles can be submitted in either French or English, and if accepted will be published in the language in which the article is received with an abstract in the other official language. An information

4. échanger des informations sur les ressources éducatives disponibles dans le domaine du service social - livres, films, vidéos, conférences et ateliers.


Présentations Les articles proposés doivent être présentés soit en français, soit en anglais. Ceux qui sont acceptés seront publiés dans la langue dans laquelle ils auront été présentés, avec un résumé dans l’autre langue officielle. Les personnes qui souhaitent rédiger un article peuvent obtenir une trousse d’information gratuitement sur demande ou en allant sur le site Web de l’ACTS.

package for prospective writers is available on the CASW web site and free on request. Articles previously published in one CASW official language may be accepted in the other official language for possible publication in the CSW with the approval of the Editorial Board in exceptional circumstances only as defined by the Editorial Board. (for example due to its major contribution to the social work profession).

Les articles déjà publiés dans l’une des langues officielles de l’ACTS peuvent être acceptés dans l’autre langue officielle en vue d’une publication éventuelle dans la revue Travail social Canadien (TSC) seulement dans des circonstances exceptionnelles approuvées par le Comité de rédaction et définies par ce dernier. (par exemple en raison d’une contribution majeure à la profession du travail social).

Articles in this category will be subject to peer review as per the CSW policy and if approved for publication they will appear in the CSW Journal with a note making reference to previous publication and stating copyright permission. CASW will not take responsibility for costs associated with copyright. For further information write to CASW Journal:

Les articles de cette catégorie seront soumis à un examen par des pairs conformément à la politique de l’ACTS, et s’ils sont approuvés, paraîtront dans la revue TSC accompagnés d’une note mentionnant leur publication antérieure et indiquant que la permission de l’auteur a été obtenue. L’ACTS n’assumera pas la responsabilité des coûts associés au droit d’auteur.

383 Parkdale Avenue, Suite 402, Ottawa, ON K1Y 4R4. Tel.: (613) 729-6668 Fax: (613) 729-9608. E-mail: [email protected] Web Site: www.casw-acts.ca

Pour plus d’informations, s’adresser à : Revue de l’ACTS, 383 avenue Parkdale, bureau 402, Ottawa (Ontario) K1Y 4R4. Tél. : (613) 729-6668 Téléc. : 613) 729-9608 Courriel : [email protected] site Web: www.casw-acts.ca


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a dernière année aura été marquée par la revitalisation de l’équipe éditoriale du Travail social canadien. Elizabeth Sheppard Hewitt en a été la corédactrice principale, appuyée par Karen Schwartz comme deuxième corédactrice. Le nombre de textes soumis continue de croître. Voulant réagir à la demande qui découle de ce fait, le Comité de rédaction a lancé, le 1er juin 2014, un projet-pilote visant à réorganiser le processus d’évaluation et de publication des articles. Le Comité de rédaction s’est vu attribuer un rôle plus actif dans l’aiguillage des articles dans le processus d’évaluation. De ce fait, nous espérons simplifier le parcours menant à la publication, tant pour les auteurs que pour les rédacteurs. Nous procéderons à l’évaluation du projet-pilote après un an.

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his past year has been one of revitalization in the editorial office of Canadian Social Work. Elizabeth Sheppard Hewitt has been the lead co-editor, with Karen Schwartz as the second co-editor. The number of submissions continues to grow, and to meet this demand, on June 1, 2014 the Editorial Board embarked on a pilot to re-organize the review and publication process. The Editorial Board has been given a greater hands-on role in guiding articles through the evaluation process. In doing so, we hope to streamline the pathway to publication for Nous avons toujours espéré que le Travail authors and editors alike. We will evaluate social canadien puisse informer tant the pilot after one year. les praticiens que les universitaires et constituer un véhicule permettant aux deux It has always been our hope that Canadian groupes de publier leurs recherches et leurs Social Work would inform practitioners as vues au sujet de leur travail. Il est essentiel well as academics, and be a place where au succès de cette publication d’assurer both can publish their research and que nous répondons aux besoins de nos thoughts about their work. Ensuring that lecteurs. C’est pourquoi nous allons réaliser we are meeting the needs of our readers un sondage au cours de l’hiver 2015. Vous is critical to the success of this publication. serez invités à répondre à un sondage en For this reason, we will be conducting a ligne afin que vous puissiez contribuer à la survey in the winter of 2015. Watch for your revitalisation continue de notre revue. En invitation to complete the online survey so outre, nous invitons toutes les personnes that you can contribute to the continued intéressées à en façonner le contenu à revitalization of the journal. As well, we mettre leur expertise au service de la 7 Canadian Social Work/Travail social canadien

encourage anyone interested in shaping its content to share your expertise as an article reviewer. Simply contact the Canadian Association of Social Workers (CASW) office and complete the forms, and we will be in touch.

revue en qualité d’évaluateurs d’articles. Vous n’avez qu’à communiquer avec les bureaux de l’Association canadienne des travailleuses et travailleurs sociaux (ACTS) et remplir les formulaires appropriés; nous communiquerons avec vous par la suite.

We continue to face the challenges that were identified last year and have actively solicited articles for review in general, and from francophone authors in particular. We will include francophone content in this journal. We continue to encourage everyone, social work practitioners and academics alike, to submit an article for review so that we can continue to represent a broad range of ideas and views about the work in which we are engaged.

Nous sommes toujours confrontés aux difficultés relevées l’an passé et avons activement sollicité des articles à être évalués, des articles en général, et d’auteurs francophones en particulier. Le présent numéro comportera du matériel en français. Nous continuons d’inciter tout le monde, tant les praticiens du travail social que les universitaires, à nous soumettre des articles à être évalués afin que nous puissions continuer de présenter un large éventail d’idées et de perspectives au sujet de notre champ de travail.

The high quality of Canadian Social Work reflects the expertise of the members of the Editorial Board, the reviewers across the country, all those who submitted articles, the copy editors—Paul Sales (English) and Gaston St-Jean (French)—and France Audet, who is the project manager for the journal. On behalf of the Editorial Board, we welcome Glen Schmidt (BCASW) who will join the board in October 2014 and thank him in advance for his expertise. We will miss Michael Crawford (BCASW), who has been a board member for six years. Thank you for your wisdom and humour, Michael. We thank the members of the Editorial Board for all of their hard work and, specifically, their willingness to take on a broader role in the review process: Caroline Corbin (SASW/MIRSW), Donna Ronan (NLASW/PEIASW) and Ian Rice (NBASW/NSASW).

La grande qualité du Travail social canadien constitue un reflet de l’expertise des membres du Comité de rédaction, des évaluateurs de partout au pays, de tous ceux qui nous ont soumis des articles, des réviseurs – Paul Sales (textes anglais) et Gaston St-Jean (textes français) – et France Audet, la gestionnaire de projet pour le compte de la revue. Au nom du Comité de rédaction, nous souhaitons la bienvenue à Glen Schmidt (ATSCB) qui se joindra au Comité en octobre 2014 et nous le remercions à l’avance pour son expertise. Michael Crawford (ATSCB) nous manquera après avoir siégé au Comité pendant six ans. Michael, nous te remercions pour ta sagesse et ton humour. Nous tenons aussi à remercier les membres du Comité de rédaction pour leur travail ardu et, plus particulièrement, pour leur ouverture à


jouer u rôle plus large dans le processus d’évaluation : Caroline Corbin (ATSS/OTSM), Donna Ronan (ATSTN/ATSIPE) et Ian Rice (ATSNB/ATSNE).

We thank Isabel Lanteigne (Francophone Representative) and Morel Caissie (CASW President) for their continued expertise. We also extend thanks to France Audet for her efficiency in the CASW National Office, managing the administrative tasks as the journal’s project manager; to Fred Phelps for his leadership in guiding the organization through its current changes; and to both France and Fred for their unwavering support not only for the journal, but for the CASW as a whole. Many, many thanks go to Sandra Veilleux who filled in for France while she was on sabbatical; Sandra did an excellent job of keeping the co-editors on track.

Merci à Isabel Lanteigne (représentante francophone) et Morel Caissie (président de l’ACTS) pour leur expertise soutenue. Merci aussi à France Audet du bureau national pour l’efficacité qu’elle démontre dans la gestion des tâches administratives en qualité de gestionnaire de projet pour le compte de la revue. Merci à Fred Phelps pour le leadership dont il fait preuve en guidant l’organisation à travers les changements actuels. Merci à France et Fred conjointement pour leur appui indéfectible non seulement au Travail social Canadien, mais aussi à l’ACTS dans son ensemble. Mille mercis à Sandra Veilleux qui a pris la relève de France au cours de son congé sabbatique; elle a su veiller avec brio à ce que les corédactrices demeurent sur la bonne voie.

The efforts of all of these individuals contribute to Canadian Social Work’s reputation as a high-quality, internationally recognized, scholarly journal. As Co-Editors, we are proud to play our role in ensuring that relevant and thought-provoking articles remain both accessible and applicable to Grâce aux efforts de toutes ces personnes, your practice. le Travail social canadien s’est forgé une réputation de grande qualité et constitue une - Karen Schwartz and Elizabeth Sheppard revue savante reconnue internationalement. En qualité de corédactrices, nous sommes Hewitt fières de jouer notre rôle pour assurer que des articles pertinents, qui suscitent la réflexion, continuent d’être mis à la disposition de tous et d’éclairer votre pratique. - Elizabeth Sheppard Hewitt et Karen Schwartz, corédactrices All articles published in this journal are anonymously peer reviewed. Tous les articles publiés dans cette revue sont évalués anonymement par des pairs. 9 Canadian Social Work/Travail social canadien

Contenu verbalisé par l’enfant victime d’agression sexuelle lors de la thérapie (TF-CBT) et diminution des symptômes Valérie Mercier, Mireille Cyr, Martine Hébert

Cette recherche a été financée par le Fonds de recherche sur la société et la culture du Québec (FRQSC), le Conseil de recherches en sciences humaines du Canada (CRSH), la Chaire de recherche interuniversitaire Marie-Vincent sur les agressions sexuelles envers les enfants, le Centre de recherche sur les problèmes conjugaux et les agressions sexuelles (CRIPCAS) et l’Équipe Violence Sexuelle et Santé (ÉVISSA). Pour de plus amples informations : Mireille Cyr, Ph.D., Département de psychologie, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, Québec, Canada, H3C 3J7

ABSTRACT

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his exploratory study examined the relationship between the content (number and types of details) verbalized by the child victim of sexual abuse (SA) during trauma-focused cognitive-behavioral therapy and the reduction of symptoms after therapy. The sample was made up of 28 children between the ages of 6 and 13 years. On the basis of the pre- and post-therapy results observed using the French versions of the Children’s Impact of Traumatic Events Scale–Revised and the Child Behavior Checklist, the children were divided into two groups: those with a reduction of and those with a persistence of post-traumatic stress symptoms and internalized and externalized 10 Canadian Social Work/Travail social canadien

symptoms following therapy. Verbatim accounts of therapy sessions concerning SA-related details were transcribed and scored as new details (disclosed only once) or repeated details in 12 detail categories. The Mann-Whitney test results indicated no significant difference between the two groups with regard to the total average number of new details and repeated details disclosed. However, compared with the persistence of symptoms group, the reduction of symptoms group verbalized significantly more new details for the action and place categories.

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u cours des dernières décennies, plusieurs programmes d’intervention ont été élaborés afin d’intervenir le plus rapidement et le plus efficacement possible auprès des enfants victimes d’agression sexuelle (AS). Toutefois, il semblerait que les diverses approches thérapeutiques n’auraient pas toutes la même efficacité (Berliner, 2005). Les résultats de plusieurs études indiquent que les thérapies cognitivo-comportementales sont particulièrement efficaces pour le traitement des enfants et adolescents victimes d’AS (Saywitz et coll., 2000; Harvey et Taylor, 2010). Parmi cellesci se retrouve la Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) (Deblinger et Helfin, 1996; Cohen et coll., 2006), considérée comme un traitement exemplaire pour ce groupe d’enfants (Silverman et coll., 2008; Hébert et coll., 2011).

La TF-CBT est une thérapie cognitivo-comportementale offerte aux enfants ayant vécu un traumatisme et a pour objectif la diminution des difficultés affectives, cognitives, UN ENVIRONNEMENT comportementales et relationnelles (Deblinger et Heflin, SÉCURISANT, AMÈNE 1996; Cohen et coll., 2006). Elle se déroule généralement L’ENFANT À ÉLABORER sur 12 séances d’environ 90 minutes et comprend des séances individuelles avec l’enfant ainsi qu’avec L’HISTOIRE DE SON son parent et des séances dyadiques parent-enfant. Le AS EN DÉCRIVANT volet enfant se divise en plusieurs composantes, dont la LES DÉTAILS ASSOCIÉS narration du traumatisme, qui constitue l’un des objectifs primordiaux de la TF-CBT (Simoneau et coll., 2011). Le AINSI QUE LES PENSÉES thérapeute, dans un environnement sécurisant, amène ET LES ÉMOTIONS QUI Y l’enfant à élaborer l’histoire de son AS en décrivant les SONT LIÉES. détails associés ainsi que les pensées et les émotions qui y sont liées. La préparation d’un récit narratif sur le traumatisme repose sur le principe de l’exposition cognitive et a pour objectifs de contrer les stratégies d’évitement employées par l’enfant ainsi que de diminuer les sentiments négatifs et les pensées erronées associés à l’AS.

LE THÉRAPEUTE, DANS

Plusieurs études ont évalué l’efficacité de la TF-CBT, notamment en la comparant avec d’autres types d’intervention comme les traitements usuels offerts (Deblinger et 11 Canadian Social Work/Travail social canadien

coll., 1996) ou la Child-Centered Therapy for Treating Posttraumatic Stress Disorder (Cohen et coll., 2004). Les résultats de ces études révèlent une diminution significative des symptômes de stress post-traumatique, des symptômes extériorisés ainsi que des symptômes dépressifs chez les enfants qui participent à la TF-CBT relativement aux enfants ayant bénéficié d’autres types d’intervention. Des mesures suivies ont aussi été effectuées afin de documenter les effets à plus long terme de la TF-CBT (Deblinger et coll., 1999; Deblinger et coll., 2006) et les résultats indiquent que les acquis chez les enfants victimes d’AS se maintiennent sur une période de deux ans suivant les interventions.

L’EXPOSITION COGNITIVE ET LE RÉCIT VERBAL

Le récit narratif est une composante du traitement TF-CBT qui repose sur l’exposition cognitive. Cette dernière découle des concepts du conditionnement classique et du conditionnement opérant et se base, de façon plus spécifique, sur le processus d’habituation (Wolpe, 1958; Stampfl et Levis, 1967). Ce processus consiste en la diminution graduelle de l’intensité de la réactivité émotionnelle à la suite d’une présentation répétée du stimulus qui en est la cause. Ainsi, selon ce principe, plus l’enfant victime d’AS est exposé de façon répétée au récit de l’événement vécu, moins il ressentira d’émotions négatives (p. ex., honte, anxiété) et de symptômes associés au traumatisme. Des études soutiennent l’efficacité de l’exposition cognitive afin de diminuer les symptômes dans le traitement de différents troubles, notamment les troubles anxieux, la dépression et le trouble de stress post-traumatique (Foa et Rothbaum, 1998; Foa et coll., 1999 ; Rothbaum et coll., 2000). Les mécanismes qui permettent d’expliquer les effets de l’exposition par narration du traumatisme ne sont pas encore élucidés. Toutefois, les écrits scientifiques font mention d’une théorie principale, soit la théorie des changements cognitifs (Pennebaker, 1997; Pennebaker et Chung, 2007; Pennebaker et Chung, 2011). Cette théorie propose que le fait de transformer des souvenirs et des images en mots modifie la façon dont la personne organise et pense à son traumatisme. Ainsi, en intégrant les pensées et les émotions, la personne peut construire plus facilement un discours cohérent de son expérience. Une fois l’événement reconstruit, il peut être plus facilement résumé et emmagasiné de façon efficace. Cette dernière théorie nécessite toutefois davantage d’appui scientifique. En ce sens, maintes études ont été effectuées dans les dernières années afin de comprendre les facteurs qui influencent la réussite ou l’échec de l’exposition. Pennebaker et Chung (2011) rapportent qu’il n’y aurait pas de différence individuelle significative (p. ex., degré d’anxiété, d’hostilité et d’inhibition), ni de différence culturelle ou de langage qui permettrait d’expliquer pourquoi certaines personnes bénéficient davantage des récits écrits. Analyser le contenu des verbalisations lors de l’exposition pourrait être une façon de mieux cerner les facteurs influençant les bénéfices physiques et mentaux qui y sont liés.


Aussi, une récente étude (Philippot et coll., 2010) indique que les participants ayant exploré en détail les aspects spécifiques d’une situation anxiogène (versus explorer de façon générale ces aspects ou ne pas faire d’exposition verbale) sont ceux qui ont rapporté le niveau d’anxiété le plus faible après l’exposition. Ces résultats rejoignent ceux d’études antérieures qui indiquent que le fait de discuter de façon détaillée d’un événement spécifique en explorant les émotions, les sensations et les pensées qui y sont liées est associé à un niveau plus faible d’intensité émotionnelle ressentie (Philippot et coll., 2006; Raes et coll., 2006). En ce sens, la présente étude exploratoire vise à examiner le lien entre le contenu verbalisé par l’enfant victime d’AS lors de l’exposition au traumatisme et la diminution des symptômes à la suite de la thérapie. En nous basant sur les recherches antérieures rapportant les études évaluatives de la TF-CBT, ainsi que sur les principes de l’exposition par récit verbal, nous formulons l’hypothèse voulant que plus les enfants auront verbalisé de détails concernant l’AS lors de la thérapie, plus l’exposition aura été complète et plus importante sera la diminution des symptômes de stress post-traumatique ainsi que des symptômes intériorisés et extériorisés suivant la thérapie. Différentes catégories de détails seront également considérées afin d’en explorer leur influence sur la présence des symptômes.

MÉTHODOLOGIE Participants L’échantillon de cette étude se compose de 28 enfants victimes d’AS ayant suivi une thérapie TF-CBT au Centre d’Expertise Marie-Vincent (CEMV) à Montréal entre le 1er janvier 2008 et le 30 juillet 2012 et leur parent non-agresseur. Les enfants, 6 garçons et 22 filles, sont âgés de 6 à 13 ans (M= 9,3 ans; ET= 2,1). Parmi ces derniers, 8 (29 %) ont subi un seul incident d’AS, 12 (42 %) ont subi quelques épisodes d’AS et 8 enfants (29 %) ont subi des épisodes répétitifs ou chroniques d’AS. Les agresseurs étaient soit une figure parentale (n=7), un membre de la fratrie (n=6), un membre de la famille élargie (n=7), une connaissance (n=7) ou un étranger (n=1). Les événements rapportés par les enfants étaient des AS très graves, impliquant une pénétration ou tentative de pénétration (n=15), des AS graves, impliquant des contacts physiques sous les vêtements ou avec déshabillage (n=11) ou des AS moins graves, impliquant des contacts physiques par-dessus les vêtements ou des expériences sexuelles sans contact physique (n=2). Le choix des participants a été déterminé en fonction de deux critères. Tout d’abord, les enfants et leur parent devaient avoir complété la thérapie ainsi que les deux questionnaires requis pour le présent projet, et ce, au début et à la fin de la thérapie. Ensuite, la totalité des enregistrements vidéos des séances devait être disponible. Au départ, 93 enfants répondaient à ces critères. Une analyse de regroupement (cluster) à l’aide des scores de 13 Canadian Social Work/Travail social canadien

différence (T2-T1 sur les trois types de symptômes) a été effectuée et a permis de diviser l’échantillon en quatre groupes distincts. Les participants faisant partie du groupe s’étant le plus amélioré et ceux du groupe s’étant le moins amélioré à la fin de la thérapie en tenant compte des scores totaux combinés sur les trois types de symptômes (CITES-II et CBCL: scores intériorisés et extériorisés) requis pour l’étude ont été sélectionnés. Finalement, 14 enfants ont été inclus pour le groupe persistance des symptômes et 14 enfants ont été retenus pour le groupe diminution des symptômes. Mesures La version française (Hébert, 2006) du Children’s Impact of Traumatic Events ScaleRevised (CITES-II, Wolfe, 2002) a été remplie par les enfants. Il s’agit d’un questionnaire autorapporté de 55 questions pour lequel l’enfant doit choisir l’une des trois réponses (faux, un peu vrai ou très vrai). Le questionnaire tient compte des trois symptômes principaux de l’état de stress posttraumatique selon le DSM-IV: les symptômes de réexpérimentation, d’hypervigilance et d’évitement. Le CITES-II permet donc d’évaluer la présence de symptômes de stress posttraumatique chez les enfants et couvre les critères B, C et D du DSM-IV. Le score total du questionnaire (incluant les symptômes de réexpérimentation, d’hypervigilance et d’évitement) a été considéré pour les analyses. À noter que selon la plus récente version du DSM (DSM-5), un groupe de symptômes additionnel s’ajoute, soit l’humeur et les cognitions négatives. Toutefois, comme la cueillette de données s’est réalisée avant la parution du DSM-5, ce groupe de symptômes n’a pas été considéré. La version française du Child Behavior Checklist for Ages 6-18 (CBCL 6-18, Vermeersch et Fombonne, 1997; Achenbach et Rescorla, 2001) est un questionnaire rempli par les parents qui permet d’évaluer la présence de symptômes intériorisés et extériorisés chez l’enfant. Le questionnaire est composé de 113 points associés aux catégories suivantes : le retrait social, la somatisation, l’anxiété, la dépression, les problèmes sociaux, les problèmes attentionnels, les comportements agressifs et délinquants. Dans cette étude, les scores globaux combinés référant aux troubles intériorisés et extériorisés ont été considérés. Procédures Les enregistrements des séances de thérapie ont été visionnés pour les 28 enfants de l’échantillon. Le verbatim anonymisé, concernant les détails associés à l’AS, a été transcrit et les détails verbalisés par l’enfant ont été cotés à l’aide d’une grille déjà élaborée (Lamb et coll., 1996, traduite par Cyr et coll., 2002). Les détails des verbalisations, définis en unité de mots, ont ensuite été classés en 12 catégories selon qu’ils concernent les actions (p. ex., « il n’arrêtait pas de m’embrasser »), les lieux (p. ex., « c’est arrivé dans le salon »), le temps (p. ex., « c’était durant l’été »), le suspect (p. ex., « il avait une moustache »), les témoins (p. ex., « ma mère dormait dans sa chambre »), la victime (p. ex., « j’avais un pyjama »), les émotions (p. ex., « j’avais peur »), les perceptions sensorielles (p. ex., « il sentait l’alcool »), les pensées (p. ex., « je voulais partir »), les parties du corps (p. ex., 14 Canadian Social Work/Travail social canadien

« ma vulve et mes fesses »), le contenu verbal (p.ex., « il m’a dit: « dis le pas » ») ou autres (p. ex., « oui », « non »). Les informations données par l’enfant ont également été cotées en tant que nouveau détail (divulgué une seule fois par l’enfant) ou détail répété (ayant été divulgué à plus d’une reprise). Avant de codifier les 28 transcriptions, deux coteurs ont été formés à utiliser la grille jusqu’à l’obtention d’un accord interjuges satisfaisant. Neuf transcriptions ont été cotées par les deux coteurs afin de s’assurer de la fidélité interjuges dont le taux moyen est de 0,93 (corrélation intraclasse).

RÉSULTATS

Tout d’abord, des analyses (chi-deux et test-t) ont été effectuées afin de vérifier s’il y avait des différences entre les groupes sur le plan de l’âge des enfants, du lien avec l’agresseur, de la durée des AS et de la sévérité des gestes vécus. Les résultats n’indiquent aucune différence significative entre les deux groupes à l’exception de la durée des AS (x2(1)= 9,58, p< .01) indiquant qu’une proportion plus grande d’enfants a vécu des agressions répétées ou chroniques dans le groupe 2 (persistance des symptômes) lorsque comparé au groupe 1 (diminution des symptômes). Toutefois, un test-t effectué n’indique pas de différence significative pour ce qui est du nombre de détails nouveaux (t(24) = 9,74, ns) ou répétés (t(24)= ,42, ns) divulgués par les enfants selon la durée des AS. De plus, aucun lien significatif n’existe entre l’âge des enfants et le nombre de détails nouveaux (r=,28, ns) ou répétés (r=,01, ns) divulgués par ces derniers. C’est pourquoi cette variable ne sera pas considérée dans les analyses. Comme plusieurs variables à l’étude ne permettent pas de répondre aux postulats de base des tests paramétriques ni leurs transformations et compte tenu de la faible taille de l’échantillon, des analyses non paramétriques de Mann-Whitney pour l’ensemble des variables ont été effectuées afin de comparer le nombre moyen total de détails verbalisés (nouveaux et répétés) ainsi que le nombre moyen de détails verbalisés pour chacune des catégories selon les groupes (voir le Tableau 1). De façon générale, les enfants des deux groupes ont rapporté un nombre moyen plus élevé de nouveaux détails concernant les catégories : action, pensée, contenu verbal, temps et lieu. Pour ce qui est des détails répétés, les catégories de détails les plus souvent divulguées indépendamment des groupes sont les suivantes : action, contenu verbal et autre. Les résultats du Test Mann-Whitney ne démontrent aucune différence significative entre les deux groupes pour ce qui est du nombre moyen total de détails nouveaux (U=69, z = 1,33, ns, r=0,25) et répétés (U=84, z= -0,64, ns, r=0,12) divulgués par les enfants. Aussi, bien que les enfants chez qui on observe une diminution des symptômes à la suite de la thérapie (Gr. 1) ont verbalisé, en moyenne, un nombre plus élevé pour 11 des 12 15 Canadian Social Work/Travail social canadien

catégories de nouveaux détails et pour 8 des 12 catégories de détails répétés que les enfants chez lesquels on observe une persistance des symptômes (Gr. 2), les résultats du Test MannWhitney n’indiquent pas de différences significatives entre les groupes pour la majorité des catégories de détails. Toutefois, lorsque comparé au groupe persistance des symptômes (Gr. 2), le groupe diminution des symptômes (Gr. 1) a verbalisé significativement plus de nouveaux détails pour la catégorie action (U=54,5, z= -2, p< .05, r= 0,38) et la catégorie lieu (U=52, z= -2,12, p< .05, r= 0,41).

Tableau 1 Comparaison du nombre moyen de détails nouveaux et répétés (écart-type) divulgués selon les catégories de détails et les groupes d’appartenance Détails nouveaux Détails répétés Catégories (détails) Diminution Persistance Mann- Diminution Persistance Mannsymptômes symptômes Whitney symptômes symptômes Whitney (n=14) (n=14) (n=14) (n=14) Action

81 (79)

38 (33)

54,5*

15(21)

11(10)

97

Pensée

45 (41)

33 (28)

91,5

5 (6)

3 (5)

90

Contenu verbal

40 (48)

25 (24)

88

8 (11)

4 (7)

74,5

Temps

40 (50)

21 (14)

76

2 (3)

5 (6)

79

Lieu

30 (33)

11 (6)

52*

6 (9)

2 (2)

71

Témoin

16 (19)

11 (13)

90

3 (4)

2 (4)

79,5

Émotion

15 (10)

13 (7)

80,5

2 (2)

2 (2)

91,5

Partie du corps

14 (14)

8 (6)

68,5

5 (7)

5 (8)

95,5

Suspect

11 (8)

8 (8)

73,5

1 (2)

2 (4)

87

Autre

9 (7)

8 (7)

91

9 (8)

5 (5)

70,5

Victime

8 (12)

3 (5)

82,5

2 (3)

1 (4)

89

Perception sensorielle

5 (12)

5 (6)

71,5

3 (7)

0 (0)

82,5

313 (261)

183 (91)

69

61 (52)

43 (22)

84

Total Note. *p< .05

DISCUSSION

L’objectif principal de cette recherche exploratoire consistait à examiner le lien entre le contenu verbalisé par l’enfant victime d’AS lors de l’exposition au traumatisme et la diminution des symptômes à la suite de la thérapie. La discussion aborde deux aspects, soit le nombre total de détails ainsi que les catégories et les types de détails. 16 Canadian Social Work/Travail social canadien

Nombre total de détails Les résultats de cette étude n’indiquent pas de différence significative entre les deux groupes (diminution ou persistance des symptômes) pour ce qui est du nombre moyen total de détails nouveaux et répétés verbalisés par les enfants victimes d’AS lors de la narration du traumatisme. LES RÉSULTATS NE Ces résultats vont à l’encontre de l’hypothèse énoncée précédemment. Les résultats ne permettent donc pas PERMETTENT DONC d’apporter une réponse claire concernant les facteurs PAS D’APPORTER qui peuvent influencer la réussite ou l’échec des séances UNE RÉPONSE d’exposition. Toutefois, puisqu’en moyenne, le groupe CLAIRE CONCERNANT présentant une diminution des symptômes à la suite de la thérapie a divulgué un nombre moyen total de LES FACTEURS QUI nouveaux détails et de détails répétés plus élevé que PEUVENT INFLUENCER le groupe présentant une persistance des symptômes, LA RÉUSSITE OU il est important de considérer que l’absence de différences significatives puisse être liée à un manque L’ÉCHEC DES SÉANCES de puissance statistique compte tenu de la petite taille D’EXPOSITION. de l’échantillon. De plus, Deblinger et coll. (2011) mentionnent que la TF-CBT avec narration du traumatisme semble être plus bénéfique pour la diminution des symptômes intériorisés (p.ex., anxiété et peur) alors que la TF-CBT sans narration du traumatisme serait plus efficace pour la diminution des problèmes de comportement, tels que rapportés par les parents (p.ex., problèmes sociaux, comportements agressifs et délinquants). Il semble donc que l’exposition au traumatisme pourrait ne pas être aussi bénéfique, notamment comme première phase du traitement, lorsque les symptômes extériorisés sont prédominants chez les enfants. Des études futures devraient tenir compte des types de symptômes présents afin de voir si l’exposition est moins prioritaire comme modalité de traitement ou devrait être précédée d’une approche ciblant les troubles de comportement, lorsque les symptômes extériorisés sont prédominants chez les enfants. Il semble également pertinent de prendre en considération le fait que les détails verbalisés par les enfants n’ont pas été classés en ordre de priorité pour eux. En ce sens, un enfant peut avoir verbalisé un petit nombre de détails qu’il juge importants (p.ex., détails suscitant beaucoup d’anxiété, de peur et de honte chez l’enfant; détails n’ayant jamais été dévoilés à une autre personne auparavant) et ainsi bénéficier davantage des effets de l’exposition qu’un enfant ayant verbalisé beaucoup de détails qu’il juge moins importants. Cet aspect, très difficile à mesurer, peut influencer l’interprétation des résultats. Il est aussi possible de se questionner sur l’influence de variables, autre que le nombre de détails, sur la réussite de l’exposition cognitive. Les écrits scientifiques rapportent 17 Canadian Social Work/Travail social canadien

que les personnes qui commenceraient leur récit narratif avec une histoire cohérente de l’événement traumatique bénéficieraient moins des séances d’exposition étant donné qu’ils auraient déjà organisé et intégré leurs souvenirs traumatiques (Pennebaker et Chung, 2011). Cet aspect est toutefois difficile à évaluer chez les enfants. Également, la période sur laquelle se déroulent les séances d’exposition pourrait avoir un impact sur les résultats obtenus. Toutefois, cet aspect n’a pas été pris en compte puisqu’il semblerait que l’exposition par récit narratif serait aussi bénéfique si elle est effectuée sur une même journée que sur plusieurs jours (Chung et Pennebaker, 2008). Catégories et type de détails Les résultats de la présente étude indiquent toutefois que les enfants chez lesquels on observe une diminution des symptômes à la suite de la TF-CBT ont divulgué un nombre significativement plus élevé de nouveaux détails concernant les actions et les lieux. Plusieurs éléments sont à considérer dans l’interprétation de ces résultats. La catégorie action est celle qui a été la plus souvent verbalisée par les enfants des deux groupes, ce qui pourrait expliquer que la différence entre les groupes soit significative contrairement à la plupart des autres catégories. Ensuite, selon Cyr et coll. (2002), les détails verbalisés par les enfants victimes d’AS peuvent être catégorisés comme étant des détails centraux (essentiels à la compréhension des AS) ou des détails périphériques (non essentiels à la compréhension des AS). En ce sens, les catégories action et lieu sont plus susceptibles de contenir des détails centraux (p. ex., « il me touchait dans la chambre ») contrairement à d’autres catégories telles que les catégories victime, pensée, émotion, témoin et suspect, qui sont plus susceptibles de contenir des détails périphériques (p. ex., « je portais un chandail rose »). Il est donc possible de croire que la verbalisation de détails centraux, puisqu’elle permet une meilleure compréhension des AS et donc possiblement une meilleure intégration et [I]L APPARAÎT PLUS cohérence de ces événements, augmente les bénéfices liés à l’exposition. Cela pourrait expliquer, en partie, les BÉNÉFIQUE POUR LES différences significatives obtenues entre les groupes. ENFANTS D’ÉLABORER DE NOUVEAUX

Selon les résultats significatifs pour ces deux catégories, il apparaît plus bénéfique pour les enfants d’élaborer de DÉTAILS QUE DE nouveaux détails que de répéter des détails déjà divulgués RÉPÉTER DES DÉTAILS auparavant. Pennebaker et Graybeal (2001) mentionnent DÉJÀ DIVULGUÉS que lorsque la structure et la cohérence de l’événement traumatique sont établies, l’individu ressent un sentiment AUPARAVANT. d’achèvement et de contrôle lui permettant de mieux s’adapter à son traumatisme. En ce sens, il est possible de croire que la répétition des détails, puisqu’elle ne favorise pas directement la cohérence et la structure des AS, n’est pas aussi bénéfique que l’élaboration de nouveaux détails. 18 Canadian Social Work/Travail social canadien

Limites de l’étude Cette étude comprend certaines limites, dont la faible taille de l’échantillon. En effet, afin de s’assurer de n’avoir que des groupes extrêmes, ce projet n’a pu répertorier que 28 participants, ce qui pourrait influencer la précision et la fiabilité des résultats. Également, certains facteurs pouvant influencer les résultats, dont les caractéristiques des intervenantes et le type de questions posées par celles-ci, n’ont pas été considérés. Bien que la formation préalable sur la TF-CBT et la formation professionnelle des intervenantes soient similaires (c.-à-d.. psychologie, sexologie, psychoéducation), plusieurs intervenantes ont réalisé les séances de thérapie (10 dans le groupe 1 et 7 dans le groupe 2) et il est possible que des facteurs non considérés dans la présente étude influent sur les résultats. Aussi, plusieurs auteurs (Hershkowitz, 2001; Cyr et Lamb, 2009) indiquent que l’utilisation de questions ouvertes (p.ex., « parle-moi de l’agression ») avec les enfants victimes d’AS, contrairement à des questions directes (p.ex., « il t’a touché sur ou sous les vêtements ? ») ou des questions fermées (p. ex., « est-ce qu’il t’a fait mal? »), entraîne un nombre plus important de détails. Cela pourrait donc influencer le nombre total de détails verbalisés par les enfants. Une autre limite de l’étude est la présence d’autres événements significatifs de nature traumatique chez les enfants pendant les séances de thérapie. En effet, d’autres événements parfois vécus par les enfants victimes d’AS et qui peuvent être très anxiogènes pour eux, comme un placement en famille d’accueil ou un témoignage à la cour, n’ont pas été considérés. Malgré l’influence possible de ces événements, il est très difficile d’en évaluer l’apport [L]ES EFFETS DES spécifique sur les symptômes présents chez les enfants à la fin du traitement. SÉANCES D’EXPOSITION PEUVENT APPARAÎTRE QUELQUES JOURS, QUELQUES SEMAINES OU MÊME QUELQUES MOIS SUIVANT L’ÉLABORATION DU RÉCIT NARRATIF.

Finalement, Pennebaker et Chung (2011) mentionnent que les effets des séances d’exposition peuvent apparaître quelques jours, quelques semaines ou même quelques mois suivant l’élaboration du récit narratif. Puisque les questionnaires ont été administrés à la fin des séances de thérapie, il n’est pas possible d’observer les effets à long terme des séances d’exposition sur les symptômes des enfants. De futures recherches tenant compte de ces limites devraient être effectuées afin de contrôler et de vérifier leur influence.

Implications cliniques Les résultats de cette étude exploratoire soulignent des éléments pertinents à prendre en compte dans les pratiques d’intervention auprès des enfants victimes d’AS. En effet, il est possible de se questionner sur l’importance en tant qu’intervenant d’encourager davantage les enfants à verbaliser des détails concernant les événements qu’ils ont vécus. Selon les 19 Canadian Social Work/Travail social canadien

résultats de cette étude, il semblerait que cela pourrait être souhaitable, notamment pour ce qui est des actions et des lieux reliés aux AS. Cela pourrait contribuer à effectuer une exposition au traumatisme qui serait possiblement plus complète, influençant ainsi la diminution des symptômes présents chez ces derniers. Toutefois, de futures recherches sur le sujet, comportant un échantillon d’enfants plus vaste, sont nécessaires afin de répondre de façon définitive à cette question.

RÉFÉRENCES

Achenbach, T.M. et Rescorla, L.A. (2001). Manual for the ASEBA School-Age Form and Profile, Burlington, VT, University of Vermont, Research Center for Children, Youth, and Families. Berliner, L. (2005). « The results of randomized clinical trials move the field forward », Child Abuse and Neglect, 29, 103-105. Chung, C.K. et Pennebaker, J.W. (2008). « Variations in the spacing of expressive writing sessions », British Journal of Health Psychology, 13, 15- 21. Cohen, J. A., Deblinger, E., Mannarino, A.P. et Steer, R.A. (2004). « A multi-site randomized controlled trial for children with abused-related PTSD symptoms », Journal of American Academy of Child Adolescent Psychiatry, 43(4), 393-402. Cohen, J.A., Mannarino, A.P. et Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents, New York, NY, Guilford Press. Cyr, M. et Lamb, M.E. (2009). « Assessing the effectiveness of the NICHD investigative interview Protocol when interviewing French-speaking alleged victims of child sexual abuse in Quebec », Child Abuse and Neglect, 33, 257-268. Cyr, M., Dion, J., Perreault, R. et Richard, N. (2002). Analyse du contenu et de la qualité de l’entrevue: Manuel de cotation des entrevues d’investigation, Montréal, Canada: Centre de Recherche Interdisciplinaire sur les Problèmes Conjugaux et les Agressions Sexuelles (CRIPCAS). Deblinger, E. et Heflin, A.H. (1996). Treating Sexually Abused Children and their Nonoffending Parents: A cognitive-behavioral approach, Thousand Oaks, CA, Sage Publications. Deblinger, E., Lippmann, J. et Steer, R.A. (1996). « Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings », Child Maltreatment, 1(4), 310-321. Deblinger, E., Mannarino, A.P., Cohen, J.A., Runyon, M.K. et Steer, R.A. (2011). « Trauma-Focused cognitive behavioral therapy for children: Impact of the trauma narrative and treatment length », Depression and Anxiety, 28, 67-75. Deblinger, E., Mannarino, A.P., Cohen, J.A. et Steer, R.A. (2006). « Follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms: examining predictors of treatment response », Journal of the American Academy of Child et Adolescent Psychiatry, 45, 1474-1484. Deblinger, E., Steer, R.A. et Lippmann, J. (1999). « Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms », Child Abuse et Neglect, 23(12), 1371-1378. Foa, E.B. et Rothbaum, B.O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD, New York, NY, Guilford Press.


Foa, E.B., Dancu, C.V., Hembree, E.A., Jaycox, L.H., Meadows, E.A. et Street, G.P. (1999). « A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims », Journal of Consulting and Clinical Psychology, 67, 194-200. Harvey, S.T. et Taylor, J.E. (2010). « A meta-analysis of the effects of psychotherapy with sexually abused children and adolescents », Clinical Psychology Review, 30, 517-535. Hébert, M. (2006). Traduction française du Children’s Impact of Traumatic Events Scale II (CITES II; Wolfe, 2002), Document inédit, Montréal, QC, Département de sexologie, Université du Québec à Montréal. Hébert, M., Bernier, M-J. et Simoneau, A.C. (2011). « Effets des interventions offertes aux jeunes victimes d’agression sexuelle », in M. Hébert, M. Cyr et M. Tourigny (dir.), L’agression sexuelle envers les enfants, Tome I (pages 205- 252), Québec, QC, Presses de l’Université du Québec. Hershkowitz, I. (2001). « Children’s responses to open-ended questions: A field study of forensic interviews », Legal and Criminological Psychology, 6, 49-63. Lamb, M.E., Hershkowitz, I., Sternberg, K.J., Esplin, P.W., Hovav, M., Manor, T. et YUDILEVITCH, L. (1996). « Effects of investigative utterance types on Israeli children’s responses », International Journal of Behavioral Development, 19, 627-637. Pennebaker, J.W. (1997). « Writing about emotional experiences as a therapeutic process », Psychological science, 8(3), 162-166. Pennebaker, J.W. et Chung. C.K. (2007). « Expressive writing, emotional upheavals, and health », in H. Friedman et R. Silver (dir.), Handbook of health psychology (pages 264-282), New York, NY, Oxford University Press. Pennebaker, J. W. et Chung, C. K. (2011). « Expressive writing: Connections to physical and mental health », in H. S. Friedman (dir.), The Oxford handbook of health psychology (pages 417-437), New York, NY, Oxford University Press. Pennebaker, J.W. et Graybeal, A. (2001). « Patterns of natural language use: disclosure, personality, and social integration », Current Directions in Psychological Science, 10, 90-93. Philippot, P., Baeyens, C. et Douilliez, C. (2006). « Specifying emotional information: Modulation of emotional intensity via executive processes », Emotion, 6, 560-571. Philippot, P., Vrielynck, N. et Muller, V. (2010). « Cognitive processing specificity of anxious apprehension: Impact on distress and performance during speech exposure », Behavior therapy, 41, 575-586. Raes, F., Hermans, D., Williams, J.M.G. et Eelen, P. (2006). « Reduced autobiographical memory specificity and affect regulation », Cognition and Emotion, 20, 402-429. Rothbaum, B.O., Meadows, E.A., Resick, P. et Foy, D.W. (2000). « Cognitive-behavioral therapy », dans E.B. Foa, T.M. Keane et M.J. Friedman (dir.), Effective Treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (pages 60-83), New York, NY, Guilford Press. Saywitz, K.J., Mannarino, A.P., Berliner, L. et Cohen, J.A. (2000). « Treatment for sexually abused children and adolescents », American Psychologist, 55, 1040-1049. Silverman, W.K., Ortiz, C.D., Viswesvaran, C., Burns, B.J., Kolko, D.J., Putman, F.W. et Amaya-Jackson, L. (2008). « Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events », Journal of Clinical Child and Adolescent Psychology, 37(1), 156-183. Simoneau, A.C., Daignault, I.V. et Hébert, M. (2011). « La thérapie cognitivo-comportementale axée sur le trauma », dans M. Hébert, M. Cyr et M. Tourigny (dir.), L’agression sexuelle envers les enfants, Tome 1 (pages 363-398), Québec, Presses de l’Université du Québec. 21 Canadian Social Work/Travail social canadien

Stampfl, T.G. et Levis, D.J. (1967). « Essentials of implosive therapy: A learning-based psychodynamic behavioral therapy », Journal of Abnormal Psychology, 72, 496-503. Vermeersch, S et Fombonne, E (1997). « Le Child Behavior Checklist : résultats préliminaires de la standardisation de la version française », Neuropsychiatrie de l’enfance et de l’adolescence, 45(10), 615-620. Wolfe, V.V. (2002). The Children’s Impact of Traumatic Events Scale II (CITES-II), Document non publié, London, ON, Canada, London Health Science Centre. Wolpe, J. (1958). Psychotherapy by reciprocal inhibition, Stanford, CA, Stanford University Press..

VALÉRIE MERCIER

EST TITULAIRE D’UN BACCALAURÉAT BIDISCIPLINAIRE EN PSYCHOLOGIE ET

PSYCHOÉDUCATION ET EST CANDIDATE AU DOCTORAT EN PSYCHOLOGIE CLINIQUE

À

AUX ENFANTS ET ADOLESCENTS

QUI VIVENT

SEXUELLES.

DU

CENTRE

MONTRÉAL. ELLE S’INTÉRESSE PRINCIPALEMENT DIFFÉRENTES PROBLÉMATIQUES, DONT LES AGRESSIONS

(D. PSY)

L’UNIVERSITÉ DE

ELLE

EST MEMBRE

DE RECHERCHE INTERDISCIPLINAIRE SUR LES PROBLÈMES CONJUGAUX ET LES AGRESSIONS

SEXUELLES (CRIPCAS) EN PLUS DE FAIRE PARTIE DE L’ÉQUIPE VIOLENCE SEXUELLE ET SANTÉ (ÉVISSA). ELLE EST ÉGALEMENT BOURSIÈRE DU FONDS DE RECHERCHE SUR LA SOCIÉTÉ ET LA CULTURE DU QUÉBEC (FRQSC).

MIREILLE CYR (PH. D. EN PSYCHOLOGIE) EST PROFESSEURE TITULAIRE AU DÉPARTEMENT DE PSYCHOLOGIE DE L’UNIVERSITÉ DE MONTRÉAL DEPUIS PLUS DE 20 ANS. ELLE EST ÉGALEMENT LA DIRECTRICE SCIENTIFIQUE DU CENTRE DE RECHERCHE INTERDISCIPLINAIRE SUR LES PROBLÈMES CONJUGAUX ET LES AGRESSIONS SEXUELLES (CRIPCAS), COTITULAIRE DE LA CHAIRE INTERUNIVERSITAIRE FONDATION MARIE-VINCENT SUR LES AGRESSIONS SEXUELLES ENVERS LES ENFANTS, EN PLUS DE FAIRE PARTIE DE L’ÉQUIPE VIOLENCE SEXUELLE ET SANTÉ (ÉVISSA). SES PROJETS DE RECHERCHE ONT PORTÉ SUR LA THÉMATIQUE DES AGRESSIONS SEXUELLES ENVERS LES ENFANTS. ELLE S’INTÉRESSE PARTICULIÈREMENT AUX SÉQUELLES DES AGRESSIONS SEXUELLES CHEZ LES ENFANTS ET LES ADOLESCENTS, AUX DÉTERMINANTS DU SOUTIEN PARENTAL ET À L’ENTREVUE D’ENQUÊTE AUPRÈS DES JEUNES ENFANTS SOUPÇONNÉS D’AGRESSION SEXUELLE. MARTINE HÉBERT (PH. D. EN PSYCHOLOGIE) EST PROFESSEURE TITULAIRE SEXOLOGIE DE L’UQAM. ELLE S’INTÉRESSE À L’AGRESSION SEXUELLE ENVERS

AU

DÉPARTEMENT

DE

LES ENFANTS ET À LA

VIOLENCE DANS LES RELATIONS AMOUREUSES DES ADOLESCENTS ET DES JEUNES ADULTES. LES PROJETS EN COURS SE CENTRENT SUR L’IDENTIFICATION DES FACTEURS LIÉS À L’ADAPTATION CHEZ LES JEUNES AYANT RÉCEMMENT DÉVOILÉ UNE AGRESSION SEXUELLE DE MÊME QUE SUR L’ÉVALUATION DES PROGRAMMES D’INTERVENTION.

LES

RECHERCHES EN COURS TENTENT AUSSI DE DÉGAGER LES FACTEURS DE RISQUE

LIÉS AUX TRAJECTOIRES DE VICTIMISATION ET DE REVICTIMISATION, À L’AIDE DE DEVIS LONGITUDINAUX, ET DE DÉGAGER LES FACTEURS LIÉS AUX PROFILS DE RÉSILIENCE. ELLE EST RESPONSABLE DE L’ÉQUIPE FRQSC - VIOLENCE SEXUELLE ET SANTÉ - (ÉVISSA), COTITULAIRE DE LA CHAIRE INTERUNIVERSITAIRE MARIE-VINCENT SUR LES AGRESSIONS SEXUELLES ENVERS LES ENFANTS, RESPONSABLE DE L’ÉQUIPE DES IRSC SUR LES TRAUMAS INTERPERSONNELS ET MEMBRE DU CENTRE DE RECHERCHE INTERDISCIPLINAIRE SUR LES PROBLÈMES CONJUGAUX ET LES AGRESSIONS SEXUELLES (CRIPCAS).


“I love my job, but . . .” A Portrait of Canadian Social Workers’ Occupational Conditions Raluca Bejan, Shelley Craig and Michael Saini

ABSTRACT

C

et article fait fond sur des données empiriques provenant de neuf enquêtes provinciales menées auprès de travailleurs sociaux inscrits (TSI) dans l’ensemble du Canada (n=5 389) dans le but de décrire leurs conditions de travail et d’explorer la complexité de la pratique du travail social. Environ un tiers des participants étaient de l’Alberta (33 %), suivi de l’Ontario (20 %), de la Nouvelle-Écosse (10 %), de la Colombie-Britannique (8 %), du Québec (8 %), du Nouveau-Brunswick (8 %), de Terre-Neuve-et-Labrador (7 %), de la Saskatchewan (3 %) et du Manitoba (2 %). Puisant en partie d’une source de recherche scientifique établissant un lien entre les facteurs organisationnels en tant que déterminants de la satisfaction en emploi, cette étude compare les apports des TSI dans leur rôle de travailleurs sociaux (niveau d’instruction, titres de compétence) et les résultats liés à leur rôle particulier en emploi (statut, salaires, avantages et conditions d’emploi au sein de l’organisation), puis met ces données en parallèle avec les niveaux de satisfaction professionnelle. Les analyses ont démontré que les TSI ont une relation amour-haine avec leur emploi. Les TSI canadiens sont des professionnels hautement qualifiés, possédant des antécédents universitaires poussés et une expérience de travail substantielle; toutefois, au chapitre du revenu, ils se retrouvent souvent en situation de sous-emploi ou occupant des emplois précaires. Paradoxalement, en dépit de charges de travail accrues, d’horaires trépidants et de leur réticence à recommander le travail social comme carrière à des amis proches ou des membres de leur famille, dans l’ensemble, les TSI semblent satisfaits de leurs carrières.

INTRODUCTION

G

uided by profession-specific commitments of serving the marginalized and disenfranchised individuals within our societies (Bisman, 2004), social workers (SWs) bring a holistic perspective to their praxis, as they integrate a full range of psychological, social, emotional and systematic factors in their daily work (Rachman, 1995). The majority of SWs work in direct practice (Herod & Lymbery, 2008), providing a continuum of client care coordination and support (Keefe, Geron, 23 Canadian Social Work/Travail social canadien

& Enguidanos, 2009). Described as effective facilitators, negotiators, team players and system thinkers by fellow colleagues (National Association of Social Workers, 1996), SWs employ advanced skills in conducting psycho-social assessments, utilizing problem solving strategies and applying a thorough knowledge of community resources in their daily work (Geron, Andrews, & Kuhn, 2005; Scharlach, Simon, & Dal Santo, 2002).

DESPITE A HISTORY OF PRACTICE WISDOM LINKING INTERVENTIONS WITH SUCCESSFUL OUTCOMES... AND DOCUMENTING SKILLS OF RELATIONSHIP BUILDING, EMPATHY, PRACTICAL ASSISTANCE AND ADVOCACY...

SWS

HABITUALLY LABOUR

Despite a history of practice wisdom linking interventions with successful outcomes (Macdonald, Sheldon, & Gillespie, 1992; Rosen & Zeira, 2000) and documenting skills of relationship building, empathy, practical assistance and advocacy (Craig & Muskat, 2013; Gibbons & Plath, 2009), SWs habitually labour under precarious employment conditions: high incidence of client-related stress factors (Collings & Murray, 1996), job burnout (Ben-Zur & Michael, 2007), elevated rates of emotional exhaustion (Evans, Huxley, Gatly, Webber, Mears, & Pajak, 2006), increased workloads and high volumes of administrative paperwork (Collings & Murray, 1996), as well as lack of supervision and weak organizational commitment (Mor Barak, Levin, Nissly, & Lane, 2006).

While previous research has documented the impact of organizational conditions on SWs’ quality of life, it has EMPLOYMENT primarily focused on singular circumstances, without CONDITIONS... portraying a comprehensive picture of their workrelated conditions, particularly in the Canadian context (Laimute, 2012; Siebert, 2006). For this reason, the current study aims to address such gaps and to create a baseline understanding of country-wide occupational conditions of Canadian SWs, by juxtaposing them to the construct of career satisfaction. UNDER PRECARIOUS

THEORETICAL FRAMEWORK

Drawing from a thread of scholarship linking organizational factors as determinants of job satisfaction (Gleason-Wynn & Mindel, 1999), this study utilizes a bottom-up psychological approach to juxtapose work-specific inputs and outputs (Sousa-Poza & Sousa-Poza, 2000) for assessing SWs’ levels of career satisfaction. Such an approach relates job satisfaction to the combination of work role inputs (workers’ levels of education, credentials) and respectively outputs (work status, wages, benefits and organizational working conditions) (Sousa-Poza & Sousa-Poza, 2000). Work role inputs are defined as individual attributes acquired by SWs through field-related work and educational experience, necessary to obtain professional regulated status in each Canadian province. Work role outputs have been found to be strong predictors of job satisfaction (Acker, 2004) and occupational 24 Canadian Social Work/Travail social canadien

contentment (Cole, Panchanadeswaran, & Daining, 2004). Benefit-informed motivational typologies divide outputs by economic, extrinsic, relational and process interrelated aspects (Borzaga & Tortia, 2006). Economic-related work role outputs, such as workers’ current salary, income levels and benefits, are broadly conceptualized under the construct of distributive justice (Tremblay, Sire, & Balkin, 2000). Strong empirical associations have been reported between career satisfaction and workers’ salary (Martin & Schinke, 1998) or benefits levels (Heneman & Schwab, 1985). For example, pay satisfaction has been linked to lower levels of emotional exhaustion, higher levels of personal accomplishments (Jenaro, Flores, & Arias, 2007) and job contentment (Smerek & Peterson, 2007). Work role extrinsic outputs, including job status (fulltime, part-time) and the overall working environment (workload changes, volume and complexities of work) have been associated with workers’ career satisfaction. Full-time employees are more satisfied with their work (Thorsteinson, 2003), particularly in comparison with THE OVERALL WORKING part-time contract workers, who tend to report higher rates of job insecurity (Feather & Rauter, 2004). In ENVIRONMENT turn, job security has been linked to high employee (WORKLOAD CHANGES, citizenship and reduced conflict at work (Roscigno & VOLUME AND Hodson, 2004). Having a so-called exhausting job also has negative effects on job satisfaction and contentment COMPLEXITIES OF (Sousa-Poza & Sousa-Poza, 2000). High caseloads and WORK) HAVE BEEN increased administrative duties (paperwork volume) ASSOCIATED WITH have been found to create additional distress and dissatisfaction among SWs (Parry-Jones, Grant, McGrath, WORKERS’ CAREER Caldock, Ramcharan, & Robinson, 1998). In fact, due to SATISFACTION. increased workloads and organizational staff shortages, it is fairly common for SWs to work an excess of six hours over and above their weekly regular contracted time (Evans et al., 2006).

WORK ROLE EXTRINSIC OUTPUTS, INCLUDING JOB STATUS (FULLTIME, PART-TIME) AND

Relational aspects, as in relations with superiors, colleagues and volunteers, have been formerly defined as work role outputs in determining one’s level of career satisfaction (Borzaga & Tortia, 2006). Positive perceptions of supervisors (Samantrai, 1992), high quality of supervision—as defined by high supervisory satisfaction (Martin & Schinke, 1998)—perceived supervisory support (Gleason-Wynn & Mindel, 1999), good relations with management (Sousa-Poza & Sousa-Poza, 2000) or effective senior management (Smerek & Peterson, 2007) are job satisfaction predictors, particularly amongst SWs (BenZur & Michael, 2007; Cole et al., 2004). 25 Canadian Social Work/Travail social canadien

Process-related aspects, including professional development and decision making autonomy, are contributing factors to SWs’ job retention levels (Tham, 2007). Professional development has been branded as a non-salary retention organizational incentive within the social services field (Henry, 1990). In addition, the association between promotional opportunities and subsequent career satisfaction (Martin & Schinke, 1998), particularly among SWs (Vinokur-Kaplan, Jayaraine, & Chess, 1994), has been documented.

CAREER SATISFACTION HAS BEEN LINKED TO LOWER RATES OF STAFF TURNOVER AMONG

SWS...

AND HIGHER RATES OF JOB-RELATED PERFORMANCE.

Career satisfaction has been linked to lower rates of staff turnover among SWs (Gleason-Wynn & Mindel, 1999) and higher rates of job-related performance (Sousa-Poza & Sousa-Poza, 2000). Despite high levels of dissatisfaction with their employers (Evans et al., 2006), SWs tend to be satisfied with their careers (Martin & Schinke, 1998). In most cases, job satisfaction has been mainly related to clients’ positive outcomes (Cole et al, 2004; Parry-Jones et al., 1998). Within the presented theoretical framework, this paper compares SWs’ incentive-driven work role inputs to specific outputs and subsequently relates them to their levels of career satisfaction.

METHODOLOGY Data Collection This study used secondary analysis based on survey data collected between 2005 and 2008 by nine provincial and territorial social work associations in Alberta, British Columbia, Quebec, Ontario, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, and Saskatchewan. Measures The surveys were adaptations of the Quality of Work Life Survey (QWLS)1 developed by the Ontario Association of Social Workers (OASW) and sent out by each provincial and territorial social work association participating in the study. Findings were amassed in report-type formats, which served as the main units of analysis. Professional associations reported on: • • •

participant demographic data (age, gender, language proficiency, disability status and racialized status); organizational data (geographical distribution, sector, organizational size, field and focus of practice, and professional role); self-reported information on work role inputs (education and training, social work experience and professional membership affiliation) and 26 Canadian Social Work/Travail social canadien

• • •

outputs, specifically economic incentives (gross annual salary, number of jobs, and core and extended benefits); extrinsic- related aspects (job status, weekly work hours, workload related changes and feelings of being rushed at work); relational-related aspects (access to social work supervision and characteristics of supervisory training); and process-related aspects (professional development and career advancement).

The career satisfaction variable was established on a 10-point scale: Respondents were asked to rate their current career satisfaction between 1(very dissatisfied) and 10 (very satisfied).2

A THEMATIC REVIEW OF ALL REGIONAL REPORTS, CONDUCTED INDEPENDENTLY BY TWO CODERS, SERVED AS THE MAIN DATA ANALYSIS TECHNIQUE AND CONSTITUTED THE BASIS FOR ALL FREQUENCY

Analysis Quantitative and qualitative analyses were undertaken. Descriptive statistics were produced using SPSS 21.0, however, methodological variances within the data collection stage (survey questions slightly altered province by province), recruitment-related inconsistencies (regional sampling differences) and discrepancies in reporting the results, made it unfeasible to disaggregate the data for a comprehensive quantitative analysis. A thematic review of all regional reports, conducted independently by two coders, served as the main data analysis technique and constituted the basis for all frequency distributions appended within the tables.

DISTRIBUTIONS

A qualitative analysis of the provincial reports was employed to identify semantically driven “repeated APPENDED WITHIN THE patterns” (Braun & Clarke, 2006) particularly related TABLES. to the occupational conditions commonly encountered by Canadian SWs. Each report was thoroughly screened for overlapping themes, common themes and sub-themes. These were shared with an advisory group (representatives from each provincial association), which reviewed the established themes and provided feedback. The ultimate analysis was informed by scholarly derived theoretical conceptualizations of work role inputs and outputs in order to explore the relationship between environmental constructs and SWs’ career satisfaction. Using triangulation (Creswell & Miller, 2000), themes were explored by various stakeholders, members of the community working group as well as multiple coders (authors, provincial representatives). This approach helped to manage any potential distortions that could have emerged from synthesizing the data by the authors. 27 Canadian Social Work/Travail social canadien

FINDINGS Respondents’ Professional and Organizational Profile A total of 5,393 social work practitioners responded to the provincial surveys. One third of participants were from Alberta (33%), followed by Ontario (20%), Nova Scotia (10%), British Columbia (8%), Quebec (8%), New Brunswick (8%), Newfoundland and Labrador (7%), Saskatchewan (3%) and Manitoba (2%). Respondents’ ages ranged from 20 to over 50 years. Provincial professional bodies did not report the data in age-specific categories; as a result, the mean and subsequent standard deviation could not be calculated. The New Brunswick Association of Social Workers catered its survey exclusively to the specific needs of local A TOTAL OF 5,393 SWs; consequently, items from its 425 respondents could not be standardized for inclusion within the data SOCIAL WORK summaries. PRACTITIONERS RESPONDED TO THE

In each participating province, over three quarters of respondents were women, reflective of the feminization PROVINCIAL SURVEYS. of the social work profession. Demographic profiles (Table 1) showed that almost all participants were proficient in English as their primary language—as expected, since most surveys were completed in English. Yet participants did have the option of completing their surveys in French, if they indicated their preference as such. Most respondents self-identified as Caucasian,3 although ethnicity was not consistently reported as a variable by all provinces. Less than one tenth of respondents indicated that they had a disability, representative of current numbers of Canadian working adults with disabilities across a variety of occupational sectors (Ontario Association of Social Workers, 2006). Mobility and mood were most often cited as a disability type, followed by hearing and visual incapacities. Less than 1% of participants in Alberta, less than 5% in Manitoba, less than 2% in Newfoundland and, respectively, 1% in Saskatchewan indicated they required specific supports within their workplace. Participants’ organizational profile was geographically confined to urban areas, within large agencies, usually containing over 100 staff members, as identified by the size of their primary, secondary and tertiary work settings (Table 2). To a certain extent, participants’ geographical distribution mirrored the regional characteristics of each province, with the industrialized area of Ontario having 87% of its workforce within large and medium sized urban districts.


Table 1 Participants’ Demographic Characteristics by Province AB n=1,775

BC n=448

QC n=417

ON n=1,114

MB n=134

NL n=368

NS n=557

SK n=155

Age Group (years) 50 & over

36%

31%

-

32%

39%

15%

41%

44%

40–49

27%

31%

-

28%

25%

34%

31%

29%

30–39

23%

25%

-

25%

22%

37%

21%

18%

20–29

14%

13%

-

15%

14%

14%

7%

9%

Female

86%

84%

83%

83%

80%

87%

81%

88%

Male

14%

16%

17%

17%

20%

13%

19%

12%

No

85%

88%

-

-

86%

-

-

89%

Yes

15%

12%

-

-

14%

-

-

11%

Gender

Racialized Status

Disability Status No

94%

90%

-

91%

95%

95%

93%

93%

Yes

6%

10%

-

9%

5%

5%

7%

7%

90%

92%

Language Proficiency English

100%

100%

-

99%

96%

100%

Other

14%

13%

-

13%

6%

1%

-

4%

French

7%

5%

-

13%

7%

2%

10%

2%

Aboriginal

2%

-

-

0%

2%

0%

-

1%

The majority of respondents reported the public sector as their primary work setting, followed by the non-profit sector. Very few participants worked within private areas. However, in the provinces of Ontario and Alberta, just over one tenth of respondents reported working within private settings, perhaps reflective of the industrialization of these two provinces and subsequent neoliberal-oriented policy directives openly adopted by their governments’ administration. Social work settings varied, as respondents indicated a number of different fields of practice (Table 3). Health (general medical health, child mental health and adult mental health) and child and family services (child welfare, family mediation, family services provision and childhood sexual abuse) were the most frequently cited fields of practice, followed by social services (income maintenance, employment assistance programs, housing, Aboriginal services, and occupational/industrial, multicultural/settlement and armed forces services), disabilities, criminal justice (domestic violence and correction related services), services to the aged, substance use (alcohol and drug use), and education (social work specific). Social planning, debt counseling, volunteer recruitment and alternate 29 Canadian Social Work/Travail social canadien

medical therapy were also identified by respondents. Direct practice was most frequently cited as the primary work focus, with a high percentage of respondents employed in front line positions. Administration and teaching were commonly noted as well. Policy work, research and community development were less frequently reported.

Table 2 Participants’ Organizational Profile by Province AB n=1,775

BC n=448

QC n=417

ON n=1,114

MB n=134

NL n=368

NS n=557

SK n=155

Geographic Distribution Urban

80%

70%

94%

87%

80%

63%

56%

64%

Rural

20%

30%

6%

13%

20%

37%

44%

36%

Non-Profit

43%

27%

-

30%

31%

9%

-

16%

Public

63%

65%

-

55%

61%

88%

-

58%

Private

13%

8%

-

17%

11%

1%

-

5%

Aboriginal Band

2%

-

-

1%

2%

-

-

-

Sector

Organizational Size Small (< 25 staff)

38%

32%

-

-

23%

28%

67%

18%

Medium (25–99)

24%

18%

-

-

14%

8%

43%

18%

Large (over 100)

58%

50%

-

-

66%

64%

-

41%

Work Role Inputs Over one half of participants had more than 10 years of field-related experience, and about one quarter reported greater than 20 years. Most respondents held a Bachelor of Social Work (BSW) degree as a minimum credential, and many others had completed graduate level education, including master’s and doctorate programs.4 Quite stark differences seemed to exist between the educational levels of social work practitioners from province to province. Ontario had the highest percentage of social workers practising with a MSW or PhD,5 which QUITE STARK may be due to the high number of social work schools DIFFERENCES SEEMED within the province. Several SWs had additional degrees and diplomas, either from similar disciplines such as TO EXIST BETWEEN education, law, nursing, sociology or women studies, or THE EDUCATIONAL from completely different fields such as accounting or LEVELS OF SOCIAL engineering. In addition, most participants were active members of their local/regional body of professional WORK PRACTITIONERS practice (Table 4). This comes as no surprise, since the FROM PROVINCE TO surveys were administered by their respective provincial PROVINCE. social work associations. 30 Canadian Social Work/Travail social canadien

Table 3 Participants’ Professional Profile by Province AB n=1,775

BC n=448

QC n=417

ON n=1,114

MB n=134

NL n=368

NS n=557

SK n=155

Health

45%

57%

-

66%

63%

35%

54%

56%

Child/ Family

57%

40%

-

30%

37%

69%

47%

31%

Social Services

23%

17%

-

8%

17%

13%

13%

13%

Field of Practice

Disabilities

14%

14%

-

8%

7%

23%

9%

6%

Criminal Justice

18%

14%

-

3%

5%

11%

8%

5%

Service to Aged

7%

9%

-

6%

10%

9%

4%

9%

Substance Use

12%

11%

-

5%

5%

11%

8%

5%

Education

7%

6%

-

3%

5%

2%

4%

2%

Other

22%

11%

-

5%

8%

7%

19%

5%

Direct Practice

87%

79%

-

70%

75%

83%

82%

56%

Community

20%

11%

-

10%

9%

10%

17%

9%

Policy

8%

6%

-

3%

7%

6%

8%

6%

Research

6%

4%

-

7%

5%

4%

4%

5%

Other

43%

12%

-

11%

40%

14%

22%

28%

Practice Focus

Organizational Role Front Line

81%

71%

81%

66%

66%

80%

70%

49%

Management

26%

21%

11%

16%

19%

13%

28%

21%

Educator

11%

8%

-

13%

10%

2%

-

10%

Consultant

11%

6%

3%

8%

15%

4%

8%

8%

Team Leader

2%

7%

3%

6%

6%

3%

-

3%

Other

6%

5%

2%

7%

5%

2%

-

0%

Note: Some questions offered the choice of multiple answers; as a result, not all percentages round up to 100%. Moreover, for mutually exclusive categories, not all respondents answered each question; consequentially, percentages might not add up to 100.


Table 4 Work Role Inputs by Province AB n=1,775

BC n=448

QC n=417

ON n=1,114

MB n=134

NL n=368

NS n=557

SK n=155

Education & Training Highest Social Work Degree Undergraduate (BSW)

49%

56%

82%

28%

58%

76%

42%

57%

Graduate (MSW/PhD)

25%

44%

18%

64%

37%

23%

52%

37%

Diploma/ Certificate

26%

-

0%

-

5%

-

-

6%

31%

28%

23%

25%

26%

13%

22%

Social Work Experience 0–5 years

22%

6–10 years

21%

21%

19%

14%

15%

20%

16%

15%

11–20 years

32%

26%

29%

33%

21%

32%

36%

31%

Over 20 years

25%

22%

24%

30%

39%

22%

35%

32%

Membership Affiliation Provincial Body

99%

61%

-

79%

96%

99%

78%

88%

Other (i.e. Union)

66%

70%

-

45%

25%

76%

63%

20%

Work Role Outputs Economic Aspects Economic aspects have been operationalized as gross salary, number of jobs, and core and extended benefits. Gross salary was further divided into five income categories (Lightman, Mitchell, & Wilson, 2008) (Table 5). Very few respondents (10%) reported incomes in the lowest quintile (under $35,000) and about 25% reported incomes between $35,000 and $49,000. Most participants’ incomes ranged between $50,000 and $65,000, and approximately 25% reported incomes between $65,000 and $80,000. On average, less than one tenth of participants reported incomes in the top quintile (over $80,000), and this group was mainly comprised of individuals holding management or executive positions. These numbers seem to reflect national standards, as data from the 2011 National Household Survey indicates that almost 10% of Canadians had a total income of more than $80,400 in 2010 (Statistics Canada, 2013). Although SWs’ salaries are above formerly reported median incomes of Canadians—$41,401 in 2005 and $47,868 in 2010—they are far below those of all other skilled professionals, such as doctors, engineers and senior managers, whose incomes (well above $191,000) place them in the 1% club (Grant & Curry, 2013). In 32 Canadian Social Work/Travail social canadien

relation to the number of jobs, most respondents, particularly from the eastern and Prairie provinces, held one primary job. However, participants from Alberta and Ontario more commonly reported holding two or more jobs.

Table 5 Economic Work Role Outputs by Province AB n=1,775

BC n=448

QC n=417

ON n=1,114

MB n=134

NL n=368

NS n=557

SK n=155

Under 35,000

16%

19%

-

10%

6%

3%

7%

10%

35,000–49,999

23%

25%

-

18%

26%

9%

18%

23%

50,000–64,999

25%

41%

-

42%

38%

77%

48%

32%

65,000–79,999

26%

13%

-

25%

24%

8%

23%

24%

80,000 and over

10%

2%

-

5%

6%

3%

4%

11%

1 job

78%

68%

-

72%

78%

87%

86%

81%

2 job

18%

24%

-

21%

13%

11%

12%

13%

3 job

4%

8%

-

7%

9%

2%

2%

6%

Suppl. Health Plan

74%

75%

-

69%

72%

68%

84%

75%

Pension Plan

64%

63%

-

68%

82%

93%

84%

73%

Paid Vacation

85%

78%

-

79%

87%

97%

93%

77%

Sick Leave

84%

77%

-

77%

87%

93%

92%

81%

Group RRSP

23%

19%

-

27%

19%

17%

20%

16%

Life Insurance

66%

54%

-

56%

69%

73%

77%

67%

Long Term Disability

72%

63%

-

69%

76%

52%

81%

72%

Paid Educational Leave

32%

55%

-

40%

40%

35%

43%

55%

Uncompensated Leave

24%

-

-

27%

25%

44%

35%

41%

Wellness Programs

37%

37%

-

27%

31%

23%

23%

29%

Employment Assistance

59%

58%

-

64%

77%

75%

79%

70%

Gross Salary ($)

Number of Jobs

Core Benefits

Extended Benefits


Most frequently cited core benefits were sick leave, paid vacation, supplementary health plans and regular pension programs (Table 5). In turn, very few SWs had access to group Registered Retirement Saving Plans (RRSPs) as part of their benefits. The most common extended benefits were life insurance, long-term disability and employment assistance, and compensated or uncompensated educational leave. Participation in wellness programs was rarely reported. Additional benefits included car insurance, parking, cell phone allowance, psychological services, tuition reimbursements or informally institutionalized “Happy Fridays” (every third Friday off in exchange of a 40 minutes addition to each work day). Overall, respondents have collectively perceived social work as a low paying profession, primarily reflected as such by the qualitative data. As expressed by one participant: The salary is barely enough for me to afford rent, my vehicle, insurance, groceries and set aside a small safety net of savings. At times it feels degrading to think that after six years of schooling, solid experience and a graduate degree, I am earning so little. (SW in Ontario) Extrinsic Aspects The following extrinsic aspects were included: work status, weekly work hours, workload changes, feeling rushed at work and weekly overtime. Across all provinces, most participants were employed full time. However, weekly hours exceeded typical full-time work. Well over two thirds of participants worked overtime, indicating their weekly work hours to top the customary 35 hours per week (Table 6). Indeed, when prompted to identify changes in their workloads over the past number of years, the majority of respondents indicated an increase: I am doing a job that would keep two full-time people busy. . . . my practice is becoming extremely stressful, just due to sheer volume. I am working far too much overtime, and I will not be able to sustain this over a prolonged time. (SW in BC) As noted in Table 6, the greatest percentage of SWs who identified workload increases was in British Columbia. SWs feel chronically overworked. Feelings of exhaustion echoed from one corner of the country to another, and shocking accounts of SWs’ work conditions emerged: I work three jobs up to 70 hours or more per week. I may leave this field. Salary cannot keep up with rising costs in Calgary. I know staff that go to the food bank and that have become homeless themselves because they are not paid enough. (SW in Alberta) 34 Canadian Social Work/Travail social canadien

Table 6 Extrinsic Work Role Outputs by Province AB n=1,775

BC n=448

QC n=417

ON n=1,114

MB n=134

NL n=368

NS n=557

SK n=155

70%

-

63%

59%

65%

67%

56%

Workload Changes Increase

66%

Decrease

4%

2%

-

3%

2%

4%

4%

5%

No change

24%

21%

-

28%

33%

23%

24%

34%

Unsure

4%

7%

6%

6%

8%

5%

5%

Usually

61%

67%

-

33%

60%

64%

59%

58%

Sometimes

33%

30%

-

63%

32%

31%

29%

34%

Rarely

6%

3%

-

4%

8%

2%

12%

8%

Yes

67%

62%

-

72%

71%

64%

67%

57%

No

33%

38%

-

28%

29%

36%

33%

43%

Feeling Rushed

Weekly Overtime

Caseloads have increased to the point where my two half-time jobs are really two full-time jobs. Not only have numbers increased, but the complexity has increased as well. (SW in Saskatchewan) Testimonials showed that increasing workloads have taken a toll on Quebec SWs as well: Nous avons des équipes qui possèdent de belles expertises mais le travail devenant lourd, manquant d’effectifs infirmiers dans certains programmes, des personnes sauvent leur peau et changent de poste pour trouver un peu de répit. Et il faut recommencer. (SW in Quebec) Some comments were so powerful that one can sense SWs’ tiredness expressed in their own words. This is my greatest stress at work. There is not enough time in the day to do the basics, let alone to offer good quality service. (SW in Newfoundland and Labrador) In addition to being chronically overworked, Canadian SWs felt rushed at work on a regular basis. Feeling rushed seemed merely the new work norm rather than the exception. Concerns were also expressed regarding the negative impact this might have on their ability to achieve social change or provide adequate service provision, some of the core values guiding the social work profession in itself. 35 Canadian Social Work/Travail social canadien

We have no time to do community capacity building, time to affect longterm positive changes in families, rather than just doing short-term stop gap measures. (SW in Nova Scotia) Relational Aspects For the most part, with the exception of Quebec, SWs relied on profession-specific supervisory advice (Table 7). Those receiving supervision from professionals within other disciplines identified nurses, psychologists, allied health professionals and business administrative professionals.

Table 7 Relational Aspects by Province AB n=1,775

BC n=448

QC n=417

ON n=1,114

MB n=134

NL n=368

NS n=557

SK n=155

Access to Social Work Supervision Yes

70%

66%

40%

68%

65%

75%

72%

60%

No

30%

34%

60%

32%

35%

25%

28%

40%

Non-Social Work Supervisor’ Credentials Allied Health

10%

4%

6%

13%

4%

4%

12%

19%

Nurse

23%

7%

26%

33%

13%

21%

17%

32%

Psychologist

8%

-

8%

5%

-

5%

8%

3%

Business/ Admin

24%

7%

8%

17%

3%

13%

25%

32%

Unknown

35%

82%

52%

32%

80%

57%

38%

14%

Supportive inter-collegial working relationships were considered a keystone in assisting SWs in current challenging work environments. I am fortunate to have excellent social work colleagues and support from the multidisciplinary team with whom I work. I look forward to coming to work each day in spite of the sometimes challenging environment. (SW in Nova Scotia) Process-Related Aspects Process-related aspects, including access to skills upgrading, professional development and self-perceived opportunities for advancement, were evident. Almost all participants reported access to skills upgrading within their professional careers. Prompted to select specific professional development prospects, many participants mentioned attendance at workshops, conferences and seminars. Specific agency-based training was also fairly common (Table 8). Fewer participants also mentioned skill-based 36 Canadian Social Work/Travail social canadien

certificate programs and courses, along with post-secondary education, such as graduate degrees. Opportunities for advancement were minimal: less than one in ten indicated an availability of advancement; about one quarter identified no advancement prospects; and the majority of participants indicated limited opportunities.

Table 8 Process-Related Aspects by Province AB n=1,775

BC n=448

QC n=417

ON n=1,114

MB n=134

NL n=368

NS n=557

SK n=155

Yes

93%

85%

-

90%

84%

85%

94%

83%

No

7%

15%

-

10%

16%

15%

6%

17%

Skills Upgrading

Professional Development Workshops/ Seminars

86%

64%

-

62%

72%

85%

95%

63%

Certificate Courses

35%

24%

-

24%

25%

26%

41%

27%

Post-Secondary Ed.

13%

10%

-

10%

8%

7%

10%

10%

Agency Training

62%

41%

-

45%

40%

64%

69%

43%

Advancement Opportunities Many

6%

4%

-

3%

6%

7%

4%

2%

Some

76%

73%

-

73%

75%

82%

76%

73%

None

18%

23%

-

25%

19%

11%

20%

25%

Career Satisfaction As reflected in Table 9, despite an overall challenging environment, the vast majority of SWs were satisfied with their careers, an attitude shared across all provinces. Paradoxically, very few respondents (less than one quarter) indicated that they would recommend social work as a career choice to family and friends.

Table 9 Career Satisfaction Levels by Province AB n=1,775

BC n=448

QC n=417

ON n=1,114

MB n=134

NL n=368

NS n=557

SK n=155

Career Satisfaction Satisfied

75%

68%

69%

78%

77%

82%

82%

78%

Dissatisfied

25%

32%

31%

22%

23%

18%

18%

22%

Recommend the Profession Yes

32%

31%

-

33%

34%

31%

37%

32%

No

25%

19%

-

22%

26%

33%

22%

20%

Unsure

43%

50%

-

45%

40%

36%

41%

48%


Qualitative comments suggested that the overall working environment influenced SWs’ hesitation to recommend the profession to others. Social workers are drained emotionally and physically. The responsibilities are huge. They cannot keep up with demand and are falling down, quitting or moving out of the province. (SW in New Brunswick) Sometimes I really wonder why I went into this field and why I am still here. (SW in BC) I have started another degree to look at doing something other than social work. (SW in Nova Scotia) The environment is toxic and draining. The overall mindset is fiscal restraint vs. the needs of vulnerable clients. (SW in New Brunswick)

DISCUSSION

This is a unique study in that it has used national data to widely explore the pulse of social work across Canada. The national profile of SWs provides valuable insight into their working conditions and motivations. A key finding was that Canadian SWs, although highly skilled professionals with strong educational backgrounds and substantial work-related experience, tend to be underemployed, financially undercompensated and working in precarious occupational positions—yet they express high levels of career satisfaction. SWs’ elevated work role inputs are not yielding them high returns in terms of organizational specific outputs. Paradoxically, this does not impact their overall level of career satisfaction. Despite adverse conditions of practice, such as increased workloads and hectic schedules, and apart from their reluctance to recommend social work as a career choice to close family members, SWs seem to love their day-to-day work. This ambiguous finding may be explained by Herzberg’s (1974) motivational theory, which conceptualizes job satisfaction on two theoretical dimensions: satisfiers and dissatisifers (House & Wigdor, 1967), based on the premise that job satisfaction and, respectively, dissatisfaction, are produced by totally different factors, whereas the opposite of job satisfaction is no job satisfaction rather than dissatisfaction (Smerek & Peterson, 2007). Dissatisfiers, also labeled as hygiene factors (Herzberg, 1974), are related to environmental work conditions and the organizational work context rather than the content per se. They include administrative practices, supervision, interpersonal relations, general working conditions, salary, and job status or job (in)security. Satisfiers, broadly defined as motivators, are related to the intrinsic nature of the work and are usually juxtaposed to levels of self-actualization and work satisfaction (i.e. occupational achievement, work in itself, 38 Canadian Social Work/Travail social canadien

responsibility to the profession, and the advancement of professional growth). Satisfiers are considered to have added motivational force than dissatisfiers, despite HAS FOUND THAT dissatisfying and precarious occupational conditions. “WORK IN ITSELF” IS Previous research has found that “work in itself” is the THE MOST POWERFUL most powerful predictor of job satisfaction (Smerek & Peterson, 2007) and therefore, the authors theorize that PREDICTOR OF JOB this work in itself as well as the process- related aspects SATISFACTION... (opportunities for advancement and professional growth) are the two mechanisms mediating the link to the overall career satisfaction. The association between SWs’ inputs and outputs and their levels of career satisfaction is preliminary, but the finding complements previous research that explored spirituality as a guiding construct for Canadian SWs (Graham, Coholic, & Coates, 2006)—which showed that social work is not just a career choice, but it is rather perceived as a calling or a vocation. Yet, due to the nature of the data, no statistical tests could be conducted to confirm such tentative suppositions. Therefore, it is important to state that Herzberg’s (1974) motivational theory was brought forward to merely understand the findings and not to purposely explain a pre-determined hypothesis. It provides a descriptive lens to contextualize the concurrence of job conditions and job satisfaction experienced by respondents. It does not lend support to the justificatory practice of SWs’ precarious occupational conditions, but rather, it provides a descriptive commentary for this project’s main findings. However, it is plausible that precarious occupational conditions are contributing to higher job turnover, despite SWs’ career satisfaction. Although high levels of satisfaction may be maintained through motivational factors, hygiene factors are not to be ignored. Coupled with recessionary societal contexts of falling revenues (Hilderbrandt & Wilson, 2010) and shaped by neoliberal forms of government restructuring (Chouinard & Crooks, 2008), the failure to attend to SWs’ occupational conditions may not only contribute to, but also perpetuate the professional erosion of a high-quality skilled workforce. As one worker has stated:

PREVIOUS RESEARCH

After 30 years in the field I never imagined I would end my career in such dire circumstances. (SW in Alberta)

STUDY STRENGTHS AND LIMITATIONS

The large sample size is a strength of the study, as it allows the portrayal of a comprehensive, national picture of the Canadian social work force and the main occupational challenges confronting social work professionals. Limitations include the inconsistency among the aggregated data sets that served as units of analyses and the use of self-reported accounts, since results captured participants’ perceptions of their occupational conditions. Theoretical limitations may emerge from having considered the constructs of “career satisfaction”’ and “job satisfaction” as synonymous. Yet the surveys only required respondents to identify 39 Canadian Social Work/Travail social canadien

their level of satisfaction in relation to their overall career, differing from the literature supporting such association merely to job satisfaction. Although this study expanded from theoretical models assessing job satisfaction, only partial models were used. For instance: • • •

the study has drawn only from Gleason-Wynn & Mindel’s (1999) conceptualization of the work environment and not their conceptualization of personal characteristics; it has referred to one side of Sousa-Poza & Sousa-Poza’s (2000) model: the work role outputs but not work role inputs; and it has also referred to only one side of the model developed by Borzaga & Tortia (2006): organizational but not motivational aspects of SW practitioners.

Since the paper did not test a particular theoretical model but, rather, made use of one to better ground and understand the current findings, the authors consider such limitation as tolerable. Lastly, discrepancies between provinces could be related to the sample size: the samples in Alberta and Ontario were larger and more representative than the other seven provinces. Despite such drawbacks, this study provides a glimpse into the working environment of Canadian SWs.

PRACTICE IMPLICATIONS

Respondents in this study perceived social work as a low paying profession. Economic aspects, such as income level and benefits, have been linked to the sector’s workforce crisis, raising implications for employee retention. By extension, this might negatively impact the quality of service provided, since much of SWs’ professional ability depends on creating, building and developing relationships with clients. External equity, measured as self-perceived fair treatment, is linked to higher levels of career satisfaction; therefore, increases in salary and income levels will mirror increases in levels of career satisfaction. Extrinsic aspects (job security, workload, volume, complexities) point towards troubling occupational trends within the social work field. It is important to consider how these work complexities, in terms of high volume and caseloads, translate into practice, for instance, in relation to SWs ratio to clients across various sectors and areas of practice.

EXTRINSIC ASPECTS (JOB SECURITY, WORKLOAD, VOLUME, COMPLEXITIES) POINT TOWARDS TROUBLING OCCUPATIONAL TRENDS WITHIN THE SOCIAL WORK FIELD.

The relational outputs of supervisory and collegial relationships along with the process-related factors in regards to SWs’ opportunities for career advancement seem to account for the dichotomous finding of fairly 40

Canadian Social Work/Travail social canadien

high levels of career satisfaction despite the poor quality of work life reported. Although this is a positive finding in itself, the continuation of these efforts is important. Team developments support good practice but are also linked with career satisfaction and retention of employees, particularly as they could indicate to highly value this work force. Organizational improvements, as they relate to current schedules and unfair salaries, are not only desirable, ORGANIZATIONAL but necessary. There is an urgent need for social service IMPROVEMENTS, AS agencies to overcome the disempowering myth that social THEY RELATE TO work intervention can only happen at the individual level (Graham, Swift, & Delaney, 2009) and to step up to the CURRENT SCHEDULES plate in reducing SWs’ caseloads as well as increasing AND UNFAIR SALARIES, their benefits packages and overall wages. Social work ARE NOT ONLY as a discipline may need to clearly articulate some of the challenges posed by the “nouveau gestionnairat” DESIRABLE, BUT (Boudreau, 2013) of professionalization, and renew NECESSARY. its conceptual ideas to better attend to these issues. Such recommendation is not provided as the “one size fits all” solution to all occupational challenges. The battle needs to be carried out on all storefronts. Positive aspects need to be set aside and fostered (relational outputs) while the challenging ones (precarious working conditions) need to be improved. Educators’ roles should not be entirely focused on mediating SWs’ career satisfaction or dissatisfaction, but rather on preparing them for the reality of these conditions in order to motivate SWs to advocate towards changing them. This may be easier said than done, especially within current neoliberal settings, however, solutions are needed in terms of easing out Canadian SWs’ workloads. More with less might not be universally sustainable, if the social work profession cares about the needs of the marginalized populations it serves. SWs are not bound to escape the context, the same way that their clients cannot, and this is perfectly in line with social work’s unique person in the environment approach. The ability of SWs to provide high quality services also depends on their occupational conditions (Lindqvist, 2012). Improving their quality of work life will, by extension, contribute to the quality of care provided to their clients (Gleason-Wynn & Mindel, 1999).

ENDNOTES

1. The original survey was developed by OASW. Professional provincial bodies undertaking the study modified the survey instrument (i.e., deleting certain questions, adding new ones, etc.) with the goal of better capturing the occupational context within their jurisdictions.


2. In the current analysis, to create the split of satisfiers and dissatisfiers (House & Wigdor, 1967) the authors used the middle score on a 10-point scale by splitting at the mode: Scores below 5 were classified as “dissatisfiers” and those above 5 as “satisfiers”. 3. Respondents were asked to identify whether or not they were part of a visible minority group. Nowadays, the visible minority terminology is not as widely used within the social work community of scholarship. Researchers prefer to use the term “racialized” in order to capture the social construction processes of race. To keep consistent with the field, the authors have used the racialization terminology, although the survey per se inquired about participants’ visible minority status. 4. Social service workers (i.e., diploma education) are not usually part of professional social work bodies. While some may have answered the survey, many others may not have done so (variations due to regional outreach efforts). As a result, the sample may be highly skewed towards those with university-level social work education. 5. MSW and PhD degrees were aggregated under one variable indicating graduate education.

REFERENCES

Acker, G. M. (2004). The effect of organizational conditions (role conflict, role ambiguity, opportunities for professional development, and social support) on job satisfaction and intention to leave among social workers in mental health care. Community Mental Health Journal, 40(1), 65–73. Ben-Zur, H., & Michael, K. (2007). Burnout, social support, and coping at work among social workers, psychologists, and nurses: The role of challenge/control appraisals. Social Work in Health Care, 45(4), 63-82. Bisman, C. (2004). Social work values: The moral core of the profession. The British Journal of Social Work, 34(1), 109–123. Boudreau, F. (2013, June). Le nouveau gestionnariat /the new managerialism. Paper presented at the National Conference of the Canadian Association of Social Work Education. Social Work at the Speed of Life. University of Victoria, BC. Bogo, M. (2010). Achieving Competence in Social Work through Field Education. Toronto, ON: University of Toronto Press. Bogo, M. (2006). Social Work Practice: Concepts, Processes, and Interviewing. New York, NY: Columbia University Press. Borzaga, C., & Tortia, E. (2006). Worker motivations, job satisfaction, and loyalty in public and nonprofit social services. Nonprofit and Voluntary Sector Quarterly, 35(2), 225–248. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. Cole, D., Panchanadeswaran, S., & Daining, C. (2004). Predictors of job satisfaction of licensed social workers: Perceived efficacy as a mediator of the relationship between workload and job satisfaction. Journal of Social Service Research, 31(1), 1–12. Collings, J. A., & Murray, P. J. (1996). Predictors of stress amongst social workers: An empirical study. British Journal of Social Work, 26(3), 375–387. 42 Canadian Social Work/Travail social canadien

Chouinard, V., & Crooks V. A. (2008). Negotiating neoliberal environments in British Columbia and Ontario, Canada: Restructuring of state – voluntary sector relations and disability organizations’ struggles to survive. Environment and Planning C: Government and Policy 26(1), 173–190. Craig, S. L., & Muskat, B. (2013). Bouncers, brokers, and glue: The self-described roles of social workers in urban hospitals. Health & Social Work, 38(1), 7–16. Creswell, J. W., & Miller, D. L. (2000). Determining validity in qualitative inquiry. Theory into Practice, 39(3), 124–130. Evans, S., Huxley, P., Gatly, C., Webber, M., Mears, A., & Pajak, S. (2006). Mental health, burnout and job satisfaction among mental health social workers in England and Wales. The British Journal of Psychiatry, 188(1), 75–80. Feather, N. T., & Rauter, K. A. (2004). Organizational citizenship behaviours in relation to job status, job insecurity, organizational commitment and identification, job satisfaction and work values. Journal of Occupational and Organizational Psychology, 77(1), 81–94. Geron, S., Andrews, C., & Kuhn, K. (2005). Infusing aging skills into the social work practice community: A new look at strategies for continuing professional education. Families in Society, 86(3), 431. Gibbons, J., & Plath, D. (2009). Single contacts with hospital social workers: The clients’ experiences. Social Work in Health Care, 48(8), 721–735. Gleason-Wynn, P., & Mindel, C. H. (1999). A proposed model for predicting job satisfaction among nursing home social workers. Journal of Gerontological Social Work, 32(3), 65–79. Graham, J. R., Swift, K., & Delaney, R. (2009). Canadian Social Policy: An Introduction (4th Edition). Toronto, ON: Pearson. Graham, J., Coholic, D., & Coates, J. (2006). Spirituality as a guiding construct in the development of Canadian social work: Past and present considerations. Critical Social Work, 7(1), 1–17. Grant, T., & Curry, B. (2013, September 11). The wealth of the nation: A snapshot of what Canadians earn. The Globe and Mail. Retrieved from http://www.theglobeandmail.com/news/politics/ who-are-the-1-per-cent-a-snapshot-of-what-canadians-earn/article14269972/?page=all Heneman III, H. G., & Schwab, D. P. (1985). Pay satisfaction: Its multidimensional nature and measurement. International journal of Psychology, 20(1), 129–141. Henry, S. (1990). Non-salary retention incentives for social workers in public mental health. Administration in social work, 14(3), 1–15. Herod, J., & Lymbery, M. (2008). The social work role in multidisciplinary teams. Practice, 14(4), 17–27. Herzberg, F. (1974). Motivation-hygiene profiles: Pinpointing what ails the organization. Organizational Dynamics, 3(2), 18–29. Hilderbrandt, T., & Wilson,B. (2010). A recovery-free zone: The unyielding impact of the economic downturn on nonprofit community social services in Ontario. Toronto, ON: Social Planning Toronto. House, R. J., & Wigdor, L. A. (1967). Herzberg’s dual-factor theory of job satisfaction and motivation: A review of the evidence and a criticism. Personnel Psychology, 20(4), 369–390. Jenaro, C., Flores, N., & Arias, B. (2007). Burnout and coping in human service practitioners. Professional Psychology: Research and Practice, 38(1), 80–87. Keefe, B., Geron, S. M., & Enguidanos, S. (2009). Integrating social workers into primary care: Physician and nurse perceptions of roles, benefits, and challenges. Social Work in Health Care, 48(6), 579–596. 43 Canadian Social Work/Travail social canadien

Laimute, Z. (2012, July). Social service agencies, occupational well being and goals attainment of social work. Paper presented at the 2012 Joint World Conference on Social Work and Social Development: Action and Impact, Stockholm, Sweden. Lightman, E., Mitchell, A., & Wilson, B. (2008). Poverty is making us s sick. A comprehensive survey of income and health in Canada. Toronto, ON: Wellesley Institute and Community Social Planning Council of Toronto. Lindqvist, A. L. (2012, July). To qualify child protection social work. Paper presented at the 2012 Joint World Conference on Social Work and Social Development: Action and Impact, Stockholm, Sweden. Lymbery, M. (2006). United we stand? Partnership working in health and social care and the role of social work in services for older people. British Journal of Social Work, 36(7), 1119-1134. Macdonald, G., Sheldon, B., & Gillespie, J. (1992). Contemporary studies of the effectiveness of social work. British Journal of Social Work, 22(6), 615–643. Martin, U., & Schinke, S. P. (1998). Organizational and individual factors influencing job satisfaction and burnout of mental health workers. Social Work in Health Care, 28(2), 51–62. Mor Barak, M. E., Levin, A., Nissly, J. A., & Lane, C. J. (2006). Why do they leave? Modeling child welfare workers’ turnover intentions. Children and Youth Services Review, 28(5), 548–577. National Association of Social Workers, (1996). Health & Social Work, 21. Ontario Association of Social Workers. (2006). OASW Quality of Life Survey. Final report. Toronto, ON: Author. Parry-Jones, B., Grant, G., McGrath, M., Caldock, K., Ramcharan, P., & Robinson, C.A. (1998). Stress and job satisfaction among social workers, community nurses and community psychiatric nurses: Implications for the care management model. Health and Social Care in the Community, 6(4), 271–285. Rachman, R. (1995). Community care: Changing the role of hospital social work. Health and Social Care in the Community, 3, 163–172. Roscigno, V. J., & Hodson, R. (2004). The organizational and social foundations of worker resistance. American Sociological Review, 69(1), 14–39. Rosen, A., & Zeira, A. (2000). Unraveling “tacit knowledge”: What social workers do and why they do it. Social Service Review, 74(1), 103-123. Samantrai, K. (1992). Factors in the decision to leave: Retaining social workers with MSWs in public child welfare. Social Work, 37(5), 454–458. Scharlach, A., Simon, J., & Dal Santo, T. (2003). Who is providing social services to today’s older adults? Implications of a survey of aging services personnel. Journal of Gerontological Social Work, 38(4), 5–17. Siebert, D. C. (2006). Personal and occupational factors in burnout among practicing social workers: Implications for researchers, practitioners, and managers. Journal of Social Service Research, 32(2), 25–44. Smerek, R., & Peterson, M. (2007). Examining Herzberg’s Theory: Improving job satisfaction among non-academic employees at a university. Research in Higher Education, 48(2), 229–250. Statistics Canada. (2013). 2011 National Household Survey: Income of Canadians. Ottawa, ON: Author. Sousa-Poza, A., & Sousa-Poza, A. A. (2000). Well-being at work: A cross-national analysis of the levels and determinants of job satisfaction. Journal of Socio-Economics, 29(6), 517–538.


Tham, P. (2007). Why are they leaving? Factors affecting intention to leave among social workers in child welfare. British Journal of Social Work, 37(7), 1225–1246. Thorsteinson, T. J. (2003). Job attitudes of part-time vs. full-time workers: A meta-analytic review. Journal of Occupational and Organizational Psychology, 76(2), 151–177. Tremblay, M., Sire, B., & Balkin, D. B. (2000). The role of organizational justice in pay and employee benefit satisfaction, and its effects on work attitudes. Group & Organization Management, 25(3), 269–290. Vinokur-Kaplan, D., Jayaratne, S., & Chess, W. A. (1994). Job satisfaction and retention of social workers in public agencies, non-profit agencies, and private practice: The impact of workplace conditions and motivators. Administration in Social Work, 18(3), 93–121.

RALUCA BEJAN, BA, MSW, IS A PHD STUDENT AT THE FACTOR-INWENTASH FACULTY OF SOCIAL WORK, UNIVERSITY OF TORONTO. HER WORK HAS BEEN PUBLISHED IN THE CANADIAN ETHNIC STUDIES, CANADIAN JOURNAL FOR SOCIAL RESEARCH, TRANSNATIONAL SOCIAL REVIEW AND MCGILL SOCIOLOGICAL REVIEW. SHELLEY CRAIG, PHD, RSW, LCSW, IS AN ASSOCIATE PROFESSOR AT THE FACTOR-INWENTASH FACULTY OF SOCIAL WORK, UNIVERSITY OF TORONTO. HER RESEARCH FOCUSES ON THE SOCIAL DETERMINANTS OF HEALTH FOR MARGINALIZED POPULATIONS AND THE IMPROVEMENT OF SUPPORT AND EDUCATION FOR SOCIAL WORKERS.

MICHAEL SAINI, PHD, MSW, RSW, IS AN ASSOCIATE PROFESSOR AT THE FACTOR-INWENTASH FACULTY OF SOCIAL WORK, UNIVERSITY OF TORONTO AND THE FACTOR-INWENTASH CHAIR OF LAW AND SOCIAL WORK. HE IS ALSO THE CO-DIRECTOR OF THE COMBINED MSW/JD PROGRAM WITH THE FACULTY OF LAW.


Book Reviews Chronique littéraire Sherpa in my backpack: A guide to international social work practicum exchanges and study abroad programs. by Schwartz, K., Kreitzer, L., Barlow, C.A. and MacDonald, L., Whitby, ON: de Sitter Publications, 2014. 185 pages. (Softcover,) ISBN 978-1-897160-84-8.

learning activities that can be used in other settings. It is easily read but provides many good points to consider for students who are planning to study abroad, especially in different cultures. It is meant to be a starting point for students in the process, however, and not a comprehensive study of the subject. The authors have included appendices to help students develop an organizational timetable for their experience, a sample MOU document and a thorough reference list.

Sherpa in my Backpack is an interesting resource for undergraduate and graduate students who are exploring international and study abroad programs. It is also useful for faculty members who are assisting students through this process. It is a very practical and user friendly guide.

Overall, Sherpa in my Backpack is highly recommended as an excellent resource for students who are contemplating study abroad / international exchanges and for faculty who are supporting and guiding students through the process.

The term “sherpa” is familiar to most of us as a local guide who leads mountain climbers through the Himalayas. The term is relevant to the subject as the authors have provided solid information to help students successfully navigate their journey. The authors have used a straightforward and concise style in their writing and they have posed helpful questions for students to consider. The book is comprised of eight sections that include social justice and anti-oppressive perspectives as a basis for working internationally. It discusses each aspect of the journey for the student. Other sections include opportunities, challenges, survival and beyond, and returning home. Each chapter not only discusses the topic but also includes comments from students and reflective questions, plus

Reviewer - Joan Davis Whelan, MSW, RSW, Field Education Coordinator and Sessional Instructor with the School of Social Work, Memorial University of Newfoundland and Labrador. Social Welfare in Canadian Society (5th ed.). by Chappell, R. (2014), Nelson Education: Toronto. 556 pages. (Softcover, $140.00). ISBN 978-0-17-651543-0. Social Welfare in Canadian Society has been widely used as a textbook in Canadian undergraduate social work degree and diploma programs. Rosalie Chappell’s 46


fifth edition of the book offers some new material as well as revisions and updates to the content from the previous edition. For example, a chapter has been added that examines the effects of poverty and poverty-reduction strategies. Other revised or new material includes an expanded and more critical focus on the effects of conservatism on social welfare policies as well as the impact of globalization on social policy in Canada. The various chapters are clearly organized and written in simple, very accessible prose. Photos, illustrative charts, statistical tables, letters, policy statements and other related materials are used to illustrate and highlight the content within each chapter. Discussion questions are also provided to encourage further thought and debate regarding the specific topics. Individual chapters give particular consideration to policies regarding poverty, children and families, older people, Aboriginal people, recent immigrants, and people with disabilities. There is also a glossary that defines key words, terms and concepts.

In this book, Chappell makes the case that globalization is an ongoing feature of contemporary society that has been accompanied by discouraging developments such as an increase in poverty, greater disparity between rich and poor, and a reluctance on the part of governments to invest in social welfare programs. Social Welfare in Canadian Society is a useful introduction to social welfare policies in Canada. It is especially suited for undergraduate social work students who require a broad introduction to the history and current state of social welfare policy in this country.

Given the breadth of the material covered in this book, it comes as no surprise that some areas of interest receive only passing mention. For example, mental health policy is afforded scant coverage that is superficial in nature. In fairness, it must be understood that this is an introductory text that provides a synopsis and overview of Canadian social welfare policy. If a reader wants a more detailed analysis of specific areas of policy, it will be necessary to examine other sources that offer a comprehensive analysis of the specific social policy and its effects.

In the Slender Margin does not offer any answers to one’s questions about death. Instead, the author, Eve Joseph, does something completely refreshing and honest: She offers perspective. Joseph is not making a statement of how people die or what it is to have a “good death”. She explores the facets of death and how people are affected by it. In the Slender Margin is a collection of facts, anecdotes, narratives, culture and religious beliefs mixed with humour, honesty and the brutality of death. Joseph takes a frank look at how little our society wants to be involved with death.

Reviewer - Glen Schmidt, PhD, RCSW, Professor of Social Work, University of Northern British Columbia School of Social Work In the Slender Margin by Joseph, E., Harper Collins Canada, 2014. 200 pages. (Hardcover, $21.99). ISBN: 9781443426718; ISBN10: 1443426717


next can be terrifying and consuming. All this author is offering is what she has experienced—and as you will discover, she still does not know what it all could mean.

Joseph’s writing is jarring; it unfolds in a non-linear fashion, randomly jumping to experiences that hold a person’s story together. Perhaps that is her point. Just because someone has died does not mean that they do not continue to live on with us. For example, Joseph knows more about her brother now than she ever did when he was alive, and perhaps that is part of her journey with this book.

This book is an engaging, personal account of the author’s journey through the experience of loss. I enjoyed its simplicity and style very much and found myself always eager to read the next page. As a grief and bereavement therapist in an acute care setting, I would recommend In the Slender Margin to anyone looking to gain perspective into the experience of grief and loss.

Death is an experience that every living thing has to face, yet much of our society lives in denial of this fact. Whether this is purposeful is not the point of this book. Joseph takes pains to highlight that people even try to remove themselves from the deaths of those they know. For example, online postings of Facebook have taken the place of phone calls or attending the funeral. This is not a judgment on her behalf, but just a statement of fact.

Reviewer - Eugene Power, MSW, RSW, Clinical Social Worker III, Eastern Health, St. John’s, NL Woven Words for Indigenous Education. by Rebecca Priegert Coulter and Ahnungoonhs/Brent Debassige (Eds.). Canadian Centre for Policy Alternatives, Montreal, Quebec, 2013. 159 pages.

The author has taken great lengths to have people understand the intimacy of death. From her years of working hospice, Joseph has provided a collection of experiences that have resonated with her. She does not take a vested interest in what is “real” or “unreal”. That is not for her to decide. Her focus is on what we do when dealing with death, and she explores many areas that most of us would not even consider, were we to spend hours talking about it. She finds commonalities among people that are vastly different.

Woven Words for Indigenous Education has been written by twelve educators enrolled in the Masters of Education program offered by Western University in partnership with the Kettle and Stony Point First Nation. Contributions to this volume include reflections about educational and leadership practices. The stories shared focus on the history of Indigenous people as part of a remembrance process to reconnect with the past in order to bring forth transformation. It looks at the collaboration between western educational institutions and Indigenous communities in

In the Slender Margin will not help you deal with your own grief. In many ways, it will not provide any answers about death at all. Joseph will quickly dispense the medical knowledge. Our concept of what happens 48


learning among Indigenous people. Each individual story of struggle helps to weave a bigger story about Aboriginal education.

a wide range of contexts, such as children’s educational programs and post-secondary education. The book also presents some practices adopted in First Nations schools where educators explore how their own past influences the work they do.

The practices shared may be adapted by social work educators to innovate in the classroom. Also, social work practitioners embracing social justice values may gain more insights about historical challenges faced by Indigenous people and ways of contributing to social change.

The stories shared enhance understanding of a colonial legacy and its impact on attitudes towards education. They provide examples of using historical events to deal with sensitive issues in the classroom or to reflect on expectations about First Nations students to avoid racial profiling. Furthermore, these stories demonstrate the significance of education and lifelong

Reviewer - Isabel Lanteigne, MSW, RSW, Assistant professor with the School of Social Work, Université de Moncton.

The books reviewed or otherwise mentioned in the journal are generally sent unsolicited to the CASW. Their inclusion in the publication in no way indicates CASW endorsement or recommendation. Habituellement, l’ACTS ne sollicite pas les ouvrages qu’elle reçoit et qui font l’objet d’une critique ou qui sont mentionnés dans le journal. La mention d’un ouvrage dans une publication de l’ACTS n’indique aucunement que l’Association adhère au contenu de cet ouvrage ou qu’elle le recommande. 49 Canadian Social Work/Travail social canadien

Providing Care Following Sudden Death: The Practice of Viewing Christina Harrington and Bethany Sprowl

ABSTRACT

E

n règle générale, à la suite d’une mort subite, il faut décider s’il devrait y avoir une exposition en maison funéraire ou non. De nombreuses contradictions existent dans les lignes directrices de la pratique et il y a un manque manifeste de données probantes à l’appui de l’exposition et de son incidence sur le processus du deuil dans son ensemble. En outre, il faut examiner les rôles et les attitudes des professionnels les plus immédiatement impliqués à la suite d’une mort subite, car, d’ordinaire, il n’y a pas d’exposition sans l’implication de professionnels. Les travailleurs sociaux sont souvent les premiers professionnels appelés à répondre aux besoins de personnes vivant un deuil subit; ils peuvent jouer un rôle clé de représentation relativement aux besoins de ces personnes et les aider à composer avec leur peine. Cette étude qualitative s’est penchée sur les perspectives et l’expérience de personnes subitement endeuillées, concernant l’exposition en maison funéraire. Les résultats de cette étude sont regroupés sous trois thèmes : les éléments particuliers afférents à l’exposition, les réactions psychiques des personnes touchées et les interactions professionnelles. On s’intéresse principalement ici aux interactions professionnelles.

I

watched and I was ignored by everyone. I was ignored. The ambulance workers did their job. The police walked in and out. The fireman walked in and out. They looked at me. No one sat with me. No one acknowledged me, with the exception of one ambulance worker who came up to me and said, “We’re doing everything we can.” He was the only person that acknowledged me at all, and that pisses me off now (Louise1, bereaved spouse).


Family members or those closest to the deceased often find themselves immersed within unimaginable experiences following a sudden death. They are called on to make difficult choices and will likely interact with many professionals and systems that will guide them from the notification of the death through to burial. Louise (above), for example, recalls her memory of emergency responders after she found her husband deceased at home. Whether the newly bereaved are observing rescue efforts; being notified or interviewed by police; receiving support by victims’ response workers; interacting with healthcare workers such as doctors, nurses or social workers; or being guided through funeral preparations by funeral home staff, clinical evidence suggests that these interactions have implications for how their grief is experienced and the death accommodated. This qualitative study aimed to uncover the lived experiences of family members following sudden death, specifically with the intervention of “viewing” in the time period following notification through to burial.

THIS QUALITATIVE STUDY AIMED TO UNCOVER THE LIVED EXPERIENCES OF FAMILY MEMBERS FOLLOWING SUDDEN DEATH, SPECIFICALLY WITH THE INTERVENTION OF

“VIEWING” IN THE TIME

The investigators in this study were two critical care social workers in a regional trauma hospital and in conjunction with a forensic morgue. Drawing on clinical experiences, NOTIFICATION THROUGH the design of this study recognized that in this early time TO BURIAL. frame professionals often function as gatekeepers to the opportunity to view the deceased and, as such, these interviews included the perceptions of family members regarding interactions with various professionals involved during this time frame. PERIOD FOLLOWING

This article reviews the lessons learned from this study as they relate to interactions with various professionals (police, social workers, victims’ response workers, emergency responders, hospital staff (e.g. doctors, nurses)). Participants themselves, through their narratives, defined which professional interactions were significant, and these typically included the aforementioned professional roles. (Additional findings specific to viewing have been published elsewhere, particularly by Harrington and Sprowl, 2011).

THE UNIQUE EXPERIENCES OF SUDDEN DEATH

Sudden deaths are often classified by the acronym NASH (natural, accidental, suicide and homicide) (Stroebe, Hanson, Schut, & Stroebe, 2008). With such deaths, there has been continued recognition of the unique and qualitatively different experiences of the bereaved (Doka, 1996; Janzen, Cadell, & Westhues, 2004; Lindemann, 1944; Rando, 1993; Redmond, 1996; Scott, 2007). Further, sudden deaths are notably differentiated 51 Canadian Social Work/Travail social canadien

and complicated by features of suddenness, untimeliness, lack of preparation, age of the deceased, a sense of preventability and often mutilating circumstances of the death (Doka, 1996; Rando, 1993; Stewart, 1998). Conceptual frameworks identify commonality in grief reactions of the suddenly bereaved, such as survivor guilt and blame, cognitive dissonance/psychic numbing, anger, fear, a sense of vulnerability, intense sadness, and shattered beliefs or assumptions (Alexander & Klein, 2000; Doka, 1996; Lindemann, 1944; Parkes, 1973; Rando, 1984, 1993; Redmond, 1996; Worden, 2009). Findings in this study support grief responses already well documented (Harrington & Sprowl, 2011). It is also widely recognized that bereavement arising from sudden, unexpected death places the bereaved at increased risk for complicated grief, physical and mental illness (Doka, 1996; Figley, 1996, 1999; Lundin, 1987; Rando, 1984, 1993; Redmond, 1996; Stroebe et al., 2008; Worden, 2009). Other circumstances, such as notification, viewing, investigative processes, and interactions with varied professionals and systems that typically coincide with sudden death, are also understood to add to the complexity of the experience. These factors can either add to the trauma or offer opportunity for solace. For instance, in their research on parental grief, Janzen, Cadell, and Westhues (2004) noted that professionals have a strong impact on bereavement following the sudden death of a child: “Negative impacts add to the trauma, while positive ones THE OPPORTUNITY help to mitigate the trauma and assist parents with the beginning of the grieving process” (p. 157). TO VIEW THE DECEASED IS A

VIEWING

COMMON EXPERIENCE

The opportunity to view the deceased is a common experience following a sudden death. Whether or not a viewing occurs tends to be governed by procedure or policy within larger systems. For example, in deaths involving criminal investigations, the coroner may deny a viewing if concern exists that doing so would compromise evidence (Coroner’s Act of Ontario, 1990).

FOLLOWING A SUDDEN DEATH.

WHETHER

OR NOT A VIEWING OCCURS TENDS TO BE GOVERNED BY PROCEDURE OR

As a bereavement intervention, whether or not family members should view the deceased also tends to be biased by observations and opinions of professionals SYSTEMS. involved during the time frame from notification to burial. Unfortunately, there has not been sufficient research specific to viewing to provide clear direction on or understanding of this practice and its effects on grief. Literature regarding the practice of viewing tends not to be evidence based and is typically represented in small sections or paragraphs of larger works. These POLICY WITHIN LARGER


works tend to emphasize how to best facilitate a viewing and/or offer contradictory opinion regarding when this should or should not occur (Awooner-Renner, 1991; Cathcart, 1995; Collins, 1989; Cooke, Cooke, & Glucksman, 1992; Davies, 2005; Finlay & Dallimore, 1991; Jones & Buttery, 1981; McLauchlan, 1990; Scott, 2007; Stewart, 1998; Vanezis & McGee, 1999; Von Bloch, 1996; Wells, 1993.) Where research does exist, it has been derived from items in larger satisfaction surveys primarily conducted in emergency departments. These works can be divided into two broad categories of findings: (a) regrets at having viewed or not having viewed (Finlay & Dallimore, 1991; Parrish, Holden, & Skiendzielewski, 1987; Singh & Raphael, 1981), and (b) perceptions about viewing compromised bodies (i.e., those with mutilating injuries) (Finlay & Dallimore, 1991; Singh & Raphael, 1981). A qualitative study by Chappel and Ziebland (2010) provides the sole exception. The authors examined why and how individuals decided to view the body, and they documented reactions to the experience. They highlight several themes regarding desire to see the body: • • • • •

to make sure it was not a mistake; to care for the dead; to say goodbye; imagined images might be worse; and a sense of duty or obligation.

When viewing is recommended and desired by the family member, it is typically seen as a key factor in facilitating healthy grieving (Rando, 1984). Viewing • • • • •

helps to anchor the reality of the death (Cathcart, 1995; Jones & Buttery, 1981; Lundin, 1987; McLauchlan, 1990; Paul, 2002; Scott, 2007; Stewart, 1998; Von Bloch, 1996; Wells, 1993); acts as verification of the circumstances surrounding the death (Harrington & Sprowl, 2011); is less distressing than imagined visions of the body (Cathcart, 1995; C happel & Ziebland, 2010; Finlay & Dallimore, 1991; Lundin, 1987); provides an opportunity to say goodbye (Alexander & Klein, 2000; Cathcart, 1995; Paul, 2002; Stewart, 1998; Von Bloch, 1996); allows the bereaved to attend to perceived presence and needs of the deceased during transition from life (Harrington & Sprowl, 2011) or to feel connection with the presence or spiritual being of the deceased (Steffen & Coyle, 2011); or


•

provides a sense of peace and solace for the bereaved having seen their loved one (Chappel & Ziebland, 2010; Harrington & Sprowl, 2011).

THERE IS ALSO SOME EVIDENCE THAT THOSE DENIED OPPORTUNITIES TO VIEW REPORT SYMPTOMS CONSISTENT WITH TRAUMATIC STRESS (I.E. NIGHTMARES, SOMATIC EXPERIENCES SUCH AS SHIVERING AND CHILLS, PERSEVERATION ON IMAGINED IMAGES OF

There is also some evidence that those denied opportunities to view report symptoms consistent with traumatic stress (i.e. nightmares, somatic experiences such as shivering and chills, perseveration on imagined images of the deceased alone in the morgue) (Harrington & Sprowl, 2011). Viewing is not always regarded as positive when there have been mutilating injuries (Cathcart, 1995; Klein & Alexander, 2003; Rando, 1984; Von Bloch, 1996). Cathcart (1995) writes that post traumatic stress disorder (PTSD) might result from viewing compromised remains. Colloquialisms such as “remember them as they were” are commonly used to discourage viewings, or viewings are flatly denied (Cathcart, 1995; Vanezis & McGee, 1999).

THE DECEASED ALONE

Although the existing, albeit limited, research favours providing the option of viewing the body regardless of its IN THE MORGUE) condition, there is evidence that health care workers do not consistently support this. Professionals involved in this early time frame (or even other family members) may discourage viewing in order to avoid encountering intense emotions (Hass, 2003; LeBrocq, Charles, Chan, & Buchanan, 2003; Stewart, Lord, & Mercer, 1999) or in the belief that they are protecting survivors from a traumatic experience (Singh & Raphael, 1981; Stewart et al., 1999). For instance, Haas (2003) highlights that the intense emotional displays by family members associated with viewing negatively influenced nurses’ attitudes toward viewing. Nurses perceived a need to control the situation in order to protect other patients. Similarly, common practice in emergency departments in England and Wales disallowed viewing if patients had disfiguring facial injuries (Cooke et al., 1992). Examples such as this highlight instances where practices or policy related to circumstances following a sudden death may, in fact, fail to consider the actual needs of the bereaved.

SYSTEMS, PROCEDURES AND POLICY—DO THEY REFLECT THE NEEDS OF THE BEREAVED?

As noted, this study was also interested in family perspectives on the support they received; the nature of their interactions with professionals; and in particular, how these factors interacted with whether or not an opportunity to view their loved one was provided. During 54 Canadian Social Work/Travail social canadien

analysis, it became apparent that the aspects described as significant for family members when interacting with professionals were not specific to viewing per se. Rather, participants described characteristics of the professionals or qualitative features of the experiences as leaving memorable impressions and having had a positive or negative impact on their grief (discussed in Results). Findings from this study begin a dialogue aiming to examine more closely how systems of professionals, policies and procedures impact on the grief responses of the suddenly bereaved. A few satisfaction surveys have considered professional interactions with the suddenly bereaved and in relation to viewing: • • • • • •

Notifiers should be warm, sympathetic, empathetic and knowledgeable about why the death occurred. It is not important that the notifier be a physician (Jones & Buttery, 1981). Having staff who were present at notification accompany families to view is beneficial, while staff discouragement from seeing the body is not (Jones & Buttery, 1981). The need for a “concluding process” remains a gap in emergency room interventions (Jones & Buttery, 1981). Respect for individual customs and religious procedures are perceived as helpful (Li, Chan, & Lee, 2002). Offering family members sedation is unhelpful (Li et al., 2002). Professionals who assisted parents in creating rituals and memorials toward saying good-bye and meaning-making positively impacted on early grieving processes (Janzen et al., 2004).

Unfortunately, most of the existing literature regarding the impact of early professional involvement only examines “how-tos” of practice, such as how to “best” support the suddenly bereaved or how to conduct notifications (Bartone, 1996; Leash, 1994; Lundin, 1987; McLauchlan, 1990; Parrish et al., 1987; Rando, 1984; Scott, 2007; Stewart, Lord, & Mercer, 1999; Von Bloch, 1996; Wells, 1993). Similar to viewing the body of the deceased, there is a dearth of literature and very few studies looking directly at systemic impacts, including the professional roles within these systems, on surviving family members. This is despite accumulating practice knowledge that negative impacts do exist. Where research in this area does exist, it has tended to centre on the criminal justice system. To illustrate, Biddle (2003) conducted a qualitative study exploring the effects on surviving family members of coroners’ suicide inquests in the UK. Her findings highlighted an interference with grief work that resulted from delayed inquests, confiscation of suicide notes or hearing graphic evidence. She also noted an exacerbation of grief symptoms such as, shame, stigma, guilt, anger and fear pre-inquest. Rynearson and Geoffrey (1999) also 55 Canadian Social Work/Travail social canadien

highlight the discrepancy between the needs of the bereaved and broader social imperatives in their discussion of proceedings following homicide: Emotional responses and needs are overshadowed by the social imperative of understanding how the death occurred, apprehending and punishing whomever was responsible, and protecting the rest of us from such a trauma (p.109). Likewise, procedures for providing death notification have been implicated as a factor impacting on the trauma and grief responses of family members. Asaro PROVIDING DEATH (2001) writes that death notifications are recounted as NOTIFICATION HAVE traumatic for many surviving family members. Further, it is widely accepted that if handled poorly, notifications can BEEN IMPLICATED AS negatively impact bereavement processes and enhance A FACTOR IMPACTING perceptibility to PTSD (Lord, 1996; Stewart et al., 1999) ON THE TRAUMA AND and complex grieving (Janzen et al., 2004; Paul, 2002; Rando, 1984; Stewart, 1998). Williams, Solomon, and GRIEF RESPONSES OF Bartone (1988) and Stewart (1998) argue, however, FAMILY MEMBERS. that notification provides opportunity for secondary prevention that will have lasting positive impacts on coping during bereavement. Rando (1993 citing Redmond, 1989) further captures these concerns:

[P]ROCEDURES FOR

Systems of health care-emergency workers, medical staff, and mental health professionals—can ameliorate or exacerbate the experience for mourners. Too often, the needs of survivors are overlooked in the crisis (e.g. notification accomplished poorly, insufficient time given for mourners to spend with the body, and questions ignored). Later on despite good intentions, survivors are misunderstood, pathologized and mistreated. . . It appears that in those instances where there is less secondary victimization, survivors have less complicated mourning reactions, given other factors (p.551). Therefore, it would seem important to establish further evidence-based practice, reflecting the stated needs of the bereaved and recognizing that the care provided at the time of death can have a significant impact on later grief processes (Biddle, 2003; Janzen et al., 2004; Jones & Buttery, 1981; Klein & Alexander, 2003; McLauchlan, 1990; Parrish et al., 1987; Vanezis & McGee, 1999).

METHODOLOGY2

This study sought a richer and improved understanding of family members’ experiences with viewing following a sudden death. Understanding that viewing is typically facilitated or 56 Canadian Social Work/Travail social canadien

denied by professionals involved from notification to burial, participants were also asked about what and whom they perceived as helpful or unhelpful throughout this time frame and, specifically, in relation to viewing. Recruitment and Sampling Strategies Participants included family members bereaved by the sudden death as a result of, for instance, myocardial infarction, suicide, homicide or motor vehicle accident (MVA). All participants • • •

were eighteen years of age or over; had experienced the sudden death of an immediate family member (where the deceased family member was between ages 1 and 65 years); and, shared a willingness to discuss experiences with viewing or feelings about not having viewed.

Perinatal death (at or soon after birth) was excluded, as these deaths involve special circumstances for the bereavement process. Individuals over age 65 years were excluded to minimize influences of anticipatory grief (given advancing age) on how the experience of viewing might be perceived. In addition, cases where death resulted from known preexisting health conditions were excluded. The study took place in one region of southern Ontario, Canada. Availability sampling was used and participants were recruited through a poster campaign in funeral homes and by disseminating information about the study, using bereavement therapists and support groups in the community as intermediaries. Participants were not solicited from within the context of the hospital where the investigators worked. Furthermore, it was recognized that the bereaved are a vulnerable population (Parkes, 1995) and, therefore, participants were required to initiate contact with the researchers so that being approached to participate did not cause further trauma. Where intermediaries were used, they were not informed of who did or did not SIXTEEN INDIVIDUALS choose to participate. Ethics approval was sought and PARTICIPATED IN obtained through the investigators’ local, joint hospitaluniversity research ethics board. SEMI-STRUCTURED, FACE-TO-FACE INTERVIEWS LASTING APPROXIMATELY ONE AND ONE HALF TO TWO HOURS.

Sixteen individuals participated in semi-structured, faceto-face interviews lasting approximately one and one half to two hours. One interview included a couple (mother and father of the deceased); one respondent experienced the sudden death of her son followed by the death of her spouse (from a pre-existing cardiac condition) within 57


two weeks. Fifteen females and one male participated, and types of death included three homicides/suspicious death, two suicides, three MVAs and seven medical deaths (i.e. heart attack, epilepsy). One individual had been diagnosed and died within two days of diagnosis. This was not excluded as it provided a point of comparison in how “sudden” is defined by the bereaved. Given that participants self-identified and that inclusionary criteria with respect to time since death was not predetermined, the time period between the death and the interviews varied from 4 months (mos) to 14 years (yrs) as follows: 4 mos: n=2; 9 mos: n=1; 1 yr: n=4; 2 yrs: n=2; 4 yrs: n=4; 7 yrs n=1 and, 13–14yrs: n=2. Data Collection and Analysis Data consisted of audiotaped, semi-structured interviews and researcher field notes that were later transcribed verbatim. Participants were assigned pseudonyms to maintain confidentiality. Interview guide construction was informed by the researchers’ experiences with family members in a hospital emergency department and from relevant literature but allowed for flexibility to THREE CORE THEMATIC incorporate information participants wanted to share. AREAS WERE Data were analyzed using open coding methods borrowed DELINEATED FROM THE from grounded theory (Strauss & Corbin, 1990). A subANALYSIS PROCESS: set of participants were contacted for member checking. VIEWING SPECIFICS, Particular attention was also paid to negative cases that deviated from other patterns in the data, such as INTRAPERSONAL not having the drive to view or experiencing negative RESPONSES AND repercussions from viewing. Three core thematic areas INTERACTIONS WITH were delineated from the analysis process: viewing specifics, intrapersonal responses and interactions with PROFESSIONALS. professionals.

RESULTS – ‘KINDNESSES AND CRUELTIES’ You recall the kindnesses and you recall the cruelties in a situation like that. And, there were the kindnesses that I remember, but there were a lot of cruelties (Louise). Findings in this study support clinical and anecdotal evidence that professionals (e.g. police, coroner, social workers, victims’ response workers, emergency responders, hospital staff) involved following notification through to burial do impact upon the grief responses of the newly bereaved. Participants in this study frequently described the nature of professional interactions as leaving a memorable impression. While they were asked specifically about interactions in relation to viewing, all discussed their experiences in tandem with professional interactions more generally from notification to burial. When 58 Canadian Social Work/Travail social canadien

data were analyzed it became apparent that aspects noted as central to viewing were the same as those noted as important in interactions more broadly during this time frame. Four sub-themes were reflected across experiences with all professional groups. These included “have a heart”, the need for instrumental and mobilizing support, the provision of choices and options, and a need for timely and concrete information.

RESPONDENTS DESCRIBED THE ABSENCE OR PRESENCE OF

“HAVING A HEART” IN INTERACTIONS

“HAVE A HEART”

Central to this theme was the issue of respect and compassion, both for the bereaved and for the deceased. Respondents described the absence or presence of “having a heart” in interactions as particularly memorable. One respondent said, “It’s their job. And it’s my son, not yours, [but] I think ya have to have a bit of a heart to do it” (Roger).

AS PARTICULARLY

Descriptions included common attributes that were, or were not, displayed to the bereaved and the deceased. MEMORABLE. This included compassion, respect, caring, honesty, and recognition of the bereaved and deceased as individuals— and not a “job”. One respondent recounted a particularly disturbing experience when he attempted to access his son’s vehicle after the fatal accident: “I’m here to get the release form [for vehicle], for my son, Henry Jones. He was killed in a car accident three days ago.” [Officer response] He goes, “Yeah, . . . toe tag on Jones! Toe tag number!” And that’s all I remember him saying: “What’s the toe tag!” I’m thinkin’, “Could you not walk to the back? Here we are, parents, and you’re yelling to the guy [at the back], ‘Toe tag!’” Me and Heather look at each other and go, “Phew”, so now were picturing Henry laying there with a toe tag (Roger). On the other hand, a woman described a positive experience when she was recognized and treated with compassion: The social worker’s office was right there. She asked me if I was okay and I said, “No”. So she took me in her office. She was the first person that actually talked to me like a person, and not just “have a seat”. She understood; she was sympathetic of my need. I didn’t go into her office, she came to me. And then she went and got me answers (Catherine). While all participants recalled interactions that were negative with strong emotion (i.e. anger, tears), two participants noted that kindness is what they later recalled with the most 59 Canadian Social Work/Travail social canadien

ease; other participants indicated that negative experiences held little significance in the overall experience of their grief. Interestingly, where interactions were perceived as negative, respondents explained these encounters as the professional trying to spare or protect them, or as the nature of the job. It is important to note that one of the most significant findings related to viewing in this study highlighted the varied ways in which the participants described a remaining sense of presence of the deceased. They discussed the desire, need or responsibility to provide care for the deceased (or ensure that care was being provided) in this time frame. Participants also shared a desire to be with the deceased during their transition from life. This dynamic overlaid many aspects of interactions with professionals. For instance, how the deceased was treated or referred to in conversation had implications for how family members then viewed the professionals involved. One mother described offering the police officer a photo of her daughter: There happened to be a picture of her and my husband on the top of the TV. … “Do you actually want to see what she looks like? To put a face to her?” Cause nobody really cared; well, I felt like they didn’t. They weren’t bad, it’s just that at the time you want somebody to feel (Cheryl).

PARTICIPANTS CONVEYED THAT PROVISION OF

“Having heart” included recognition and treatment of the deceased (and bereaved) as persons, as well as recognition of the relationship between the bereaved and deceased that was ongoing following the death.

INSTRUMENTAL AND

Instrumental/Mobilizing Support Participants conveyed that provision of instrumental and mobilizing support was helpful. When this support was WAS HELPFUL. WHEN absent, it was identified as an aspect of the interaction THIS SUPPORT WAS that could have been improved. For example, one ABSENT, IT WAS participant indicated, “Even if they had said, ‘It’s okay to hold her hand’, that may have helped” (Martha). IDENTIFIED AS AN Other participants noted that providing a business card ASPECT OF THE or bereavement resources, such as local support groups, INTERACTION THAT with the invitation to call the professional was not helpful during the initial hours post-notification. Initially, they COULD HAVE BEEN described that their attention was focused on being with IMPROVED. the deceased, understanding what had occurred, or that they were too disoriented or numb to give consideration to such resources. Alternatively, a follow-up call or visit was identified as potentially more supportive. MOBILIZING SUPPORT


Choices/Options Choices and options presented at all phases in the process were also perceived as helpful. One widow indicated, “That’s my feeling on the matter: give people choices. I felt like I had all my choices taken away from me” (Louise). Another shared the following: It was important that somebody went out with me when I viewed him on the front yard. I might have appreciated it if one of my friends could have gone out with me rather than a police officer. I don’t remember if it wasn’t allowed, it just wasn’t considered; they didn’t ask me (Kelly). The option of a partial viewing provided by the funeral director was also appreciated as described here: “But if Heather needs to see him or to touch him or something like that, I can close the top part [of coffin],” he said, “That way she can hold his hand if she wants or put her hand on his leg, or you can if you want” (Roger).

THE OFFER OF CHOICES OR OPTIONS IN THE DIRECTION

The offer of choices or options in the direction and support being provided demonstrated respect and compassion for respondents in this study and for their deceased loved one.

Timely, Concrete Information Finally, every participant in the study emphasized the BEING PROVIDED intense need for concrete details regarding the death. DEMONSTRATED With respect to viewing specifically, participants described RESPECT AND the opportunity to view as affirming the reality of the death. But they expanded this notion by indicating that COMPASSION FOR the reality they sought was more than just needing to see RESPONDENTS IN THIS that the death had occurred: Participants desired to know STUDY AND FOR THEIR the reality of the circumstances of the death, such as to confirm identity, to confirm visually the facts they had DECEASED LOVED ONE. been told and to understand the mechanism of how the death occurred. Support from professionals involved at the time was often sought to fulfill this need. AND SUPPORT

Remaining questions regarding the death were highlighted as a continued source of distress for family members. These questions were often tied to concern for the suffering of the deceased. One woman described traumatic dreams related to her husband’s suicide:


I was in absolute panic because I’d had a nightmare that he used a very thin cord. . . . “I need to know this detail,” I said. “I need the coroner to tell me this, I need to know.” . . . He assured me it had been a thick cord and no way in any way severed his neck. I needed to have that; I needed a very, very concrete picture. I mean it sounds really gruesome, but I had to have those details; in my mind I needed to put together that picture. Even though I hated the thoughts of the picture, I just had to have those pieces (Kelly). Timeliness and accuracy of the information provided was emphasized, as described by this respondent: One thing that upset me was that nurse coming over; I distinctly remember that. “I just want you to know your son was very, very sick when he left us.” And my initial thought was, “Well, why did you let him leave if he was so sick?” I had visions of him getting out of the hospital bed and walking out the door. . . . I never thought of him dying. Maybe she was trying to offer me comfort or solace, but it just confused me. You forget a lot, but certain things stay in your mind, and that’s one of them that stayed in my mind was that nurse. That shouldn’t have happened (Ester). While all family members emphasized the need for timely and concrete details, there was variation in the ability to access these details depending on the type of death. For instance, in suicide, homicide or suspicious deaths where the details could not be released and/or a body viewed, WHILE ALL FAMILY family members felt their grief was suspended in many ways. When the information respondents desired was not MEMBERS EMPHASIZED obtained, questions remained and caused distress even THE NEED FOR TIMELY years later. AND CONCRETE DETAILS, THERE WAS

DISCUSSION

Participants in this study shared many experiences and insights that offer direction to current practices ABILITY TO ACCESS following a sudden death. They clearly articulated THESE DETAILS value in preparation prior to viewing and being offered choices and supportive direction following the DEPENDING ON THE death. The significance of concrete information in the TYPE OF DEATH. grieving process draws attention to the need for more comprehensive follow-up services for the bereaved after the initial crisis is ameliorated. For instance, a social worker might be of assistance in accessing coroners’ reports. VARIATION IN THE


IT IS CLEAR THAT PROFESSIONALS AND VOLUNTEERS

(AS IS SOMETIMES THE CASE WITH VICTIMS’ RESPONSE WORKERS) PLAY A SIGNIFICANT ROLE THROUGHOUT THE TIME

It is clear that professionals and volunteers (as is sometimes the case with victims’ response workers) play a significant role throughout the time frame following notification and in relation to viewing opportunities. When interactions were perceived as caring, honest and including expressions of kindness, participants recalled these interactions as positive in facilitating their grieving process. “Cruelties” evoked negative emotions, suggesting a residual impact on the individuals’ bereavement experiences. Inaction and inattention toward the deceased and bereaved were also noted as disturbing experiences.

FRAME FOLLOWING

Underlying participants’ perceptions as to whether or not an interaction was positive was the degree to which the professionals involved conducted themselves in a RELATION TO VIEWING manner that conveyed respect and appreciation for the OPPORTUNITIES. deceased as a person. Family members described in varied ways that they perceived a remaining presence of the deceased. It can be argued that this perception drives the intense desire to see the deceased. Further, being drawn to see the deceased was more indicative of a need, right or responsibility to assist and care for the deceased through a final life transition rather than to simply provide the bereaved with evidence that the death has occurred. The sense of a remaining presence of the deceased overlaid other experiences immediately following the death as well, such as tending to the final preparations and how professionals interacted with the deceased. However, one participant felt clearly that her spouse was “gone” and experienced an intense need to flee from his body. NOTIFICATION AND IN

I called 911, I tried to wake him up but I knew . . . and I told them no it was too late. . . . I was alone with him, and I sat with him—but it wasn’t him; it was a shell and I recognized that even then (Louise). It is unclear from this data whether this response is related to her having found her spouse deceased or her belief that his presence was no longer there. Of cautionary note, another participant described the coroner’s expression of honesty as a memorable kindness, particularly when he stated, “If it were my son, I would not view him.” There is, however, an ethical responsibility in professional roles to be aware of exercising professional power, which may better serve the professional than the bereaved family member.


IMPLICATIONS FOR SOCIAL WORK

Whelan and Gent (2013) critically examined the role of social workers providing singlesession practice in instances of viewing in hospital mortuaries. They highlight the potential and efficacy of these sessions in assisting the newly bereaved despite the limited time during which support is provided. While the study discussed in this paper did not isolate the role social workers as a focal point for exploration, it was conducted by social workers and offers a call to action for social workers to continue to critically examine practice, professional role and epistemology in this area. Goldsworthy (2005) completed a comprehensive review of social work literature on bereavement from 1992–2002. She notes a dearth of social work presence in bereavement literature and an absence of social work theory. Yet arguably no other profession is as equipped as social work to add contributions to this field. As a profession, social work is attuned to the firstvoice, individualized needs of bereaved individuals and AS A PROFESSION, families. At the same time, social workers also appreciate SOCIAL WORK how social systems and the procedures, policies and IS ATTUNED TO professional roles therein can function to ameliorate later THE FIRST-VOICE, risks, including complicated grief, or can in fact further victimize the suddenly bereaved. INDIVIDUALIZED NEEDS OF BEREAVED

The challenge in this regard is that social workers, too, are often constrained and face barriers in the systems within which they work. This is particularly true in the context of FAMILIES. health care, where many social workers will interact with the bereaved. More and more, social workers are being called on to address complex needs with fewer resources to do so. In a climate of reductions in health care, accessibility to and availability of social workers poses further challenges. For instance, while it made be ideal to provide follow-up calls for bereaved family members, a hospital social worker may not have the time or be permitted to follow and address ongoing needs that are perceived as the responsibility of the community. INDIVIDUALS AND

Limited evidence to support viewing practices also presents challenges. For instance, administrators may be loath to support the costs of bringing in a social worker after hours to facilitate a viewing without evidence to support this practice as preventative to later burdens on the system, be that health or mental health. Nonetheless, moving forward, social workers can advocate for the needs of the bereaved and add to evidence-based knowledge and theoretical development, thus laying foundation for change. As in this study, attention to the first hand experiences and stated needs of 64 Canadian Social Work/Travail social canadien

the bereaved themselves offers an initial measure to facilitate enhanced practice and policy. Furthermore, in later bereavement care, social workers should be attuned to how interventions and professional interactions from notification to burial may continue to influence and shape the grieving process.

THE RESULTS OF THIS

SUMMARY AND FUTURE DIRECTIONS

Professionals are an inextricable part of the unfolding of the experience of early bereavement. They have the STUDY HAVE BEGUN potential to use their roles to assist the bereaved not only TO UNCOVER THE in immediate coping, but also by potentially reducing INTRINSIC VALUE OF the risk of later complicated grief. Viewing may offer one means to this end. The results of this study have VIEWING FOLLOWING begun to uncover the intrinsic value of viewing following SUDDEN DEATH. sudden death. However, further research is indicated to explore factors that may correlate with further trauma or victimization of the newly bereaved; to examine potential gender and cross-cultural differences in experiences from notification to burial; and to explore the interdependent relationship between experiences in this time frame, professional roles and larger systemic imperatives. Through sharing their stories, participants here enriched and illuminated aspects of the practice of viewing. Their experiences also highlight the need for professionals to critically examine current practices and policies to ensure that they are congruent with the stated needs of the newly bereaved.

ENDNOTES

1. Names of participants have been replaced with pseudonyms to protect confidentiality. 2. As noted, this article is one in a series of publications. Fuller methodology discussion and study limitations can be found in Harrington and Sprowl (2011).

ACKNOWLEDGMENTS

Thank you to the participants who enriched our knowledge by sharing their stories. Thank you to P.X. Dermody Funeral Homes for resource and staff support as well as funding, and to Dignity Memorial Funeral Homes for resource and staff support. Thank you also to Ross Klein, PhD, Memorial University, Canada, for editorial assistance.


REFERENCES

Alexander, D. A., & Klein, S. (2000). Bad news is bad news: Let’s not make it worse. Trauma, 2, 11–18. Asaro, M.R. (2001). Working with adult homicide survivors, Part 1: Impact and sequelae of murder. Perspectives in Psychiatric Care, 37(3) July-September, 95–101. Awooner-Renner, S. (1991). I desperately needed to see my son. British Medical Journal, 302, 356. Bartone, P. T. (1996). Family notification and survivor assistance: Thinking the unthinkable. In A. E. Norwood (Ed.), Emotional aftermath of the Persian Gulf war: Veterans, families, communities, and nations (p. 315–350). Washington DC, US: American Psychiatric Association. Biddle, L. (2003). Public hazards or private tragedies? An exploratory study of the effects of coroners’ procedures on those bereaved by suicide. Social Sciences and Medicine, 56, 1033. Cathcart, F. (1995). Seeing the body after death. British Medical Journal, 297, 997–998. Chapple, A., & Ziebland, S. (2010). Viewing the body after bereavement due to traumatic death: Qualitative study in the UK. British Medical Journal, 304, c2032. Collins, S. (1989). Sudden death counseling protocol. Dimensions of Critical Care Nursing, 8(6), 375–385. Cooke, M. W., Cooke, H.M., & Glucksman, E. E. (1992) Management of sudden bereavement in the accident and emergency department. British Medical Journal, 304, 1207–1209. Coroner’s Act of Ontario (1990). Retrieved January 14, 2011, from http://www.ontca/Ontario%20C oroners%20Act.pdf Davies, R. (2005). Mothers’ stories of loss: Their need to be with their child and their child’s body after death. Journal of Child Health Care, 9, 288–300. Doka, K. (Ed.). (1996). Living with grief after sudden loss: Suicide, homicide, accident, heart attack, stroke. Washington, DC: Hospice Foundation of America, Taylor & Francis. Figley, C. (1996). Traumatic death: Treatment implications. In K. Doka (Ed.), Living with grief after sudden loss: Suicide, homicide, accident, heart attack, stroke (chapter 7). Washington, DC: Hospice Foundation of America, Taylor & Francis. Figley, C. (Ed.) (1999). Traumatology of grieving: Conceptual, theoretical, and treatment foundations. USA: Brunner/Mazel, Taylor & Francis Group. Finlay, I., & Dallimore, D. (1991). Your child is dead. British Medical Journal, 302, 1524–1525. Goldsworthy, K. K. (June 01, 2005). Grief and loss theory in social work practice: All changes involve loss, just as all losses require change. Australian Social Work, 58(2), 167–178. Harrington, C. M., & Sprowl, B. (2011). Family members’ experiences with viewing in the wake of sudden death, Omega: Journal of Death and Dying, 64(1), 65–82. Hass, F. (2003). Bereavement care: Seeing the body. Nursing Standard, 17(28), 33–37. Janzen, L., Cadell, S., & Westhues, A. (2004). From death notification through the funeral: Bereaved parents’ experiences and their advice to professionals. Omega, 48(2), 149–164. Jones W. H., & Buttery, M. (1981). Sudden death: Survivors’ perceptions of their emergency department experience. Journal of Emergency Nursing, 7, 14–17. Klein, S., & Alexander, D. A. (2003). Good grief: A medical challenge. Trauma, 5, 261271. Leash, R. M. (1994). Death notification: A practical guide to the process. Hinesburg, VT US: Upper Access.


LeBrocq, P., Charles, A., Chan, T., & Buchanan, M. (2003). Establishing a bereavement program: Caring for the bereaved families and staff in the emergency department. Accident and Emergency Nursing, 40(2), 170–180. Li, S. P., Chan, C. W. H., & Lee, D. T. F. (2002). Helpfulness of nursing actions to suddenly bereaved family members in an accident and emergency setting in Hong Kong. Journal of Advanced Nursing, 40(2), 170–180. Lindemann, E. (1944). Symptomology and management of acute grief. American Journal of Psychiatry, 101, 141–148. Lord, J.H. (1996). America’s number one killer: Vehicular crashes. In K. Doka, (Ed.), Living with grief after sudden loss: Suicide, homicide, accident, heart attack, stroke (chapter 3). Washington, DC: Hospice Foundation of America; Taylor & Francis. Lundin, T. (1987). The stress of unexpected bereavement. Stress Medicine, 3, 109–114. McLauchlan, C. A. J. (1990). Handling distressed relatives and breaking bad news. British Medical Journal, 301, 1145–1149. Parrish, G. A., Holden, K. S., & Skiendzielewski, J. J. (1987). Emergency department experience with sudden death: A survey of survivors. Annals of Emergency Medicine, 16, 792–796. Parkes, C.M. (1973). Bereavement: Studies of grief in adult life. New York: Tavistock Publications Ltd. Paul, R. J. (2002). Viewing the body and grief complications. In G.R. Cox & R.G.Stevenson, (Eds.), Complicated grieving and bereavement: Understanding and treating people experiencing loss. Amityville, N.Y: Baywood Publishing Company Inc. Prichard, E. R., Colard, J., Orcutt, B. A., Kutscher, A. H., Seeland, I., & Lefkowitz, N. (1977). Social work with the dying patient and the family. New York: Columbia University Press. Rando, T. (1984). Grief, dying and death: Clinical interventions for caregivers. Champaign, IL.: Research Press. Rando, T. (1993). Treatment of complicated mourning. Champaign, IL: Research Press. Redmond, L. M. (1996). Sudden violent death. In K. Doka, (Ed.), Living with grief after sudden loss: Suicide, homicide, accident, heart attack, stroke (chapter 5). Hospice Foundation of America, Washington, DC: Taylor & Francis. Rynearson, E.K., & Geoffrey, R. (1999). Bereavement after homicide: Its assessment and treatment. In C. Figley, (Ed.), Traumatology of grieving: Conceptual, theoretical, and treatment foundations (chapter 7). USA: Brunner/Mazzel, Taylor & Francis Group. Scott, T. (2007). Sudden traumatic death: Caring for the bereaved. Trauma, 9, 103–109. Singh, B., & Raphael, B. (1981). Post disaster morbidity of the bereaved a possible role for preventative psychiatry? The Journal of Nervous and Mental Disease, 169(4), 203–212. Strauss, A., & Corbin, J.M. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Thousand Oaks, CA: Sage. Steffen, E., & Coyle, A. (2011). Sense of presence experiences and meaning making in bereavement: A qualitative analysis. Death Studies, 35(7), 579–609. Stewart, A. E. (1998). Complicated bereavement and posttraumatic stress disorder following fatal car crashes: Recommendations for death notification practice. Death Studies, 23(4), 289–321. Stewart, A. E,. Lord, J. H., & Mercer, D. L. (1999). A survey of professionals’ training and experiences in delivering death notifications. Death Studies, 24, 611–631.


Stroebe, M. S., Hanson, R. O., Schut, H., & Stroebe, W. (2008). Handbook of bereavement research and practice: Advances in theory and intervention. Washington, DC: American Psychological Association. Vanezis, M., & McGee, A. (1999). Mediating factors in the grieving process of the suddenly bereaved. British Journal of Nursing, 8(14), 932–937. Von Bloch, L. (1996). Breaking the bad news when sudden death occurs. Social Work in Health Care, 23(4), 91–97. Wells, P. J. (1993). Preparing for sudden death: Social work in the emergency room. Social Work, 38(3), 339–342. Whelan, J., & Gent, H. (2013). Viewing of deceased persons in a hospital mortuary: Reflections for social work practice. Australian Social Work, 66(1). Williams, C. I., Solomon, S. D., & Bartone, P. (1988). Primary prevention in aircraft disasters. American Psychologist, 43, 730–739. Worden, J.W. (2009). Grief counseling and grief therapy: A handbook for the mental health practitioner (4th ed.). New York, NY: Springer Publishing Company Inc.

CHRISTINA HARRINGTON, PHD, RSW, HAS FIFTEEN YEARS OF CLINICAL EXPERIENCE IN MEDICAL SOCIAL WORK, CRITICAL CARE AND MENTAL HEALTH. FOR THE PAST FIVE YEARS, CHRISTINA HAS PRACTISED PRIVATELY WITH INDIVIDUALS AND FAMILIES AFFECTED BY MOTOR VEHICLE ACCIDENTS, WORK PLACE INJURY, ADJUSTMENT, TRAUMA, LOSS AND FATALITY. HER MOST RECENT RESEARCH EXAMINES TRAUMA AND GRIEF IN COMBAT-RELATED DEATH. CHRISTINA IS THE CO-OWNER AND DIRECTOR OF SOCIAL WORK SOLUTIONS CANADA. SHE RECEIVED UNDERGRADUATE DEGREES IN PSYCHOLOGY AND SOCIAL WORK FROM MCMASTER UNIVERSITY; A MASTERS OF SOCIAL WORK FROM DALHOUSIE UNIVERSITY AND, RECENTLY COMPLETED A PHD IN SOCIAL WORK FROM MEMORIAL UNIVERSITY OF NEWFOUNDLAND. BETHANY SPROWL, MSW, RSW, HAS FIFTEEN YEARS OF CLINICAL EXPERIENCE IN MEDICAL SOCIAL WORK. FOR THE PAST ELEVEN YEARS, SHE HAS BEEN EMPLOYED AS A SOCIAL WORKER IN THE EMERGENCY DEPARTMENT OF A TRAUMA CENTRE WITH A CORONER ’S MORGUE, PROVIDING CRISIS INTERVENTION, BEREAVEMENT CARE AND SUPPORTIVE SERVICES. BETHANY ALSO HAS CONSIDERABLE EXPERIENCE PROVIDING CRISIS AND BEREAVEMENT CARE IN OBSTETRICS AND PAEDIATRIC ONCOLOGY. BETHANY OBTAINED HER UNDERGRADUATE DEGREES IN PHILOSOPHY AND SOCIAL WORK FROM MCMASTER UNIVERSITY AND A MASTERS OF SOCIAL WORK FROM DALHOUSIE UNIVERSITY.


Voices from the Community: Barriers and Recommendations for Domestic Violence Services for South Asian Women in the GTA Purnima George and Mariam Rashidi

ABSTRACT

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es interventions conventionnelles actuelles en matière de violence familiale ne répondent pas aux besoins des femmes et des familles de l’Asie du Sud vivant dans le Grand Toronto. Si l’on veut s’attaquer à cet enjeu de plus en plus important, il faudra que ces services s’adaptent pour répondre aux besoins des utilisateurs de services provenant de l’Asie du Sud. S’inspirant de perspectives anticolonialistes, féministes antiracisme et anti-oppression, cet article vise à combler le fossé des services en mettant en lumière les obstacles que doivent surmonter les femmes d’origine sudasiatique pour accéder à des services de lutte contre la violence familiale et en présentant des recommandations visant l’adaptation des services en vue d’éliminer ces obstacles. Nos conclusions sont le fruit d’entrevues qualitatives menées auprès de 11 praticiens en service social d’origine sud-asiatique et de 7 survivantes de violence familiale, également d’origine sud-asiatique.

INTRODUCTION

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outh Asian immigrants constitute one of the fastest growing immigrant groups in North America (Ahmad, Driver, McNally, & Stewart, 2009). Statistics Canada has predicted a presence of more than one million South Asians in the city of Toronto by 2017 (Belanger & Malenfant, 2005). South Asians are people who have immigrated from India, Pakistan, Sri Lanka and Bangladesh (Lindsay, 2001). Despite these growing numbers, there has not been enough research conducted to explore social issues and barriers experienced by these communities in accessing existing services (Shankar, Das, & Atwal, 2013). Experiences of practitioners working with South Asian women provide anecdotal information on the lived experiences of domestic violence. A study conducted by Ahmad, Riaz, Barata, and Stewart (2004) showed that 24 percent of the women interviewed 69 Canadian Social Work/Travail social canadien

experienced physical abuse by their partners within the first five years. These statistics are relatively higher than family violence statistics for women in the Canadian general population. According to police-reported data for 2010, there were almost 99,000 victims of family violence even after considering that only 22 percent of all incidents are reported to the police (Sinha, 2012). There are no statistics available regarding the frequency of access and usage of domestic violence services by South Asian women, yet time and again, community activists, practitioners and scholars have critiqued current domestic violence services for their universal approach (Ahmad et al., 2004; Chokshi, Desai, & Adamali, 2010; Guruge, 2010; Raj & Silverman, 2007; Shirwadkar, 2004; Smith, 2004). While some services may claim to be “culturally appropriate”, they do not take into consideration the unique needs arising from the context THIS PAPER SHARES of South Asian women as racialized, immigrant women in Canada (Preisser, 1999). The lack of change in service PERSPECTIVES OF delivery is likely to perpetuate the marginalization of COMMUNITY MEMBERS these women both within their family and in the ON BARRIERS Canadian society at large. This paper shares perspectives EXPERIENCED BY of community members on barriers experienced by South Asian women in accessing existing domestic violence SOUTH ASIAN WOMEN services. On the basis of the findings we argue for reIN ACCESSING EXISTING conceptualizing domestic violence services to respond DOMESTIC VIOLENCE to unique intersecting and interlocking oppressions experienced by South Asian women as racialized SERVICES. immigrants in the Greater Toronto Area (GTA).

LITERATURE REVIEW

When exploring the literature on domestic violence, it is apparent that feminist scholars have systematically disregarded the experiences of minority women, especially immigrant women (Abraham, 2000). According to Anitha (2011), there has been a growing academic interest in domestic violence in South Asian immigrant communities. However, the focus has been on problematizing the culture, as opposed to analyzing structural influences (Ayyub, 2000; Goel, 2005; Preisser, 1999; Venkataramani-Kothari, 2007). Using a systemic intersectional analysis of the experiences of violence for immigrant women, Abraham (2000), Agnew (1998), Ayyub (2000), Dasgupta (2000), George and Ramkissoon (1998), Gill (2004), Jiwani (2005), Liao (2006), Razack (2003) and Sokoloff and Dupont (2005) have analyzed how gender, race and class intersect to influence the experience of domestic violence. Literature documents barriers that South Asian women experience in accessing domestic violence services, such as limited contact with family, lack of support in foreign country, fear of deportation or immigration documents being 70 Canadian Social Work/Travail social canadien

taken away, lack of English speaking skills, financial dependence on spouse, and fear of losing children (Abraham 2000; Dasgupta, 2000; Guruge, 2010; Merali, 2009; Raj & Silverman, 2007; Shirwadkar, 2004). Other challenges include stereotypes, patriarchy, cultural differences, lack of information about rights and services in Canada, and lack of support from their own community (Chokshi et al., 2010; Guruge, 2010; Merali, 2009; Raj & Silverman, 2007; Shirwadkar, 2004; Venkataramani-Kothari, 2007). Jiwani and Razack argue that South Asian women’s vulnerability towards systemic and institutional forms of violence prevents them from accessing services.

WITHIN THE LITERATURE, THERE IS A GROWING CONCERN REGARDING MAINSTREAM SERVICE PROVIDERS WHO RESPOND TO ISSUES OF VIOLENCE IN FAMILIES AND COMMUNITIES WITHIN COMMUNITIES OF COLOUR IN A CULTURALLY

Within the literature, there is a growing concern regarding mainstream service providers who respond to issues of violence in families and communities within communities of colour in a culturally imperialistic manner that “others” them. This is due to universalizing women’s experiences to suit a mainstream framework of service delivery, which ultimately perpetuates further forms of colonialism and racism (Campbell, 2009; Strier & Binyamin, 2010; Westoby & Ingamells, 2010). Burman, Smailes, and Chantler (2004), Jiwani (2005) and Razack (2003) challenge such culturalist explanations of domestic violence within immigrant communities. Burman et al. (2004) state that “explicitly cultural or racialized explanations for domestic violence warranted the overlooking of violence in favour of problematizing culture” (p. 340).

According to Preisser (1999), mainstream service providers have “very little knowledge about the South THAT “OTHERS” THEM. Asian client’s background and often are not cognizant of the client’s expectations” (p. 691). As Preisser explains, in the South Asian community, domestic violence occurs not simply between a woman and her spouse, but between a woman, her spouse, in-laws and the community at large. Yoshioka and Choi (2005) condemn the individualistic nature of mainstream services that disregard the wishes of service users who come from collectivist cultures and may wish to stay with their families. Kim (2002) argues that the main goal of intervention in mainstream services is for the survivor to leave the relationship. The survivor is then guided through the shelter system, and their partner is prosecuted through the criminal justice system. According to Chantler, Burman, and Batsleer (2003) and Latta and Goodman (2005), racialized service users of mainstream services are frustrated because they feel unheard, “othered”, thereby undermining their lived experiences. IMPERIALISTIC MANNER


A NUMBER OF SCHOLARS CRITIQUE THE UNIVERSAL APPROACH TO SERVICE DELIVERY AND ARGUE FOR SERVICES TAILORED TO SPECIFIC COMMUNITIES.

A number of scholars critique the universal approach to service delivery and argue for services tailored to specific communities (Ahmad et al, 2009; Khaja & Frederick, 2008; Latta & Goodman, 2005). Agnew (1998) argues that even in agencies that are designed to be culturally specific, counselors often do not recognize power differences caused by race and class in their relationship to their clients. The basic structure of intervention maintains mainstream conceptualization and interventions to violence (Agnew, 1998). Also, Sakamoto (2007) has articulated that agencies who work with racialized communities are funded by the state whose underlying motive is “immigration integration”.

There is little literature speaking to the importance of involving religious and key community leaders, as they are prominent figures that people look up to (Latta & Goodman, 2005; Ringel & Park, 2008). The dominant discourse does not acknowledge that a person is a part of a community and is dependent on the support of its community members (Guitsina, 2008). Therefore, Guitsina advocates for community involvement in domestic violence. Pennington-Zoellner (2009) highlighted the growing nature of involvement of different institutions within the healing process, from formal networks of the criminal justice system and shelters to include informal networks, such as neighbours, family, friends and colleagues. The literature examined reveals little research on the barriers that South Asian women experiencing abuse face in accessing services in the GTA. Our findings fill in this gap by presenting the perspectives of survivors, practitioners, managers and community activists on barriers experienced by South Asian women experiencing domestic violence in accessing services. The participants also provide recommendations for a reconceptualized model of service delivery.

RESEARCH METHODOLOGY

This research combined critical ethnography and phenomenological approaches to inquiry (Padgett, 2008, p.40). This research used critical ethnography to “break through the confines in defense of the voices and experiences of subjects whose stories are otherwise restrained and out of reach” (Madison, 2005, p.5). This research was undertaken on the inspiration provided by a few practitioners and Council of Agencies Serving South Asian community (CASSA), who have been working with South Asian women living in abusive situations. The practitioners felt the need for a change in conceptualization of domestic violence and provision of services for addressing domestic violence in the South Asian community. However, they felt that their voices constituted a minority of voices 72 Canadian Social Work/Travail social canadien

within mainstream service provision and often were lost. These conversations led to the development of this research, which sought to interview other practitioners who work with South Asian women and gathered their perspectives. Very much in keeping with the goal of critical ethnography, the purpose of this research was to influence change in the way domestic violence within South Asian community was understood and responded to by the larger society in the GTA.

AS A PART OF THIS INQUIRY, INTERVIEWS WERE CONDUCTED WITH VARIOUS

As per the literature, critical ethnography is a politically motivated, ethnographic practice (Thomas, 1992). Critical ethnography also focuses on projects that challenge dominant, hegemonic, global structures at the intersection of race, gender, class, sexuality and disability (Bhattacharya, 2008).

COMMUNITY MEMBERS

As a part of this inquiry, interviews were conducted with various community members to represent their views on the issue. Along with critical ethnography, VIEWS ON THE ISSUE. phenomenological interviews were conducted with survivors to understand their lived experiences of violence and barriers they experienced in accessing services (Creswell, 2013). TO REPRESENT THEIR

Organizations from which participants might be drawn were recruited using snowball technique (Neuman, 2006) through community networks, South Asian women’s organizations and agencies that work with South Asian women experiencing domestic violence in the GTA. Once that process was completed, participants from these sites were selected using purposive sampling technique (Neuman, 2006) that allows selection based on participants’ ability to provide the needed information (Neuman, 2006). Accordingly, the service providers needed to have either front-line experience of working with South Asian women experiencing domestic violence or managerial experience of working in agencies that serve South Asian women. Altogether, 11 participants who are community activists, community lawyers, executive/program directors, and social work practitioners were selected. Women survivors of violence were recruited through an electronic flyer sent to agency directors and practitioners. The flyers were also posted on agency notice boards. Seven women who had been out of violent situations for at least three years, represented one of the South Asian ethnicities and were comfortable speaking in English were selected. Issues of confidentiality were discussed and participants were given the option to select a pseudonym. Except for women survivors, all other participants preferred to retain their original name. Interviews were conducted at a location preferred by participants. In-depth interviews lasted for approximately ninety minutes. 73 Canadian Social Work/Travail social canadien

Participants were asked three questions: • • •

their perspectives on factors leading to domestic violence within the South Asian community in the GTA in the post-immigration phase; the barriers experienced by women in accessing existing services; and their recommendations on type of services needed.

The interviews were recorded and transcribed. The transcribed data were read and, initially, all data segments were assigned code labels. Different code labels that discussed different aspects of the same issue were then grouped together under major themes for analysis and interpretation (Creswell, 2013). Ethnographic analysis and thematic analysis are linked; according to Creswell (2013), “the cultural interpretation is description of the group and themes related to the theoretical concepts being explored in the study” (p. 92). This paper presents data only on the barriers experienced and recommendations for services.

MAJOR FINDINGS

Research findings are divided into two sections, one outlining the barriers in accessing domestic violence services, and the other outlining recommendations for changing services to meet the needs of South Asian women.

BARRIERS Narrow Definition of Safety Participants identified the mainstream model of domestic violence services that mandates the abused woman to leave the home and enter an unfamiliar environment like a shelter, with or without children, as a significant barrier. According to Angie, “We make an assumption that the best thing for [the woman] to do is to leave. That is a very limited and narrow definition of safety.” Uzma, a community activist, describing the situation that a woman may find herself in, said, When you are an immigrant here—no family, no supports . . . plus the one person who is familiar to you is now turning abusive—you are going to put up with him as long as you can, not because you are submissive, not because your traditions teach you that or your religion says something, but because it makes perfect sense.


Andalee, a practitioner clarified why women often call police. She said, They are calling 911 because they want an elder, respected someone to come and talk to her husband to stop the behaviour. They are not saying, “Take him away and put him in jail.” We need interventions that would have an impact, but would not necessarily criminalize the partner. Garima, a survivor, provided the rationale for calling police. According to her, As soon as he held my neck, trying to choke me . . . I really pushed him away and went into my room, locked myself up and called the cops. . . . I didn’t know what to do because I did not know anybody here. I just called the cops and they just left [with her husband]. The findings demonstrate that current models of domestic violence services should not assume that the best option for the survivor is for their spouse to leave the home. Sole Focus on the Woman in Intervention A significant reason for the failure of mainstream domestic violence services is the sole focus on the abused woman. This can be problematic for South Asians who hold strong family and community values. As Baldev, a community leader and executive director of an agency, explained: We have repeatedly heard from women in shelters, “If you want to help me, you cannot work just with me.” A lot of women would say, “My partner is right here, speak to him.” The policy says that you cannot speak directly with her partner. . . . If there are two (or more) people in a conflict, then how is it appropriate to intervene with only one of the individual’s in conflict? . . . When we say “violence against women” then it really doesn’t include the children, the men, the elders of the community, the uncles, aunts, whoever else is surrounded in that extended family. It becomes an issue between a man and a woman, and in that type of a conflict only the wife becomes the victim. The findings demonstrate that the mainstream, individualistic approach is not effective for members of communal cultures. Lack of Acceptance for South Asian Cultural Values South Asian culture upholds collectivism, centrality of family and being with children as a way of life. This influences a woman’s decision regarding leaving an abusive situation. 75 Canadian Social Work/Travail social canadien

According to Zahra, a lawyer and executive director, “The factors that a woman is taking into consideration are that ‘I could lose my connection to my new family, my extended family, and my whole community by “just leaving.’” Angie, a practitioner, added, We need to respect the fact that she will put up with certain aspects of the community to keep the family together. For her, maybe that will outweigh the risks and cons of leaving. . . . I just feel like that there is so much judgement that plays when women decide to do that. Angie’s comment refers to the judgement by service providers when South Asian women prioritize family over self, as their decision does not fit with the current model of service.

ALL SURVIVORS IDENTIFIED LACK OF INCOME AND EMPLOYMENT AS A CRITICAL BARRIER TO LEAVING THEIR HOME.

Combination of Personal and Structural Barriers All survivors identified lack of income and employment as a critical barrier to leaving their home. As Garima explained, “You can’t just sit at home and do nothing. I wanted to work.” It was disheartening to note that most survivors were either searching for employment or were working in minimum wage jobs.

Farrah, a community activist and practitioner, described the limitation of the mainstream model that is based on individual therapy and decontextualizes marital relationship from societal oppressions experienced by South Asian women and their families. In her opinion, the larger societal oppressions actually dissuade women from leaving their abusive situation. She said, When I talk with young South Asian women… they are dealing with violence from the external community, . . . dealing with media, . . . dealing with policy, . . . dealing with institutions that are based in racist colonial practices; and they are also dealing with their community that is under attack, which is insulating in itself sometimes. Zahra shared about racism encountered by South Asian women in shelters. She explained, “They cook white food, [have] no concept of South Asian dress and culture, and make really, derogatory statement. So that in itself is going to feel like a prison.”


Survivors also discussed feeling vulnerable with authorities and in dealing with existing social service institutions. According to Garima, “When he physically assaulted me, it did not go down as physical assault. It went down as a verbal dispute because I did not have marks and I wasn’t able to talk to them.” If women like Garima are left to feel that authorities do not trust them, then they are not likely to access their services while in danger. In fact, Garima was advised by her friends not to challenge the assessment done by police for fear of retribution.

PRACTITIONERS ALSO POINTED OUT THE FEAR OF WOMEN LOSING THEIR CHILDREN TO CHILD WELFARE AUTHORITIES.

Practitioners also pointed out the fear of women losing their children to child welfare authorities. Farrah said, “I have heard women saying that I’m not going for counselling. CAS will come and take my kids. Children’s Aid Society (CAS) does not have an analysis around South Asian community.” Farrah’s assertion regarding CAS’s lack of analysis around the community is yet another example of the limitation of a universal model of service.

South Asian women often lack legal information on domestic violence services. Sakina, a survivor, shared her experience with a settlement worker who was not of any help. She said, “The worker didn’t even tell me about shelter. . . . She would see bruises on me. But nobody said, ‘Look it’s wrong!’ and go call police.” As Nazreen, a survivor, emphasized, “We should teach the information to those women, in their own language”. The lack of legal information not only poses a social risk, but it also leads these women to be in danger of what Angie calls “institutional risk”.

RECOMMENDATIONS

Participants spoke about the need for a holistic approach to address the issue. However, for the sake of simplicity, we present each recommendation separately. Pre-crisis Services Some practitioners recommended creating services that are developed around the context of South Asian women. Zahra and Baldev spoke of the importance of empowerment. According to Zahra, “If women don’t have knowledge about their rights or their legal information that’s appropriate for their situation, how are they supposed to act differently?” In practitioner Farishta’s opinion, women must be educated not merely on their legal rights, but also on life skills. “More agencies need to help women by offering programs around language ... job skills. If every woman is offered that opportunity, then she will feel like she isn’t trapped.” In Angie’s opinion, “pre-crisis is also about engaging communities in open dialogue to whatever extent possible.” Amra, a program co-ordinator, proposed workshops that explore various issues affecting community members. 77 Canadian Social Work/Travail social canadien

Work with Community and Family Members Participants highlighted the need for a community-based approach that is in sync with a community’s collectivist culture. According to Baldev, “One aspect that we have to recognize is how healing happens in communities, not just [with] individuals.” Angie pointed out the gaps in existing services, such as, The thing that is lacking is prevention . . . and education . . . and outreach and support beforehand. What is also lacking is work with men. Social supports are not just in terms of services but also in terms of community building. Deepa, a lawyer and an activist, illustrated the community outreach and education strategy that she used, which was, Go to their spaces, . . . temples, . . . gurudwaras, . . . spaces where they are more comfortable talking about things. I’ve gone to factories where women work, . . . like a samosa factory. I’ve gone to houses where people meet for tea party and stuff like that. . . . I think it works best . . . if you’re trying to educate them. Amra, and other participants advocated for community education. Zahra emphasized the need for a community-wide campaign such as, Everything from billboards in different languages to commercials to radio programs, to every single communication medium that exists in all of the different South Asian communities. . . . We bombard those networks to get to women and everyone about violence and how to stop it, so it becomes a part of our ongoing dialogue and discourse. Farishta and a survivor, Nazreen, recommended naming workshops something other than domestic violence to attract participants, such as “parenting workshops”, “know-yourrights” workshops, “self-care” or “yoga.” Uzma stressed that the approach of work with the community should not be one of culture-blaming and pathologizing. She suggested initiating dialogues with community members as opposed to having support groups. In her opinion, this spirit should be demonstrated even in community education programs. In keeping with the central value of South Asian culture, participants suggested that interventions should find a way of keeping the family together if that is what the woman desires. As Zahra noted, “We need to heal people. We need to heal relationships. We need to do it in connection as opposed to isolation.” Baldev believes that “within our community, because our culture functions on this entire family-oriented basis, there have [sic] been 78 Canadian Social Work/Travail social canadien

lots of evidence where the behaviour of the individual gets corrected through empowering the rest of the family.” For Uzma, a relevant aspect of work with families is work with men. She argued, Men need as much support . . . and in fact, men need quite a bit of support because in this society, ironically, what is happening is that . . . because of racism and because of pathologizing of ethno-racial women, a lot of supports are offered to women. In Farrah’s opinion, work with men is of strategic importance as they are “the gatekeepers of these communities.” In this context, Amra spoke about engaging in dialogues with community leaders as they have access to and influence over the community. Work with Religious Leaders Often in South Asian community, families turn to religious leaders for direction during difficult circumstances. Zahra advocated for involving religious leaders, saying that, We need champions in specific communities. So sympathetic Imams, . . . Pundits, whoever understands that this is not in the best interest of any community. . . . It’s a disease and that men who are being violent are not healthy men. . . .We need to get these champions to help move through the denial.

ALL PARTICIPANTS IDENTIFIED POVERTY AS A MAJOR BARRIER IN LEAVING AN ABUSIVE HOME.

HOWEVER,

SURVIVORS ALSO ADDED THAT THE LACK OF INCOME AND EMPLOYMENT FOR THEIR SPOUSE WAS A MAJOR STRESSOR IN THEIR FAMILY.

Farrah gave the example of a Muslim family-violence project in London, Ontario, that has been successful in engaging male members of the community, including the priests, in dialogue on the issue of domestic violence. Addressing Structural Barriers All participants identified poverty as a major barrier in leaving an abusive home. However, survivors also added that the lack of income and employment for their spouse was a major stressor in their family. In response, Uzma advocated for a universal child care program. She lamented, “There is no universal childcare policy which looks into the issues of poverty. That’s why the majority of people who are living below the level of poverty line happen to be single mothers and women of colour.” Participants also advocated for addressing racism in services and job-market. Farrah commented, 79


How do you build a movement that challenges the racism and xenophobia that exists? That’s why [name of an agency] their model really interests me . . . ‘cause I feel that they are having those discussions that I feel are not happening in the VAW sector here. So we need to have those discussions. Participants recognized that responding to domestic violence structurally implied building the capacity of South Asian women and the community to challenge the impacts of poverty and racism felt by women and community members. Developing Alternative Forms of Service Delivery Based on the consideration that domestic violence in South Asian community can only be addressed by providing a wide range of services, Uzma shared her vision of a, Service coalition . . . so, you have all services . . . employment services . . . housing services . . . crisis intervention, etc. in one place. So, you do preemployment services, . . . actual employment search, . . . post-employment support, and building of relationships between these workers and organising them and the redevelopment process. In Uzma’s opinion, organizing services from a single site would be easier for women who may not have enough money and time to travel to different agencies. Zahra, too, supported this idea, as it is “a one-stopshopping kind of thing.” Supporting this idea, Angie emphasized that “there is enough collectiveness amongst the agencies that understand such issues that would come together with a unified voice.” However, they recognized the limitation of developing a coalition in the current neo-liberal context where agencies compete against each other for a small pot of funding.

OUR FINDINGS COMPLEMENT THE ARGUMENTS OF OTHER STUDIES THAT CHALLENGE THE IMPOSITION OF A MAINSTREAM MODEL OF

SOUTH ASIAN WOMEN.

DISCUSSION

Our findings complement the arguments of other studies that challenge the imposition of a mainstream model of services on South Asian women (Ahmad et al, 2009; Khaja & Frederick, 2008; Latta & Goodman, 2005). Similar to other scholars such as Campbell (2009), Strier and Binyamin (2010) and Westoby and Ingamells (2010), our findings speak to the importance of an approach that is grounded in and is responsive to the context of these women. Seen from this perspective, our findings offer new insights on the safety that goes beyond physical separation to a more supportive role by police and agencies that would fill in the gap left by the lack of family members and

SERVICES ON


networks in this country. This supports Sakamoto’s (2007) assertion that the definition must come from within the community. As argued by Abraham (2000), and Mullender and Hague (2001), our findings also reveal that the lack of financial and social supports is a significant barrier to leaving an abusive home. Our findings demonstrate a strong link between domestic violence and poverty, and therefore, there is a need for agencies serving South Asian women to provide these supports to women who are especially vulnerable to financial instability. However, we realize that these additional supports are short-term solutions. As revealed by our findings and previous scholarship (Dasgupta, 2000; Gill, 2004; Jiwani, 2005; Razack, 2003), practitioners have discussed the need for addressing structural barriers that create conditions of exclusion, marginalization, impoverishment and vulnerabilities experienced by South Asian women as racialized immigrant women. These findings support Mohanty’s (1997) argument that the experiences of immigration and the structural inequalities in their new nation affect the experiences of domestic violence for immigrant women. Seen from this perspective, domestic violence is not an individual problem, but a social and political one. Given the socio-political nature of the problem and the community’s cultural values, our findings confirm existing literature on the significance of work with families, the community and religious leaders (Ahmad et al, 2009; Bui, 2003; Guitsina, 2008; Raj & Silverman, 2007; Shankar et al. 2013; Yoshioka et al, 2003; Yoshioka and Choi, 2005). However, while the literature also speaks to the importance of community education and awareness (Ahmad et al., 2009) our findings propose that work at the community level also needs to focus on addressing impacts of racism and discrimination experienced by community members in the Canadian context. Lastly, our findings contribute to practice through the recommendation of a coalition of services located at a single site to support women. Khaja and Frederick (2008) discuss the need for different types of services, but they do not discuss the idea of having a coalition of services. [O]UR FINDINGS

IMPLICATION FOR SOCIAL WORK PRACTICE

CONTRIBUTE TO PRACTICE THROUGH THE RECOMMENDATION OF A COALITION OF SERVICES LOCATED AT A SINGLE SITE TO SUPPORT WOMEN.

Findings of this study are relevant for domestic violence services within the GTA, and they suggest that a wide range of factors contribute towards South Asian women’s lack of access to these services. Hence, any response to domestic violence for South Asian women will need to adopt a holistic approach that envisions work with the community and challenging societal barriers that South Asians experience in the GTA. An essential aspect of this holistic approach is the work with women. 81


The findings call upon social workers to consider pre-crisis intervention with women focusing on personal empowerment; language skills; enhancement of job skills; and information on housing, immigration policy and their rights in relation to police, the criminal justice system, domestic violence protocols and services. The findings call upon social workers to develop a coalition of services that responds to the varying forms of intersecting and interlocking oppressions (Crenshaw, 1991; Hill Collins, 2000; Nash, 2008) of race, ethnicity, age, education, income, faith, language and immigration status that women might be experiencing and find difficulty in overcoming. Intersecting and interlocking oppressions mean that “different oppressions intersect at innumerable points in everyday life and are mutually reinforcing, creating a total system of oppression in which one system of stratification cannot be addressed in isolation from all the others” (Wineman, 1984, p. 169). Along with pre–crisis work, social workers need to respond to women who are already living in abusive situations. Supportive services based on the intersecting oppressions would help women identify various supports that they require. Rather than adopting an expert role, WORK WITH social workers are called upon to work collaboratively MEN COMPRISES with women and create easier access to services that fit with the cultural values and choices that women make. DISMANTLING PATRIARCHAL VALUES AND EXTENDING SUPPORTS IN DEALING WITH CHALLENGES THEY MAY FACE IN SETTLING IN THE

GTA.

Work with men comprises dismantling patriarchal values and extending supports in dealing with challenges they may face in settling in the GTA. Work with family members—an integral aspect of work with the community—calls for identifying strengths within the family and working with these strengths to initiate dialogues and critical reflection on the impact of violence on the family and children.

As against an agency-based approach to service delivery, findings recommend the need for practitioners to reach out to the community, initiate critical dialogues with various groups and collaborate on ways of addressing violence that are germane to the community. The dialogues could focus on various discursive practices within the community that enforce patriarchy and unequal treatment of women (Shankar et al., 2013). These dialogues need to come from a place of respect and collaboration rather than focusing on the deficiencies of the community. A critical component of community work would also be working with religious leaders and using their power and authority to denounce violence within families. In addition, work at the community level needs to also focus on addressing impacts of racialization and discrimination, including labour market discrimination and other such stressors in the lives of community members. Social workers engaging with domestic 82 Canadian Social Work/Travail social canadien

violence need to connect the community’s “personal” to the “political” and engage in advocacy efforts that challenge racialization and marginalization of immigrant groups. It is important for social workers to support and actively engage in advocacy towards eliminating these barriers that South Asian families experience in the GTA.

AS OUR RESEARCH HAS SHOWN, THE ISSUE

CONCLUSION

As our research has shown, the issue of domestic violence for immigrant communities goes beyond current understandings of a mere dispute between two OF DOMESTIC VIOLENCE partners. The voices of community members have shown FOR IMMIGRANT that the issue is complex and multi-dimensional. There COMMUNITIES GOES is a need for a paradigm shift in addressing the issue from the “personal” realm to the “political” realm: to BEYOND CURRENT the perspective that centres the values and experiences of UNDERSTANDINGS South Asian women as racialized, immigrant women and OF A MERE DISPUTE commits to addressing the multiple barriers at personal, familial and societal levels that these women and their BETWEEN TWO families experience in the GTA. In sum, domestic violence PARTNERS. services for South Asian women in the GTA can only be made accessible by decentring the universal model and by reconceptualizing them from anti-colonial, critical race feminist and anti-oppression perspectives that centre and honour the experiences of these women, their cultural values and their collective way of life. Rather than blaming the community, the findings advocate for a fresh beginning—starting the work from and with the community and its women to tackling patriarchy and the varied oppressions that impact them in their current local context.

ACKNOWLEDGMENTS

The authors wish to thank all research participants, CASSA and Faculty of Community Services, Ryerson University who made this study possible.

REFERENCES

Abraham, M. (2000). Speaking the unspeakable: Marital violence among South Asian immigrants in the United States. New Brunswick, NJ: Rutgers University Press. Agnew, V. (1998). In search of a safe place: Abused women and culturally sensitive services. Toronto: University of Toronto Press. Ahmad, F., Driver, N., McNally, M.J., & Stewart, D. (2009). “Why doesn’t she seek help for partner abuse?” An exploratory study with South Asian immigrant women. Social Science and Medicine, 69(4), 613–622. Ahmad, F., Riaz, S. Barata, P., & Stewart, D. (2004). Patriarchal beliefs and perceptions of abuse among South Asian immigrant women. Violence Against Women, 10(3), 262–282.


Anitha, S. (2011). Legislating gender inequalities: The nature and patterns of domestic violence experienced by South Asian women with insecure immigration status in the United Kingdom. Violence Against Women, 17(10), 1260–1285. Ayyub, R. (2000). Domestic violence in the South Asian Muslim immigrant population in the United States. Journal of Social Distress and the Homeless, 9, 237–248. Belanger, A., & Malenfant, C. R. (2005). Ethno-cultural diversity in Canada: Prospects for 2017. Ottawa: Statistics Canada. Bhattacharya, H. (2008). New critical collaborative ethnography. In S.N. Hesse-Biber & P. Leavy (Eds). Handbook of emergent methods (pp.303–322). New York: The Guilford Press. Bui, H. N. (2003). Help-seeking behavior among abused immigrant women: A case of Vietnamese American women. Violence Against Women, 9(2), 207–239. Burman, E., Smailes, S.L., & Chantler, K. (2004). “Culture” as a barrier to service provision and delivery: Domestic violence services for minoritized women. Critical Social Policy, 24(3), 332–357. Campbell, A. (2009). Intersections of violence: The role of immigration status in women’s experiences of and responses to domestic violence in Canada. Toronto: Ryerson University Chantler, K., Burman, E., & Batsleer, J. (2003). South-Asian women: Exploring systemic service inequalities around attempted suicide and self-harm. European Journal of Social Work, 6(2), 31–48. Chokshi, R., Desai, S., & Adamali, A. (2010). Overview of domestic violence in the South Asian community in Canada: Prevalence, issues, and recommendations. In J. Fong (Ed.), Out of the shadows: Women abuse in ethnic, immigrant, and aboriginal communities (pp. 264–283). Toronto: Women’s Press. Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics and violence against women. Stanford Law Review, 43(6), 1241-1299. Creswell, J.W. (2012). Five qualitative approaches to inquiry. In Qualitative inquiry and research design (3rd ed) (pp. 69-110). LA: Sage. Creswell, J. (2013). Qualitative research inquiry & research design: Choosing among five approaches (3rd ed.). Thousand Oaks: SAGE. Guruge, S. (2010). Perceptions of intimate male partner violence and determinants of women’s response to it: Findings from a study in the Sri Lankan Tamil community in Toronto. In J. Fong (Ed.), Out of the shadows: Women abuse in ethnic, immigrant, and aboriginal communities (pp. 264–283). Toronto: Women’s Press. Dasgupta, S.D. (2000). Charting the course: An overview of domestic violence in the South Asian community in the United States. Journal of Social Distress and the Homeless, 9(3), 173–185. George, U., & Ramkissoon, S. (1998). Race, gender, and class: Interlocking oppressions in the lives of South Asian women in Canada. Journal of Women and Social Work, 13(1), 102–118. Gill, A. (2004). Voicing the silent fear: South Asian women’s experiences of domestic violence. The Howard Journal, 43(5), 465–483. Goel, R. (2005). Sita’s trousseau: Restorative justice, domestic violence, and South Asian culture. Violence Against Women, 11, 639–665. Guitsina, J. (2008). Violence against women in intimate partner relationships: Community responsibility, community justice. Contemporary Justice Review, 11(4), 351–361. Hill Collins, P. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment (2nd ed. Ed.). New York: Routledge. 84 Canadian Social Work/Travail social canadien

Jiwani, Y. (2005). Walking a tightrope: The many faces of violence in the lives of racialized immigrant girls and young women. Violence Against Women, 11(7), 846–875. Khaja, K., & Frederick, C. (2008). Reflection on teaching effective social work practice for working with Muslim communities. Advances in Social Work, 9(1), 1–7. Kim, M. (2002). Innovative strategies to address domestic violence in Asian and Pacific Islander communities: Examining themes, models, and interventions. Asian & Pacific Islander Institute on Domestic Violence: San Francisco. Latta, R. E., & Goodman, L.A. (2005). Considering the interplay of cultural context and service provision in intimate partner violence: The case of Haitian immigrant women. Violence Against Women, 11(11), 1441–1464. Liao, M. S. (2006). Domestic violence among Asian Indian immigrant women: Risk factors, acculturation, and intervention. Women and Therapy, 29(1/2), 23–39. Lindsay, C. (2001). The South Asian community in Canada. Profile of ethnic communities in Canada. Statistics Canada. Catalogue no89-621-XIE — No6. Madison, S. D. (2005). Critical ethnography: Method, ethics and performance. Thousand Oaks, CA: SAGE. Merali, N. (2009). Experiences of South Asian brides entering Canada after recent changes to family sponsorship policies. Violence Against Women, 15(1), 321–339. Mohanty, C. (1997). Cartographies of struggle: Third world women and the politics of feminism. In C. Mohanty, A. Russo, & L. Torres (Eds.), Third world women and the politics of feminism (pp. 1–47). Bloomington & Indianapolis: Indiana University Press. Mullender, A., & Hague, G. (2001). Women survivors’ views. In J. Taylor-Browne (Ed.), What works in reducing domestic violence: A comprehensive guide for professionals (pp. 1–33). London, UK: Whiting and Birch. Neuman, W.L. (2006). The meanings of methodology. In Social research methods: Qualitative and quantitative approaches, (6th ed.) (pp. 79–109). Boston, New York: Pearson. Nash, J.C. (2008). Re-thinking intersectionality. Feminist Review, 89(1), 1–15. Padgett, D. K. (2008). Qualitative methods in social work research (2nd ed.). Thousand Oaks, CA: SAGE. Pennington-Zoellner, K. (2009). Expanding “community” in the community’s response to intimate partner violence. Journal of Family Violence, 24, 539–545. Preisser, A. B. (1999). Domestic violence in South Asian communities in America: Advocacy and intervention. Violence Against Women, 5, 684–699. Raj, A., & Silverman, J. G. (2007). Domestic violence help-seeking behaviors of South Asian battered women residing in the United States. International Review of Victimology, 14(1), 143–170. Ringel, S., & Park, J. (2008). Intimate partner violence in the Evangelical community: Faith-based interventions and implications for practice. Journal of Religion and Spirituality in Social Work: Social Thought, 27(4), 341–360. Razack, S. (2003). A violent culture or culturalised violence? Feminist narratives of sexual violence against South Asian women. Studies in Practical Philosophy, 3(1), 80–104. Sakamoto, I. (2007). A critical examination of immigrant acculturation: Toward an anti-oppressive model with immigrant adults in a pluralistic society. British Journal of Social Work, 37, 515–535.


Shankar, J., Das, G., & Atwal, S. (2013). Challenging cultural discourses and beliefs that perpetuate domestic violence in South Asian communities: A discourse analysis. Journal of International Women’s Studies, 14(1), 248–262. Shirwadkar, S. (2004). Canadian domestic violence policy and Indian immigrant women. Violence Against Women, 10(8), 860–879. Sinha, M. (2012). Family violence in Canada: A statistical profile, 2010. Statistics Canada. Smith, E. (2004). Nowhere to turn? Responding to partner violence against immigrant and visible minority women. Department of Justice, Sectoral Involvement in Departmental Policy Development (SIDPD). Sokoloff, N.J., & Dupont, I. (2005). Domestic Violence at the intersections of race, class, and gender: Challenges and contributions to understanding violence against marginalized women in diverse communities. Violence Against Women, 11, 38. Strier, R., & Binyamin, S. (2010). Developing anti-oppressive services for the poor: A theoretical and organizational rationale. British Journal of Social Work, 40, 1908–1926. Thomas, J. (1992). Doing critical ethnography. Newbury Park, CA: SAGE. Venkataramani-Kothari, A. (2007). Understanding South Asian immigrant women’s experiences of violence. In S. D. Dasgupta (Ed.), Body evidence: Intimate violence against South Asian women in America (pp. 20–45). New Brunswick, NJ: Rutgers University Press. Westoby, P., & Ingamells, A. (2010). A critically informed perspective of working with resettling refugee groups in Australia. British Journal of Social Work, 40, 1759–1776. Wineman, S. (1984). The politics of human services. Montreal: Black Rose Books. Yoshioka, M. R., Gilbert, L., El-Bassel, N., & Baib-Amin, M. (2003). Social support and disclosure of abuse: Comparing South Asian, African American, and Hispanic battered women. Journal of Family Violence, 18(3), 171–180. Yoshioka, M. R., & Choi, D.Y. (2005). Culture and interpersonal violence research: Paradigm shift to create a full continuum of domestic violence services. Journal of Interpersonal Violence, 20(4), 513–519.

PURNIMA GEORGE, PHD, IS AN ASSOCIATE PROFESSOR IN THE SCHOOL OF SOCIAL WORK AT RYERSON UNIVERSITY. MARIAM RASHIDI, MSW, MPPAC, WORK.

IS A

RESEARCH ASSISTANT

AT

RYERSON SCHOOL


OF

SOCIAL

Redefining Child Protection Culture: Relational Narrative Practice Doug Egan and John Yakielashek

RÉSUMÉ

C

e projet retrace les étapes de la réorganisation de la culture et des pratiques d’un organisme de protection de l’enfance et d’un organisme communautaire sans but lucratif, par le biais de l’élaboration d’un cadre conceptuel de pratique intégrée : la pratique axée sur le récit interactif [relational narrative practice]. Les organismes de protection de l’enfance ont une expérience limitée de la thérapie du récit (White et Epston, 1990) et de la théorie du socioconstructivisme (Burr, 2003) comme fondements d’une approche de la pratique. La déconstruction et l’examen critique de la culture plus large de la protection de l’enfance ont constitué des éléments du processus qui a permis la mise en place de pratiques qui reflètent la complexité de parvenir à un équilibre entre les politiques , les valeurs et les croyances, d’une part, et l’état intérieur des praticiens, d’autres part. Ce projet est né en réaction à une intolérance du climat toxique entre l’organisme gouvernemental de protection de l’enfance et l’organisme communautaire sans but lucratif auquel il était lié par contrat. Le désir d’établir un rapport de collaboration entre les deux organismes, mus par des valeurs communes et aspirant à des résultats communs pour les familles, a permis d’explorer de nouvelles façons de faire les choses. Le rôle du pouvoir et de la culture organisationnelle est examiné dans le contexte du travail de protection de l’enfance. La proposition de projet comprenait la mise en place de structures et de pratiques hebdomadaires visant à soutenir la culture nouvellement établie et devant exercer un effet tampon sur la culture organisationnelle plus large qui, dans bien des cas, amène les travailleurs en protection de l’enfance à se retrancher derrière des positions et des pratiques traditionnelles. L’évaluation du projet a mis en lumière des résultats souvent surprenants, contribuant à l’évolution soutenue de notre pratique en protection de l’enfance ainsi que des rapports de collaboration avec l’organisme communautaire.


T

his paper will explore a joint project that examines the development of a practice framework in child protection that is embedded within social constructionist theory (Burr, 2003) and, more specifically, narrative therapy (White & Epston, 1990; Freedman & Combs, 1996; Madigan, 2011). The project is a joint effort between a government child protection agency and family counsellors from a communitybased non-profit agency in a rural community in British Columbia, Canada. The codefining and creation of “collaborative relationships” between the two agencies was not without resistance but has become a critical foundation in the project, resulting in the object of inquiry being problems rather than people. The practice framework, which we have called “Relational Narrative Practice”, reflects the complexity of balancing policy, values, beliefs and the inner condition of practitioners. In addition to critically examining many of the assumptions that organize our work with individuals and families, the paper will also reflect on the prevailing culture of organizations, both government and nongovernment, and its role in influencing our work with individuals and families. Structures to counteract this prevailing culture will be examined and an analysis of outcomes leading to the ongoing evolution ORGANIZATIONAL of our practice. CULTURES ARE CREATED, MAINTAINED

ORGANIZATIONAL CULTURE

The culture of an organization is an observable, powerful force. It is more than the rules, responsibilities and roles BY PEOPLE AND, in an organization: It is comprised of the assumptions, beliefs and norms that create a common ground for IN PART, CREATED everyone. Organizational cultures are created, maintained AND MAINTAINED BY or transformed by people and, in part, created and LEADERSHIP. maintained by leadership. The helping culture in general and the culture of child protective service organizations have a view of people and problems that is reflected in their principles, legislative guidelines, language and policies that inform the practice of workers in the organization. We felt it critical to understand the influence of culture and the elements that need to be considered in the development of a counter culture that supports our preferred practice. OR TRANSFORMED

The prevailing approach in child protection and helping professions is to identify problems through the completion of assessments and offering solutions through prescribed interventions. The result of is that the story of who the person is and the meaning of their experience is ascribed by the professional’s meaning and knowledge, which effectively marginalizes the person’s experience. Associated documentation requirements create a living record of people viewed through professional lenses that, in turn, distort people’s story and experiences. Bureaucratic and accreditation requirements may also entrench professional meanings and knowledge of people.


Child welfare bureaucracies and mental health and counselling services can confuse means with ends, resulting in the completion of paper-work requirements BUREAUCRACIES becoming over-valued performance indicators (Munroe, AND MENTAL HEALTH 2011). The field of child welfare in particular has a AND COUNSELLING tumultuous history of searching for definitive solutions to complex and complicated issues facing individuals and SERVICES CAN families (Stevens & Cox, 2008; Drisko & Grady, 2012). CONFUSE MEANS WITH Globally, child protection services are under constant ENDS, RESULTING scrutiny and pressure to improve services (Clarke, 2004). IN THE COMPLETION The scrutiny and pressure come in various forms: formal inquiries authored by individuals or groups external OF PAPER-WORK to the organization; media responses to particular REQUIREMENTS tragedies; and internal reviews or audits. The response BECOMING OVERto this scrutiny often comes in the form of structural changes to the management of the organization and/or VALUED PERFORMANCE an introduction of strategies to reduce the possibility of INDICATORS. error in judgement by workers. In general, mechanisms to reduce errors of judgement include identifying those responsible for the error and provide further teaching and mentoring; developing prescriptive procedures and policies in an effort to reduce human error; or increasing the monitoring of worker practice to ensure compliance with prescribed practice. Munro (2011) speaks of this in her review of child protection and Webb (2006) describes what he calls an “audit culture”.

CHILD WELFARE

Child protection workers describe experiencing increasing fear and doubt in their practice as they continue to juggle the persistent dilemma of supporting families and protecting children. Both authors can recount examples from personal practice where the fear of something happening—liability—pressed us to act in a way that was contrary to good practice and the values that brought us to this work. One example is involvement with a young mother who had begun to develop a working relationship with John (co-author and, at the time, front line social worker with the child protection agency) and she initially expressed mistrust of the child protection agency. She was engaging in services such as day care, had left her abusive partner and the home was now cleaner. We would continue to receive reports of drug use, yet this mother began to trust John enough to hint that these were problems that she would like to change, but she had not yet “confessed” to such. Investigative child protection processes are typically set up to seek truth and facts. How do you know she is not doing drugs? What evidence can a social worker collect? Investigating social workers have to code whether a child is “in need of protection” or “not in need of protection”. The complexity and context of families’ lives are often lost 89 Canadian Social Work/Travail social canadien

in coding and prescribed assessments. One day after receiving a report of possible drug use, John recounts being frustrated at this mother’s “lack of cooperation”, “resistance” and “denial”, and stated, “Well then, I will have to make you take a drug test.” She calmly asked, “Why?” Unable to find the right “collaborative” word, John stated, “To prove you are lying.” She looked at John in silence, with penetrating eyes, as if to confirm that John was just like all her past experiences with child protection. It was at that moment the light bulb went off, we could see her defensive walls go up, trust sailed away like a ship, and we were left wondering why. Why is it so important to force admissions of guilt when it goes contrary to healthy relational dynamics? This experience is shared by many child protection social workers who have voiced that they feel (real or imagined) pressure from the child protection culture to do a “good investigation” and push for an admission of guilt: to find facts and truth. Thorough assessments will yield the story from families, but one also has to allow room for the exploration of meaning to the actions. In the end, this mother did talk about her struggles with drug use, but had stopped using; and her ex-husband was making false allegations. Across the globe, the culture of child protection has shaped relationships not only with the families we serve, but also with contracted community agencies. THE CULTURE OF Historically, our relationship between the government CHILD PROTECTION agency and the community agency could be characterized HAS SHAPED as hierarchical and paternalistic. The community agency RELATIONSHIPS was expected to provide the necessary services as outlined by the government social workers, and any NOT ONLY WITH failure to do so would be viewed as a breach in the THE FAMILIES WE contractual relationship. It was expected that community SERVE, BUT ALSO agency workers would carry out the plan with clients as developed by the government social worker. Typically WITH CONTRACTED included in the plan was an outline of prescriptive COMMUNITY AGENCIES. services, which may include family support, a youth worker, parent support, education and the expectation that the community workers follow the plan and report back to the government social worker. Frequently, community contractors were seen to be the “eyes and ears” of protection social workers. If there was to be a fundamental shift in philosophy with regards to how we saw people and problems, there needed to be an equal shift in the relationship between the government agency and the community agency. This, in part, required a shift in the culture of the government child protection agency.

ACROSS THE GLOBE,

ROLE OF POWER IN SHAPING CULTURE

Considerations of the role of power are important to raise in our reflection of the influence of organizational culture on our work. In Michel Foucault’s (1967, 1981) examination 90 Canadian Social Work/Travail social canadien

of power, he contrasts what he refers to as “traditional power”, which he suggests is appropriated by certain individuals or groups and enacted according to their particular interests, with modern power, which exists in the shadows of traditional power. He describes traditional power as being exercised from the top down and typically operates to oppress, repress, limit, prohibit, impose and coerce. This form of power has a presence both in the context of bureaucratic systems where child welfare workers experience it in the form of policies and procedures and, at times, in management intervention. Clark (2004) calls this the “universalization of management” and an audit culture is created (p. 121). Management intervention is frequently enacted in our work with individuals and families in child welfare, where it is rationalized as a requirement to address risk and ensure the safety of children. In contrast, Foucault describes modern power as the predominant system of power in the achievement of social control. This is a power that recruits people’s active participation in the fashioning of their lives, their relationships and their identities according to the constructed norms of the prevailing culture. He suggests that when conditions are established for persons to experience ongoing evaluation according to particular institutionalized norms, when these conditions cannot be escaped and when persons become isolated in their experience of these conditions, then they will become guardians of themselves. In these circumstances, persons will perpetually evaluate their own behaviour and engage in operations on themselves to forge themselves as “docile bodies”. This has become OUR APPROACH TO the primary mechanism of social control. When applied to the culture of child welfare where fear is a significant PRACTICE EMBRACES feature and influence, workers frequently succumb and A PARTICULAR become docile bodies in an attempt to accommodate to PHILOSOPHICAL the prevailing culture. POSITION WITH AN Principles/Philosophy Informing Practice EMPHASIS ON THE Our approach to practice embraces a particular IMPORTANCE OF philosophical position with an emphasis on the importance of relationship and conversation with others. RELATIONSHIP AND An ongoing analysis, enquiry and reflection with self and CONVERSATION WITH others is seen as critical. It is not about finding truths, OTHERS. science or otherwise, nor is it about object or things: It is about people. Principles inform both a professional and personal way of being in the world; the two cannot be separated. Congruence is required in the way we think about and relate to people in our lives. The following principles and ideas have informed our work with clients and provided us with the foundation of our “integrated” practice framework (Dickerson, 2010), which we refer to as relational narrative practice.


Experiences are best understood within a social, cultural and political context. The narrative metaphor is the guiding metaphor to our work. It suggests that we seek to make sense of our lives and experiences by ascribing meaning through stories, which themselves arise within social conversations and culturally available discourses. HareMustin (1994) defines discourse as a “system of statements, practices, and institutional structures that share common values” (p. 19). With this understanding, discourse includes our cultural assumptions, our daily habits which are frequently unexamined, and the economic, political and cultural institutions within which these assumptions and actions exist. Shifting from internalizing to externalizing conversations. When people seek assistance, they typically speak about the problem in ways that make it somehow part of them or within them: “I’m unmotivated and just can’t seem to get the energy.” Child protection and mental health systems regularly locate problems inside people. These internalizing conversations (conversations that locate problems inwardly) frequently become frustrating for people as they begin to see themselves as inadequate and unable to change their circumstances. If people do not embrace the internalizing process. they are identified as resistant and/or in some form of denial. White (1988), who pioneered the idea of externalizing problems, felt that shifting the focus of concern outside the person separates the person from problematic identity conclusions and dominant discourses. Externalizing reduces the effects of labelling and pathologizing, and fosters collaboration with helpers in resolving the problem. We have found that this greatly reduces the shame, guilt and blaming that is typically with associated with traditional approaches in child welfare. Shifting from internalizing to externalizing conversation has allowed families to move from blaming and shaming to uniting in their fight against disrespectfulness and other issues identified RESTRAINTS DO by families. NOT CAUSE PEOPLE People will achieve their desires unless restrained TO BEHAVE IN A from doing so. PARTICULAR MANNER; The theory of restraint, which has been invaluable in our THEY PREVENT US work with clients, has evolved from the work of Bateson (1972, 1979), White (1988) and Jenkins (1990) in his FROM BEHAVING IN A work in the area of violence. The idea of restraint is MANNER WE DESIRE. based on the belief that unless restrained from doing so, people will strive to achieve their particular desires or preferences. Restraints are traditions, beliefs and habits that influence how we participate in and make sense of the world. Restraints do not cause people to behave in a particular manner; they prevent us from behaving in a manner we desire.


Creating and Sustaining a Counterculture to Support Practice. In response to the power and influence of the prevailing helping culture and the particular culture of the government agency, it was felt that a deliberate strategy was necessary for the creation and sustaining of a counterculture. These strategies or structures support a practice informed by social constructivist and narrative ideas and principles (Freedman & Combs, 1996; White & Epston, 1990), as outlined above. The transformation and development of the counter-culture was critical and initially met with much resistance. As with most organizations, an awareness of the need for change occurs with outsider questions. This took the form of a new clinical supervisor at the community agency (Doug) asking questions from THE CHILD PROTECTION the perspective of narrative inquiry (Hancock & Epston, OFFICE, LIKE MANY (2008); White & Epston, 1990). In addition, John had arrived from another part of the country just prior to ACROSS THE COUNTRY, Doug and immediately felt the “culture of fear” that HAD STAFF ON STRESS was prevalent. The child protection office, like many LEAVE AND OTHERS across the country, had staff on stress leave and others trying to leave, and the relationship with the community TRYING TO LEAVE, AND agency was described as “toxic”. The impetus for cultural THE RELATIONSHIP change was, in part, out of survival as working in this WITH THE COMMUNITY environment was not sustainable. In an effort to develop and sustain a counter culture, our two organizations AGENCY WAS wrote a formal proposal that legitimized these DESCRIBED AS structures for staff and management, but also acted as “TOXIC”. an accountability document. In no way did we want to suggest that these practices are the best or only way to do collaborative work. The examples below are part of the outcome as we strove to integrate narrative ideas into our work. Describing what is different in our practice is best reflected in the responses from the families and community professionals with whom we work. Recent examples include several mothers coming into the child protection office seeking advice and help after vowing “never to set foot in our office”, and new clients stating they have found staff helpful and that they felt believed in and supported. This is reflected in the increase in the number of self-referrals in both agencies. The vision for our practice is that every interaction is intentional in supporting families to achieve their preferred lives and practice, based on the belief that parents want to do their best. The structures below are intended to ground practice in our philosophical stance and keep us from falling into a default position based in fear. Weekly joint intake meetings Protection social workers and staff from the community agency meet weekly to assess new intakes in both offices, to code as per government standards and to determine who may be best suited to work with the family. The weekly meetings have become the foundation 93 Canadian Social Work/Travail social canadien

from which we have kept alive the counter culture and ensured that practice is based on our shared values and principles. The weekly meetings are part of an accountability structure as we consider the potential to cause harm in relationships where there are inequities of power. One person will often take the role of listening to the dialogue as if they were the client and interjecting their thoughts and feelings to what is being said. These meetings also allow for greater relationship building between agencies, streamlining of referral and reporting processes, and ensuring that families receive the most appropriate service.

THERE HAS BEEN A NOTICEABLE SHIFT FOR SOME FAMILIES, WHO HAVE COME TO SEE CHILD PROTECTION SERVICES AS POTENTIALLY HELPFUL AND SUPPORTIVE.

Joint home visits and case conferences Standard practice has become that child protection social workers and counsellors from the community agency jointly see families for child protection intakes and ongoing services. The cultural and practice shifts that have occurred as a result cannot be overstated. A sense of shared responsibility has emerged that greatly reduces social worker stress and acts as a buffer from the culture of fear and liability, or what Stevens and Cox (2008) call being pushed to “the edge of chaos”. There has been a noticeable shift for some families, who have come to see child protection services as potentially helpful and supportive.

Monthly education days Ongoing learning is pivotal as a counter cultural activity and promotes professional development and “freshness” in our roles. The community agency staff and social workers meet once a month to consider new ideas in relation to their work as well as reflect on the nature of their relationships with each other. Supervision Supervision is seen as one of the most influential elements in sustaining a practice that considers people and problems from a narrative and social constructivist perspective. Every Wednesday, Doug comes to the government agency and participates in a supervision session with one of the protection social workers and their supervisor (John). This joint supervision allows for an outsider view of practice and acts as a buffer to the prevailing culture of child protection and its problem-saturated lens. The focus of supervision is on our relationship with our clients, and it has shifted from ensuring the completion of paper work requirements to reflecting on the nature of relationships formed with clients. 94 Canadian Social Work/Travail social canadien

Creation of new forms Child protection staff, while ensuring adherence to government policies and forms, also consider what is important to reflect about families, including acknowledging hopes, abilities, skills and desires. The challenge in the completion of records is that the government forms reflect a view of people and problems somewhat different from our philosophical approach. Subtle changes have created consistency in language with narrative and collaborative principles. The family plan begins with asking families about their hopes and dreams for their lives—what is their “preferred life”. Beginning with this question has created a new experience for families OUR ENDEAVOR IS that opens the door for a more collaborative relationship. The form then asks about the obstacles to achieving the TO CREATE LIVING above goals and the plan to achieve them. The next section RECORDS THAT ARE asks them to describe the sustaining factors—i.e., “What REFLECTIVE OF PEOPLE is going well?”— and the plan to sustain these factors. Our endeavor is to create living records that are reflective AS WE HAVE TO COME of people as we have to come to know them, to enhance TO KNOW THEM, TO safety and to build trusting relationships with our ENHANCE SAFETY AND families. The ongoing challenge is the continued meeting TO BUILD TRUSTING of system requirements, as compliance to government standards must be maintained, which often means the RELATIONSHIPS WITH duplication of forms. OUR FAMILIES.

OUTCOMES AND INDICATORS

The authors note that the qualitative nature of the project does not allow one to draw conclusive links in practice shifts to the outcomes below and will be the focus of future research. Informal evaluation of the pilot project, however, revealed unexpected financial and practice changes that have strengthened our story and aided in sustaining practice shifts. Woven into these outcomes is a story of cultural change and a renewed vision and mandate. The mandate of child protection agencies is not to keep children safe: That is the parent’s job (Child, Family and Community Services Act. Guiding Principles 2. (a), 1996). Rather, the role of child protection workers is to journey alongside families as they move toward their “preferred self” and ensure their children reach their full potential in all domains of their life. This mandate is based on a philosophical belief that parents want to provide the best care possible for their children. Child protection then becomes a process of establishing relationship that allows for thorough assessments through an evidenced-based practice model that is based on values and beliefs that see parents as the experts in their own lives. Family safety plans need to instill hope and are based on a sense of shared responsibility. The idea of shared responsibility has created a new experience for protection social workers, one which has greatly enhanced a positive work environment and a distancing from the need to “take control” (Turnell & Edwards, 1999). Below are some of the observations from our work together. 95 Canadian Social Work/Travail social canadien

Work Place Environment Child protection staff, community professionals and staff at the community agency have given anecdotal evidence that the office work environment is more consistent with the office’s vision of becoming “a place people want to come to”. In the years leading up to the project, it was not uncommon for 50% of the child protection staff to be on stress leave while the other 50% were trying to leave. The office could be described as in a state of “triage” due to inadequate staffing. Since the project began there have been no stress leaves and the one staff who had to leave due to her husband’s transfer “wished she never had to…” and is “…scared what practice will be like in my new office”. The recognition that the culture of the government office also impacts administrative personnel has meant considering what is important for them, including having them feel connected to the nature of the work. The emphasis on the philosophical approach has meant traditional role distinctions within the government organization and between the government organization and the community agency have become less important with the focus on people’s abilities, skills and desires. Reduction of Children in Foster Homes There has been a significant drop in the number of children in government care. At the time of writing this article, there were five children in foster care compared to a monthly average of 28–30 THERE HAS BEEN A (2004–2008). Since the project began in 2008, there has been a decline in the number of children needing foster SIGNIFICANT DROP homes, and when children are not deemed safe at home, IN THE NUMBER the use of out-of-care options has increased. In 2010, OF CHILDREN IN children that came into care were all by a Consent Order or a Voluntary Care Agreement; there were no contested GOVERNMENT CARE. removals in 2010 and only one in 2011, resulting in reduced court costs. The significance of these changes requires a more rigorous evaluation and methodology, however, as other variables may account for these statistics. While the causes of these changes cannot be conclusively linked to practice shifts, the impact on office culture and the working relationship with clients cannot be understated and can only be described as moving toward our preferred practice. Children Returned Home Sooner An increasing number of children are returning home sooner than we would have previously predicted. Recent examples include a nine year-old “permanent ward”, a four-year boy as well as two teens who returned to their parents—all of which, upon admission, were assessed as they would “never go home”. The parents of these four recent cases talked of their relationship with the social worker and agency staff as being one of 96 Canadian Social Work/Travail social canadien

the key elements in the return. Similar responses to instilling hope in families is found in other research (Lietz & Strength, 2011; Dunst & Trivette, 2009; DeBoer & Cody, 2006). Responses to slip-ups, such as the young mother’s story above, were not dealt with in a punitive manner, but instead as an opportunity to create a new story of resilience as they moved past the incident. Coding Does not Drive the Process Intake calls to both agencies are now jointly assessed at the Thursday meetings. Coding no longer drives the INTAKE CALLS TO BOTH response; instead, the focus is on the needs of the family. Optimally, the child protection social worker and agency AGENCIES ARE NOW counsellor will go to the home and begin the assessment JOINTLY ASSESSED process. Government policy standards are adhered AT THE THURSDAY to as the intake call is coded, but only after adequate information is received. This allows protection workers MEETINGS. CODING NO to go to the home and enact the core values that our LONGER DRIVES THE practice is based on, such as curiosity, possibilities and RESPONSE; INSTEAD, collaboration. THE FOCUS IS ON THE Further outcomes are the decrease in investigations NEEDS OF THE FAMILY. performed by the government agency and an increase in self referrals to the community agency (53% increase in self referrals from 2006 to 2010; further increases seen in 2012 and 2013). This is assessed as a significant indicator of collaborative practice. The weekly intake meetings allow for in depth discussions of intakes from both agencies to ensure that no safety issues are being missed. Reduced Spending As fewer children come into government care, resources can be shifted toward preventative measures and toward ensuring that children that returned home remain united with their families. The government agency has seen a change in the way it spends money as outof-care options have increased, such as children being placed with relatives (Kith and Kin, Extended Family Program) versus traditional foster care. Foster parents are now being used in mentorship roles with teens and young parents. Families in extreme financial hardship are being provided with immediate practical solutions that otherwise might have resulted in stress leading to abuse and neglect. Budget spending has seen a decrease, and in 2011 the government agency under spent its budget by about 34% (similar spending levels remained in 2012 and 2013). The community agency, however, has seen a significant increase in referrals resulting in budget pressures. This dilemma highlights some of the systemic and structural constraints to 97 Canadian Social Work/Travail social canadien

innovative and collaborative practice. The government agency greatly benefits from the close working relationship with its community partner, but there is little flexibility toward sharing resources in a tangible way. Practice Shifts Practice shifts can be seen in viewing families as possessing the skills and abilities to solve their own problems versus basing plans on an expert stance. An area in which we continually need growth is in regard to responses to family violence. Historically, child protection has held mothers responsible for the safety of their children, frequently ignoring their attempts to ensure safety. Mothers often feel further blame and humiliation as their efforts are either diminished or ignored—and this further victimizes women who are experiencing violence. This can result in children being vulnerable to future attacks from the perpetrator of violence. Practice shift has meant a focus on mothers’ responses to the violence, including their efforts to ensure the safety of their children. Highlighting the mother’s response to violence has created opportunities and possibilities for them as their creativity and determination is recognized.

CONCLUSION AND IMPLICATIONS

The genesis of this project was born out of a growing desire for our practice to be consistent with the values and beliefs that brought us to this work. An agreed upon intolerance of the power imbalance between the government agency and community agency created commonality that allowed a new culture to emerge. When the project proposal was first presented in 2008, THE GENESIS OF THIS the preamble stated, “How does one hold to the values that brought us to this work in the face of overwhelming PROJECT WAS BORN obstacles?” This project is an attempt to listen to what our OUT OF A GROWING families are telling us and to do child protection work in DESIRE FOR OUR a different way. PRACTICE TO BE The practitioners involved in this project have faced CONSISTENT WITH THE many obstacles and an unyielding pressure from the VALUES AND BELIEFS larger child protection and helping culture to conform to decades of practice, policy and beliefs rooted in what THAT BROUGHT US TO we call the “cover your ass theory”. Human nature is to THIS WORK. fear and resist change; thus, structures were required to prevent default behaviour. The development of trust and relationship is key (Miller, Duncan, & Hubble, 1997) which has required intentional energy and commitment by all staff in a line of work that is rife with urgency and in which little value is given to reflection (Heron, 2005; D’Cruz, Gillingham, & Melendez, 2007). One of the greatest challenges facing this project has been maintaining the structures that were put in place to nurture relationship and a culture of continuous learning and critical analysis of 98 Canadian Social Work/Travail social canadien

practice. The weekly meetings between the government agency and the community agency have meant pushing aside the urgency of requests from clients, upper management and community professionals in order to keep these meetings sacred in our calendars. This act alone is counter cultural, as seemingly urgent requests have to wait till the meeting is over. Our administration staff can attest to this pressure as they have to field urgent calls and resist the urge to pull us out of our meetings. Evaluation of the project to date reveals a further need to grow and define our practice framework and the culture that can support it. Old thinking patterns continue to emerge and constant energy has to go into moving forward. When making referrals, child protection staff still have to fight against thoughts such as, “Just take the referral as we are too busy to deal with this,” “This is what we pay you for,” . . . and the list could go on. Power imbalance exists in all relationships (Dacher, Gruenfeld, & Anderson, 2003) yet the desire for a collaborative relationship between our two agencies forces continual examination of our feelings and actions, particularly in times of stress, constant change and systemic demands. At times, we may reach too far for equality and a blending of our roles, which is evidenced in feedback REFLECTING ON SOME from staff, such as, “We are not sure of where we are going or our mandate.” This is evidence that continual OF THE CHANGES feedback loops (Miller & Duncan, 2000), reflection and SINCE THE PROJECT careful tending are required to sustain the gains made in BEGAN REVEALS our relationships and practice. EXCITING POSSIBILITIES Reflecting on some of the changes since the project FOR CULTURAL began reveals exciting possibilities for cultural change CHANGE IN CHILD in child protection and the relationships between government and community agencies. As with all of life, PROTECTION AND relationships are contextual and those involved in this THE RELATIONSHIPS study recognize that the process documented cannot be BETWEEN GOVERNMENT replicated in other agencies; neither is there a “right” way to engage with families. This project is based on AND COMMUNITY social constructionist philosophy, which recognizes the AGENCIES. relative nature of relationships and systemic interactions. Child protection staff enjoy coming to work as they begin to experience change in the families they work with. Comments from families, such as, “This is different,” “I want you to keep my file open,” have truly been inspiring—and it has been a privilege to be part of this common journey.


ACKNOWLEDGMENTS

The authors wish to thank all the staff at the government agency and community agency who contributed to the creation of the pilot project that led to the writing of this paper.

REFERENCES

Ayre, P. (2001). Child protection and the media: Lessons from the last three decades. British Journal of Social Work, 31(6), 887–901. Bateson, G. (1972). Steps to an ecology of mind: Collected essays in anthropology, psychiatry, evolution, and epistemology. University of Chicago Press. Bateson, G. (1979). Mind and nature: A necessary unity (Advances in systems theory, complexity, and the human sciences). Hampton Press. Burr, V. (2003). Social Constructionism (2nd ed.). New York: Routledge. Child, Family and Community Service Act. (1996). Chapter 46. Queens Printer, Victoria, British Columbia, Canada. Clark, J. (2004). Changing welfare, changing states: New directions in social policy. London, Sage. Dacher, K., Gruenfeld, D., & Anderson, C. (2003). Power, approach and inhibition. Psychology Review, 110(2), 265–284 D’Cruz, H., Gillingham, P., & Melendez, S. (2007). Reflexivity, its meanings and relevance for social work: A critical review of the literature. The British Journal of Social Work, 37(1), 73–90. De Boer, C., & Cody, N. (2006). Good helping relationships in child welfare: Learning from stories of success. Child and Family Social Work, 12, 32–42. Dickerson, V. C. (2010). Positioning oneself within an epistemology: Refining our thinking about integrative approaches. Family Process, Vol 49(3), 349–368. Drisko, J. W., & Grady, M. D. (2012). Evidence-based practice in clinical social work, New York, Springer. Dunst, C. J., & Trivette, C.M. (2009). Capacity-building family-system intervention practices. Journal of Family Social Work, 12, 119–143. Foucault, M. (1967). Madness and civilization. New York: Pantheon Books. Foucault, M, (1981), The History of sexuality. Harmonondsworth: Penguin. Freedman, J., & Combs, G. (1996). Narrative Therapy: The social construction of preferred realities. New York: Norton. Hancock, F., & Epston, D. (2008). The craft and art of narrative inquiry in organizations. In D. Barry & H. Jensen (Eds.), The Sage handbook of new approaches in management and organization (pp. 485–502). London: Sage. Hare-Mustin, R. (1994). Discourses in the mirrored room: A postmodern analysis of therapy. Family Process, 33, 19–35. Heron, B. (2005). Self reflection in critical social work practice: Subjectivity and the possibilities of resistance. Reflective Practice: International and Multidisciplinary Perspectives, 6(3), 341–351. Jenkins, A. (1990). Invitations to responsibility: The therapeutic engagement of men who are violent and abusive. Dulwich Centre Publications. Jenkins, A. (2009). Becoming ethical: A parallel, political journey with men who have abused. Dorset: Russell House. 100 Canadian Social Work/Travail social canadien

Keltner, D., Gruenfeld, D. H., & Anderson, C. (2003). Power, approach, and inhibition. Psychological Review, 110(2), 265–284. Lietz, C., & Strength, M. (2011). Stories of successful reunification: A narrative study of family resilience in child welfare. Families in Society: The Journal of Contemporary Social Services, 92(2), 203–210. Madigan, S. (2011). Narrative therapy. Washington: American Psychological Association. Madsen, W. C. (2009). Collaborative helping: A practice framework for family-centered services. Family Process, 48(1), 103–116. Madsen, W. C. (2006). Teaching across discourses to sustain collaborative practice. Journal of Systemic Therapies, 25(4), 44–58. Miller, S., Duncan, B., & Hubble, M. (1997). Escape from Babel: Toward a unifying language for psychotherapy practice. New York: W. W. Norton & Company, Inc. Miller, S. D., & Duncan, B. L. (2000a). Paradigm lost: From model-driven to client-directed, outcome-informed clinical work. Journal of Systemic Therapies, 19, 20–34. Munro, E. (2005). Improving practice: Child protection as a systems approach. London: LSE Research Articles Online. Munro, E. (2011). The Munro Review of Child Protection: Final report. London: TSO. Stevens, I., & Cox, P. (2008). Complexity theory: Developing new understandings of child protection in field settings and residential child care. British Journal of Social Work 38(7), 1320–1336. Turnell, A., & Edwards, S. (1999). Signs of safety: A solution and safety orientation approach to child protection casework. New York: W.W. Norton & Company. Webb, S. A. (2006). Social work in a risk society: social and cultural perspectives. London: Palgrave Macmillan. White, M. (1988). The externalizing of the problem and the re-authoring of lives and relationships. Dulwich Centre Newsletter, Spring. White, M. (2007). Maps of narrative practice. New York: Norton. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton. PRIOR TO ESTABLISHING A PRIVATE PRACTICE IN 1986, DOUG EGAN, MSW, RSW, WAS EMPLOYED IN CHILD WELFARE IN ALBERTA AS A FRONTLINE WORKER, SUPERVISOR AND CONSULTANT. HIS PRIVATE PRACTICE HAS INCLUDED CLINICAL AND CONSULTATION WORK WITH INDIVIDUALS, FAMILIES, GROUPS AND COMMUNITIES IN ALBERTA, BRITISH COLUMBIA, NUNAVUT AND THE NORTHWEST TERRITORIES. HE PROVIDES CONSULTATION AND SUPERVISION TO GOVERNMENT AND NON-PROFIT ORGANIZATIONS INCLUDING HIS CURRENT WORK AS CLINICAL SUPERVISOR WITH COMMUNITY CONNECTIONS IN REVELSTOKE, BC. JOHN YAKIELASHEK, BSW, RSW, HAS BEEN EMPLOYED AS A FRONT LINE WORKER IN CHILD PROTECTION BOTH IN ALBERTA AND BRITISH COLUMBIA SINCE 1992. HE IS CURRENTLY THE TEAM LEADER AT THE MINISTRY OF CHILDREN AND FAMILY DEVELOPMENT OFFICE IN REVELSTOKE. JOHN IS INVOLVED IN VARIOUS TRAINING INITIATIVES IN BRITISH COLUMBIA, HAS A KEEN INTEREST IN COMMUNITY DEVELOPMENT AND IN BRINGING CONCEPTS FROM NARRATIVE AND COLLABORATIVE PRACTICE TO THE FIELD OF CHILD PROTECTION.


REPORT/RAPPORT

Promoting Equity for a Stronger Canada: The Future of Canadian Social Policy

S

ince the 1990s, tax cuts and restrictive federalism have diminished the federal government’s role in social programming, and federal fiscal contribution to provincial social programs is expected to decline. The decentralization of social policy which this implies will reduce the federal government’s accountability to the provinces and create discrepancies between provinces’ services. Furthermore, it undermines a social contract between the federal government and the Canadian people based on a notion of shared rights and responsibilities. There is, in short, no pan-Canadian vision for social policy in this country. CASW is deeply concerned about the impact these ‘hands off’ policies and practices will have on the health care, social inclusion, and social protection of Canadians. In this report, CASW reaffirms the importance of a pan-Canadian vision of social policy based upon a concept of coordinated federalism in which the federal government negotiates with the provinces and territories and helps to finance social programs under certain guiding principles. It is a vision ensuring that all Canadians have basic rights to a common minimum standard of service across the country.


Promoting Equity for a Stronger Canada: The Future of Canadian Social Policy

Authors: Dr. Glenn Drover Allan Moscovitch Dr. James Mulvale


Ce document est disponible en français


Contents

Introduction.....................................................................................................................................106 3 10 Income Equity............................................................................................................................... 113 CASW’s Proposal .................................................................................................................. 125 22 24 Social Equity................................................................................................................................. 127 CASW’s Proposal ................................................................................................................. 140 37 39 Health Equity ................................................................................................................................ 142 CASW’s Proposal ................................................................................................................. 152 49 50 Conclusion .................................................................................................................................... 153


Introduction In this paper, the Canadian Association of Social Workers (CASW) recommends the adoption of an equity framework for social policy in which the federal government plays a shared role with the provinces and the territories. Based on a concept of income, social, and health equity, the framework is very different from the vision advocated and promoted by the current government.1 While the Conservative government has undone some important policy initiatives of previous governments, such as the termination of the Kelowna Accord and the national child care plan, it has also introduced a universal child care benefit, a child tax credit, an employment credit and a home renovation tax credit. Fundamentally though, the Conservative government’s vision of social policy differs from CASW in two fundamental ways. Prime Minister Harper and his colleagues promote a diminishing role for the federal government in the development of social programs and envision a restrictive federalism in which programs delivered by different levels of government are distinct within their own jurisdiction.2 A diminishing role of the federal government is being achieved by tax cuts. The total tax take has already been reduced from about 16% of gross domestic product (GDP) to 14%. Program expenses are projected to decline further from 2010–11 to 2016–17.3 Cuts are one half of the story: restrictive federalism is the other. The current government, unlike previous Conservative governments, is erecting a firewall between the federal government and the provinces.4 The current Prime Minister has never met with provincial leaders to discuss social policy. Budgets are drawn up to provide unconditional transfers so that the provinces can run social programs without perceived federal interference. In the future, transfers will be based on population growth and rates of inflation, with little or no provincial input.

1

Equity, in this report, refers to access to the distribution of income as well as the provision of social and health services.

2

Keith Banting refers to three federalisms in relation to social policy and intergovernmental decision making: classic federalism in which programs are delivered by different levels of government acting independently; shared cost federalism in which the federal government offers financial support to other levels of government on certain conditions; and joint decision federalism in which formal agreement of both levels of government is required before programs are developed. Banting, Keith, 2009. “The Three Federalisms: Social Policy and Intergovernmental Decision-Making.” in Herman Bakvis and Grace Skogstad, eds., Canadian Federalism: Performance, Effectiveness, and Legitimacy, Don Mills ON: Oxford University Press. The approach we take is slightly different from Banting. Restrictive federalism, as we see it, is based upon the classical model but also draws upon joint decision federalism. Coordinated federalism is more closely related to a combination of shared cost federalism and joint decision making process.

3

Government of Canada, Budget 2012, Chapter six, The Fiscal Outlook, http://www.budget.gc.ca/2012/plan/chap6-eng.html

4

Boessenkool, Ken, 2013, “Revealed: Stephen Harper is conservative. Really.” Macleans, July 12.


The vision of CASW, by contrast, is based on a concept of coordinated federalism in which the federal government negotiates with the provinces and territories and helps to finance social programs under certain guiding principles. It is a vision ensuring that all Canadians have basic rights to a common minimum standard of service across the country. Coordinated federalism does not preclude provinces and territories from administering their own programs or establishing their own goals. It simply supplements their goals with national social programs that are entirely or partially funded by the federal government. The merits of coordinated federalism are also grounded in two fundamental principles: constitutionality and economic viability. Constitutionality: Constitutions outline the rights and responsibilities of governments and citizens and set out legal mechanisms to assure those rights and responsibilities. Under the Canadian constitution, the federal government is largely responsible for national economic development and related matters including banking, currency, monetary policy, trade and defense. The provinces are responsible for social and educational services as well as matters related to civil and property rights. As a result of the division of powers in the constitution, Canada is considered to be the most decentralized federal welfare state in the OECD.5 Federal and provincial governments have relative autonomy within their own areas of jurisdiction. The federal government also has residual powers in order to assure peace, order, and good government. Restrictive federalism is built on the idea that one level of government should interfere with others as little as possible. A distinct division of powers, in which the provinces had full responsibility for social programs, was the norm in intergovernmental relations from the time of confederation in the nineteenth century to the great depression in the 1930’s. From the 1930s to 1990s however, the federal government became more involved in the direct provision of pensions and employment insurance, as well as in the cost sharing of social and health services. In recent years, the Government of Canada has moved to reverse that trend and minimize federal involvement by increasing unconditional transfers and touting the benefits of tax point transfers. This reversal, that began under the leadership of Prime Minister Mulroney and that has continued to influence our present government, is regrettable. It undermines a social contract between the

5 Herbert Obinger, Stephan Leibfried, and Francis Castles, Federalism and the welfare state: new world and European experiences, 2005, Cambridge University Press.


federal government and the Canadian people based on a notion of shared rights and responsibilities.6 A fairly well defined social contract developed in Canada in the latter half of the twentieth century and is partially enshrined in the Charter of Rights and Freedoms and in the Constitution Act of 1982. In terms of social policy, it was accepted that most social and health programs were efficiently administered by the provinces or territories, but it was also recognized that the federal government had an important role to play in promoting national equity.7 Increasingly, therefore, the federal government has played a role in the shared funding of health, social, and educational services, as well as the full funding of some income security programs such as pensions, employment insurance, and benefits for families with children. As a form of cooperation between the federal and provincial governments evolved, it admittedly created friction. Some provinces, like Québec and increasingly Alberta, have viewed it as an unnecessary and unwanted intrusion into matters of provincial jurisdiction. Other provinces complained about the fairness or adequacy of federal funding. For politicians, federal provincial cooperation has been, at times, a messy affair due to the need for constant negotiation and the potential for open disagreement. For citizens, on the other hand, it broadened the range of political ideologies that have input into the negotiating process and enhanced democratic discourse. It also diminished, even if it did not eliminate, the tendency for either level of government to act unilaterally. In spite of complexity in navigating differing political perspectives and priorities, the majority of Canadians seem to be satisfied with the outcome of shared responsibility for social policy. In 2002, a public opinion study by a leading research organization found that the top priorities of Canadians were social ones, such as health care, education, employment, and child poverty.8 In 2009, a poll by Nanos Research found that Canadians strongly supported the public health system and public solutions to make public health care stronger.9 In 2013, a poll by Environics Research has shown that a majority of Canadians are willing to pay higher taxes to protect public services.10 Coordinated federalism, as CASW envisions it, is not perfect. It leaves room for dispute. It does, 6 With respect to the social contract, we draw upon ideas in a paper by Kenneth Norrie, Robin Boadway and Lars Osberg, “The Constitution and the Social Contract” in Robin Boadway, Thomas Courchene and Douglas Purvis, Economic Dimensions of Constitutional Change, Kingston, John Deutsch Insitute, 1991. 7

8

Kenneth Norrie et al, pp 226-233 Matthew Mendelsohn, Canada’s Social Contract: Evidence from Public Opinion, 2002, Canadian Policy Research Networks.

9

10

Nanos Poll: Overwhelming support for public health care, 2009, Nupge.ca. 2009-08-13. The poll was commissioned by the Broadbent Institute, http://www.broadbentinstitute.ca/


however, provide a political framework for current and future social programs. It can accommodate the special status of Québec. It can accommodate provincial and territorial priorities. And it is constitutional.

Economic Viability: A Californian professor of economics, Peter Lindert, explored the history of tax-based social programs over a long period of time and concluded that social spending contributed to, rather than inhibited, economic development.11 The notion that social programs inhibit economic development is particularly strong when the economy is sluggish, as is the present circumstance. In the early 1980s, many western European countries, which already had advanced social programs, experienced slow growth compared to the United States and Canada. Based on that observation, a theory developed that social programs limited labor market flexibility and leaders like Margaret Thatcher used that belief to shift England away from state provided social and health services to market driven systems of provision.12 By the turn of the century, however, the notion that social programs were the cause of an economic slowdown came into question. The case against was based on a one-sided view of cost benefit which looked at the risks, not the advantages. In contrast, a 2002 OECD study found that while some social programs may have had a marginally negative impact on economic output, others actually improved human capital and labor market productivity. 13 In a more recent study, two epidemiologists found that stimulus spending on social programs can not only stimulate economic development, but also reduce social problems associated with recessions. 14 A strong determinant of health is a robust safety net. The real danger to health, they found, was not recession, but austerity. When social safety nets were slashed in times of recession, economic shocks turned into health crisis. They found that countries with higher social program 11 Peter H. Lindert, Growing Public: Social Spending and Econmic Growth since the Eighteenth Century, Cambridge University Press, 2004. This summary of the book in this paragraph is derived from Ole Meldgaard, Social welfare and economic growth, pdf (internet access), Meldgaard is president of the European National Anti-poverty Network, Denmark. Also, Richard Wildinson and Kate Pickett, The Spirit Level: Why More Equal Societies Almost Always Do Better, 2000, Allen Lane. 12 Rebecca Blank and Richard Freeman, “Evaluating the Connection between Social Protection and Economic Flexibility”, in Rebecca Blank, ed., Social Protection versus Economic Flexibility: Is There a Trade-Off?, University of Chicago Press, 1994. 13

The OECD is a unique forum where the governments of 30 democracies work together to address the economic, social and environmental challenges of globalization. Member countries include Canada and the United States as well as most of the countries of western Europe.

14

David Stuckler and Sanjay Basu, The Body Economic: Why Austerity Kills, Harper Collins, 2013.


expenditures had higher life expectancy. It also seems that the ratio of social service expenditures to health service expenditures is associated with health outcomes, not simply the amount spent on health services.15 While social programs enhance economic development and improve health, they are also essential instruments for poverty reduction. In a 2010 Organisation for Economic Co-operation and Development (OECD) study of 14 European countries, it was found that economic growth was not a sufficient condition for poverty reduction.16 The role of social transfers was more decisive than the role of per capita Gross Domestic Product (GDP) in reducing poverty as well as income inequality. More generally, social programs also help to sustain economic development by building social cohesion and a sense of citizenship as well as reducing conflict.17 They do so by increasing equitable access to public services and investment in human capital, particularly education and health, thereby improving the quality of labor and lowering risks for society as a whole during times of economic downturn. 18 The pursuit of economic growth as a sole or primary solution to societal woes has been, and remains, a dominant ideology of most governments, including Canada’s. Increasingly, however, that ideology is being challenged, not only by environmentalists but also by economists, like Jeff Rubin (former economist of CIBC World Markets), who suggests that the high price of fuel will dampen or possibly end growth unless we change the way we traditionally view and promote it. 19

Whatever path economic development in Canada takes in the future, it should be balanced so that employment creation and social protection go hand in hand with investment. A balanced model approach is actively encouraged by the Global Agenda Council on Employment and Social Protection of the World Economic Forum. Specifically, the Council proposes the following measures for balanced development: targeted investments in infrastructure; public investment in “green jobs;” shifting taxation from employment to environmental “bads;” tax cuts or increases in cash transfers to low-income households; robust minimum wage floors to prevent wage deflation; greater progressivity in the 15

See Gina Browne, Stephen Birsch, Lehana Thabane, Better Care: An Analysis of Nursing and Healthcare System Outcomes, Canadian Foundation of Healthcare Improvement, June 2012.

16 Yannis Dafermos and Christos Papatheodorou, “The Impact of Economic Growth and Social Protection on Inequality and Poverty: Empirical Evidence from EU Countries, Paper presented at the 1st International Conference in Political Economy, Rethymno, Crete, 2010. 17

OECD, Promoting Pro-Poor Growth: Social Protection, 2009, 25. The guide has been produced for developing countries but the principles are based on the experience of developed countries with advance programs of social protection.

18

OECD, Promoting Pro-Poor Growth: Social Protection, 2009, 22-25.

19

Jeff Rubin, Why Your World is About to Get a Whole Lot Smaller, Vintage Canada, 2010 and Jeff Rubin, The End of Growth, Random House of Canada, 2012.


tax system; higher levels of investment in active labor market programs; and flexible schemes to promote job retention and job sharing. 20 While acknowledging that reform of some social programs may be necessary to take into account demographic changes (e.g., an aging population), the Council concludes that the experience of the Nordic countries shows that comprehensive social programs are not an obstacle to good economic performance. By way of contrast, the recent performance of the US suggests that relatively underdeveloped social program protection can be a cause of weakness and instability rather than strength. It is not, then, an issue of whether comprehensive social programs are affordable but a question of who pays and how much. “Where social protection systems need to be reformed, governments have a choice. They can either impose change or they can negotiate change with the relevant stakeholders. Building consensus with social partners may be slower, but is a more certain [and democratic] way to a durable solution.”21 CASW proposes three ways in which the government of Canada can encourage pan-Canadian income, social and health equity: (1) the development of a basic income; (2) the use of the Canada Social Transfer to finance income security and promote social inclusion; and (3) the strengthening of federal support of provincial/territorial health care services. To be more specific regarding income equity, CASW recommends that the federal government initiate a process to review and renew the income security system in Canada with a view to the development of a targeted and affordable basic income. A basic income could build upon existing negative income tax mechanisms such as the Guaranteed Income Supplement for seniors, the Canada Child Tax Benefit for families with young children, the Working Income Tax Benefit, and the Goods and Services Tax/ Harmonized Sales Tax Credit. Implementing a comprehensive basic income would require the federal government to engage in careful planning with provincial and territorial governments based on a principle of coordinated federalism as advanced in this report. Secondly, with respect to social equity, CASW recommends that the federal government follow the lead of the European Union and use a governance technique such as the Open Method of Coordination (OMC) to ensure a pan-Canadian dimension to income security and social services programs. The OMC is a cyclical process involving the development of EU-wide objectives, goals, guidelines and indicators: translation of these into member state national plans; peer 20 World Economic Forum, Global Agenda Council on Employment and Social Protection, The Case for an Integrated Model of Growth, Employment and Social Protection, 2012, 5. The next few paragraphs draw mainly from this report, 13-15. 21 World Economic Forum, Global Agenda Council on Employment and Social Protection, The Case for an Integrated Model of Growth, Employment and Social Protection, 2012, 15.


review and mutual learning; and public reporting. The process is managed by a highly developed intergovernmental relations system involving the European Commission and the governments of each of the 28 EU member states, as well as EU-wide social partners and civil society organizations. In Europe, the OMC has proven to be a flexible and effective method of bringing governments of widely different perspectives and persuasion together to tackle common problems like the reduction of poverty or social exclusion. To move in this direction, the federal government should initiate meetings with the provinces and territories to discuss the future of the Canada Social Transfer. This means not only a discussion about the amount of money transferred, but the conditions under which it will be transferred. Without initially setting any conditions on the Canada Social Transfer, both orders of government need, first of all, to decide whether they can find common objectives and agree on a policy framework for income security and social programs. Thirdly, regarding health equity, CASW recommends that the federal government take action to ensure that the conditions of the Canada Health Act (public administration, comprehensiveness, universality, portability and accessibility) are met in order for the provinces and territories to receive federal funding. In addition, CASW recommends that the federal government take the lead in providing financial incentives for the provinces and territories to transform the health care system into one that is patient centered, community-based and cost efficient. One way to do this is to fund a panCanadian initiative to provide benchmarking indicators that will support accountability and stimulate change. CASW also recommends that, in terms of overall funding, the federal portion of health care costs cover, in the short term, 20% of total public health expenditures and that the proportion of public spending to total health spending should remain around 70%. Both targets are realistic within the current economic environment. They have been achieved in recent years and surpassed in earlier years. In the following sections of the report, the rationale for these (and related) recommendations is outlined in detail. Each section provides: (i) background information, including relevant research; (ii) a statement on the value and importance of federal leadership; and (iii) a set of recommendations.


Income Equity Canada has developed a complex and often confusing array of income support programs over the last hundred years. They have developed in a somewhat ad hoc and incremental fashion, and have varied in their purposes and target populations. Some have been geared to specific age brackets (e.g. children and seniors). Others have provided support to individuals with conditions of sickness, work-related injury, or disability. Still others have been based on economic challenges related to family (e.g. widowhood or single parenting responsibilities) or one’s status in the labor market (e.g. insurance against unemployment, workfare programs, and tax credits for the working poor). There has also been a division of responsibility in income security between the federal and provincial governments with contributory and more universal programs generally being offered at the federal level, and last resort income security programs such as social assistance being left to the provinces. Despite this broad array of income security programs in Canada, poverty persists and individuals lacking income and/or economic resources frequently fall through the cracks of our current social safety net. As a result, there are increasingly frequent calls for a broad scheme for a “basic” income to eliminate complexity and overlap in the delivery of income security through the provision of more comprehensive and unconditional support. In its most ambitious form, a basic income aims to provide an adequate income for all with very few if any strings attached.22 The background section below defines and outlines components of a basic income and provides a description of its two alternative delivery mechanisms – through a demogrant and through a negative income tax. Next is a brief history of some of the debates about a basic income and proposals which have been made, in the past, in Canada. Following that are recommendations that the federal government move forward initiatives with the provinces and territories to set in place a version of a basic income that would be constitutionally feasible and both fiscally sustainable and affordable. It is the position of CASW that such an initiative would make a very significant contribution to the reduction of income inequality and the negative consequences of high levels of poverty.

22 In Canada and elsewhere, a basic income is sometimes referred to as a guaranteed income. We use the term basic income, partly because the term will not be confused with existing programs in Canada like the guaranteed income supplement for seniors.


Background The Basic Income Earth Network (BIEN) has been a prominent proponent of a basic income over the last quarter century. BIEN defines the term in this fashion: A basic income is an income unconditionally granted to all on an individual basis, without a means test or work requirement. It is a form of minimum income guarantee that differs from various forms of guaranteed income that now exist in […] three important ways: o it is paid to individuals rather than households; o it is paid irrespective of any income from other sources; o it is paid without requiring the performance of any work or the willingness to accept a job if offered. 23 In Canada, there have been a variety of proposals for what has usually been labeled a “guaranteed annual income.” The proposals for a ‘made-in-Canada’ basic income have incorporated some but not all elements of the BIEN definition. Some, for example, have been targeted at specific age groups (typically children or seniors). Others have been intended as a supplement to replace labor market income for those unable to work. Whether comprehensive, as outlined by BIEN, or partial as proposed in Canada, there are two general ways in which a basic income can be paid as a cash transfer to individuals or households – through a universal demogrant or through a negative income tax mechanism.24 A universal demogrant involves an up-front payment, typically tax-free, to all (adult) citizens. This version of a basic income is paid regardless of income level, in the same amount to all individuals, and paid out on a predictable and regular (e.g. monthly) basis. A demogrant may or may not be a taxable income. A demogrant could be linked to progressive income taxation where those with greater income pay higher rates, or it could be tied a tax regime that is somewhat regressive or even flat, where everyone pays the same rate regardless of income. Consequently, the taxation of other forms of income (e.g. wages or salaries) has differing implications for how a demogrant would be financed and how much redistribution would occur. Many argue that more progressive or higher across-the-board tax rates are necessary in order to finance a basic income scheme. 23

http://www.basicincome.org/bien/

24

The following discussion is based on the Inset on p. 21 of Young, Margot and James P. Mulvale. 2009. Possibilities and Prospects: The Debate Over a Guaranteed Income. 2009. http://www.policyalternatives.ca/publications/reports/possibilitiesand-prospects


A negative income tax mechanism provides basic income benefits to anyone whose income falls below a predetermined level of minimally adequate income. This threshold can be adjusted to family configuration and size. To use a hypothetical scenario, the threshold could be set at $24,000 per year for a single adult, $36,000 for a couple, with $6,000 added for each dependent child or adult that is part of the family unit. So for a married couple with two children, the threshold of income adequacy would be $48,000 per year.

If the pre-tax household income level was exactly at this threshold, the family would not pay income tax but would also not receive benefits. If the income was above this threshold, they would pay income tax according to the prescribed rates. If the income fell below this threshold, they would be eligible for a ‘top up’ to the threshold equal to their shortfall. So if their pre-tax income was $30,000, this family would receive a benefit of $18,000. In the rare circumstance in which a family received no income from any other source, a full benefit of $48,000 would be paid. In principle, a negative income tax benefit targeted to those with low income would be less expensive than a universal demogrant paid to everyone. A disadvantage is that there is a time lag between claiming and receiving a benefit. If payments are based on income tax returns from the previous year, for example, there could be a delay of up to a year before benefits are received. A person in immediate need of income may have to wait, and another person whose economic circumstances have improved may be receiving the benefit when it is no longer really needed.25 Basic Income Proposals in Canada There is a long history of debate about a basic income in modern Western political thought, dating back to the early 1500s.26 In twentieth century Canada, the idea of a basic income as a means to achieve economic security and equity surfaced in several proposals, studies, and campaigns at various points in time.27 In the 1930s, the Social Credit government in Alberta argued for regular cash payments to be paid to individuals by the provincial government, as a means of economic stimulus and redistribution. But the promise of such a universal “social credit” was not implemented due to a lack of funds in the provincial treasury and opposition by the federal government. 25 NIT proposals can address this problem with a provision for advance claims by persons whose economic circumstances worsen and who require immediate income support. Such claims can be reconciled in later taxation periods when their circumstances may have improved. In NIT schemes it may also be wise to retain a residual social assistance option for those with urgent and immediate needs, and who have not yet filed an income tax return that would determine their NIT benefit. 26

See http://www.basicincome.org/bien/aboutbasicincome.html#history.

27

Young and Mulvale, 2009, pp. 12 – 16. The discussion which follows is based on this source. See also Mulvale, James P. and Yannick Vanderborght. 2012. “Canada: a guaranteed income framework to address poverty and inequality?” In R. Caputo (ed.), Basic Income Guarantee and Politics. New York: Palgrave Macmillan.


In 1968, the Economic Council of Canada, a federally funded crown corporation, noted the presence of poverty in Canada “on a much larger scale than most Canadians probably suspected” and pointed to the idea of a basic income as a possible remedy to the problem. In 1971, a Special Senate Committee on Poverty, chaired by Senator David Croll, recommended a basic income financed and administered by the federal government, and delivered through a negative income tax. This scheme would have ensured a base income of at least 70% of the poverty line, but would not have been paid to single employable adults under age 40. In the same year, the Castonguay-Nepveu Commission recommended a three-tier income security plan for Quebec, consisting of a basic negative income tax, benefits for “employable” people that would top up low earnings, and better benefits for those “not employable.” Around this same time, the Department of National Health and Welfare pointed to a basic income model as a means of fighting poverty, and called for further study and investigation. In 1970, the Royal Commission on the Status of Women recommended that a “guaranteed annual income be paid by the federal government to the heads of all one-parent families with dependent children.” In 1973, a minority federal Liberal government initiated a social security review, which argued for a two-tiered approach to social assistance, including a guaranteed annual income plan for those who could not work and an income supplement for the working poor. After the early 1970s, discussion of a basic income faded from public policy discourse as concerns grew about inflation, unemployment, and the perceived need for cuts to government spending. However, interest in the idea persisted in certain quarters, and from 1974 to 1979, a basic income pilot project called Mincome was carried out in Dauphin, Manitoba under the auspices of the provincial and federal governments. Although this experimental project eventually lost political support and published no official findings, recent analysis of population health data by Dr. Evelyn Forget reports a number of positive outcomes attributable to the Mincome scheme. They include: a significant reduction in hospitalization (especially for admissions related to accidents and injuries); a fall in physician contacts for mental health diagnoses; and a greater proportion of high school students continuing on to grade 12.28 Hum and Simpson, who were directly involved in the development of the Mincome project, also point out that the Dauphin experiment did not lead to a significant withdrawal of labor supply, 28

Evelyn L. Forget, The Town with No Poverty—Using Health Administration Data to Revisit Outcomes of a Canadian Guaranteed Annual Income Field Experiment, 2011.


which countered a common argument of critics that a basic guaranteed income would cause people to avoid paid work.29 In 1982, a Royal Commission on the Economic Union and Development Prospects for Canada (the Macdonald Commission) again recommended a version of a basic income. It was set at a very low level and involved the elimination of other income security measures such as unemployment insurance and old age security. The proposal, because of its restrictive nature, was strongly opposed by the labor movement and other civil society organizations. During the minority parliament of 2008 – 2011, calls to consider moving towards a basic income model came from committees in both the Senate and the House of Commons.30 The Senate SubCommittee on Cities published a report entitled, In from the Margins. It recommended a wide range of measures to address poverty, the lack of affordable housing, and homelessness. In addition, it made two recommendations specifically regarding a basic income: … (that) the federal government publish a Green Paper … to include the costs and benefits of current practices with respect to income supports and of options to reduce and eliminate poverty, including a basic annual income based on a negative income tax, and to include a detailed assessment of completed pilot projects on a basic income in New Brunswick and Manitoba (Recommendation 5). … (that) the federal government develop and implement a basic income guarantee at or above the LICO31 for people with severe disabilities (Recommendation 53). A House of Commons committee also made a recommendation to the Conservative government that it should “create a federal basic income program for persons with disabilities and support a disability-related supports program to be delivered by the provinces and territories.” The committee “decided not to make a recommendation regarding a universal basic income, considering it preferable to take one step at a time and begin with a program benefitting only persons with a disability.” Although the Commons committee was less supportive of an overall basic income than the Senate committee, the former did refer to the possibility of moving toward the goal of a universal basic income in an incremental fashion. 29

Derek Hum & Wayne Simpson (2001-01/02). A Guaranteed Annual Income? From Mincome to the Millennium”". Policy Options/Options Politique, pp. 78–82.

30

The work of these two Parliamentary Committees is described in Mulvale & Vanderborght, 2012.

31

The low income cut-off, a measure used by Statistics Canada, and popularly referenced by community organizations as the poverty line in Canada.


Interestingly, one of the most prominent advocates of a basic income on the contemporary political scene in Ottawa has been Conservative senator Hugh Segal.32 In recent years, Senator Segal has publicly and repeatedly proposed the introduction of a federally initiated basic income, arguing that Canada has the money to ensure that every citizen can live with dignity. According to Segal, "when we look at the billions we now spend on social policy, it's clear we have the capacity."33

In February 2008, Segal introduced a notice of motion in the Senate calling for “a fulsome study on the feasibility of a Guaranteed Annual Income […] or Negative Income Tax as a means of reducing poverty and providing a real solution to those currently living below what is considered the Canadian poverty line.”34 Support for a basic income has been proposed across the political spectrum. In the 1960s, a prominent right wing proponent of a basic income, in the form of negative income tax, was the economist Milton Friedman, a strong advocate of the free market and laissez-faire capitalism.35 In a contemporary context in Canada, a centrist think tank like the Conference Board of Canada has also been an advocate. Recently, its senior Vice-President and Chief Economist, Glen Hodgson, wrote that “a guaranteed annual income remains an appealing ‘big idea’ whose time has yet to arrive politically. There is no better time than right now to heat up the debate.”36 As part of his support for considering the basic income option, Hodgson points to three advantages of this model of income security: Existing social welfare programs can be streamlined into one universal system of transfers that are delivered without condition through the income tax system, reducing public administration significantly and providing related savings; –recipients would still have a strong incentive to work if earned income were taxed at low marginal rates, thereby strengthening labor force 32

Segal, Hugh. 2008 (April). Guaranteed annual income: why Milton Friedman and Bob Stanfield were right. Policy Options http://www.irpp.org/en/po/budget-2008/guaranteed-annual-income-why-milton-friedman-and-bob-stanfield-were-right/

33

According to the Toronto Star, March 5, 2007.

34

Quoted from a “Communique” and “Notice of Motion” released by the Office of Senator Hugh Segal, Senate of Canada, February 6, 2008. 35

Friedman, Milton. 1962. Capitalism and Freedom. Chicago: University of Chicago Press.

36

Hodgson, Glen. 2011 (Dec.). A Big Idea Whose Time Has Yet to Arrive: A Guaranteed Annual Income. Ottawa: The Conference Board of Canada. www.conferenceboard.ca/economics/hot_eco_topics/default/11-1215/A_Big_Idea_Whose_Time_Has_Yet_to_Arrive_A_Guaranteed_Annual_Income.aspx Hodgson, Glen 2012 (March). Reinventing the Canadian Tax System: The Case for Comprehensive Tax Reform. Ottawa: The Conference Board of Canada.


attachment and increasing the availability of labor; and health care spending on low-income Canadians could be lowered if a (basic income) reduced the prevalence of poverty and created better health outcomes.37 Hodgson goes on to state that a guaranteed annual income could be constructed through an approach to federal-provincial relations that is similar to what is advanced in this paper: “Since social assistance and publicly funded health care are delivered by the provinces, careful coordination would be required between the federal government and the provinces to make a (basic income) work.” Hodgson further argues that “a realistic next step would be to pilot the impact of a basic annual income in one or more communities, monitoring its fiscal and social impacts and the potential fiscal savings over time, especially as related to publicly fund health care. Practical and Strategic Matters If there is sufficient public and political will to move towards a basic income approach to income security in Canada, it will be crucial to develop a practical strategy to maximize the possibility that such efforts will bear fruit. In the past, Canadian governments have introduced new social programs incrementally. For both political and financial reasons, a gradual approach to building a basic income might be the most politically and financially feasible. Canada already has mechanisms in place for income support that could potentially be ‘stitched together’ to create a more comprehensive and coordinated income for all. The existing assortment of programs is largely geared to different stages of the life cycle. For families with young children, the Canada Child Tax Benefit / National Child Benefit Supplement (CCTB / NCBS) program use a negative income tax mechanism to deliver benefits to parents in low and modest income households. There is also the Universal Child Care Benefit, which resembles a demogrant. It is available to all families with pre-school age children. While the amount paid out is very modest, there are no conditions on how the money can be spent by families that receive it. The Caledon Institute on Social Policy has developed an interesting proposal that simplifies child benefits and makes them more progressive (i.e. would transfer more money to families in greater economic need). Caledon’s model raises the combined Canada Child Tax Benefit/National Child Benefit Supplement to $5400 per child. The increased cost ($4 billion) of such an enhanced benefit would be covered, according to Caledon, by eliminating the Universal Child Care Benefit and the non-refundable Child Tax Credit (which also cost $4 billion). So, the total cost of child benefits would not increase beyond 37

See Hodgson above.


the current $19 billion expenditure.38 Such a reform in the child benefits framework would approximate a partial form of (income-tested and targeted) basic income for families with young children. In regard to seniors, we have an Old Age Security/Guaranteed Income Supplement program. Old Age Security is paid as a demogrant (albeit a taxable one for seniors with higher incomes) and the Guaranteed Income Supplement is a negative income tax mechanism targeting low income seniors. Another modestly-scaled negative income tax mechanism currently in place for adults with low incomes is the Goods and Services Tax/Harmonized Sales Tax Credit. Also, the Working Income Tax Benefit is intended to encourage labor market attachment for individuals with low income. In addition, there is a range of other federal benefits available (e.g. Employment Insurance and the Canada Pension Plan with different subcategories of eligibility), not to mention social assistance and other (usually ‘last resort’) benefits at the provincial level. The Canadian patchwork quilt of income security programs is complex and multi-layered, and is confusing for persons wanting or needing benefits. A basic income could reduce this complexity and make the income security system easier to navigate, thereby saving administrative costs. Consequently it would be an important objective in the process of designing a coordinated basic income to reduce, in the long term, the complexity of the current array of programs, which would also help to eliminate duplication and fill gaps. This exercise, national in scope, would be best accomplished in a spirit of coordinated federalism, in which the federal government takes leadership but coordinates with provinces and territories to tailor national initiatives to local circumstances. Designing a simpler and more effective income security floor for everyone in Canada could also be facilitated by respecting the constitutional breakdown of federal / provincial responsibilities. Provinces could concentrate their resources in providing social and health services to persons who need additional support beyond having enough income to live on, and the federal government could play a lead role in providing (or at least cost-sharing) income security that operates in a more seamless and effective manner. An interesting proposal along this line is the proposal from the Caledon Institute on Social Policy,39 which proposes a federally-delivered

38 Sherri Torjman and Ken Battle. Welfare Re-form: The Future of Social Policy in Canada. Ottawa: Caledon Institute on Social Policy, November 2013, pp. 7 -8 39 Sherri Torjman and Ken Battle. Welfare Re-form: The Future of Social Policy in Canada. Ottawa: Caledon Institute on Social Policy, November 2013.


“basic income” that is specifically targeted to persons with “severe and prolonged disabilities.” With such a program in place, the funding that would otherwise have been spent by provincial/territorial governments on income support for disabled persons can be redirected to “a wide range of disability supports.” While Caledon’s proposal is more targeted and categorical than the approach proposed in this paper (i.e. the Caledon proposal is only for the “severely disabled”), it does make a clear distinction between federal responsibility for income support and provincial/territorial responsibility for services and support that people need for a life of dignity and independence.

In order to develop and implement a basic income scheme, public support must be gained from various quarters beyond the political sphere and government policy specialists. A broad coalition in favor of a basic income will need to be built. It can draw on the work of academics, policy analysts from the voluntary sector, think tanks, and grassroots activists. 40 Estimating Costs Any version of guaranteed income would obviously involve substantial government transfers, although costs would vary considerably depending on the design of the program. In preliminary work to estimate the actual cost of a basic income in Canada, Lerner, Clark and Needham presented a hypothetical model that would be paid as a universal demogrant to all citizens and permanent residents. They calculated a cost of $198.6 billion in 1999 dollars for a scheme that would pay an income of $7,000 per year to persons age 65 and over, $5,000 to persons aged 21 to 64, $3,000 to persons under 21, with an additional $5,000 paid to each household, to be divided equally among adult members of the household.41 They envisioned this scheme as a replacement for federal benefits for elderly persons and children, as well as for unemployment insurance benefits. The net cost of the model was calculated at $161.7 billion in 1999 dollars. 42 Such a scheme would have eaten up most public revenue and thus would be clearly unaffordable. By contrast, in 1994, Human Resources Development Canada compared the cost of a basic income delivered as a universal demogrant to the cost of a negative income tax version. The demogrant option was estimated to require the expenditure of an additional $93 billion, even though it would pay benefits far below a “livable” level.

40 One group that currently brings many of these constituencies together is the Basic Income Canada Network, the Canadian national affiliate of the Basic Income Earth Network. 41

Lerner, S., C.M.A. Clark, and W.R. Needham. 1999. Basic Income: economic security for all Canadians. Toronto: Between the Lines.

42

As a point of comparison, the total federal government revenue for fiscal year 1999/2000 was just over $178 billon. See Annual Financial Report of the Government of Canada, Fiscal Year 1999-2000.


On the other hand, the cost of the negative income tax model was estimated at $37.3 billion. This latter option was judged to be “cost-neutral” as it could be financed by savings in other programs such as unemployment insurance, the child tax benefit, and federal contributions towards social assistance. Another study by Hum and Simpson estimated the costs of various versions of a universal, nontaxable benefit set at the poverty line, coupled with a tax-back rate on earned income. In one scenario, a basic income was very expensive, costing $217.1 billion; almost triple the amount of federal transfer payments to individuals in 2000. On the other hand, the authors estimated the cost of a more modest and targeted basic income to be much less ($37.8 billion). They also concluded that the cheaper version would in fact reduce poverty more efficiently than the more costly version.43 In 2012, Senator Segal argued that the overall cost of a basic income for Canada would be manageable.44 As he noted: If the average top-up per person below the poverty line was $10,000 annually and if all of the three million lowest income people in Canada received the full amount—that would be an upfront cost of $30 billion—roughly 10 percent of the present Canadian federal budget. But that up-front cost would be reduced by savings elsewhere. Detailed and rigorous costing of a range of contemporary basic income options for Canada is social policy work that has yet to be done. The approximate estimates cited above clearly suggest that a negative income tax model would be more fiscally feasible. Part of this cost estimation could gauge how negative income tax based benefits interact with other federal and provincial benefits, and with federal and provincial income tax. Such an analysis, for example, could shed light on savings in existing benefit programs (e.g. Employment Insurance) that would be drawn upon less with a negative basic income in place. Thinking longer term, it will also be helpful to do further investigations of how a negative income tax based basic income in Canada would enable us to reduce expenditures in areas such as health care, criminal justice, and special education – given the well-established links between poverty and negative social outcomes such as poor health, entanglement with criminal justice, and impeded learning and development in children.45 43 Hum, Derek and Wayne Simpson. 2005. The Cost of Eliminating Poverty in Canada: Basic Income With an Income Test Twist. Pp. 282 – 292 in K. Widerquist, M. Lewis, and S. Pressman (eds.), The Ethics and Economics of the Basic Income Guarantee. Aldershot, UK: Ashgate. 44 Hugh Segal. 2012 (Dec.). Scrapping Welfare: The case for guaranteeing all Canadians an income above the poverty line. Literary Review of Canada, http://reviewcanada.ca/magazine/2012/12/scrapping-welfare/ 45 The Dollars and Sense of Solving Poverty, National Council of Welfare Reports, Vol. 130. Ottawa: National Council of Welfare, Autumn 2011.


A basic income in Canada that paid reasonable benefits and had a broad reach would enable us to lower poverty and the income gap between the rich and poor. Not only would it enable us to realize some immediate cost savings in existing income security programs, it also could lower government expenditure in the long run by reducing the negative social outcomes of high rates of poverty and economic insecurity.

Need for Federal Leadership The cost projections outlined above provide approximate ideas of the cost of different basic income scenarios, but clearly more research needs to be undertaken to produce detailed and upto-date data. Such research would explore different models of delivery, various levels of benefits, and how different government revenue mechanisms would affect affordability. Such hard-headed analysis of public finances would illuminate the way to an achievable and effective basic income across the country. Modernization and improvement in the income security system in Canada cannot occur without federal leadership. Currently, the federal government covers most of the costs of transfer payments to individuals. The provinces and territories are important but secondary players. Furthermore, if a basic income is delivered through a negative income tax mechanism, federal leadership is essential to ensure coordination of intergovernmental tax arrangements and agreements.46 An advantage of using a negative income tax mechanism is that it is already a tried and true method of delivery for existing income transfers to individuals and families. A negative income tax mechanism can also be used to determine eligibility and benefit amounts, as is now done for more targeted benefits such the Child Tax Benefit, the Guaranteed Income Supplement for seniors, the Goods and Services Tax/Harmonized Sales Tax Credit, and the Working Income Tax Benefit. In fact, a comprehensive basic income for low income Canadians could be fashioned from (and partially funded by) these more categorical federal benefits. The existing programs linked to the filing of income tax returns could be ‘stitched together’ and extended in regard to eligibility and level of benefit. Whether a basic income takes the form of a targeted benefit or is more universal, federal and provincial/territorial levels of government would have to find common ground. The 46 Regarding a negative income tax based form of a basic income at the federal level, Senator Hugh Segal (2008) emphasizes that such a program would not only reduce poverty but also eliminate government policing of poor people’s lives that is required in means-tested programs such as social assistance.


provinces/territories would have to agree to federal leadership and coordination in income security matters.47 The federal government would have to foster (and to some extent cost-share) the provision of a more comprehensive income security system as well as health services and social program supports at the provincial level that would address the longer-term and systemic roots of poverty. A better defined jurisdictional ‘division of labor’ between the federal and provincial/territorial levels of government could do a more effective job of reducing poverty and increasing income equality in the short to medium term.48

47

The provinces and Territories called for coordinated social policy reform in the 1990’s. See Ministerial Council on Social Policy Reform and Renewal, Report to the Premiers, 1995.

48 Another important but complex question that goes beyond the scope of our discussion here is the best design and delivery mechanisms for income support and service delivery that could be established between the federal and Aboriginal governments. On the income security side, it is interesting to note that select Aboriginal jurisdictions (e.g. the Inuvialuit Regional Corporation) pay their residents a small but universal dividend resembling a basic income from revenues earned from economic development activities, including resource extraction.


CASW Proposal: CASW recommends that the federal government initiate a process to review and renew the income security system in Canada with a view to the possibility of developing a targeted and affordable basic income. It should be targeted initially to provide income support for all individuals who are economically insecure and vulnerable because of age, labour market status or disability. It would serve to increase income equity in the country and social inclusion of members of society who are currently excluded from the mainstream. A comprehensive basic income could build upon existing negative income tax mechanisms such as the Guaranteed Income Supplement for seniors, the Canada Child Tax Benefit for families with young children, the Working Income Tax Benefit, and the Goods and Services Tax/ Harmonized Sales Tax Credit. A more comprehensive, integrated, and seamless negative income tax based benefit system for Canadians would have to address issues of income insecurity and precarious employment that affect working age Canadians. Such a system of benefits would also have to introduce improvements to benefit levels and ease of access to our existing program for seniors and children. A revamped architecture of income security in Canada could be introduced incrementally to preserve fiscal integrity, but should also be planned and implemented as an ‘overhaul’ rather than tinkering at the margins. Implementing a comprehensive basic income would require the federal government to engage in careful planning with provincial and territorial governments based on a principle of coordinated federalism as advanced in this report. A basic income would largely supplement, but not replace completely, the need for provincial and territorial financial assistance to those in immediate and dire need due to circumstances beyond their control. Some sort of social assistance will still be necessary in those cases. However, the bulk of people currently on social assistance would be eligible for a basic income. In designing a comprehensive basic income, it would also be essential to determine how it would link with other programs at the provincial/territorial level (such as job training and child development services) or federal level (such as employment insurance and the Canada and Québec pension plans). Such a review would be guided by the principle that benefit amounts paid out must not be reduced but, where possible, enhanced in amount and that the overall benefit ‘system’ should be simplified and streamlined in regard to application and take-up procedures. As a targeted program (as opposed to a more universal demogrant), a basic income


administered through a negative income tax mechanism would ensure an efficient expenditure of public revenue. A targeted basic income would also be partially funded by existing federal programs for children, the disabled, and seniors, as well as by federal contributions to provincial social assistance through the Canada Social Transfer (CST). As a measure that would significantly reduce poverty in Canada, a targeted basic income would also reduce the long term social and financial costs of poverty in areas such as health care, education and criminal justice.49 Social workers are intimately familiar with the struggles of clients who have inadequate income. Every day, social workers experience examples in our professional practice of the social, emotional, and health-related harms of living in poverty. CASW calls on the federal government to demonstrate leadership in developing a more equitable and just income support system for Canadians. A basic income provides a model for income equity. It merits careful consideration and pragmatic development in Canada and beyond.

49

The huge literature on the costs of poverty is usefully summarized in The Dollars and Sense of Solving Poverty (Ottawa: National Council of Welfare, 2011). http://publications.gc.ca/site/archiveearchived.html?url=http://publications.gc.ca/collections/collection_2011/cnb-ncw/HS54-2-2011-eng.pdf .


Social Equity The Canada Social Transfer, first suggested in 1994, was accompanied by the termination of the Canada Assistance Plan and with it all but one of the standards which were a part of that legislation. Since then, there has been a lack of federal leadership. CASW would like to see a renewal. In announcing the termination of the Canada Assistance Plan, the federal government was signaling its intention to provide the provinces with the flexibility that several provincial governments had been asking for over the previous decade. 50 It was also a partial response to two Quebec government reports recommending greater provincial autonomy particularly in social programs.51 This new arrangement, in which provincial governments are regarded as having considerably more latitude in authority over such areas as health, social services, social assistance, and postsecondary education, was initiated by the Liberal party in power after 1993 and was justified by the need to control expenditures. In fact, this economic argument was stretched to initiate a significant transformation in federal provincial relations that culminated in the signing of the Social Union Agreement in 1999. While the federal government has retained its role in program areas that have become constitutionally the authority of the federal government (such as the Old Age Security, Employment Insurance and the Canada Pension Plan), it has devolved its role in areas that were historically the provinces’ authority but in which, as previously outlined, it had become involved. In spite of this trend, the Canada Social Transfer still plays an important role in the funding of income security (particularly social assistance), social services (including child development programs) and post-secondary education. The active engagement of the federal government in future developments is important, not only to ensure funding, but also to encourage panCanadian initiatives. CASW proposes that governments in Canada use a governance technique such as the Open Method of Coordination (OMC) to ensure a pan-Canadian dimension to income security and 50

The Allaire Report, A Quebec Free to Choose, appeared in January 1991. It called for the transfer of 22 areas of governance to become exclusively provincial. It was adopted by the Liberal Party of Quebec in March of that year. http://en.wikipedia.org/wiki/Allaire_Report; Mollie Dunsmuir, Law and Government Division, Library of Parliament, Constitutional Activity From Patriation To Charlottetown (1980 – 1992) November 1995, 23 Available at http://www.parl.gc.ca/Content/LOP/researchpublications/bp406-e.pdf ; Quebec National Assembly, Commission on the Political and Constitutional Future of Quebec, or Bélanger-Campeau Commission, Report, March 1991;

51 The Quebec referendum on sovereignty in 1995 so frightened the federal government that within a few years, and by administrative means, the nature of the federation was transformed from the regime of fiscal federalism to the present arrangement.


social services programs to further the modernization of income security and social services through the Canada Social Transfer.52 An Open Method of Coordination is a tested and true method of coordinating sensitive social policies in the European Union, where centralized governing bodies in Brussels have even less formal authority than the federal government in Ottawa.

In short, CASW believes that the federal government can and should play an active role in the development of social programs as it has done in the past. However, CASW is also mindful of provincial and territorial sensitivities and realizes that Ottawa is not able to impose strict conditions over social programs for which it has limited constitutional responsibility. That is why CASW proposes a technique like an Open Method of Coordination. Background: In 1941, the federal government assumed exclusive authority for income and corporation taxes by signing a series of agreements with each of the provinces. The provinces would be compensated for the surrender of their rights to the income and corporation tax for the duration of the war and for one year after. Exclusive access to these tax instruments would permit the federal government to raise substantial funds for the war effort.53 During the Second World War, largely through the work of its advisory committees, the federal government released three major reports on health, social security and housing. Through the work of the Advisory Committee on Health Insurance, the federal government released a report in March 1943 on the possible post war expansion of publically supported heath care. It became known as the Heagerty Report. 54 Through the work of the Advisory Committee on Reconstruction, the federal government also released reports on social programs and housing. These were the Marsh Report, also released in March 1943, and the Curtis Report, released in 1944. These reports held out the promise of a

52 While post secondary education is a component of the Canada Social Transfer, we focus, in this paper, on income security and social services. 53 This is the origin of what became known as the tax rental agreements. James A. Maxwell, Recent Developments in DominionProvincial Fiscal Relations in Canada, National Bureau for Economic Research, 1948, 10-11 http://papers.nber.org/books/maxw48-1 ; A.R. Dobell, Intergovernmental Finance, The Canadian Encyclopedia, http://www.thecanadianencyclopedia.com/articles/intergovernmental-finance 54 Heather Macdougall, “Into Thin Air: Making National Health Policy, 1939-45,” Canadian Bulletin Of Medical History, 26:2 2009, 283-313. Available At Http://Www.Cbmh.Ca/Index.Php/Cbmh/Article/Viewfile/1400/1367 . See also “Making Medicine: The History Of Health Care In Canada 1914-2007”, Http://Www.Civilization.Ca/Cmc/Exhibitions/Hist/Medicare/Medic3h08e.Shtml


major transformation of social and health policy after the war, changes which would involve a transformation in the authority of the federal and provincial governments in these areas. At war’s end, the federal government presented a series of proposals to the Dominion Provincial Conference of August 1945.55 Known as the Green Book, the federal government’s proposals contained ideas for a substantial expansion of social security drawing on the ideas current in the previous 15 years, including the Bennett government’s New Deal, the Report of the Royal Commission on Dominion Provincial Relations, and the three wartime reports on healthcare, social security and housing.56 The Family Allowance was the first universal program of support for children. It was initially paid out only for children under the age of 16 and later extended to all those under 18.57 Since 1945, support for children has remained a key part of federal social benefits. While the family allowance was terminated in 1992 by the Mulroney Progressive Conservative government, the federal government has continued a social benefit for children, but delivered through the income tax.58 A second key categorical program introduced during the post war period was the Old Age Security in 1951. 59 In addition, the Old Age Assistance Act provided for a means tested and cost shared pension for people between the ages of 65 and 70.60 A third key and categorical program introduced in the same period was the Disability Assistance benefit. It was also a benefit that was 50/50 cost shared with the provinces and means tested. 61 55

Proposals of the Government of Canada. August 1945.

56

Meetings throughout 1945 and 1946 did not result in a comprehensive agreement on taxation and on social programs, despite the federal government’s offer of funding to the provinces as an incentive to cede exclusive control of income and corporate taxes. Instead the federal government signed 8 individual agreements with the provinces which continued the model of the wartime tax rental agreements. It did not sign an agreement with Quebec. A.R. Dobell, “Intergovernmental Finance,” See The Canadian Encyclopedia, http://www.thecanadianencyclopedia.com/articles/intergovernmental-finance. 57 Between 1946 and 1962, there were several federal social program initiatives despite the failure of the negotiations around the Green Book Proposals of 1945. The Family Allowance was brought into being in 1944, and the first cheques under the program were paid out in 1945. 58

Raymond B. Blake, From Rights to Needs A History of Family Allowances in Canada, 1929-92, UBC Press, 2009. A portion of the text is available at http://www.ubcpress.ca/books/pdf/chapters/2008/FromRightstoNeeds.pdf

59 First passed into legislation in 1927 as a program to provide some federal funding to those provinces that chose to introduce a means tested pension, it was transformed into a second universal program, through constitutional amendment in 1952. 60

Dennis Guest, Old-Age Pension, Canadian Encyclopedia, http://www.thecanadianencyclopedia.com/articles/oldage-pension; Historical Statistics of Canada, Section C, Social Security, http://www.statcan.gc.ca/pub/11-516-x/sectionc/4057749-eng.htm

61 John E. Osborne, The Evolution Of The Canada Assistance Plan, National Health and Welfare, 1985. Available at http://www.canadiansocialresearch.net/capjack.htm


A fourth key federal social program was the 1956 Unemployment Assistance Act, made retroactive to 1955, “whereby provinces with agreements were reimbursed for half their expenditures on assistance to needy unemployed people, with no ceiling on individual benefits or federal expenditures.”62

The last key federal social program introduced in the period was the Hospital Insurance and Diagnostic Services Act, passed in 1957. The Act “offered to reimburse, or cost share, one-half of provincial and territorial costs for specified hospital and diagnostic services. This Act provided for publicly administered universal coverage for a specific set of services under uniform terms and conditions. Four years later, all the provinces and territories had agreed to provide publicly funded inpatient hospital and diagnostic services.”63 Tax Sharing and Program Financing In 1962, the federal government negotiated a new arrangement with the provinces on the major taxes in dispute between them.64 Instead of renting their taxing powers, the federal government established an agreement with the provinces that became known as tax sharing.65 The agreement applied to nine provinces; Quebec continued to collect its own taxes. On the other side of the ledger, during the period from 1963 to 1972, the Canadian welfare state took a distinctive shape and identity. Successive minority Liberal governments from 1963 to 1968, led by Lester Pearson, and a majority Liberal government led by Pierre Trudeau from 1968 to 1972, initiated and/or agreed to the reform of the major federal social programs. By 1972, these social programs constituted a Canadian welfare state. 62 John E. Osborne, The Evolution Of The Canada Assistance Plan, National Health and Welfare, 1985. Available at http://www.canadiansocialresearch.net/capjack.htm The Unemployment Assistance Act introduced the first continuing assistance to those provinces that wanted to take advantage of the funding. The legislation was intended to provide assistance only on behalf of those who were unemployed and employable. The same category of beneficiary that the Report of the Rowell Sirois Commission recommended should be placed under the authority of the federal government. 63 Historical Statistics of Canada, Section C, Social Security, http://www.statcan.gc.ca/pub/11-516-x/sectionc/4057749-eng.htm; Health Canada, Canada's Health Care System, available at http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2011-hcssss/index-eng.php . By the beginning of the 1960s, the federal government had made a modest start, coming some distance down the road towards the development of a Canadian welfare state. It had instituted a universal child benefit paid directly to families, mostly to mothers. It had also instituted several indirect categorical income support programs through offering to support those provinces willing to spend 50% of the cost. Lastly, it had instituted a program to support the availability of provincial hospital based care. It received a significant amount of revenue through “renting” the provinces’ claims to the income and corporate taxes and in turn compensating them for the rental. 64 Auditor General of Canada, Report 1989, Chapter 14, http://www.oag-bvg.gc.ca/internet/English/parl_oag_198911_14_e_4263.html 65 Under this system the federal government would vacate a percentage of the three taxes in order that the provinces could receive the revenues from the vacated percentage. The percentage was set initially at 16% of personal income tax to be increased by 1% per year; 9% of corporation profits; and 50% of succession duties. See Claude Belanger, Canadian federalism, the Tax Rental Agreements of the period of 1941-1962 and fiscal federalism from 1962 to 1977, http://faculty.marianopolis.edu/c.belanger/quebechistory/federal/taxrent.htm.


The period was marked by the creation of the Canada Assistance Plan, a federal program to cost share social assistance and social services; reforms to the Old Age Security; a federal social insurance based pension plan which would ensure 25% of the average industrial wage; a new wholly federal Guaranteed Income Supplement to provide assistance to people over 65 who would not have access to the new federal pension; a substantial revision to the Unemployment Insurance Act in 1971, under which most of the labor force would be covered by insurance against unemployment; and the universal Medical Care Act passed in 1966 under which the federal government would share half of the costs of provincially administered physician based personal medical care.66

In order to receive funding under the Canada Assistance Plan, the provinces had to consolidate previous legislation into one program available to all persons in the provinces who, according to a review of their income and expenditures, could be considered to be in need. Federal programs to assist the provinces with funding for people with disabilities and for unemployed but employable people were terminated. Provincial Mothers’ Allowances and pre-existing welfare programs were also terminated and replaced with one piece of legislation. Under the Canada Assistance Plan, no province could institute residence requirements, nor could any province establish procedures that would involve residents having to accept employment as a condition of receiving assistance. These were among several standards for the provincial administration of social assistance. The legislation was silent on the question of social services. The legislation did say that the federal government could spend on provincial programs that were intended to prevent poverty. It was under this statement that the federal government initiated spending on provincial child care and social service programs.67 66

Health Canada, Canada's Health Care System, available at http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2011-hcssss/index-eng.php Five principles or standards for the implementation of medicare were articulated in the legislation. After several episodes in which provincial governments implemented practices which appeared to be in contravention, the federal government reiterated the standards in the Canada Health Act passed in 1984. The five Canada Health Act principles provide for: 1. 2. 3. 4. 5.

Public Administration: All plans must be operated on a non-profit basis by a public authority accountable to the provincial or territorial government. Comprehensiveness: Provincial and territorial plans must insure all medically necessary services provided by hospitals, and medical practitioners. Universality: Provincial and territorial plans must provide health insurance to all residents on uniform terms and conditions. Accessibility: Provincial and territorial plans must provide all insured persons reasonable access to medically necessary hospital and physician services without financial or other barriers. Portability: Provincial and territorial plans must cover all insured persons when they move to another province or territory within Canada and when they travel abroad.

67 It should also be noted that under the terms of the Canada Assistance Plan, the provinces could extend social assistance and social services to Aboriginal people living on reserve and receive funding but since this remained a federal jurisdiction, the


Several key issues emerged in the development of these programs. Since at least some of them represented federal involvement in what had been declared to be areas of provincial authority, an agreement had to be reached on constitutional amendments that would support them. The establishment of federal Unemployment Insurance, Old Age Security and the Canada Pension Plan were all established with the support of a constitutional amendment.

Some of the federal programs were intended to provide funds in support of provincial programming and administration. In essence they were conditional programs and were based on 50/50 cost sharing. Funding for conditional grant programs in support of hospital insurance, medicare, and post-secondary education were combined in the Established Programs Financing Acts of the 1960s, and then in, 1977, the cost sharing and conditionality was terminated in favour of a per capita block grant. Provinces were still supposed to continue the programs for which they received funding but there was no further accountability.68 A further issue was conditionality. Two programs in particular were based on the establishment of federal conditions for provincial administration: the Canada Assistance Plan and the Canada Health Act. Each required that provincial administration meet a series of standards laid out in legislation. Of these only the Canada Health Act remains in place. The last issue was federal social programming direct to individuals. Between 1940 and 1995, the federal government obtained provincial agreement to initiate social insurance programs, and direct support programs. Both types of program provide a direct link between the federal government and the beneficiary. The former includes unemployment insurance and public pensions, while the latter includes Old Age Security and child related benefits. provinces did not take advantage of the availability of funding. Why cost share when the federal government had full responsibility? Especially after the Federal government agreed to fund on reserve welfare and social services at 100% in Ontario through an agreement signed in 1965. At the same time the federal government did agree that access to welfare should be extended to people living on reserve at the same rates and on the same conditions as those offered by the province in which the reserve was located. This was a dramatic change in the availability of social programs on reserve, coming 12 years after the Old Age Pension was extended to Aboriginal people, and 19 years after the Family Allowance was extended to cover Aboriginal children on reserve. 68 Amy Verdun and Donna E. Wood, Governing the social dimension in Canadian federalism and European integration, Canadian Public Administration, 56:2, June 2013, 173-84; Nadia Verrelli, The Federal Spending Power, Institute of Intergovernmental Relations, Queen’s University, May 2008; Stephen Laurent and François Vaillancourt, Federal-Provincial Transfers for Social Programs in Canada: Their Status in May 2004, IRPP Working Paper Series, no. 2004-07.

Federal conditional grants were also available to the provinces for the support of Old Age Assistance for persons 65 to 69, Assistance for Blind Persons, and Assistance for Disabled Persons. These programs were combined into the Canada Assistance Plan at its formation in 1966. It remained the only cost-shared conditional grant program until its termination in 1996. By the end of this period cost sharing was no longer on the agenda of federal provincial programming.


Evolution of an Alternative During the postwar era up until the 1970s, Keynesian ideas of demand management dominated. In this context, social programs were the solution to the problem of cyclical economic growth by saving for a rainy day when economic conditions were good and unemployment lower, and paying out more benefits when unemployment was higher, which would help maintain demand and keep the economy moving. Post 1980, social programs became the problem, not the solution. The solution was to reduce government expenditure, lower taxes and free the business sector to innovate and create jobs. Business and government were unified during the period in support of lower taxes, while simultaneously arguing that government deficits and debt also had to be lowered. 69 The 1990s were a period of substantial change in the organization of social programs as a result of several changes taking place in the country. The election of the Progressive Conservative Party in 1984 marked the advent of neo-liberal ideas in national government.70 While some of its early attempts at curbing or terminating social programs were unsuccessful, the Progressive Conservative government of Brian Mulroney was later able to make some significant changes such as the termination of the Family Allowance, a program which the Prime Minister had declared to be a sacred trust during the 1984 election.71 After the 1993 election, the federal Liberal government decided to radically change the system of funding of provincial social programs. The two major remaining funding programs were the Canada Assistance Plan and the Established Programs. The government decided to terminate both and replace them with a single funding program called the Canada Health and Social Transfer. In doing do, the government ended the conditionality that helped to maintain a set of national standards in the provision of social assistance and social services, leaving only those standards incorporated into the Canada Health Act.

69 Government regulations were regarded as a significant problem that formed a barrier to successful innovation. In general the point was to rely more private initiative and private enterprise and to do this government was to get smaller. 70 The new government began its period in power symbolically by officially repudiating full employment as a goal of government, and adopting many of the ideas emanating from the Report of the Macdonald Commission, the Royal Commission on the Economic Union and Development Prospects for Canada. 71 This period was also marked by political conflict over the 1982 constitution, a document that did not have the approval of the province of Québec. In the province there was debate about the range and extent of autonomy the province should be seeking. Two reports on the subject both suggested that the government of the province have responsibility for a much wider range of program areas including social programs. Externally there was debate about whether the federation could have differing conditions for Québec and for the other provinces.


Presented as a cost and deficit reduction measure, it also marked a major change in the construction of the federation. In Québec it meant that the federal government was less involved in provincial affairs, and in all of the provinces it meant that neo-liberal governments could introduce the social assistance measures they had wanted to legislate for some time. It also meant no further redistribution through social measures.72 The provinces and the federal government did attempt to establish a new basis for moving forward in the Social Union Framework Agreement signed in February 1999.73 Under the agreement, the federal government can no longer introduce conditional program funding without the agreement of the majority of provinces. While this has not made new programming impossible, it does mean that the federal government cannot proceed as it did in the past by introducing a program and then trying to obtain individual provincial cooperation. At the same time, the agreement does recognize that the federal government can continue to have a direct relationship with individuals in the country. The federal government can introduce new benefits to individuals as it sees fit. While the agreement appears to have fallen into disuse, these principles appear to have remained a guiding force in relation to new federal provincial social programs. Now that the provinces have a much wider range of responsibility for providing social programs in areas in which the federal government previously had an involvement, it is appropriate to ask what was gained and what was lost. Was the federal involvement helpful? Was it appropriate? For those who have supported strong federalism, the answer is clearly yes. For those who supported either Quebec’s right to go its own way or the rights of all provinces to regain authority for social programs which they believe were allocated to the provinces under the British North America Act, the answer is no. Post 1999, it is perhaps best to characterize the new arrangement as one of restrictive federalism in which the rights of the provinces in the social area are in the ascendency. Supporters of this approach believe that the provinces are in the best position to judge what is needed in their part of the world and therefore national programs are neither desirable nor useful. 72 All provinces would receive only per capita grants for health and social programs. And no province would have to pay attention to federally enforced standards – except one, no residence requirements for social programs. In 2004, the federal government decided to separate the transfer into two parts – a health transfer and a social transfer. See Report Of The Council Of The Federation Working Group On Fiscal Arrangements, Assessment Of The Fiscal Impact Of The Current Federal Fiscal Proposals, Main Report, July 2012; Hamish Telford, Peter Graefe and Keith Banting, Defining the Federal Government’s Role in Social Policy: The Spending Power and Other Instruments, IRPP, September 2008,Vol.9, no. 3. 73 A Framework to Improve the Social Union for Canadians: An Agreement between the Government of Canada and the Governments of the Provinces and Territories, February 4, 1999


The present Conservative government, a majority government freed from the restraints of five years in its previous minority status, is one that shares this view of federalism. It is very unlikely to support an approach to negotiations in 2014 that will involve a return to the view of social programs entailed in fiscal federalism. It is also unlikely that it will engage in any new federal social policy initiative beyond what has been done already: the Universal Child Care Benefit,74 and the gradual change in the age of eligibility for the Old Age Security from 65 to 67 to take effect in 2023.75 If the current Conservative government’s perspective prevails into the future, the Canadian welfare state for citizens who are not First Nations and do not live on a reserve will in future consist of two parts: a core of national programs legislated by and administered by the federal government, and a series of health, social assistance, and social service programs in each province and territory. Each will have a different array of health and social programs, and a differing set of services and conditions associated with them. Social citizenship will be qualified by the province of residence, not by the national government. 76 Need for Federal Leadership: The Conservative government’s support for the rights and autonomy of the provinces is coupled with two other key principles: a core belief in the value of private markets in the provision of health and social programs, as well as a belief in small government.77 Accordingly, there is, from this perspective, no role for the federal government in either shaping provincial policy or in creating a sense of shared citizenship through the availability of health and social programs of more or less the same standard across the country.78 The only role for the 74

http://www.cra-arc.gc.ca/bnfts/uccb-puge/menu-eng.html

75

http://www.servicecanada.gc.ca/eng/services/pensions/oas/changes/index.shtml .

76

For First Nations Peoples living on reserve, the same conditions will, in principle, prevail as those off reserve. In practice, however, the federal government has not guaranteed the same conditions on reserve as those available to other citizens in the same province. Funding has often not been sufficient to provide the same standard. Although the federal government has apologized for the residential school system they have not ensured that those in need in reserve communities have the necessary services available to them.

77 A core belief in private markets and private enterprise will colour their approach to federal support for medicare. While it is unlikely that the principles of the Canada Health Act will be changed because of their symbolism, the federal government will be prepared to continue the present policy of neglect of enforcement. The number of private clinics will grow in the provinces despite being in direct violation of one of the five principles. The delisting of procedures will also continue as neo-liberal oriented provincial governments attempt to reduce expenditures on health care in the face of demographic pressures from an aging population. 78 The belief in small government, when linked with restrictive federalism, will keep them from formulating a more positive role for the federal government in the Canadian welfare state. Neither will they wish to introduce a collaborative role with the provinces. This in spite of the fact that section 36 (1) (2) of the Constitution Act of 1982 states that “Parliament and the Legislatures….are committed to promote equal opportunities for the well-being of Canadians…..and providing essential public


federal government is in providing some share of the funds and in requiring the provinces to be broadly accountable for how funds are spent. It is in this area alone that the Conservative government may be prepared to act.

CASW, by contrast, proposes that the federal government needs to play a more active role in providing leadership in the promotion of pan-Canadian social policy and the furtherance of a sense of shared citizenship. CASW also believes that federal leadership can be achieved without overriding, or appearing to override, provincial and territorial authority. This could be achieved by using a technique such as the Open Method of Coordination adopted by the EU. 79 In 2012, CASW explored, along with a group of scholars and practitioners, several historical, current, and potential roles, policies, and practices related to the Canada Social Transfer, which have major implications for the well-being of all Canadians and for the sustainability of Canada’s social programs.80 Each of the participants in the project was aware of the current debates about the limited role of the federal government in relation to health care as well as the virtual lack of federal leadership with respect to the Canada Social Transfer. Currently the Canada Social Transfer provides funds in three broad areas: post secondary education, social assistance, and various social services (including child care). CASW focuses on the latter two areas. A major concern of the participants was the lack of accountability in relation to the Canada Social Transfer, either on the part of the federal government or the provinces and territories. One participant hoped that the Canada Social Transfer would be used to further human rights standards as a backdrop to social programs since Canada is a signatory to the International Covenant on Economic, Social and Cultural Rights, which guarantees individuals an adequate standard of living. 81 Another participant suggested that some aspects of the Canada Social Transfer, particularly the component related to income security and poverty reduction should be transferred in its entirety to the federal government since the federal government is currently responsible for the bulk of services of reasonable quality to Canadians”. The 1982 Constitution also affirms the federal government’s commitment to the principle of making equalization payments to ensure that provincial governments had sufficient revenues to provide reasonably comparable levels of public services at reasonably comparable levels of taxation. 79 The Open Method of Coordination was launched in Europe in 2006 as a mechanism for coordinating social policies in areas where the European Union has limited authority. See Bart Vanhercke and Peter Lelie, Benchmarking social Europe a decade on: demystifying the OMC’s learning tools, in Fenna, A. and Knuepling, F. (Eds.), Benchmarking in Federal Systems: Australian and International Experiences, Productivity Commission : Melbourne 80

CASW, Canada Social Transfer Project: Accountability Matters, 2012, http://www.defendingsocialprograms.ca/

81

Shelagh Day, Executive Director of the Centre for Poverty and Human Rights as quoted in CASW, Canada Social Transfer Project, 2012.


income transfers to individuals.82 The Caledon Institute of Social Policy believes that before conditions and standards are applied to a financing instrument like the Canada Social Transfer, there is a need for a shared vision of what Canada’s income security system should look like.83 CASW agrees with that position. More broadly, participants in the project felt that there were several options that could be introduced by the federal government in order to ensure some degree of accountability for the billions of dollars transferred to the provinces through the Canada Social Transfer, including a clarification of objectives, principles, standards and conditions.84 Overall, though, participants thought that both the federal government and provincial/territorial governments could play leadership roles: the federal government in relation to the development of a vision for income security programs with respect to the Canada Social Transfer; the provinces (and the territories) by coordinating a forum for the renewal and modernization of social policy.85 Some participants, however, said that restrictive conditions should not be attached to the Canada Social Transfer since adequate levels of income security and social protection could be brought about by other means in order to ensure that Canadians experienced similar levels of access wherever they lived. 86 One way forward would be to follow the lead of the European Union - an economic and political union of 28 member states. In terms of social policy, the Union operates primarily through voluntary coordination, not through restrictive measures. Therefore, the European parliament, and other related supranational bodies, cannot impose conditions on member states.87

82 John Stapleton, social policy consultant, Open Policy Ontario, as quoted in CASW, Canada Social Transfer Project, 2012, page 37. 83

See for example, Torjman, S., & Battle, K. (1995). Can we have national standards. The Caledon Institute of Social Policy. Ottawa, ON, and more recently Ken Battle, Sherri Torjman and Michael Mendelson, The 2014 Unbalanced Budget, 2014, Ottawa ON. 84

CASW, Canada Social Transfer Project: Accountability Matters, 2012, section on available policy tools, pages 39ff.

85

CASW, Canada Social Transfer Project: Accountability Matters, 2012, section on available policy tools, p 63.

86

CASW, Canada Social Transfer Project: Accountability Matters, 2012, section on available policy tools, page 55.

87

The governance of the European Union is far more complex and decentralized than the Canadian federation. At a supranational level, it includes The European Commission (responsible for legislative initiatives); the European Parliament (representing citizens in the legislative process); the Council of the European Union (representing each of the European states in the legislative process); the European Council (representing heads of states); and the Council of the European Union (representing different ministries of the member states).


Instead, the union uses a ‘soft governance technique,’88 as a mechanism for coordinating sensitive social policy areas where the European Union has very limited, if any, authority. At the same time, there is relatively broad recognition of the need for some degree of adequacy and accessibility in three social policy areas: social protection, social inclusion and health care.

Essentially, the European Union uses a set of coordinating measures to encourage pan European social policy rather than hard legislation. It is governance by persuasion, not by fiat.89 Like our provincial and territorial governments, member states of the EU maintain their authority over sensitive policy issues. To promote some degree of convergence of social policies, a technique called the Open Method of Coordination is invoked. An Open Method of Coordination is a means of spreading best social practices in member states and achieving sufficient social policy convergence to ensure economic goals of smart growth, sustainable growth and inclusive growth.90 The six steps of coordination are: the development of a framework of common objectives; the selection of key issues; the building of common indicators; the involvement of governmental and non-governmental stakeholders in the process; benchmarking; and the production of joint reports. The European Union’s 2020 social strategy revolves around three broad policy goals which are widely accepted by member states: social inclusion; social protection; and health care. They are the same areas covered in this report, and the first two – social protection and social inclusion – correspond to two of the three components in the Canada Social Transfer – income security and social services. If Canada is to achieve something similar – CASW believes it can and should - the federal government has to work with other levels of government to ensure financial sustainability and modernization of social protection and social inclusion programs across the country. To achieve this, both orders of government need to develop some common objectives, social indicators, stakeholder involvement and joint reporting mechanisms. Interestingly, this approach to funding and policy has been developed in Canada through the benchmarking of health care. Benchmarking is a way of making comparisons based on an agreed

88 See Donna Wood, The Canada Social Transfer and the Deconstruction of Pan-Canadian Social Policy, page 28. http://www.vibrantcalgary.com/uploads/pdfs/Canada_social_transfer_Wood_brief.pdf. 89

Bart Vanhercke and Peter Lelie, “Benchmarking social Europe a decade on: demystifying the OMC’s learning tools”, in Fenna, A. and Knuepling, F. (Eds.), Benchmarking in Federal Systems: Australian and International Experiences, Productivity Commission : Melbourne\\ 90

Bart Vanhercke and Peter Lelie, page 173.


upon set of indicators.91 The Canadian Institute for Health Information has been an important player, at the national level, in the development of pan Canadian performance indicators. Similar organizations exist in some of the provinces. More specifically, the Health Indicators Project is an example of a performance benchmarking approach to the improvement of health care across the country. The project provides reliable and comparable data on the health of Canadians, the health care system and the determinants of health. National consensus conferences have provided a mechanism to develop a common performance indicator framework. Similar initiatives have been undertaken with respect to hospital reporting. According to Baranck, Veillard and Wright, the Canadian system of benchmarking is paving the way for future health care practices. They also think that performance indicators are increasingly a basis for policy discussions concerning ways to improve health systems.92 They seem, in other words, to provide information about standards and practices that not only inform but also influence intergovernmental cooperation and coordination.

91

Baranck, Patricia, Jeremy Veillard and John Wright, “Benchmarkding health care in federal systems: the Canadian experience”, in Fenna, A. and Knuepling, F. (Eds.), Benchmarking in Federal Systems: Australian and International Experiences, Productivity Commission : Melbourne 92 Baranck, Patricia, Jeremy Veillard and John Wright, “Benchmarkding health care in federal systems: the Canadian experience”, page 108.


CASW Proposal: A benchmarking approach to the improvement of income security and social programs is also possible. Income security provides a measure of social protection to citizens. Social programs encourage their social integration into the larger society. Both require federal leadership to develop a modern policy framework that stretches across the provinces and territories. Both require federal leadership to ensure accountability CASW recommends that the federal government follow the lead of the European Union and initiate discussion about the future of the Canada Social Transfer using a technique such as the Open Method of Coordination to ensure some level of convergence of programs across the country. In Europe, an Open Method of Coordination has proven to be a flexible and effective method of bringing governments of widely different perspectives and persuasion together to tackle common problems such as the reduction of poverty or social exclusion. To move in this direction, the federal government should initiate meetings with the provinces and territories to discuss the future of the Canada Social Transfer. This means not only a discussion about the amount of money transferred, but the way in which it will be transferred. In other words, without initially setting any conditions on the Canada Social Transfer, both orders of government need, first of all, to decide whether they can find common objectives and agree on a policy framework for income security and social services programs.93 They then need to build an intergovernmental knowledge base through the development of common indicators and quantitative benchmarking, as is currently being done in health care. The development of indicators could also involve experts and non-government stakeholders in the process in order to be as inclusive as possible. Finally, CASW recommends that a technique such as an Open Method of Coordination in modernizing income security and social services programs be guided by the following principles: need; comprehensiveness; accessibility; fairness; portability; universality; and public or nonprofit administration. 94 93 In the European case, income security measures and social programs have been considered a multidimensional domain. Therefore, they worked initially on the development of consensus around the main challenges. In terms of social protection, key issues were income adequacy and financial sustainability. In terms of social inclusion, key issues were child poverty and homelessness. 94

In what follows here we have outlined an approach to income security and social programs which parallels wording in the Canada Health Act. In that Act, however the principles are in effect a set of conditions on the transfer of funds from the federal government to the provinces. In our proposal, however, the seven principles which we outline are intended only as guides to preliminary discussion for the development of a framework. They may or may not become conditions for federal transfers.


x A principle of need presupposes income security and social programs will be made available according to a personal and/or financial assessment of an applicant; A principle of comprehensiveness means that an agreed range of income security and social programs are available within each province and territory and funded through public expenditures. Any province or territory is free to initiate new programs that are beyond an agreed range of programs; x A principle of accessibility means that an agreed range of publicly funded income security and social programs will be available to all Canadians when they need them; x A principle of fairness presupposes that all citizens have the right to apply for any publically supported program, and to have their application reviewed by an appropriate body within a reasonable period of time. Applicants have the right to a written decision within a reasonable period of time and the right to appeal any decisions, to have an appeal heard within a reasonable period of time and to receive a written decision within a reasonable period of time. During the period of appeal, applicants have the right to temporary financial support and/or services. x A principle of portability means that all Canadians are covered by publicly funded income security and social programs wherever they travel or live within Canada. x A principle of universality means that income security and social programs will be available to all Canadians in need of them. x A principle of public and not for profit administration presupposes that publicly funded income security and social programs will be managed by a public agency on a not-for-profit basis and delivered by either public or private organizations on a not for profit basis.


Health Equity The health care system is one of the hallmarks of equitable social policy in Canada. Without ongoing federal leadership and funding, its future is at stake. The question of how to fund and address growing health costs is the topic of significant debate and discussion across the country. In response to that debate, the federal government has drawn a line in the sand and unilaterally announced that its contribution to health care spending will substantially decline over the next 30 years. CASW proposes that this position is fundamentally flawed, not only because it passes the burden of health care funding to the provinces and territories, but also because it undermines the capacity to achieve national health care standards that enable Canadians to be treated fairly and similarly across the country regardless of where they live. Without significant federal leadership and funding, there will be no pan-Canadian health care system. Without a national vision, Canada’s international ranking in health care performance will continue to slide. Without federal leadership, the conditions of the Canada Health Act will be undermined. Without adequate federal funding, the health care system is unsustainable. Our proposal to fix the current abrogation of national leadership and funding is simple. The federal government – this one or another – needs to step up to the plate, enforce the conditions of the Canada Health Act, restore federal transfers relative to provincial/territorial health spending to what they were prior to the cut backs of the 1990s, and provide financial incentives to promote reform and economic efficiencies in health care delivery. The proposal, which we outline in further detail below, is affordable and sustainable. The federal government has the fiscal capacity to be involved. It also has the constitutional right. The decision is one of political choice and priority, not affordability and sustainability. Background: Since the late 1950s, the burden of health care funding has fallen on both levels of government. The first implementation of funding at the federal level was the Hospital Insurance and Diagnostic Services Act in 1957. The second was the Medical Care Act in 1966. Under the Constitution, health is not exclusively assigned to one level of government.95 While the constitution grants the provinces primary jurisdiction in health care delivery, the federal government has primary responsibility for health care to some classes of people (e.g., aboriginal

95 The following few paragraphs are drawn primarily from Canada Senate, Study Committee on Social Affairs, Science and Technology, Time for Transformational Change: A Review of the 2004 Health Accord, 2012: and Marlisa Tiedemann, The Federal Role in Health and Health Care, Social Affairs Division, Parliamentary Information and Research Service, Library of Parliament, 2011.


people, military, and inmates of federal prisons), control of public hazards and matters related to national emergencies. With respect to health care funding, however, federal jurisdiction stems from its jurisdiction over public debt and property and its general spending taxing power, which allows it to raise money and spend it as it sees fit, as well as any conditions it may set for the receipt of that money. As a consequence of the overlap of responsibilities, in 1982, the Supreme Court of Canada stated that “health is not a matter which is subject to specific constitutional assignment but instead is an amorphous topic which can be addressed by valid federal or provincial legislation, depending on the circumstances of each case on the nature or scope of the health problem in question.”96 In 1977, the Hospital Insurance and Diagnostic Services Act and the Medical Care Act were replaced by the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act and, in 1996, the transfers were combined with the Canada Assistance Plan to form the Canada Health and Social Transfer. During this process, the federal government changed both the nature of the entitlement and the funding arrangement so that federal transfers were divided between cash and tax points and declined from about 35% of provincial health care costs in the 1960s to about 23-24% where it was in the 1980s.97 Due to the merger of the different programs, the government also passed the Canada Health Act (CHA) in 1984 in order to ensure that the terms and conditions established under the original hospital and Medicare acts were not lost. The genesis of the act was recognition that the federal government’s influence on health care standards had been reduced due to changing funding arrangements. The purpose of the CHA was to establish criteria and conditions in respect of insured health services provided under provincial law that must be met before a full cash contribution may be made. It is further stated that the primary objective of Canadian health care policy is to facilitate reasonable access to health services without financial or other barriers.98 Within a decade of the passage of the act however, Canada was faced with a serious recession. In response to growing budget deficits, and looming health care expenditures, the federal government took action. “The result was a round of significant cuts both to the operating budgets of departments and to their grants and contributions — many in the range of 15 percent to 25 96

Schneider v. The Queen [1982] 2 S.C.R. 112 at 142. Quoted in Marlisa Tiedemann, footnote one.

97

Office of the Parliamentary Budget Officer, Renewing the Canada health Transfer: Implications for Federal and ProvincialTerritorial Fiscal Sustainability, p 3, Figure 3-02. Officially, the cost sharing arrangement was 50-50 but that applied to hospital and physician services, not to all provincial health care costs. 98

Canada, Canada Health Act Consolidation RSC, 1985, last amended on June 29, 2012.


percent and some even higher. Transfers to the provinces were also cut sharply — by more than 21 percent over a two-year period.”99 A major consequence of the cuts was a significant reduction in health transfers to the provinces such that the level of cost sharing relative to provincial health spending fell as low as 10%. The impact on the provinces was severe. It led to cuts in hospital budgets, physician reimbursement, increased wait times, reductions in elective services, and layoffs across health human resources. The severity of the cutbacks served to undermine Canadian confidence in health care and in government leadership. Faced with mounting public pressure, the federal government established the Royal Commission on the Future of Health Care.100 It reported in 2002 and recommended sweeping changes to ensure health system sustainability. In 2003, federal and provincial leaders got together and agreed upon priorities to restore public confidence. They agreed on an action plan based on the following principles: x x x x x x x

universality, accessibility, portability, comprehensiveness, and public administration; access to medically necessary health services based on need, not ability to pay; reforms focused on the needs of patients to ensure that all Canadians have access to the health care services they need, when they need them; collaboration between all governments, working together in common purpose to meet the evolving health care needs of Canadians; advancement through the sharing of best practices; continued accountability and provision of information to make progress transparent to citizens; and Jurisdictional flexibility.101

In 2004, the Prime Minister announced $41 billion over 10 years of new federal funding in support of the action plan on health. The new funding was to be used to strengthen ongoing federal health support; meet the financial recommendations of the royal commission; improve the quality of care; and reduce wait times among other system reforms. The government also split cash transfers, which had been previously merged, into the Canada Health Transfer and the Canada Social Transfer. In 2005, an automatic escalator was introduced which had the effect of increasing the health transfer by 6% annually.

99

Ontario Ministry of Finance, Commission on the Reform of Ontario’s Public Services, Public Services for Ontarians: A Path to Sustainability and Excellence, Chapter 2, The Fiscal Challenge in Context, http://www.fin.gov.on.ca/en/reformcommission/chapters/ch2.html

100

Royal Commission on the Future of Health Care in Canada (Romanow), Building on Values: The Future of Health Care in Canada, Final Report, 2002.

101

Health Canada, A ten year plan to strengthen health care, http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2004fmm-rpm/index-eng.php


In 2011, however, three years before the end of the 10-year agreement, the federal government unilaterally announced that the 6% increase would only continue until 2017, after which federal funding would be based on a three year moving average of the Gross Domestic Product (GDP) with a minimum of at least 3% each year. Reaction of the provinces and territories to this unilateral federal action was swift. Premiers are calling on the federal government to avoid unilateral changes to programs affecting provinces and territories, “and particularly measures involving cutbacks in financial support, including offloading or downloading responsibilities.”102 Physicians and other health professionals also do not like the proposal, not only because it leads to the underfunding of health care but also because it is perceived as an abdication of federal leadership in promoting equitable and fair access to high quality health care services across the country.103 Sustainability of Health Care The sustainability of health care has been an issue in public policy since its inception. The 1964 Royal Commission on Health Services (Emmett Hall) focused on public financing and priorities and opted for a limited range of insured services to contain costs.104 The 2002 Royal Commission on the Future of Health Care in Canada led by Roy Romanow addressed the issue of long-term sustainability.105 Each commission concluded that public funding of health care was preferable to private funding. In spite of the commission’s recommendations however, a debate still rages today about the affordability or sustainability of public funding of health care services. While it is not a new debate, it grows louder as governments grapple with budget shortfalls, slow economic growth and declining revenues. Opponents of the current system of financing argue that healthcare costs are being progressively pushed to levels of expenditure that cannot be sustained. They largely base their analysis on the fact that the growth in health care costs is outstripping total government revenues and unchecked they will absorb an increasing share of all expenditures. 102

Council of the Federation, Communiqué, Canada’s Premiers continue to work on modernizing fiscal arrangements, July 26, 2013. 103

In 2012, Dr John Haggie, then president of the Canadian Medical Association, is quoted as saying that: Ottawa has an essential oversight role, ensuring that similar care is available across the country. ---- what Canadians have told us is they would rather like some standards, equity and equitability across the country.” In article by André Picard, Aglukkaq defends Ottawa’s hands-off role in health care funding, Globe and Mail, August 13, 2012. 104

Royal Commission on Health Services, Volume 1, 1964.

105

Royal Commission on the Future of Health Care in Canada (Romanow), Building on Values: The Future of Health Care in Canada, Final Report, 2002.


An example is a 2011 report of the Fraser Institute. It dramatizes the problem in the following way: total provincial health spending has grown at an average annual rate of 7.5% over the previous ten years, compared to only 5.7% for total available provincial revenue (including federal transfers): health expenditures in Canada’s two largest provinces (Ontario and Quebec) consume more than 50% of total revenues; and most provinces actually spend more that 60% of their own sourced revenue on health care if federal transfers are excluded from the calculation.106 Raising the same concerns, a 2001 Conference Board of Canada report comes to some of the same conclusions. Although the percentage of expenditures to revenues is calculated differently, the trend is the same. The Conference Board concludes that “public health care expenditures will increase from 31 cents of every provincial and territorial tax dollar in 2000 to 42 cents by 2020,” and that per capita health care spending is projected to increase by 58% in the same period while other government services will increase by only 17%. 107 Looking at government health expenditures in relation to government revenues, however, is only part of the equation. A more balanced picture can be obtained by comparing expenditures to gross domestic product or GDP and economic growth (which are better measures of our overall capacity to pay). The Canadian Federation of Nurses Unions, for example, states that organizations like the Fraser Institute and the Conference Board overstate the problem. Canada’s total health expenditures in 2011 were 11.6% of GDP and public health expenditures were 8.1%. Health expenditures were in line with most other developed countries and considerably less than the USA. 108 The Canadian Foundation for Healthcare Improvement (formerly Canadian Health Services Research Foundation) makes the same point, claiming that the argument about public health care being unsustainable is a myth. When measured against GDP, the foundation acknowledges that health expenditures have increased over time but notes that the increases have been in line with other developed countries and in fact, more moderate than many.109 Canadian Doctors for Medicare states that the myth of health care being unsustainable is neat and plausible but wrong. They distinguish between medicare costs (i.e., medically insured services) and total government health care spending. While Medicare costs have remained remarkably stable at 4% to 5% of GDP over the last 35 years, other health care expenditures have increased more substantially. But even with these increases, total expenditures only 106

Brett Skinner and Mark Rovere, Canada’s Medicare Bubble: Is Canada’s Health Spending Sustainable without User-based Funding?, Studies in Health Care Policy, 2011, See also, Brett Skinner, Canadian Health Policy Failures: What’s Wrong? Who Gets Hurt? Why Nothing Changes, Fraser Institute, 2009.

107

The Conference Board of Canada, The Future Cost of Health Care in Canada, 2000 to 2020, Balancing Affordability and Sustainability Detailed Findings by Pedro Antunes, Glenn Brimacombe, and Jane McIntyre, 2001. 108

Canadian Federation of Nurses Unions, Health Care Sustainability, Backgrounder, November 2011.

109

Canadian Health Services Research Foundation, Myth: Canada’s System of Healthcare Financing is Unsustainable, 2010.


increased from 5% of GDP in 1980 to 7% in 2009, which, according to them, is hardly unsustainable.110 Robert Evans, a well known health economist, suggests that public health care is as sustainable as we want it to be; it is a matter of the political choices we make. He acknowledges that provincial spending on health care has taken an increasingly larger share out of provincial budgets in recent years but that this shift is a simple consequence of substantial cuts in personal and corporate income taxes, leading to lower revenues. Tax cuts between 1997 and 2004 alone led to $470.8 billion in lost government revenue.111 There have been more tax cuts since then. For a comprehensive international comparison of health care expenditures in Canada and other developed economies, it is helpful to look at statistics provided by the Organisation for Economic Cooperation and Development (OECD). The most recent comparative statistics in 2011 indicate that Canada’s total health expenditures as a percentage of GDP at 11.2% were above the OECD average and fifth highest of thirty-eight countries. However, public health expenditure, at 70.4% of total health expenditure, was below the OECD average and lower than twenty-one other countries.112 Interestingly, countries with higher public expenditures generally had lower overall health expenditures. Hence, if the federal government remained actively engaged in funding, it could continue to encourage cost containing strategies. Also, in 2010 and again in 2011, the growth rates in health expenditures in OECD countries began to stagnate. In Canada health spending growth slowed by 3.0% in 2010 and 0.8% 2011.113 This pace of slower growth in expenditure since 2010 is also noted by the Canadian Institute for Health Information (CIHI). Overall, though, health care costs from 2000 to 2010 grew at a faster rate than the economy.114 The institute identifies three distinct phases in the growth of total health expenditures (public and private): a growth phase from 1975 to 1991; disinvestment and retrenchment from 1991 to 1996; and another growth phase from 1996 to 2010. 115

110

Canadian Doctors for Medicare, Neat, Plausible and Wrong: The Myth of Health Care Unsustainability, February, 2011. If private as well as public health expenditures are included, however, the proportion of GDP devoted to health care is considerably higher. See C.D. Howe Institute Commentary: The Health Papers, Chronic Healthcare Spending Disease, authors David Dodge and Richard Dion, 2011. 111 Robert G. Evans, Public health care as sustainable as we want it to be, The Star, Editorial Opinion, June 1, 2010. See also Robert G. Evans, Economic Myths and Political Realities: The Inequality Agenda and the Sustainability of Medicare, UBC Centre for Health Services and Policy Research, July 2007. 112

OECD Health Data 2013, Website, Frequently Requested Data

113

OECD Press Release, Health spending continues to stagnate, 27/06/2013

114

Canadian Institute for Health Information, National Health Expenditure Trends, 1975 to 2012, Figure 7.

115

Canadian Institute for Health Information, National Health Expenditure Trends, 1975 to 2012, Figure 2


The recent slow pace in health care expenditures does not mean that they will not increase in the future. A report by the C. D. Howe Institute projects health care spending (public and private) from 2013 to 2031. Based on factors known to drive up costs (such as demographic changes, technology, and personnel), the study suggests that by 2031, health care costs will bring the ratio of expenditure to GDP to a range of 15% to 19%.116

The implication of this increase is not that it is overwhelming; the increases do not eat up “all or even a majority of the gains in income” over that same period of time.117 And the lower projected range is even less than the percentage of GDP currently spent on health care in the United States. But it does suggest that governments are going to have to increase their revenues, and improve health care delivery, if they want to continue financing health care at current or higher levels of service. Most worrying in that respect is the recently announced shift of the burden of health care costs from the federal to the provincial and territorial governments. If federal contributions to health care were maintained at the rate of increase provided in the 2004 health accord (6% annually), the Parliamentary Budget Officer estimated that the federal cash transfer would average 21.6% of provincial territorial health spending from 2011 to 2035 and even higher after that. By contrast, the federal government’s unilateral decision to change the cash transfers means that the share of federal funds to the provinces and territories will only grow 3% to 4% annually and payments to provincial-territorial spending will decrease substantially from 20.4% in 2010-11 to an average of 18.6% from 2010-2011 to 2035-36 and even less (13.8%) over subsequent years.118 Need for Federal Leadership: There is a deficit of federal leadership in health care. The deficit is intentional. Speaking to the Canadian Medical Association in 2012, the former health minister, Leona Aglukkaq, defended the hands-off role of the government this way: “Decision-making about health care is best left to the provincial, territorial and local levels. I will not dictate to the provinces and the territories how they will deliver services or set their priorities.”119 As we suggested earlier, the hands-off approach to health care and other social programs has served the present Conservative government well in political terms. Because constitutional responsibility for health and social services belongs to the provinces (and territories), it has 116

C.D. Howe Institute Commentary: The health Papers, Chronic Healthcare Spending Disease, authors David Dodge and Richard Dion, 2011. 117 C.D. Howe Institute Commentary: The Health Papers, Chronic Healthcare Spending Disease, authors David Dodge and Richard Dion, 2011, page 8 118

Office of the Parliamentary Budget Officer, Renewing the Canada Health Transfer: Implications for Federal and Provincial – Territorial Fiscal Sustainability, Ottawa, January 12, (Revised January 19) 2012, 119

Globe and Mail, Aglukkaq defends Ottawa’s hands-off role in health care funding, August 13, 2012.


lessened, to some degree, tensions between the different levels of government, particularly in relation to Quebec. CASW thinks that this political choice is in fact an abrogation of responsibility on the part of the federal government to commit to national equity, both horizontal and vertical. Horizontal equity implies that citizens, wherever they reside, should be provided with similar levels of health care. Vertical equity is more general in nature, implying at a minimum that health care has to be portable and accessible across jurisdictions so that individuals are free to move as appropriate to enhance equality of opportunity. The federal government is moving away from a principle of national equity. Instead, it seems to be bent on a strategy that will unravel Canada’s health care system and balkanize health care delivery within the provinces and territories. In 2011, it unilaterally announced that the 10-year health accord would not be renewed upon expiry in 2014. A concept of a national pharmaceutical strategy, which was part of the accord, was also ruled out. There is no federal involvement in the Health Care Innovation Working Group of the Council of the Federation (representing the provinces and territories). And in March 2014, the Health Council of Canada was closed.120 Over the past decade, many professional and non-governmental organizations have tried unsuccessfully to persuade the federal government to revitalize its commitment to health care and promote health care reform. The Canadian Medical Association and the Canadian Nurses Association outlined six principles to guide health care transformation in Canada. The principles have been supported by over 125 organizations including CASW. Among the principles is an affirmation that “the health care system has a duty to Canadians to provide and advocate for equitable access to quality care and multi-sectoral policies to address the social determinants of health.” Another is that “sustainable health care requires universal access to quality health services that are adequately resourced and delivered along the full continuum in a timely and cost-effective manner.”121 The Medical Reform Group is another professional group emphasizing the need for a strong federal role in setting health policy. It believes, as CASW does, that “the issue of whether the federal government should be involved in setting and maintaining standards for the delivery of

120

Jeff Morrison,“Health care in Canada and the role of the federal government”, Canadian Pharmacists Journal, July/Augus 2013.

121

Principles to Guide Health Care Transformation in Canada, Canadian Nurses Association and Canadian Medical Association, July 200, pages 2 and 3. The six principles are: patient centered; quality; health promotion and illness protection; equitable; sustainable; and accountable.


social services is fundamentally an issue about the model of society we want for Canada.”122 In health care, it is a debate about whether we want to maintain a single payer model which is universally accessible, move toward American style privatization or incorporate user copayments. The disadvantages of the American system are well known. It is the most expensive system in the developed world and the least universally accessible. For that reason, there are not too many organizations in Canada that openly advocate for it. Advocacy of co-payments or European style insurance, however, is another matter. Janice MacKinnon, former Minister of Finance in Saskatchewan, is a strong advocate of copayments. In a recent report issued by the MacDonald Laurier Institute, she proposes a tax based co-payment scheme that would link the use of the health care system and the ability to pay. It would, she claims, be equitable in so far as low income citizens would be exempt. The advantage of using the income tax system is that it would raise revenue and lead to a reduction of utilization. The disadvantage to patients is that those who most use the system, through no fault of their own, would be most penalized.123 MacKinnon’s other recommendations are, in the judgment of CASW, more propitious. They include recommendations about putting greater emphasis on homecare, relocating, where feasible, emergency services to community clinics and improved pharmaceutical coverage.124 What is missing from MacKinnon’s analysis is a pan-Canadian vision of health care. By contrast, the Health Action Lobby Group (HEAL), a coalition of 34 national health and consumer organizations of which CASW is a member values an active federal role in health care. In a report entitled “Functional Federalism and The Future of Medicare in Canada,” HEAL found that there was strong support by the stakeholders they interviewed for a practical federal approach of doing what works best to improve access to, and improve the quality of, the health system.125 In terms of health care reform, HEAL places strong emphasis on the need for chronic disease management, home care, long-term care, access, and mental health. 122

Medical Reform Group, Principles and Policy Statements, Statement on the Necesssity for a Strong Federal Role in Setting Health Policy, http://www.medicalreformgroup.ca/principles/federal_role_in_canadian_health_policy/

123

Janice MacKinnon, Health Care Reform from the Cradle of Medicare, MacDonald Laurier Institute, 2013, pages 15-17. MacKinnon bases her recommended reform on two studies: Aba, Shay, Wolfe D. Goodman, and Jack M. Mintz. 2002. “Funding Public Provision of Private Health: The Case for a Copayment Contribution through the Tax System.” Health Law Canada 22 (4): 85-100; and Stabile, Mark. 2003. “The Role of Benefit Taxes in the Health Care Sector.” University of Toronto Working Paper. http://www.law-lib.utoronto.ca/investing/reports/rp14.pdf 124

She does not recommend a national pharmaceutical plan and instead suggests that the provinces work together to create savings and better provision. She argues that the federal government cannot afford to develop a national plan without increasing debt. It is not clear why the provinces are in any better position. Moreover, her concern about rising costs is based upon excess expenditures over revenues, not the overall capacity of the economy. 125

Tholl, Bujold & Associates, Functional Federalism and the Future of Medicare in Canada, A Report to the Health Action Lobby, 2012. p iv. By functional federalism, they mean shared leadership between the federal and provincial/territorial governments


The Canadian Health Coalition, a public advocacy organization dedicated to the preservation and improvement of Medicare, is even more forthright in its support of federal leadership. In a 2011 report to a Senate committee, the coalition recommends a renewed ten year plan with adequate funding including the continuation of the 6% escalator; a comprehensive plan to deal with an Aboriginal health gap; a national pharmaceutical strategy; comprehensive home and continuing care; and reforms to reduce wait times.126 John Millar, a clinical professor in the School of Population and Public Health at the University of British Columbia, also highlights the need for federal leadership to transform the health care system. Noting that rising costs are driven by technological advances, drugs and human resources, he says that we need to provide community based resources that will improve population health, reduce inequities, and reduce health care expenditures. In his judgment, “an essential step in this transformation would be a coordinated pan-Canadian effort to develop indicators and data bases that will support accountability in health care and drive the required changes.”127 CASW is in general agreement with many of these suggestions. Taken together, they round out the health care system of this country to bring it closer to the range of comprehensive services provided in some of the developed countries of Europe. CASW is opposed to more privatized financing of the system because there is limited evidence to show that private financing leads to significant public savings or better health care.128 Furthermore, it seems that our health care system is sustainable in relation to our overall economy or capacity to pay. The major gap is a lack of political will to finance it.

126

Canadian Health Coalition brief to the Standing Senate Committee on Social Affairs, Science and Technology on its Review of the progress in implementing the 2004 health Accord, Secure the Future of Medicare: A Call to Care, November 10, 2011.

127

John Millar, Canadian health care needs a massive transformation, Editorial Opinion, The Star, Wednesday March 14, 2012.

128

Some evidence on this issue is reported in an article by R. Sacha Bhatia, “Alternative Financing for health care: A path to sustainability?”, Canadian Medical Association Journal, April 17, 2012See, for example, See also D. Drummond and D. Burleton, “Charting a path to sustainable health care in Ontario: 10 proposals to restrain cost growth without compromising quality of care”, TD Economics Special Reports. Toronto, TD Bank Financial Group; 2010. :www.td.com/economics/special/db0510_health_care.pdf


CASW Proposal: Active federal leadership and significant federal funding is essential if our health care system is to survive. Without both, health care will be increasingly balkanized. CASW recommends that the federal government take action to ensure that the conditions of the Canada Health Act (public administration, comprehensiveness, universality, portability and accessibility) are met in order for the provinces and territories to receive federal funding. In addition, CASW recommends that the federal government take the lead in providing financial incentives for the provinces and territories to transform the health care system into one that is patient centered, community-based and cost efficient. One way to do this is to fund a panCanadian initiative to provide benchmarking indicators that will support accountability and stimulate change. More fundamentally, CASW recommends that, in terms of overall funding, the federal portion of health care costs cover, in the short term, 20% of total public expenditures and that the proportion of public spending to total spending should remain around 70%. Both targets are realistic within the current economic environment. They have been achieved in recent years and surpassed in earlier years. In the long term, CASW recommends that the federal increase its portion to 24% of total public health expenditures, a level that was achieved in the 1980s, and a target that is realistically manageable if the federal government were to continue the 6% escalator beyond 2017. At the same time, the proportion of public spending to total spending on health care could be increased to 72% - the current average for OECD countries.


Conclusion Since the 1990s, tax cuts and restrictive federalism have diminished the federal government’s role in social programming, and federal fiscal contribution to provincial social programs is expected to decline. The current Conservative Government envisions a restrictive federalism in which programs delivered by different levels of government are distinct within their own jurisdiction. This decentralization will reduce the federal government’s accountability to the provinces and create discrepancies between provinces’ services. Furthermore, it undermines a social contract between the federal government and the Canadian people based on a notion of shared rights and responsibilities. CASW is deeply concerned about the impact these ‘hands off’ policies and practices will have on the health care, social inclusion, and social protection of Canadians. CASW envisions coordinated federalism in which the federal government negotiates with the provinces and territories and adopts an equity framework for social policy. Such a vision would ensure that all Canadians have basic rights to a common minimum standard of service across the country. CASW asserts such an approach would be supported by adopting and enforcing national standards, as well as building upon negative income tax mechanisms to provide a comprehensive basic income. Noting that countries with higher public expenditures generally had lower overall health expenditures, CASW’s suggestions would ensure efficient expenditure of public revenue and reduce the long term social and financial costs of poverty in areas such as health care, education, and criminal justice. To achieve these ends, CASW proposes that the federal government adopt a policy on health and social issues guided by the principles of need, comprehensiveness, accessibility, fairness, portability, universality, and public or non-profit administration.


REPORT/RAPPORT

Promouvoir l’équité pour un Canada plus fort: l’avenir de la politique sociale canadienne

D

epuis les années 1990, des allégements fiscaux et un fédéralisme restrictif ont réduit la capacité du gouvernement fédéral de jouer un rôle dans les programmes sociaux et on s’attend à ce que la contribution fédérale aux programmes sociaux provinciaux diminue. Une telle décentralisation contribuerait à réduire la reddition de compte du gouvernement fédéral à l’endroit des provinces et créerait des disparités de services entre les provinces. Cela contribuerait, en outre, à miner le contrat social entre le gouvernement fédéral et la population canadienne, un contrat fondé sur la notion de droits et responsabilités partagés. Il est, en bref, aucune vision pancanadienne pour la politique sociale dans ce pays. L’ACTS est profondément préoccupée par les incidences qu’auront les politiques et les pratiques non interventionnistes sur les soins de santé, l’inclusion sociale et la protection sociale des Canadiens. Dans le présent rapport l’ACTS réaffirme l’importance d’une vision pancanadienne fondée sur la notion d’un fédéralisme coordonné dans le cadre duquel le gouvernement fédéral négocie avec les provinces et territoires et contribue au financement de programmes sociaux en vertu de certains principes directeurs. Il s’agit d’une vision qui vise à assurer que tous les Canadiens ont un droit fondamental à une prestation de service s’appuyant sur des normes minimales communes dans l’ensemble du pays.


Promouvoir l'équité pour un Canada plus fort: l'avenir de la politique sociale canadienne

Auteurs: Dr. Glenn Drover Allan Moscovitch Dr. James Mulvale


Ce document est disponible en anglais


Contents

Introduction.....................................................................................................................................158 3 10 Équité du revenu ........................................................................................................................... 165 Proposition de l'ACTS ........................................................................................................... 179 24 26 Équité sociale ................................................................................................................................ 181 Proposition de l'ACTS .......................................................................................................... 196 41 43 Équité en santé .............................................................................................................................. 198 Proposition de l'ACTS .......................................................................................................... 209 54 50 Conclusion .................................................................................................................................... 210


Introduction Dans le présent document, l'Association canadienne des travailleuses et travailleurs sociaux (ACTS) recommande l'adoption d'un cadre conceptuel fondé sur l'équité, voulant qu'à l'avenir le gouvernement fédéral joue un rôle partagé avec les provinces et territoires en matière de politique social. Ce cadre intègre la notion d'équité au chapitre du revenu, des programmes sociaux et de santé et propose une vision très différente de celle préconisée et promue par le gouvernement actuel1. Bien que le gouvernement conservateur ait annulé certaines initiatives politiques d'importance de gouvernements antérieurs, telles que l'Accord de Kelowna et le Plan national sur la garde des enfants, son gouvernement a par ailleurs mis en place la Prestation universelle pour la garde des enfants, le Crédit d'impôt pour enfants, le Crédit d'impôt à l'emploi et le Crédit d'impôt pour la rénovation domiciliaire. La vision de la politique sociale du gouvernement conservateur diffère fondamentalement celle de l'ACTS à deux égards. Ainsi, le premier ministre Harper et ses collègues favorisent un rôle décroissant du gouvernement fédéral dans l'élaboration des programmes sociaux et entrevoient une forme de fédéralisme restrictif dans le cadre duquel les programmes offerts par divers ordres de gouvernement seront distincts au sein même de leur propre sphère de compétence2. On parvient à réduire le rôle du gouvernement fédéral au moyen de réductions fiscales. Les entrées fiscales ont déjà été réduites, passant de quelque 16 % à 14 % du produit intérieur brut (PIB). On prévoit que les dépenses liées aux programmes vont décroître encore plus de 20102011 à 2016-20173. Les compressions ne reflètent que la moitié du tableau; l'autre moitié est liée au fédéralisme restrictif. Contrairement aux gouvernements conservateurs précédents, le gouvernement conservateur actuel érige des pare-feux entre le gouvernement fédéral et les provinces4. 1

Dans le présent rapport, la notion d'équité fait référence à l'accessibilité aux programmes de sociaux et de santé ainsi qu'à la répartition ultime du revenu.

2 Keith Banting fait référence à trois formes de fédéralisme en lien avec la politique sociale et la prise de décisions intergouvernementales : le fédéralisme classique, dans le cadre duquel les programmes sont offerts par divers ordres de gouvernement agissant indépendamment; le fédéralisme à frais partagés, où le gouvernement fédéral assure un soutien financier à d'autres ordres de gouvernement à certaines conditions; le fédéralisme fondé sur un pouvoir de décision conjoint requérant une entente formelle entre deux ordres de gouvernement avant que des programmes soient élaborés. Banting, Keith, 2009. “The Three Federalisms: Social Policy and Intergovernmental Decision-Making.” dans Herman Bakvis et Grace Skogstad, (dir.), Canadian Federalism: Performance, Effectiveness, and Legitimacy, Don Mills ON: Oxford University Press. Notre approche diffère quelque peu de celle de Banting. Selon nous, le fédéralisme restrictif, comme nous le concevons, est fondé sur le modèle classique, mais puise aussi dans le fédéralisme fondé sur un processus décisionnel mixte. Le fédéralisme coordonné est associé de plus près à un amalgame du fédéralisme à frais partagés et du fédéralisme fondé sur un pouvoir de décision conjoint. 3

Gouvernement du Canada , le budget 2012, chapitre 6 : Perspectives financières. http://www.budget.gc.ca/2012/plan/chap6-fra.html

4

Boessenkool, Ken, 2013,"Revealed: Stephen Harper is conservative, Really," Macleans, juillet 12.


Le premier ministre actuel n'a jamais rencontré ses homologues provinciaux pour discuter de politique sociale. Les budgets sont élaborés de manière à offrir des transferts inconditionnels permettant aux provinces de mettre en place des programmes sociaux, sans interférence apparente du gouvernement fédéral. À l'avenir, les transferts seront fondés sur la croissance de la population et les taux d'inflation, ne laissant que peu ou aucune place à la participation des provinces. À l'opposé, la vision de l'ACTS est fondée sur la notion de fédéralisme coordonné dans le cadre duquel le gouvernement fédéral négocie avec les provinces et territoires et contribue au financement de programmes sociaux en vertu de certains principes directeurs. Il s'agit d'une vision qui vise à assurer que tous les Canadiens ont un droit fondamental à une prestation de service s'appuyant sur des normes minimales communes dans l'ensemble du pays. Le fédéralisme coordonné n'empêche pas les provinces et territoires de gérer leurs propres programmes ou de fixer leurs propres buts. Il ne fait que bonifier leurs buts au moyen de programmes sociaux financés en tout ou en partie par le gouvernement fédéral. Les mérites du fédéralisme coordonné s'appuient sur deux principes fondamentaux: la constitutionnalité et la viabilité économique. Constitutionnalité Une constitution a pour but d'énoncer les droits et responsabilités d'un gouvernement et de ses citoyens et de préciser les mécanismes juridiques nécessaires à la préservation des ces droits et responsabilités. En vertu de la Constitution canadienne, le gouvernement fédéral est responsable en grande partie du développement économique national et de matières connexes, incluant le système bancaire, la monnaie, la politique monétaire, le commerce et la défense. Les services sociaux et éducatifs ainsi que les questions liées aux droits civils et aux droits de propriété relèvent de la compétence des provinces. Comme résultat du partage des pouvoirs, dicté par la Constitution¸ le Canada est considéré comme l'État providence le plus décentralisé de l'OCDE5. Les gouvernements fédéral et provinciaux jouissent d'une autonomie relative dans leur propre sphère de compétence. Le gouvernement fédéral jouit également de certains pouvoirs résiduels lui permettant d'assurer la paix, l'ordre et le bon gouvernement. Le fédéralisme restrictif est fondé sur l'idée qu'un ordre de gouvernement donné devrait interférer le moins possible dans les affaires d'un autre ordre. Depuis la confédération au 19e siècle jusqu'à la Grande Crise des années 1930, la norme au chapitre des relations intergouvernementales 5

Herbert Obinger, Stephan Leibfried et Francis Castles, Federalism and the welfare state: new world and European experiences, 2005, Cambridge University Press.


s'appuyait sur une séparation nette des pouvoirs voulant que la responsabilité des programmes sociaux relève entièrement des provinces. Toutefois, entre les années 1930 et 1990, le gouvernement fédéral s'est investi davantage dans la prestation directe des pensions et de l'assurance-emploi, de même que dans le partage des coûts des services sociaux et de santé. Au cours des dernières années, le gouvernement du Canada a entrepris de renverser cette tendance et de maximiser la participation du fédéral et majorant les transferts inconditionnels et en faisant miroiter les avantages du transfert de points d'impôt. Ce renversement de tendance, amorcé sous la gouverne du premier ministre Mulroney, a continué d'influencer le gouvernement actuel et est regrettable. Il mine le contrat social entre le gouvernement fédéral et la population canadienne en s'appuyant sur une notion de droits et responsabilités partagés6. Un contrat social assez bien défini a été élaboré au Canada au cours de la deuxième moitié du 20e siècle et est partiellement enchâssé dans la Charte des droits et libertés et dans la Loi constitutionnelle de 1982. Au chapitre de la politique sociale, il y était accepté que la plupart des programmes sociaux et de santé étaient gérés efficacement par les provinces ou les territoires et reconnu, en outre, que le gouvernement fédéral avait un rôle important à jouer pour promouvoir l'équité nationale7. Ainsi, le gouvernement fédéral a joué un rôle grandissant dans le financement partagé des services de santé, des services sociaux et des services d'éducation, de même qu'en finançant totalement certains programmes de sécurité du revenu, tels que les pensions, l'assurance-emploi et les prestations aux familles ayant des enfants. Certes, l'évolution vers une forme de fédéralisme coopératif entre le gouvernement fédéral et les gouvernements des provinces a entraîné certaines tensions. Certaines provinces, comme le Québec et, de plus en plus, l'Alberta, y ont vu une intrusion inutile et non justifiée du fédéral dans des champs de compétence provinciale. D'autres se sont plaintes de l'iniquité ou de l'inadéquation du financement fédéral. La coopération fédérale-provinciale s'est avérée parfois gênante pour les élus, du fait qu'elle requérait des négociations constantes et comportait un potentiel de mésentente ouverte. D'autre part, elle présentait pour les citoyens un éventail plus large d'idéologies politiques pouvant influencer le processus de la négociation et contribuer plus positivement aux discours démocratique. Et même si elle n'y a pas mis fin, elle a aussi atténué la tendance à agir unilatéralement de l'un ou l'autre des ordres de gouvernement. En dépit de la complexité de naviguer entre diverses perspectives et priorités politiques, la majorité des Canadiens semble satisfaite des résultats découlant d'une responsabilité partagée en 6

Pour ce qui est du contrat social, nous sommes inspirés des idées de Kenneth Norrie, Robin Boadway et Lars Osberg dans leur document intitulé : “The Constitution and the Social Contract” que l'on retrouve dans Robin Boadway, Thomas Courchene et Douglas Purvis, Economic Dimensions of Constitutional Change, Kingston, John Deutsch Insitute, 1991 7 Kenneth Norrie et coll., pp 226-233


matière de politique sociale. En 2002, une étude d'opinion publique, menée par une organisation de pointe du monde la recherche, a révélé que les priorités de nature sociale figuraient en tête de liste chez les Canadiens, notamment la santé, l'éducation, l'emploi et la pauvreté des enfants8.

En 2009, un sondage mené par Nanos Research a révélé que les Canadiens étaient fortement favorables au système public de santé, de même qu'à des solutions publiques destinées à le renforcer9. En 2013, un autre sondage, mené par Environics Research, a démontré qu'une majorité de Canadiens accepterait un taux d'imposition plus élevé dans le but de protéger les services publics10. Le fédéralisme coordonné imaginé par l'ACTS n'est pas parfait. Il laisse place à des litiges. Il propose par ailleurs un cadre politique pour les programmes sociaux actuels et futurs. Il peut accommoder le statut particulier du Québec, de même que les priorités des provinces et territoires. Il est en outre constitutionnel. Viabilité économique Un professeur de sciences économiques de la Californie, Peter Lindert, s'est penché sur l'historique des programmes sociaux à incidence fiscale sur une longue période et a conclu que les dépenses relatives aux programmes sociaux contribuaient au développement économique plutôt que de l'inhiber11. L'idée que les programmes sociaux font obstacle au développement économique est particulièrement convaincante lorsque l'économie traîne de la patte, comme c'est le cas actuellement. Au début des années 1980, de nombreux pays de l'Europe occidentale, qui offraient déjà des programmes sociaux élaborés, ont connu une croissance lente comparativement aux États-Unis et au Canada. Cette observation a donné lieu à la naissance d'une théorie selon laquelle les programmes sociaux limitent la flexibilité du marché du travail; de là, des dirigeants comme Margaret Thatcher se sont servis de cette façon de voir les choses pour amener l'Angleterre à passer d'un régime de services sociaux et de santé offerts par l'État à des systèmes de prestation fondés sur une économie de marché12. 8

Matthew Mendelsohn,"Canada’s Social Contract: Evidence from Public Opinion", Canadian Policy Research Networks, 2002

9

Nanos Poll: Overwhelming support for public health care, 2009, Nupge.ca. 2009-08-13.

10

Ce sondage a été commandé par le Broadbent Institute, http://www.broadbentinstitute.ca/

11

Peter H. Lindert, Growing Public: Social Spending and Econmic Growth since the Eighteenth Century, Cambridge University Press, 2004. Le résumé de ce livre présenté dans ce paragraphe est puisé de Ole Meldgaard, Social welfare and economic growth, pdf (offert dans Internet), Meldgaard est président du Réseau européen de lutte contre la pauvreté. Cf. aussi Richard Wildinson et Kate Pickett, The Spirit Level: Why More Equal Societies Almost Always Do Better, 2000, Allen Lane. 12 Rebecca Blank et Richard Freeman, “Evaluating the Connection between Social Protection and Economic Flexibility”, in Rebecca Blank, (dir.), Social Protection versus Economic Flexibility: Is There a Trade-Off?, University of Chicago Press, 1994.


Toutefois, au tournant du siècle, l'idée voulant que les programmes sociaux soient la cause d'un ralentissement économique a été remise en question. L'argument contre était fondé sur une vision partiale des coûts-bénéfices qui ne s'attardait qu'aux risques et non aux avantages. En revanche, une étude de l'OCDE a constaté que, même si certains programmes sociaux ont pu avoir une incidence marginalement négative sur le rendement économique, d'autres ont de fait contribué à une amélioration du capital humain et à la productivité du marché du travail13. Dans une étude plus récente, deux épidémiologistes ont constaté que les dépenses de relance au titre des programmes sociaux contribuent non seulement à stimuler le développement économique, mais aussi à atténuer les problèmes sociaux associés aux récessions14. Un filet social résistant constitue un solide déterminant de la santé. Ils ont constaté que ce qui menace vraiment la santé, ce n'est pas la récession, mais l'austérité. Lorsque le filet social a été affaibli à l'occasion de récessions, il s'en est suivi un choc économique qui a engendré une crise en santé. Ils ont également constaté que, dans les pays qui dépensent le plus au titre des programmes sociaux, l'espérance de vie est plus longue. Il semble également que le ratio des dépenses au chapitre des services sociaux par rapport aux dépenses en santé, et non seulement les montants consacrés à la santé, soit lié aux résultats en santé15. Alors que les programmes sociaux contribuent à un meilleur développement économique et à une amélioration de la santé, ils constituent également des instruments essentiels pour la réduction de la pauvreté. En 2010, l'Organisation de coopération et de développement économiques (OCDE) a réalisé une étude portant sur 14 pays européens, dans le cadre de laquelle on a constaté que la croissance économique ne constituait pas une condition suffisante pour réduire la pauvreté16. Les transferts sociaux avaient un rôle plus déterminant que le produit intérieur brut (PIB) pour réduire la pauvreté ainsi que l'inégalité du revenu. De manière plus générale, les programmes sociaux contribuent également à soutenir le développement économique en établissant un climat de cohésion sociale et un sentiment de citoyenneté, en plus de réduire les conflits17. Ils y parviennent en assurant un accès équitable et accru aux services publics et en investissant dans le capital humain, notamment en éducation et

13 L'OCDE est un forum unique au sein duquel les gouvernements de 30 démocraties collaborent en vue de s'attaquer aux défis économiques, sociaux et environnementaux que pose la mondialisation. On y retrouve le Canada et les États-Unis, de même que la plupart des pays de l'Europe occidentale. 14

David Stuckler et Sanjay Basu, The Body Economic: Why Austerity Kills, Harper Collins, 2013.

15

Gina Browne, Stephen Birsch, Lehana Thabane, Better Care: An Analysis of Nursing and Healthcare System Outcomes, Canadian Foundation of Healthcare Improvement, juin2012. 16 Yannis Dafermos et Christos Papatheodorou, “The Impact of Economic Growth and Social Protection on Inequality and Poverty: Empirical Evidence from EU Countries, Texte présenté à la 1st International Conference in Political Economy, Rethymno, Crete, 2010. 17 OECD, Vers une croissance pro-pauvres : La protection sociale, 2009, 25. Ce guide a été produit à l'intention des pays en développement, mais ses principes sont fondés sur l'expérience de pays développés, dotés de programmes avancés de protection sociale.


en santé, améliorant de ce fait la qualité du travail et abaissant les risques pour la société dans son ensemble lors de ralentissements économiques18. La recherche de la croissance économique comme solution unique et principale aux problèmes sociétaux a été et demeure une idéologie dominante de la plupart des gouvernements, incluant celui du Canada. Mais cette idéologie est de plus en plus remise en question, non seulement par les environnementalistes, mais aussi par des économistes, tel Jeff Rubin (ancien économiste en chef Marchés mondiaux CIBC) qui laisse entendre que le prix élevé du pétrole pourrait freiner la croissance ou même y mettre fin, si on ne change pas notre façon traditionnelle de la voir ou de la promouvoir19. Quelle que soit la voie qu'empruntera le développement économique au Canada à l'avenir, elle devrait comporter un équilibre afin que la création d'emploi et la protection sociale aillent de pair avec les investissements. L'adoption d'une approche équilibrée est promue activement par le Global Agenda Council on Employment and Social Protection [Conseil de l'agenda mondial sur l'emploi et la protection sociale] du Forum économique mondial. Plus spécifiquement, le Conseil propose les mesures suivantes pour favoriser un développement équilibré : des investissements ciblés dans l'infrastructure; des investissements gouvernementaux dans les « emplois verts »; une fiscalité axée sur les torts causés à l'environnement plutôt que sur l'emploi; des allégements fiscaux ou des augmentations en espèces aux ménages à faible revenu; un salaire minimum élevé pour prévenir la déflation; une plus grande progressivité dans le système fiscal; des taux plus élevés d'investissement dans des programmes actifs liés au marché du travail; des procédés flexibles destinés à promouvoir la rétention d'emploi et le partage d'emploi.20 Tout en reconnaissant qu'une réforme de certains programmes sociaux pourrait s'imposer pour tenir compte de changements démographiques (p. ex. le vieillissement de la population), le Conseil conclut que l'expérience des pays nordiques démontre que des programmes sociaux plus complets ne constituent pas un obstacle à un bon rendement économique. Par contre, le rendement récent des États-Unis tend à démontrer que des programmes de protection relativement peu développés pourraient constituer une source de faiblesse et d'instabilité plutôt qu'une source de vigueur. La question n'est donc pas de savoir si on a les moyens de s'offrir des programmes sociaux plus complets, mais plutôt de savoir qui paie et combien. « Là où des systèmes de protection sociale ont besoin d'être réformés, les gouvernements ont le choix : ils peuvent soit imposer des changements ou négocier des changements avec les parties prenantes concernées. Il pourrait être 18

OECD, Vers une croissance pro-pauvres : La protection sociale, 2009,22-25 Jeff Rubin, Why Your World is About to Get a Whole Lot Smaller, Vintage Canada, 2010 et Jeff Rubin, The End of Growth, Random House of Canada, 2012.

19

20 World Economic Forum, Global Agenda Council on Employment and Social Protection, The Case for an Integrated Model of Growth, Employment and Social Protection, 2012, 5. Les quelques paragraphes qui suivent sont essentiellement inspiré de ce rapport,13-15.


plus long de parvenir à un consensus avec les partenaires sociaux, mais il s'agit d'un moyen plus certain (et démocratique) de parvenir à une solution durable21. L'ACTS propose trois moyens par lesquels le gouvernement du Canada pourrait favoriser une équité pancanadienne en matière de revenu, en matière sociale et de santé : (1) en instaurant un revenu de base; (2) en recourant au Transfert canadien en matière de programmes sociaux pour financer la sécurité du revenu et promouvoir l'inclusion sociale; (3) en renforçant l'appui fédéral envers les services de soins de santé provinciaux et territoriaux. De manière plus spécifique, en ce qui concerne l'équité du revenu, l'ACTS recommande que le gouvernement fédéral amorce un processus visant à revoir et à renouveler le système de sécurité du revenu au Canada dans le but d'instaurer un revenu de base ciblé et abordable. Un revenu de base pourrait faire fond sur les mécanismes existants d'impôt négatif, tels le Supplément de revenu garanti à l'intention des aînés, la Prestation fiscale canadienne pour enfants à l'intention des familles ayant de jeunes enfants, la Prestation fiscale pour le revenu de travail et le Crédit pour la TPS/TVH. La mise en œuvre d'un revenu de base global exigerait que le gouvernement fédéral s'engage dans un processus de planification judicieuse avec les gouvernements provinciaux et territoriaux, en s'appuyant sur un principe de fédéralisme coordonné, comme celui prôné dans ce rapport. Deuxièmement, en ce qui a trait à l'équité sociale, l'ACTS recommande que le gouvernement fédéral s'inspire de l'Union européenne (UE) et utilise une technique de gouvernance comme la Méthode ouverte de coordination (MOC) pour assurer que les programmes de sécurité du revenu et de services sociaux aient une dimension pancanadienne. La MOC est un processus cyclique qui implique l'élaboration d'objectifs, de buts, de lignes directrices et d'indicateurs à l'échelle de l'UE; leur transposition dans les plans nationaux des États membres; un examen par les pairs et la présentation de rapports publics. Le processus est géré par un système très élaboré de relations intergouvernementales mettant à contribution la Commission européenne et les gouvernements de chacun des 28 États membres, de même que des partenaires sociaux et des organisations de la société civile à l'échelle de l'UE. En Europe, la MOC s'est avérée une méthode souple et efficace d'amener des gouvernements de perspectives et de convictions très différentes à collaborer en vue de s'attaquer à des problèmes communs comme la réduction de la pauvreté et l'exclusion sociale. Pour aller dans le même sens, le gouvernement fédéral devrait entreprendre des rencontres avec les provinces et territoires pour discuter de l'avenir du Transfert canadien en matière de programmes sociaux. Cela veut dire des discussions qui ne se limiteraient pas aux sommes d'argent transférées, mais qui porteraient aussi sur les conditions auxquelles seraient effectués les transferts. 21 World Economic Forum, Global Agenda Council on Employment and Social Protection, The Case for an Integrated Model of Growth, Employment and Social Protection, 2012, 15


À défaut de fixer des conditions dès le départ pour les transferts, les deux ordres de gouvernement devront, d'abord et avant tout, décider s'ils sont en mesure de s'entendre sur des objectifs communs et sur un cadre stratégique applicable à la sécurité du revenu et aux programmes sociaux. Troisièmement, en ce qui concerne l'équité en santé, l'ACTS recommande que le gouvernement fédéral entreprenne des actions en vue d'assurer que les conditions de la Loi canadienne sur la santé (administration publique, intégralité, universalité, transférabilité et accessibilité) sont respectées avant que le financement fédéral ne soit transféré aux provinces et territoires. L'ACTS recommande, en outre, que le gouvernement fédéral prenne l'initiative et offre des incitatifs financiers aux provinces et territoires dans le but de transformer le système de santé en un système centré sur le patient, ancré dans la collectivité, efficace et à moindre coût. Une façon d'y parvenir serait de financer une initiative pancanadienne visant l'élaboration d'indicateurs d'analyse comparative pouvant soutenir la reddition de compte et stimuler le changement. L'ACTS recommande aussi que la part fédérale des coûts du système de santé couvre, à court terme, 20 % des dépenses totales de l'État et que la proportion des dépenses publiques en santé demeure à environ 70 % des dépenses totales en santé. Ces deux cibles sont réalistes dans l'environnement économique actuel. Elles ont été atteintes au cours des dernières années et dépassées précédemment. Le raisonnement qui sous-tend ces recommandations (et d'autres y étant liées) est exposé en détail dans les sections qui suivent de ce rapport. Chaque section comprend : (i) un exposé du contexte, incluant certaines recherches pertinentes; (ii) une déclaration de la valeur et de l'importance d'un leadership fédéral; (iii) un ensemble de recommandations.

Équité du revenu Introduction Le Canada a mis au point un éventail complexe et parfois déconcertant de programmes de soutien du revenu au cours des derniers cent ans. Ils ont été élaborés plus ou moins au cas par cas et de manière progressive, ayant des buts et des populations cibles diversifiés. Certains ont été conçus à l'intention de groupes d'âge particuliers (p. ex. les enfants et les aînés). D'autres visaient à offrir un soutien à des personnes aux prises avec la maladie, les conséquences d'un accident de travail ou d'un handicap. Par ailleurs, d'autres étaient centrés sur des défis économiques liés à la famille (p. ex. une situation de veuvage ou de monoparentalité) ou au statut d'une personne sur le marché du travail (p. ex. une assurance contre le chômage, des programmes de travail obligatoire et des crédits d'impôt à l'intention des travailleurs à faible revenu).


On a également assisté à une division des responsabilités au chapitre de la sécurité du revenu entre les gouvernements fédéral et provinciaux, les programmes d'assistance financière et les programmes plus universels étant en règle générale offerts par le gouvernement fédéral et les programmes de sécurité du revenu de dernier recours, telle l'aide sociale, étant laissés aux provinces. Malgré le large éventail de programmes de sécurité du revenu existant au Canada, la pauvreté persiste et il arrive souvent que des personnes à court de revenus ou de ressources économiques passent entre les mailles du filet de sécurité sociale actuel. Conséquemment, les appels se font de plus en plus nombreux pour la mise en place d'un régime de revenu de base étendu qui éliminerait la complexité et les chevauchements dans la prestation de la sécurité du revenu au moyen d'un mécanisme plus englobant et inconditionnel. Dans sa forme la plus ambitieuse, un revenu de base viserait à assurer que tous jouissent d'un revenu adéquat ne comportant aucune ou que peu de conditions22. La section contexte ci-dessous définit et énonce les éléments d'un revenu de base, en plus de fournir une description de deux modes de rechange de mise à disposition du revenu de base, soit au moyen de subventions démographiques ou d'un impôt négatif. On y présente ensuite un bref historique de la question du revenu de base et des propositions formulées par le passé au Canada. On y trouvera ensuite certaines recommandations voulant que le gouvernement fédéral aille de l'avant avec les provinces et territoires pour mettre en place une version du revenu de base qui soit réalisable sur le plan constitutionnel, tout en étant à la fois durable et abordable. De l'avis de l'ACTS, une telle initiative contribuerait de manière significative à réduire l'inégalité du revenu et les conséquences négatives de taux élevés de pauvreté. Contexte Définition de revenu de base Le Basic Income Earth Network (BIEN) a été un éminent précurseur du revenu de base au cours du dernier quart de siècle. Il définit cette notion comme suit : un revenu de base est un revenu accordé inconditionnellement à tous les citoyens sur une base individuelle, sans qu'ils soient soumis à un examen des ressources ou à des exigences d'emploi. Il s'agit d'une forme de revenu minimum garanti qui se distingue de diverses formes actuelles de revenu garanti de trois façons importantes : o il est versé à des particuliers plutôt qu'à des ménages; 22 Au Canada et ailleurs, on parle parfois de revenu garanti pour traiter du revenu de base. Nous utilisons les mots « revenu de base », en partie pour éviter que le terme soit confondu avec des programmes canadiens existants, tel le Supplément de revenu garanti pour les aînés.


o il est versé sans égard à tout revenu provenant d'autres sources; o il est versé sans que la personne soit requise de travailler ou de se montrer disposée à accepter un emploi, si on lui en offre un23. On retrouve un éventail de propositions relatives à ce qu'on a habituellement appelé revenu annuel garanti au Canada. Les propositions afférentes à une forme de revenu de base made-inCanada incorporent certains éléments de la définition formulée par BIEN, mais pas tous. Par exemple, certaines ciblent des groupes d'âge particuliers, tels les enfants ou les aînés. D'autres sont conçues comme un supplément visant à remplacer un revenu d'emploi pour les personnes incapables de travailler. Qu'il s'agisse d'une définition globale, telle celle énoncée par BIEN, ou d'une définition partielle, telle celle proposée au Canada, il existe deux façons générales de verser un revenu de base en espèces et à grande échelle à des particuliers ou des ménages, en l'occurrence au moyen d'une subvention démographique universelle ou d'un impôt négatif24. Une subvention démographique universelle comprend une allocation forfaitaire, normalement libre d'impôt, versée à tous les citoyens (adultes). En vertu de cette forme de revenu de base, un montant égal est versé à toutes les personnes, sans égard à leur niveau de revenu, et sur une base prévisible et régulière (p. ex. mensuellement). Une subvention démographique de ce genre pourrait ou non constituer un revenu imposable. Un revenu de base fondé sur une subvention démographique pourrait être associé à une forme d'impôt sur le revenu progressif en vertu duquel les personnes ayant un revenu plus élevé sont assujetties à des taux plus élevés, ou associé à un régime fiscal quelque peu régressif ou forfaitaire en vertu duquel tous paient le même taux, quel que soit leur revenu. Conséquemment, l'imposition d'autres formes de revenu (p. ex. les gages ou les salaires) aurait des incidences différentes sur la façon dont les subventions démographiques seraient financées et sur la part de celles-ci qui serait redistribuée. Nombreux sont ceux qui soutiennent que des taux d'imposition plus progressifs ou des taux plus élevés de manière généralisée seraient nécessaires pour financer un revenu de base. Un impôt sur le revenu négatif procure un revenu de base à toute personne dont le revenu est inférieur à un seuil préétabli de revenu minimalement adéquat. Ce seuil peut être ajusté en fonction de la configuration et de la taille d'une famille. Hypothétiquement, ce seuil pourrait être fixé à 20 000 $ pour un adulte vivant seul et à 36 000 $ pour un couple, 6 000 $ venant s'ajouter 23

http://www.basicincome.org/bien/ La discussion qui suit est fondée sur la notice explicative qui apparaît à la page 21 de Young, Margot et James P. Mulvale. 2009. Possibilities and Prospects: The Debate Over a Guaranteed Income. 2009. http://www.policyalternatives.ca/publications/reports/possibilities-and-prospects 24


à cette somme pour chaque enfant ou adulte à charge faisant partie de cette famille. Ainsi, dans le cas d'un couple marié ayant deux enfants, le seuil de revenu adéquat serait de 48 000 $ par année.

Advenant que le revenu avant impôt d'un ménage se situe précisément à ce seuil, cette famille ne paierait aucun impôt, mais ne recevrait aucune contribution. Si le revenu était supérieur à ce seuil, la famille paierait des impôts en fonction des taux prescrits. Advenant que le revenu de la famille soit inférieur à ce seuil, elle serait admissible à une prestation complémentaire égale à son manque à gagner. Ainsi, si son revenu avant impôt était de 30 000 $, cette famille recevrait une prestation d'impôt négatif (PIN) de 18 000 $. Dans le rare cas où une famille n'aurait aucun revenu de source quelconque, elle recevrait la pleine prestation de 48 000 $. En principe, un impôt sur le revenu négatif ciblant les personnes à faible revenu s'avérerait moins coûteux qu'une subvention démographique universelle versée à tous les citoyens. Ce modèle comporte un désavantage, en l'occurrence le délai entre le moment de la réclamation et la réception de la prestation. Ainsi, si les prestations étaient fondées sur la déclaration de revenu de l'année précédente, il pourrait s'écouler jusqu'à une année complète avant que la prestation ne soit reçue. Une personne ayant besoin d'un revenu immédiat pourrait devoir attendre, alors qu'une personne dont la situation économique s'est améliorée pourrait recevoir une prestation dont elle n'a plus vraiment besoin25. Propositions relatives au revenu de base au Canada Les débats entourant le revenu de base ont cours depuis très longtemps et remontent aux années 1500 de l'ère moderne de la pensée politique26. Au Canada du vingtième siècle, l'idée d'un revenu de base comme moyen d'assurer une sécurité financière et l'équité a fait surface à divers moments dans le cadre de plusieurs propositions, études et campagnes27. Dans les années 1930, le gouvernement du crédit social de l'Alberta prônait que des paiements en espèces soient versés à tous par le gouvernement provincial, comme moyen de stimuler l'économie et de redistribuer la richesse. Mais la promesse d'un tel crédit social universel ne s'est pas concrétisée en raison du manque d'argent de la province et de l'opposition du gouvernement fédéral. 25 Les propositions relatives aux PIN pourraient s'attaquer à ce problème au moyen d'une disposition permettant aux personnes dont la situation économique se détériore et qui ont besoin d'un soutien de revenu immédiat de présenter une demande anticipée. De telles réclamations pourraient être conciliées à des périodes d'imposition subséquentes, lorsque leur situation pourrait s'être améliorée. Dans le cadre d'un régime fondé sur des PIN, il serait peut-être sage de retenir les prestations d'aide sociale comme option résiduelle pour les personnes ayant des besoins urgents et immédiats et qui n'ont pas encore produit une déclaration de revenu permettant d'établir les prestations de PIN auxquelles elles auraient droit. 26 Consulter le site : http://www.basicincome.org/bien/aboutbasicincome.html#history 27 Young and Mulvale, 2009, pp. 12 – 16. La discussion qui suit est fondée sur cette source. Consulter aussi Mulvale, James P. et Yannick Vanderborght. 2012. “Canada: a guaranteed income framework to address poverty and inequality?” Dans R. Caputo (dir.), Basic Income Guarantee and Politics. New York : Palgrave Macmillan.


En 1968, le Conseil économique du Canada, une société de la Couronne financée par le gouvernement fédéral, soulignait que la pauvreté au Canada sévissait à une échelle beaucoup plus large que ne le soupçonnaient la plupart des Canadiens et mettait de l'avant l'idée d'un revenu de base comme solution possible à ce problème. En 1971, un Comité spécial du Sénat sur la pauvreté, présidé par le sénateur David Croll, a recommandé l'instauration d'un revenu de base financé et géré par le gouvernement fédéral et mis en œuvre au moyen d'une prestation d'impôt négatif. Ce régime aurait permis d'assurer un revenu de base correspondant à au moins 70 % du seuil de la pauvreté, mais n'aurait pas été versé à des adultes célibataires de moins de 40 ans, capables de travailler. Cette même année, la Commission Castonguay-Nepveu recommandait un plan de sécurité du revenu en trois volets pour le Québec, comprenant un impôt négatif de base, des prestations à l'intention des personnes en mesure de travailler dans le but de suppléer leur faible revenu et des prestations bonifiées aux personnes n'étant pas en mesure de travailler. À peu près au même moment, le ministère de la Santé nationale et du Bien-être avançait l'idée d'un modèle de revenu de base comme moyen de lutte à la pauvreté, et demandait qu'on procède à des études et des enquêtes plus poussées. En 1970, la Commission royale d'enquête sur la situation de la femme recommandait que le gouvernement fédéral verse un revenu annuel garanti à tous les chefs de famille monoparentale ayant des enfants à charge. En 1973, un gouvernement fédéral libéral minoritaire a lancé un examen de la sécurité sociale, qui prônait la mise en œuvre d'une approche de la sécurité sociale à deux volets, incluant un revenu annuel garanti pour les personnes incapables de travailler et un supplément de revenu pour les travailleurs à faible revenu. À l'issue des années 1970, les discussions entourant la mise en œuvre d'un revenu garanti ont graduellement disparu du discours public, alors qu'on était davantage préoccupé par l'inflation, le chômage et la nécessité perçue que les gouvernements procèdent à des compressions de dépenses. L'idée a néanmoins continué de mijoter dans certains milieux et, de 1974 à 1979, un projet pilote, intitulé Mincome, a été réalisé à Dauphin (Manitoba) sous l'égide des gouvernements provincial et fédéral. Bien que ce projet expérimental en soit venu à perdre ses appuis politiques et bien qu'il n'ait pas publié de constats officiels, une analyse récente de données relatives à la santé de la population, réalisée par la Dre Evelyn Forget, fait état de nombreux résultats positifs attribuables au régime Mincome. Ces résultats incluent une baisse significative des hospitalisations (notamment des admissions liées à des accidents ou des blessures); une baisse des visites chez le médecin aux


fins de diagnostics afférents à la santé mentale; une proportion plus élevée d'étudiants de niveau secondaire poursuivant leurs études jusqu'en 12e année28. Hum et Simpson, qui ont participé activement à l'élaboration du projet Mincome, soulignent en outre que l'expérience de Dauphin n'a pas entraîné une réduction significative de la maind'œuvre, contrairement à un argument souvent exprimé par certains critiques voulant qu'un revenu de base garanti ait comme conséquence que les gens se retirent du milieu du travail rémunéré29. En 1982, une Commission royale sur l'union économique et les perspectives de développement du Canada (la Commission Macdonald) a encore une fois recommandé la mise en œuvre d'une forme de revenu de base. Ce revenu était établi à un très faible niveau et impliquait l'élimination d'autres mesures de sécurité sociale, telles que l'assurance-chômage et la sécurité de la vieillesse. Cette proposition a fait face à une vive opposition de la part du mouvement syndical et d'autres organisations de la société civile en raison de sa nature restrictive. Au cours des années de gouvernement minoritaire de 2008 à 2011, des appels ont été entendus de la part de comités du Sénat et de la Chambre des communes demandant qu'on aille de l'avant avec la mise en œuvre d'un modèle de revenu de base30. Le Sous-comité sur les villes du Comité sénatorial permanent des affaires sociales, des sciences et de la technologie a publié un rapport intitulé Pauvreté, logement, itinérance : les trois fronts de la lutte contre l’exclusion. On y recommandait une large gamme de mesures pour contrer la pauvreté et le sans-abrisme, et pallier le manque de logement abordable. Le sous-comité a en outre formulé deux recommandations particulières au sujet du revenu de base : …que le gouvernement fédéral publie un livre vert qui présentera les coûts et les avantages des mesures actuelles de soutien du revenu et traitera de différentes solutions pour réduire et éliminer la pauvreté, y compris un revenu annuel garanti basé sur un impôt négatif, ainsi qu‘une évaluation détaillée des projets pilotes concernant un revenu de base qui ont été menés au Nouveau-Brunswick et au Manitoba (recommandation 5); … que le gouvernement fédéral élabore et mette en œuvre une garantie de revenu de base 28

Evelyn L. Forget, The Town with No Poverty—Using Health Administration Data to Revisit Outcomes of a Canadian Guaranteed Annual Income Field Experiment, 2011.

29 Derek Hum et Wayne Simpson (2001+01/02) "A Guaranteed Annual Income? From Mincome to the Millenium", Policy Options/Oprions politiques, pp. 78-82 30

Le travail de ces deux comités parlementaires est décrit dans Mulvale & Vanderborght, 2012


égal ou supérieur au seuil de faible revenu (SFR)31 pour les personnes ayant une incapacité grave. (Recommandation 53). Un comité de la Chambre des communes a également recommandé que le gouvernement conservateur « crée un programme fédéral de soutien du revenu de base à l’intention des personnes handicapées et appuie un programme de mesures de soutien pour les personnes handicapées qui serait offert par les provinces et les territoires ». Le Comité « a décidé de ne pas formuler de recommandation sur un Revenu annuel garanti (RAG) universel, jugeant préférable de procéder par étapes et de débuter par un programme ne profitant qu'aux personnes handicapées ». Bien que le comité de la Chambre des communes ait été moins favorable que celui du Sénat à l'idée d'un revenu de base universel, celui-ci a néanmoins traité de la possibilité de chercher à mettre en œuvre un revenu de base universel de façon progressive. Le sénateur conservateur Hugh Segal32 est peut-être le plus éminent promoteur d'un revenu de base sur la scène politique contemporaine à Ottawa. Il a, en effet, proposé publiquement et de manière répétée l'instauration par le gouvernement fédéral d'un revenu de base garanti, soutenant que le Canada possède les ressources nécessaires pour assurer que chaque citoyen puisse vivre dans la dignité. Selon Segal « quand on considère les milliards que nous dépensons actuellement au chapitre de la politique sociale, il est clair que nous en avons les moyens33 ». En février 2008, Segal a déposé un avis de motion, demandant au Sénat de « procéder à une étude approfondie de la faisabilité d'un revenu annuel garanti (RAG)…ou d'un impôt négatif comme moyens de réduire la pauvreté et d'apporter une solution réelle aux personnes vivant sous ce que l'on considère comme le seuil de la pauvreté au Canada34». L'idée d'un revenu de base a été proposée en provenance de tous les horizons politiques. Dans les années 1960, l'économiste Milton Friedman a été un éminent partisan de droite d'un revenu de base qui prendrait la forme d'un impôt négatif ainsi qu'un ardent promoteur du libre marché et du capitalisme de laisser-faire35. Dans le contexte contemporain au Canada, un groupe de réflexion centriste, tel le Conference Board of Canada, va dans le même sens. Son premier vice-président et économiste en chef, Glen

31 Le seuil de faible revenu est une mesure utilisée par Statistique Canada et un point de référence populaire cité par les organismes communautaires comme ligne de la pauvreté au Canada. 32

Segal, Hugh. 2008 (April). Guaranteed annual income: why Milton Friedman and Bob Stanfield were right. Policy Options http://www.irpp.org/en/po/budget-2008/guaranteed-annual-income-why-milton-friedman-and-bob-stanfield-were-right/

33

Selon le Toronto Star du 5 mars 2007.

34

Citations provenant d'un Communiqué et d'un Avis de motion émanant du bureau du sénateur Hugh Segal, Sénat du Canada, le 6 février 2008. 35

Friedman, Milton. 1962. Capitalism and Freedom. Chicago: University of Chicago Press.


Hodgson, écrivait récemment : « un revenu annuel garanti demeure une "grande idée" attrayante dont le moment n'est pas encore venu politiquement. Il n'y a pas de meilleur moment que maintenant pour attiser le débat36. L'appui de Hodgson pour l'option d'un revenu de base est fondé sur trois avantages de ce modèle de sécurité sociale : Les programmes de bien-être social pourraient être rationalisés et donner lieu à un système universel unique de transferts, livrés sans condition par le truchement du régime d'impôt sur le revenu, ce qui réduirait considérablement l'administration publique et donnerait lieu à des économies correspondantes. Les bénéficiaires demeureraient fortement incités à travailler, si leur revenu gagné était imposé à de faibles taux marginaux, ce qui renforcerait leur attachement au marché du travail et accroîtrait la disponibilité de travailleurs. Les dépenses en santé pour les Canadiens à faible revenu pourraient être moindres, si un revenu de base venait atténuer la prévalence de la pauvreté et contribuer à de meilleurs résultats en santé. 37 Hodson poursuit en affirmant qu'un régime de Revenu annuel garanti pourrait être mis sur pied par le biais d'une approche des relations fédérales-provinciales semblable à celle mise de l'avant dans ce document. « Comme l'aide sociale et les soins de santé financés par le secteur public sont offerts par les provinces, il faudrait assurer une bonne coordination des gouvernements fédéral et provinciaux pour qu'un revenu de base atteigne les buts désirés. » Hodson fait en outre valoir « qu'une prochaine étape réaliste serait de procéder à une analysepilote des impacts d'un revenu annuel garanti dans une ou plusieurs collectivités, évaluant ses incidences fiscales et économiques et les économies fiscales potentielles au fil des ans, notamment celles liées aux soins de santé financés par le secteur public. Enjeux pratiques et stratégiques S'il se développe une volonté publique et politique suffisamment ferme d'adopter une approche de la sécurité sociale fondée sur une approche de revenu de base, il sera crucial d'élaborer une stratégie pratique destinée à maximiser la possibilité que ces efforts portent des fruits. Par le passé, les gouvernements canadiens ont introduit de nouveaux programmes sociaux en procédant graduellement. Tant pour des raisons politiques que financières, une approche graduelle de mise 36

Hodgson, Glen. 2011 (Dec.). A Big Idea Whose Time Has Yet to Arrive: A Guaranteed Annual Income. Ottawa: The Conference Board of Canada. www.conferenceboard.ca/economics/hot_eco_topics/default/11-1215/A_Big_Idea_Whose_Time_Has_Yet_to_Arrive_A_Guaranteed_Annual_Income.aspx 37

Cf. Hodgson ci-dessus


en œuvre d'un régime de revenu de base pourrait s'avérer la plus viable sur les plans politique et financier. Le Canada dispose déjà de mécanismes de soutien du revenu, qui pourraient potentiellement être amalgamés pour créer un système plus global et plus coordonné de revenu de base pour tous. L'assortiment de programmes existant est largement axé sur les différentes étapes du cycle de vie. Dans le cas des familles ayant de jeunes enfants, la Prestation fiscale pour enfants/Programme de la prestation nationale pour enfants utilise un mécanisme d'impôt négatif pour livrer des avantages aux parents de ménages à faible revenu. Il existe également une Prestation universelle pour la garde d'enfants, qui ressemble à une subvention démographique. Bien qu'il s'agisse de montants modestes, aucune condition ne s'applique à la façon dont les sommes peuvent être dépensées par les familles prestataires. Le Caledon Institute on Social Policy a mis au point une proposition intéressante qui simplifie les prestations aux enfants et les rend plus progressives (en fonction de cette proposition, des montants plus élevés seraient versés aux familles ayant les plus rands besoins). En vertu de l'approche prônée par Caledon, la Prestation canadienne fiscale pour enfants et le Supplément de la prestation nationale pour enfants combinés atteindraient 5 400 $ par enfant. Ainsi, le coût total des prestations pour enfants n'excéderait pas la dépense actuelle de 19 milliards de dollars38. Selon Caledon, les coûts additionnels de telles prestations majorées (4 milliards de dollars), seraient compensés par l'élimination de la Prestation universelle pour la garde des enfants et du Crédit d'impôt non remboursable (dont le coût est d'environ 4 milliards de dollars). Une telle réforme du cadre de référence des prestations aux enfants constituerait une forme partielle de revenu de base (en fonction du revenu et ciblée) à l'intention des familles ayant de jeunes enfants, De même, dans le cas des aînés, il existe la Sécurité de la vieillesse/Supplément de revenu garanti. La Sécurité de la vieillesse est versée à la manière d'une subvention démographique (bien qu'elle soit imposable pour les aînés ayant un revenu plus élevé) et le Supplément de revenu garanti est un mécanisme d'impôt négatif ciblant les aînés à faible revenu. Un autre mécanisme d'impôt négatif moyennement modeste est en place à l'intention des adultes à faible revenu; il s'agit en l'occurrence du crédit pour la TPS/TVH. La Prestation fiscale pour le revenu de travail vise à favoriser l'adhésion au marché du travail de personnes à faible revenu. Il existe, en outre, une myriade d'autres prestations fédérales (p. ex. l'Assurance-emploi et le Régime de pension du Canada, assujettis à diverses sous-catégories de critères d'admissibilité), 38 Sherri Torjman and Ken Battle. Welfare Re-form: The Future of Social Policy in Canada. Ottawa: Caledon Institute on Social Policy, Novembre 2013, pp. 7 -8


sans mentionner l'aide sociale et d'autres mesures (généralement de dernier recours) offertes par les provinces. Le patchwork canadien de programmes de sécurité du revenu n'est rien sinon complexe et à couches multiples et, la plupart du temps, une source de confusion pour les personnes désirant ou ayant besoin d'aide. L'un des avantages du modèle fondé sur un revenu de base est qu'il pourrait atténuer cette complexité, rendre plus facile de naviguer dans le système de sécurité sociale et, de ce fait, permettre d'amoindrir les coûts administratifs. Conséquemment, un objectif important du processus serait, à long terme, de coordonner un régime de revenu de base dans le but de réduire la complexité de l'éventail des programmes actuels et, du même coup, d'éliminer les dédoublements et de combler les écarts. Cet exercice d'envergure nationale se déroulerait préférablement dans un esprit de fédéralisme coordonné où le gouvernement fédéral jouerait un rôle de chef de file, mais coordonnerait son action avec celles des provinces et territoires afin que des initiatives nationales soient adaptées aux circonstances locales. Il pourrait s'avérer plus facile de concevoir un seuil minimum de sécurité du revenu plus simple et plus efficace, si on respectait la répartition constitutionnelle des compétences fédérales/provinciales. Les provinces pourraient concentrer leurs ressources à assurer des services sociaux et de santé aux personnes requérant un soutien plus poussé que le simple fait de recevoir ce qui leur faut pour vivre, alors que le gouvernement fédéral pourrait jouer un rôle de premier plan pour offrir un programme de sécurité du revenu d'une manière plus homogène et efficace – ou à tout le moins en partager les coûts. Une proposition intéressante en ce sens émane du Caledon Institute on Social Policy39 qui propose l'instauration d'un revenu de base versé par le gouvernement fédéral, ciblant de manière particulière les personnes ayant des handicaps graves et prolongés. Si un tel programme existait, les fonds qui auraient autrement été dépensés par les gouvernements des provinces et territoires au titre du soutien du revenu des personnes handicapées pourraient être réaffectés à un large éventail de mécanismes de soutien aux personnes handicapées. Bien que l'approche proposée par Caledon soit plus ciblée et catégorique que celle mise de l'avant dans le présent document (l'approche de Caledon ne s'appliquant qu'aux personnes gravement handicapées), elle établit néanmoins une distinction claire entre la responsabilité fédérale en matière de soutien du revenu et celle des provinces et territoires responsable des services et de l'appui dont les gens ont besson pour vivre dans la dignité et de manière autonome. Pour parvenir à mettre en œuvre un régime de revenu de base, il faudra s'assurer du soutien de divers secteurs de la population, au-delà de la sphère politique et des fonctionnaires spécialistes des politiques. Il faudra bâtir une large coalition de personnes favorables à un revenu de base, 39 Sherri Torjman and Ken Battle. Welfare Re-form: The Future of Social Policy in Canada. Ottawa: Caledon Institute on Social Policy, novembre 2013.


s'inspirant des travaux d’universitaires, d'analystes des politiques du secteur volontaire, de groupes de réflexion, de même que des militants de la base40. Évaluation des coûts Toute forme de revenu garanti entraînerait évidemment des transferts gouvernementaux importants, bien que les coûts puissent varier considérablement en fonction de la nature du programme. Dans le cadre de travaux préliminaires visant à estimer le coût réel de la mise en œuvre d'un revenu garanti au Canada, Lerner, Clark et Needham ont élaboré un modèle hypothétique en vertu duquel le revenu de base serait versé en tant que subvention démographique universelle à tous les citoyens et résidents permanents. Ils ont établi à 198,6 milliards de dollars (en dollars de 1999) la mise en œuvre d'un régime qui assurerait un revenu de 7 000 $ aux personnes de 65 ans et plus, de 5 000 $ aux personnes de 21 à 64 ans, de 3 000 $ aux personnes de moins de 21 ans, en plus d'une somme additionnelle de 5 000 $ versée à tous les ménages et à être divisée en parts égales entre tous les membres qui composent un ménage41. Ils entrevoyaient ce régime comme un remplacement des prestations fédérales versées aux aînés et aux enfants ainsi que des prestations d'assurance-emploi. On a établi le coût net de ce régime de revenu garanti à 161,7 milliards de dollars en dollars de 199942. À titre de comparaison, le revenu total du gouvernement fédéral pour l'exercice 1999/2000 excédait légèrement 178 milliards de dollars. Un tel régime goberait presque entièrement les revenus de l'État et serait clairement inabordable. Par ailleurs, en 1994, Développement des ressources humaines Canada a procédé à une analyse des coûts d'un revenu garanti offert à titre de subvention démographique universelle comparativement à une version d'impôt négatif de ce même revenu. On a estimé que l'offrir sous la forme d'une subvention démographique, entraînerait des dépenses additionnelles de l'ordre de 93 milliards de dollars, bien que les prestations offertes soient bien en deçà de ce qu'il faut pour vivre. Par contre, on a estimé à 37,3 milliards de dollars le fait de l'offrir sous la forme d'un impôt négatif. On a jugé que cette option serait à coût neutre puisqu'elle pourrait être financée à même 40 Le Réseau canadien pour le revenu garanti, l'affiliée canadienne du Basic Income Eartn Network (BIEN), regroupe déjà bon nombre des ces forces vives. 41 Lerner, S., C.M.A. Clark, et W.R. Needham. 1999. Basic Income: economic security for all Canadians. Toronto: Between the Lines. 42 À titre de comparaison, le revenu total du gouvernement fédéral pour l'exercice 1999-2000 était d'un peu ^plus que 178 milliards de dollars. Cf. Rapport financier annuel du gouvernement du Canada; Exercice 1999-2000.


les économies réalisées dans d'autres programmes, tels que l'assurance-chômage, la Prestation fiscale pour les enfants et les contributions fédérales au titre de l'aide sociale. Dans une autre étude, Hum et Simpson ont estimé les coûts de diverses versions de prestations universelles non imposables correspondant au seuil de la pauvreté, jumelée à un taux de récupération fiscale applicable au revenu gagné. Dans l'un des scénarios envisagés, un revenu garanti s'avérait très dispendieux au coût de 217,1 milliards de dollars, soit près du triple des paiements de transferts effectués à des personnes par le gouvernement fédéral en 2000. En revanche, Hum et Simpson ont estimé à moins de 37,8 milliards de dollars, une somme de beaucoup inférieure, le coût d'un régime de revenu garanti plus modeste et plus ciblé. Ils ont également conclu que la version la plus économique contribuerait de fait plus efficacement que la version plus généreuse à réduire la pauvreté43. En 2012, le sénateur Hugh Segal soutenait que les coûts globaux d'un régime de revenu garanti au Canada seraient gérables44. Il avançait ce qui suit: « Si le supplément moyen était de 10 000 $ par personne vivant sous le seuil de la pauvreté et si les trois millions de personnes ayant le plus faible revenu au Canada recevaient le plein montant, cela entraînerait une dépense initiale de 30 milliards de dollars – soit plus ou moins 10 % du budget fédéral actuel. Mais cette dépense initiale serait amoindrie grâce aux économies réalisées ailleurs. » Il reste encore à effectuer un travail au chapitre des politiques sociales, en l'occurrence une analyse détaillée et rigoureuse de l'éventail des options qui s'offrent aujourd'hui au Canada en ce qui a trait au revenu de base. Les estimations citées ci-dessus indiquent clairement qu'une approche fondée sur un impôt négatif serait la plus facilement réalisable sur le plan fiscal. Une partie de cette estimation des coûts pourrait permettre de jauger comment des prestations axées sur une approche d'impôt négatif interagit avec les autres prestations fédérales et provinciales, de même qu'avec l'impôt fédéral et provincial. Ainsi, une telle analyse pourrait apporter un éclairage sur les économies réalisées dans les programmes de prestations existants (p. ex. l'Assuranceemploi) qui seraient moins sollicités si un régime d'impôt négatif était en place. Si l'on pense à plus long terme, il serait également utile d'examiner plus à fond comment un revenu de base fondé sur un régime d'impôt négatif permettrait de réduire les dépenses dans des secteurs, tels que les soins de santé, la justice pénale et l'éducation spécialisée – compte tenu du 43

Hum, Derek et Wayne Simpson. 2005. "The Cost of Eliminating Poverty in Canada: Basic Income With an Income Test Twist." Pp. 282 – 292 , dans K. Widerquist, M. Lewis, et S. Pressman (dir.), The Ethics and Economics of the Basic Income Guarantee. Aldershot, UK: Ashgate.

44

Hugh Segal, 2012 (déc.) "Scrapping Welfare; The Case for Garanteeing All Canadians an Income Above the Poverty Line". Litterary Review of Canada. http://reviewcanada.ca/magazine/2012/12/scraping-welfare/


rapport bien établi entre la pauvreté et des résultats sociaux négatifs comme une mauvaise santé, des démêlés avec la justice et le développement des enfants45. Un revenu de base au Canada, qui offrirait des prestations raisonnables et aurait une large portée, nous permettrait de réduire la pauvreté et l'écart de revenu entre les riches et les pauvres. Non seulement cela permettrait-il de réaliser des économies immédiates dans les programmes de sécurité du revenu, cela pourrait également permettre de réduire les dépenses de l'État à plus long terme, en atténuant les résultats sociaux négatifs découlant de taux élevés de pauvreté et de l'insécurité économique. Nécessité d'un leadership fédéral Les projections de coûts présentées ci-haut fournissent un aperçu du coût des différents scénarios en matière de revenu de base, mais d'autres études s'imposent manifestement pour en arriver à des données détaillées et à jour. De telles études se pencheraient sur différents mécanismes de mise en œuvre, divers niveaux de prestations, de même que sur l'incidence qu'auraient divers mécanismes gouvernementaux de génération de revenus sur le caractère abordable de telles mesures. Une analyse aussi résolue des finances publiques illuminerait la voie à suivre pour mettre en œuvre un régime de revenu de base atteignable et efficace dans l'ensemble du pays. On ne saurait procéder à la modernisation et l'amélioration du régime de sécurité sociale au Canada sans leadership fédéral. À l'heure actuelle, le gouvernement fédéral absorbe la plus grande part du coût des paiements de transferts aux particuliers. Les provinces et territoires sont des joueurs importants, mais secondaires. En outre, si un revenu de base devait être offert par le truchement d'un mécanisme d'impôt négatif, il serait essentiel que le gouvernement fédéral assume un leadership pour assurer la coordination intergouvernementale des arrangements et des ententes fiscales46. L'un des avantages de recourir à un mécanisme d'impôt négatif est qu'il s'agit d'une approche qui a fait ses preuves dans le cadre de transferts existants aux particuliers et aux familles. Un régime d'impôt négatif pourrait également servir à déterminer l'admissibilité et le montant des prestations, comme on le fait maintenant dans le cas de prestations ciblées, telles que la Prestation fiscale pour les enfants, le Supplément de revenu garanti applicable à l'intention des aînés, et la Prestation fiscale pour le revenu de travail. 45 Le sens des sous pour résoudre la pauvreté, Rapports du Conseil national du bien-être social, Vol. 130. Ottawa: Conseil national du bien-être social, automne 2011. . 46 Prônant la mise en œuvre d'un revenu de base fondé sur un impôt négatif au niveau fédéral, le sénateur Hugh Segal (2008) insiste sur le fait qu'un tel programme contribuerait non seulement à réduire la pauvreté, mais éliminerait aussi la nécessité d'un contrôle gouvernemental de la vie des pauvres, un contrôle nécessaire dans le cadre de programmes fondés sur les moyens, telle l'aide sociale.


En fait, un revenu de base global à l'intention des Canadiens à faible revenu pourrait être modelé (et financé en partie) à partir de ces prestations fédérales plus catégoriques. Les programmes existants, liés à la production d'une déclaration de revenus, pourraient être amalgamés et élargis au chapitre de l'admissibilité et du niveau des prestations. Qu'un régime de revenu de base prenne la forme d'une prestation ciblée ou qu'il soit plus universel, il faudrait que les ordres de gouvernement fédéral, provincial et territorial trouvent un terrain d'entente. Les provinces et territoires devraient accepter que le gouvernement fédéral joue un rôle de chef de file et qu'il assure la coordination en matière de sécurité du revenu47. Le gouvernement fédéral devrait favoriser la mise en œuvre (et dans une certaine mesure en partager les coûts) d'un régime de sécurité du revenu plus global, de même que de services de santé et de programmes sociaux au niveau provincial, qui s'attaquerait à plus long terme aux racines profondes de la pauvreté. Une répartition plus claire des responsabilités des diverses compétences, fédérales et provinciales, nous permettrait d'agir plus efficacement pour réduire la pauvreté et assurer une égalité du revenu plus grande à court et à moyen terme48.

47 Les provinces et territoires ont réclamé une réforme coordonnée des politiques sociales dans les années 1990. Cf. Ministerial Council on Social Policy Reform and Renewal, Report to the Premiers, 1995. 48 Un autre enjeu important, mais complexe, dépasse la portée de la présente discussion; il s'agit en l'occurrence de savoir quelle est la meilleure conception et quels sont les meilleurs mécanismes de soutien du revenu et de prestation des services pouvant être mis sur pied entre les gouvernements fédéral et autochtones. Au chapitre de la sécurité du revenu, il est intéressant de noter que certaines compétences autochtones (telle l'Inuvialuit Regional Corporation) versent à leurs résidents un dividende de faible valeur, mais universel, qui ressemble à un revenu de base provenant d'activités de développement économique, incluant l'extraction de ressources.


Proposition de l'ACTS L'ACTS recommande que le gouvernement fédéral lance un processus visant à revoir et à renouveler le régime de sécurité au revenu au Canada dans le but d'envisager la mise en place possible d'un régime de revenu de base ciblé et abordable. Il devrait initialement être ciblé afin d'offrir un soutien de revenu à toutes les personnes confrontées à une insécurité économique et vulnérables en raison de leur âge, de leur statut sur le marché du travail ou d'un handicap. Il contribuerait à une égalité économique accrue au pays et à l'inclusion sociale de personnes qui sont actuellement exclues du reste de la société. Un régime global de revenu de base pourrait s'appuyer sur des mécanismes d'impôt négatif comme le Supplément de revenu garanti, la Prestation fiscale canadienne pour enfants, la Prestation fiscale à l'emploi, de même que le crédit pour TPS/TVH. La mise en œuvre d'un régime global de revenu de base exigerait que le gouvernement fédéral entreprenne une planification minutieuse, en collaboration avec les gouvernements des provinces et territoires, fondée sur les principes du fédéralisme coordonné, comme il a été proposé dans le présent rapport. Un revenu de base comblerait en grande partie, sans le pallier entièrement, le besoin d'une aide financière provinciale ou territoriale aux personnes qui en ont immédiatement besoin ou qui ont des besoins pressants en raison de circonstances hors de leur contrôle. Une forme quelconque d'aide financière serait toujours nécessaire dans de tels cas. La majeure partie des personnes vivant actuellement de l'aide sociale serait, toutefois, admissible à un revenu de base. En concevant un revenu de base global, il serait important de déterminer comment celui-ci s'harmoniserait à d'autres programmes de compétence provinciale/territoriale (tels que la formation à l'emploi et les services de développement de l'enfance) ou de compétence fédérale (tels que l'assurance-emploi et les régimes de pension du Canada ou du Québec). Un tel examen serait guidé par le principe voulant que les sommes versées ne doivent pas être amoindries, mais, dans la mesure du possible être bonifiées et que le régime des prestations dans son ensemble soit simplifié et rationalisé en ce qui a trait aux procédures de demande et d'acceptation. En tant que programme ciblé (par opposition à une subvention démographique, plus universelle) un revenu de base géré au moyen d'un impôt négatif assurerait que les fonds publics sont dépensés de manière efficiente. Un revenu de base ciblé serait également financé en partie par le truchement de programmes fédéraux existants à l'intention des enfants, des personnes handicapées et des aînés, de même que par le truchement de contributions fédérales aux programmes provinciaux d'aide sociale par le biais di Transfert canadien en matière de programmes sociaux (TCPS).


Un revenu de base ciblé contribuerait de manière significative à réduire la pauvreté au Canada, en plus de réduire les coûts sociaux et financiers à long terme de la pauvreté dans des secteurs, tels que la santé, l'éducation et la justice pénale49. Les travailleurs sociaux ont une connaissance intime des difficultés auxquelles doivent faire face les clients dont le revenu est inadéquat. Chaque jour, les travailleurs sociaux sont exposés dans leur pratique professionnelle aux dommages engendrés par la pauvreté sur les plans social, émotionnel et de la santé. L'ACTS en appelle au gouvernement fédéral d'assumer un rôle de chef de file dans l'élaboration d'un régime de soutien du revenu plus équitable et plus juste au Canada. Un revenu de base constitue un modèle en matière d'équité du revenu. Il mérite qu'on y réfléchisse attentivement et qu'on le mette en œuvre de manière pragmatique au Canada et ailleurs.

49

On trouvera un résumé utile de la littérature abondante sur les coûts de la pauvreté dans The Dollars and Sense of Solving Poverty (Ottawa: National Council of Welfare, 2011). http://publications.gc.ca/site/archiveearchived.html?url=http://publications.gc.ca/collections/collection_2011/cnb-ncw/HS54-2-2011-eng.pdf


Équité sociale Introduction Le Transfert canadien en matière de programmes sociaux, d'abord proposé en 1994, a marqué la fin du Régime d'assurance publique du Canada (RAPC) et, du même coup, de toutes les normes intégrées à cette loi, sauf une. Nous avons été témoins, depuis, d'un manque de leadership fédéral. L'ACTS souhaiterait qu'il se manifeste de nouveau. En annonçant la fin du Régime d'assurance publique du Canada (RAPC), le gouvernement fédéral signalait son intention de procurer aux provinces la souplesse que plusieurs gouvernements provinciaux réclamaient depuis une décennie50. Ce geste constituait également une réponse partielle à deux rapports du gouvernement du Québec, ayant recommandé une plus grande autonomie provinciale, notamment au chapitre des programmes sociaux51. Le référendum québécois sur la souveraineté de 1995 a suscité une telle crainte chez le gouvernement fédéral que, en l'espace de quelques années, au moyen de mesures administratives, la nature de la fédération a été transformée d'un régime de fédéralisme fiscal en un nouvel arrangement qui reste encore à nommer. Ce nouvel arrangement – en vertu duquel on considère que les gouvernements provinciaux ont plus de latitude en regard de l'autorité qu'ils exercent dans des domaines, tels que la santé, les services sociaux, l'aide sociale, l'enseignement postsecondaire, le logement, la formation en emploi et l'immigration – est le fruit du gouvernent libéral qui a été au pouvoir après 1993 et s'appuyait sur le besoin de contrôler les dépenses. De fait, on a étiré cet argument économique dans le but d'amorcer une transformation importante dans les relations fédérales-provinciales, qui a donné lieu à la signature d'une Entente-cadre sur l'union sociale en 1999. Il en est ressorti un gouvernement fédéral différent de tout autre gouvernement fédéral depuis les années 1940. Bien que le gouvernement fédéral ait conservé son rôle dans le secteur des programmes devenus de compétence fédérale en vertu de la Constitution (tels que la Sécurité de la vieillesse, l'Assurance-emploi, et le Régime de pensions du Canada), il 50 Le Rapport Allaire, Le Québec libre de ses choix, a été publié en janvier 1991. Il recommandait d'amender la constitution afin que 22 secteurs de gouvernance deviennent exclusivement de compétence provinciale. Ce rapport a été adopté par le Parti libéral du Québec en mars de cette même année. http://en.wikipedia.org/wiki/Allaire_Report; Mollie Dunsmuir, Law and Government Division, Library of Parliament, Constitutional Activity From Patriation to Charlottetown (1980 – 1992) , novembre 1995, 23. Cf. http://www.parl.gc.ca/Content/LOP/researchpublications/bp406-e.pdf ; Assemblée nationale du Québec, Commission sur l'avenir politique et constitutionnel du Québec ou Rapport de la Commission Bélanger-Campeau, mars 1991. 51 Le Référendum de 1995 sur la souveraineté du Québec a suscité une telle crainte chez le gouvernement fédéral qu'en quelques années seulement et par des moyens administratifs, la nature de la fédération a été transformée d'un régime de fédéralisme fiscal en l'arrangement qui prévaut aujourd'hui,


s'est consacré à des champs relevant historiquement de la compétence des provinces, dans lesquels, comme nous l'avons déjà souligné, il en était venu à s'impliquer. Malgré cette tendance, le Transfert canadien en matière de programmes sociaux joue toujours un rôle important dans le financement de la sécurité sociale (notamment en matière d'aide sociale), des services sociaux (incluant les programmes de développement de l'enfance) et de l'enseignement postsecondaire. La participation active du gouvernement fédéral dans des avancées futures est importante, non seulement pour en assurer le financement, mais aussi pour stimuler des initiatives pancanadiennes. L'ACTS propose que le gouvernement fédéral ait recours à une technique de gouvernance comme une méthode ouverte de coordination visant à favoriser la modernisation du régime de sécurité sociale et des services sociaux au Canada par le biais du Transfert canadien en matière de programmes sociaux52. Une méthode ouverte de coordination est une méthode éprouvée et fiable de coordination de politiques sociales particulièrement sensibles au sein de l'Union européenne (UE) où des organismes de gouvernance centralisés à Bruxelles ont encore moins de pouvoir que le gouvernement fédéral d'Ottawa. En bref, l'ACTS est d'avis que le gouvernement fédéral peut et devrait jouer un rôle actif dans l'élaboration de programmes sociaux, comme il l'a fait par le passé. L'ACTS est toutefois consciente des susceptibilités provinciales et territoriales et réalise qu'Ottawa n'est pas en mesure d'imposer de conditions strictes en matière de programmes sociaux en regard desquels il ne dispose que d'une compétence constitutionnelle limitée. C'est pourquoi l'ACTS propose de recourir à une technique comme une méthode ouverte de coordination. Contexte Le gouvernement fédéral a assumé le pouvoir exclusif en matière d'impôt sur le revenu et d'impôt sur les sociétés en signant, en 1941, une série d'ententes avec chacune des provinces. Ces ententes prévoyaient que les provinces seraient compensées pour avoir cédé leurs droits à l'impôt sur le revenu et sur les sociétés pour la durée de la guerre et pour une année subséquente. Un accès exclusif à ces outils fiscaux allait permettre au gouvernement fédéral d'amasser des sommes importantes pour soutenir l'effort de guerre. C'est de là que provient ce qu'on en est venu à appeler accords sur la location de domaines fiscaux53.

52 Bien que l'enseignement postsecondaire soit une composante du Transfert canadien en matière de programmes sociaux, le présent document met l'accent sur la sécurité du revenu et les services sociaux.

53

.James A. Maxwell, Recent Developments in Dominion-Provincial Fiscal Relations in Canada, National Bureau for Economic Research, 1948, 10-11 http://papers.nber.org/books/maxw48-1 ; A.R. Dobell, "Intergovernmental Finance", The Canadian Encyclopedia, http://www.thecanadianencyclopedia.com/articles/intergovernmental-finance.


Au cours de la Seconde Guerre mondiale, en grande partie grâce au travail de ses comités consultatifs, le gouvernement fédéral a publié trois rapports importants sur la santé, la sécurité sociale et le logement. Comme suite au rapport du Comité consultatif de l'assurance maladie, le gouvernement fédéral a publié en mars 1943 un rapport traitant de l'expansion possible après la guerre d'un service de santé soutenu par l'État. Ce rapport fut connu sous le nom de Rapport Haegerty54. Comme suite au travail du Comité consultatif de restauration, le gouvernement fédéral a également publié des rapports sur les programmes sociaux et sur le logement. Il s'agissait, en l'occurrence, du Rapport Marsh, publié en mars 1943, et du Rapport Curtis, publié en 1944. Ces rapports promettaient une transformation majeure des politiques sociales et de santé après la guerre, soit une transformation de la compétence des gouvernements fédéral et provinciaux dans ces domaines. À la fin de la guerre, le gouvernement fédéral a présenté une série de propositions à la Conférence fédérale-provinciale d'août 194555. Regroupées dans ce qu'on a appelé Livre vert, les propositions du gouvernement fédéral contenaient certaines idées devant mener à une expansion substantielle de la sécurité sociale, inspirée des idées acceptées au cours des 15 années précédentes, incluant le Nouveau pacte mis de l'avant par le gouvernement Bennett, le rapport de laCommission royale des relations entre le Dominion et les provinces ainsi que les trois rapports produits durant la guerre sur la santé, la sécurité sociale et le logement56. Plusieurs initiatives de programmes sociaux ont vu le jour entre 1946 et 1962, en dépit de l'échec des négociations entourant les propositions du Livre vert de 1945. L'Allocation familiale a été instaurée en 1944, les premières prestations en vertu de ce programme ont été versées en 1945. L'Allocation familiale a été le premier programme universel de soutien aux enfants. Elle était d'abord versée aux seuls enfants de moins de 16 ans, puis fut étendue aux enfants de moins de 18

54 Heather Macdougall, “Into Thin Air: Making National Health Policy, 1939-45,” Canadian Bulletin Of Medical History, 26:2 2009, P. 283-313. Http://Www.Cbmh.Ca/Index.Php/Cbmh/Article/Viewfile/1400/1367

Making Medicine: The History Of Health Care In Canada 1914-2007 Http://Www.Civilization.Ca/Cmc/Exhibitions/Hist/Medicare/Medic-3h08e.Shtml 55

Propositions du Gouvernement du Canada, août 1945

56

Les réunions tenues en 1945 et 1946 n'ont pas abouti à une entente globale sur la fiscalité et les programmes sociaux, malgré l'offre du gouvernement fédéral de fournir du financement aux provinces pour les inciter à céder le contrôle de l'impôt sur le revenu des particuliers et des sociétés. Le gouvernement fédéral a plutôt signé huit ententes avec les provinces, prolongeant de ce fait l'approche des accords sur la location de domaines fiscaux conclus en temps de guerre. Il n'a pas signé d'entente avec le Québec. A.R. Dobell, “Intergovernmental Finance,” Cf. The Canadian Encyclopedia, http://www.thecanadianencyclopedia.com/articles/intergovernmental-finance.


ans57. Le soutien aux enfants est demeuré une part importante des avantages sociaux fédéraux depuis 1945. Bien que le gouvernement progressiste conservateur de Brian Mulroney ait mis fin au programme d'allocations familiales en 1992, le gouvernement fédéral a continué d'offrir des prestations sociales pour enfants par le truchement de l'impôt sur le revenu58.

Un deuxième programme clé a été instauré dans l'après-guerre : la Sécurité de la vieillesse, en 195159. D'abord introduite en loi en 1927 en tant que programme destiné à fournir du financement aux provinces optant d'offrir un régime de pension fondé sur les moyens, il a été transformé en un deuxième programme universel, au moyen d'amendements constitutionnels en 1952. En outre, la Loi pourvoyant à l'assistance-vieillesse assurait une pension fondée sur les moyens et à frais partagés pour les personnes âgées de 65 à 70 ans60. Un troisième programme clé a été instauré à cette même période : l'allocation aux personnes handicapées. Il s'agissait d'un programme dont les coûts étaient partagés à parts égales avec les provinces et d'un régime lié aux ressources61. La Loi sur l'assistance-chômage de 1956 a donné naissance à un quatrième programme social fédéral, rétroactif à 1955; en vertu de cette Loi, les provinces ayant signé une entente ont été remboursées pour la moitié des sommes qu'elles avaient consacrées à l'assistance de chômeurs dans le besoin, sans plafonnement des prestations individuelles ou des dépenses fédérales62. Le dernier programme social fédéral à voir le jour au cours de cette période a été la Loi sur l'assurance-hospitalisation et les services diagnostiques, adoptée en 1957. Cette Loi proposait de rembourser ou de partager les coûts, la moitié des coûts encourus par les provinces et territoires pour des services d'hospitalisation et de diagnostic définis. Elle prévoyait en outre une couverture universelle administrée par l'État pour un ensemble défini de services, en vertu d'un 57 De 1946 à 1962, plusieurs initiatives fédérales en matière de programmes sociaux ont vu le jour, malgré l'échec des négociations portant sur les propositions du Livre vert de 1945. L'Allocation familiale a été instaurée en 1944 et les premières prestations ont été versées en 1945. 58

Raymond B. Blake, From Rights to Needs : A History of Family Allowances in Canada, 1929-92, UBC Press, 2009. On trouvera une partie de ce texte à l'adresse : http://www.ubcpress.ca/books/pdf/chapters/2008/FromRightstoNeeds.pdf

59 D'abord introduit en droit comme un programme destiné à fournir du financement aux provinces qui opteraient d'introduire un régime en de retraite lié aux ressources, il a été transformé en un deuxième programme universel au moyen d'un amendement constitutionnel en 1952. 60

Dennis Guest, "Old-Age Pension", Canadian Encyclopedia, http://www.thecanadianencyclopedia.com/articles/oldage-pension; Historical Statistics of Canada, Section C, Social Security, http://www.statcan.gc.ca/pub/11-516-x/sectionc/4057749-eng.htm

61

John E. Osborne, The Evolution Of the Canada Assistance Plan, Santé et Bien-être Canada, 1985. http://www.canadiansocialresearch.net/capjack.htm

62

John E. Osborne, The Evolution Of the Canada Assistance Plan, Santé et Bien-être Canada, 1985. http://www.canadiansocialresearch.net/capjack.htm La Loi sur l'assistance-chômage a instauré le premier régime d'assistance continue aux provinces qui souhaitent profiter du financement offert. Cette Loi visait à procurer une aide seulement aux personnes sans emploi et employables. La même catégorie de bénéficiaires qui, selon que le rapport de la Commission RowellSirois, devrait relever de la compétence du gouvernement fédéral.


ensemble particulier de services soumis à des modalités et conditions uniformes. Quatre ans plus tard, toutes les provinces et tous territoires avaient accepté d'offrir des services d'hospitalisation et de diagnostic financés par l'État63.

Partage fiscal et financement de programmes En 1962, le gouvernement fédéral a négocié un nouvel arrangement avec les provinces dans le but de régler certains différends fiscaux entre eux64. Plutôt de louer leur pouvoir de taxation, le gouvernement fédéral a conclu une entente avec les provinces, connue sous le nom de partage des recettes fiscales65. L'entente s'appliquait à neuf provinces; le Québec a continué de percevoir ses propres impôts. En revanche, l'État-providence canadien a pris une forme et une identité distinctives entre 1963 et 1972. Des gouvernements libéraux minoritaires successifs, sous la gouverne de Lester Pearson de 1963 à 1968 ainsi qu'un gouvernement libéral majoritaire sous la gouverne de Pierre Trudeau de 1968 à 1972 ont entrepris ou convenu de procéder à une réforme des grands programmes sociaux fédéraux. En 1972, ces programmes sociaux constituaient l'État-providence canadien. Cette période a été marquée par : la création du Régime d'assurance publique du Canada (RAPC), un programme fédéral visant le partage des coûts liés à l'aide sociale et aux services sociaux; des réformes de la Sécurité de la vieillesse; un régime de pensions fédéral, fondé sur l'assurance sociale, qui assurerait 25 % du salaire industriel moyen; un nouveau Supplément de revenu garanti, entièrement financé par le fédéral, qui viendrait en aide aux personnes de plus de 65 ans qui n'auraient pas accès au nouveau Régime de pensions du Canada; en 1971, une révision en profondeur de la Loi sur l'assurance-chômage en vertu de laquelle la plupart des travailleurs seraient couverts en cas de manque d'emploi; la Loi sur l'assurance- maladie, 63

Statistiques historiques du Canada, section C, Sécurité sociale: http://www.statcan.gc.ca/pub/11-516-x/sectionc/4057749fra.htm; Santé Canada, Le système de santé du Canada : http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2011-hcs-sss/indexfra.php. Rendu au début des années 1960, le gouvernement fédéral avait eu un départ modeste, ayant franchi quelques étapes vers la mise en place d'un État-providence canadien. Il avait instauré une prestation universelle pour enfants, versée directement aux familles, principalement aux mères. Il avait également instauré plusieurs programmes spécifiques indirects de soutien du revenu, en offrant de soutenir les provinces disposées à en assumer 50 % des coûts. Enfin, il avait institué un programme visant à soutenir l'offre de soins hospitaliers offerts par les provinces. Il a engrangé des revenus importants par le biais des accords sur la location de domaines fiscaux, conclus avec les provinces, puis en les compensant par la suite. 64 1989 - Rapport du vérificateur général, chapitre 14 http://www.oag-bvg.gc.ca/internet/Francais/parl_oag_198911_14_f_4263.html 65

En vertu de ce système, le gouvernement fédéral allait renoncer à un pourcentage des trois taxes afin que les provinces puissent profiter des revenus en découlant. Le pourcentage de l'impôt sur le revenu a d'abord été fixé à 16 % et devait être majoré de 1 % annuellement. Le pourcentage a été fixé à 9 % dans le cas des profits des sociétés et à 50 % dans le cas des droits successoraux. Cf. Claude Belanger, Canadian federalism, the Tax Rental Agreements of the period of 1941-1962 and fiscal federalism from 1962 to 1977, http://faculty.marianopolis.edu/c.belanger/quebechistory/federal/taxrent.htm


adoptée en 1966, en vertu de laquelle le gouvernement fédéral assumerait la moitié des coûts de soins médicaux personnels prodigués par un médecin, un programme géré par les provinces66. Dans le but de recevoir du financement en vertu du Régime d'assurance publique du Canada (RAPC), les provinces ont eu à consolider leurs lois antérieures en un seul programme à l'intention de toutes personnes de la province, considérées dans le besoin à la suite d'un examen de leur revenu et de leurs dépenses. On a mis fin aux programmes fédéraux visant à aider les provinces à soutenir financièrement des personnes handicapées ainsi que les personnes sans emploi, mais employables. Les allocations maternelles provinciales et les programmes de bienêtre social préexistants ont également été abolis et remplacés par une seule loi. En vertu du Régime d'assurance publique du Canada, aucune province ne pouvait imposer de condition de résidence ni adopter des procédures forçant un résident à accepter un emploi comme condition pour recevoir de l'aide. Ces normes étaient au nombre de plusieurs normes afférentes à l'administration de l'aide sociale par les provinces. La loi n'abordait aucunement la question des services sociaux. Elle affirmait par ailleurs que le gouvernement fédéral pouvait dépenser pour des programmes provinciaux destinés à prévenir la pauvreté. C'est en s'appuyant sur cette déclaration que le gouvernement fédéral a commencé à investir dans des programmes provinciaux de garde d'enfants et des programmes de services sociaux. On n'a jamais adopté de normes relatives aux services sociaux67. 66

Santé Canada, Le système des soins de santé du Canada : http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2011-hcssss/index-fra.php Cette loi énonce cinq principes ou normes pour la mise en œuvre du régime d'assurance-maladie. À la suite de plusieurs épisodes où des gouvernements provinciaux avaient adopté des pratiques qui semblaient contrevenir à la Loi, le gouvernement fédéral a réaffirmé les normes contenues dans la Loi canadienne sur la santé de 1984. Les cinq principes de la Loi canadienne sur la santé sont : 1. la gestion publique : il faut que le régime provincial d’assurance-santé soit géré sans but lucratif par une autorité publique nommée ou désignée par le gouvernement de la province; 2. l’intégralité : les régimes provinciaux /territoriaux doivent veiller à ce que tous les services de santé requis soient fournis par les hôpitaux et des médecins; 3. l’universalité : au titre du régime provincial d’assurance-santé, cent pour cent des assurés de la province ont droit aux services de santé assurés prévus par celui-ci, selon des modalités uniformes; 4. l’accessibilité : suppose que le régime provincial d'assurance-santé offre les services de santé assurés selon des modalités uniformes et qu'il ne fait pas obstacle, directement ou indirectement, et notamment par facturation aux assurés, à un accès satisfaisant par eux à ces services; 5. la transférabilité : les régimes proviciaux/territoriaux doivent couvrir toutes personnes lorsque celles-ci déménagent dans une autre province ou territoire ou lorsqu'elles voyagent à l'étranger. 67 Notons qu'en vertu du Régime d'assurance publique du Canada, les provinces pouvaient accorder de l'aide sociale et des programmes sociaux à des autochtones vivant sur une réserve et recevoir du financement pour le faire, mais, comme cela demeurait de compétence fédérale, les provinces ne se sont pas prévalues du financement disponible. Pourquoi partager les coûts alors que la pleine responsabilité revenait au gouvernement fédéral? Particulièrement après que le gouvernement fédéral eut accepté de financer à 100 % le bien-être social et les services sociaux sur les réserves en Ontario dans le cadre d'une entente signée en 1965. Au même moment, le gouvernement fédéral convenait que les personnes vivant sur des réserves devaient avoir accès au bien-être social au même taux et aux mêmes conditions que celles appliquées par la province où la réserve était située. Il s'agissait là d'un changement radical au chapitre des programmes sociaux offerts sur les réserves, cela 12 ans après la Sécurité de la vieillesse eut été offerte aux autochtones et 19 ans après que le programme des allocations familiales eut été élargi pour inclure les enfants autochtones vivant dans des réserves.


Plusieurs enjeux majeurs sont apparus dans le cadre de l'élaboration de ces programmes. Puisqu'au moins quelques-uns de ces programmes constituaient une incursion fédérale dans des champs déclarés de compétence provinciale, il fallait en arriver à s'entendre sur des amendements constitutionnels qui appuieraient ces programmes. L'Assurance-chômage, la Sécurité de la vieillesse et le Régime de pensions du Canada ont tous été mis en place avec l'appui d'un amendement constitutionnel.

Certains des programmes fédéraux étaient destinés à procurer du financement à l'appui de la programmation et l'administration provinciales. Il s'agissait essentiellement de programmes conditionnels, fondés sur un partage des coûts à 50/50. Le financement du programme de subventions conditionnelles à l'appui de l'assurance-hospitalisation, du régime d'assurancemaladie et de l'enseignement postsecondaire a été regroupé dans les lois sur le financement des programmes établis des années 1960, puis, en 1977, on a mis un terme au partage des coûts et à la conditionnalité afin de les remplacer par des subventions globales par habitant. Les provinces devaient toujours continuer d'offrir les programmes pour lesquels elles recevaient du financement, mais elles n'avaient plus à rendre compte68. Un autre enjeu avait trait à la conditionnalité. Deux programmes étaient notamment fondés sur la fixation de conditions fédérales pour l'administration par les provinces : le Régime d'assurance publique du Canada et la Loi canadienne sur la santé. Chacun requérait que l'administration provinciale se conforme à une série de normes inscrites dans la loi. Seule la Loi canadienne sur la santé demeure toujours en place. Le dernier enjeu avait trait à des programmes sociaux fédéraux offerts directement à des particuliers. Entre 1940 et 1995, le gouvernement fédéral a obtenu l'assentiment des provinces pour mettre sur pied des programmes d'assurance sociale et de soutien direct. Chacun de ces deux types de programme comporte un lien direct entre le gouvernement fédéral et le bénéficiaire. Les premiers incluent l'assurance-chômage et les régimes de pensions de l'État, les derniers, la Sécurité de la vieillesse et les prestations destinées aux enfants. Évolution d'une approche de rechange Au cours de la période de l'après-guerre jusque dans les années 1970, les théories de la gestion de la demande, prônées par Keynes, ont occupé le haut du pavé. Dans ce contexte, les programmes sociaux constituaient une solution au problème de la croissance économique cyclique en permettant d'épargner en prévision de temps plus difficiles pendant que les 68 Amy Verdun et Donna E. Wood, "Governing the social dimension in Canadian federalism and European integration", Canadian Public Administration, 56:2, June 2013, 173-84; Nadia Verrelli, The Federal Spending Power, Institute of Intergovernmental Relations, Queen’s University, May 2008; Stephen Laurent et François Vaillancourt, Federal-Provincial Transfers for Social Programs in Canada: Their Status in May 2004, IRPP Working Paper Series, no. 2004-07.


conditions économiques étaient bonnes et que le taux de chômage était bas, puis de verser plus de prestations lorsque le taux de chômage était plus élevé; cela contribuerait à soutenir la demande et d'assurer que l'économie continue de tourner.

Après 1980, les programmes sociaux se sont avérés un problème plutôt qu'une solution. La solution consistait à réduire les dépenses gouvernementales, baisser les impôts et permettre aux gens d'affaires d'innover et de créer de l'emploi. Au cours de cette période, les gens d'affaires et le gouvernement parlaient d'une même voix à l'appui de baisses d'impôts, tout en soutenant qu'il fallait réduire les déficits et la dette de l'État69. Les années 1990 ont constitué une période de changement substantiel au chapitre de l'organisation des programmes sociaux comme conséquence de nombreux autres changements se produisant au pays. L'élection du Parti progressiste conservateur en 1984 a marqué l'avènement d'idées néolibérales au sein du gouvernement national.70 Bien que ses premiers efforts visant à contenir ou éliminer certains programmes sociaux n'aient pas donné les résultats escomptés, le gouvernement progressiste conservateur de Brian Mulroney est éventuellement parvenu à effectuer certains changements importants, comme l'élimination de l'Allocation familiale, un programme dont le premier ministre avait dit pendant la campagne de 1984 qu'il s'agissait d'une vache sacrée.71 Cette période a également été marquée par des conflits politiques entourant la Constitution de 1982, un document n'ayant pas été ratifié par le Québec. On a débattu dans la province de la portée et de l'étendue de l'autonomie que la province devrait chercher à obtenir. Deux rapports ont été produits sur ce sujet, l'un et l'autre suggérant que la province soit responsable d'un éventail beaucoup plus large de programmes, incluant les programmes sociaux. En dehors du Québec, on discutait à savoir s'il pouvait y avoir au sein de la fédération des conditions distinctes pour le Québec et les autres provinces. Suite à l'élection de 1993, le gouvernement fédéral libéral a décidé d'apporter des changements radicaux au mode de financement des programmes sociaux provinciaux. Il restait alors deux programmes majeurs de financement: le Régime d'assurance publique du Canada (RAPC) et le 69 On considérait que les relations gouvernementales constituaient un problème important et un obstacle à la réussite de l'innovation. En général, on considérait qu'il fallait se fier davantage à l'initiative et l'entreprise privées, ce qui exigeait que l'on réduise la taille de l'État. 70 Le nouveau gouvernement a entrepris sa période au pouvoir de manière symbolique en répudiant officiellement le plein emploi en tant que but du gouvernement et en adoptant bon nombre des idées proposées dans le rapport de la Commission Macdonald, la Commission royale d'enquête sur l'union économique et les perspectives de développement du Canada. 71 Cette période a aussi été marquée par des querelles politiques entourant la Constitution de 1982 à laquelle le Québec n'avait pas adhéré. Dans la province on débattait de l'étendue et de la portée de l'autonomie que le Québec devrait chercher à obtenir. Deux rapports suce sujet suggéraient que le gouvernement de la province ait la compétence d'une gamme plus large de programmes, incluant les programmes sociaux. À l'extérieur de la province, on discutait à savoir si, au sein de la fédération, il pouvait y avoir des conditions distinctes pour le Québec et les autres provinces.


financement des programmes établis. Le gouvernement a décidé d'éliminer ces deux sources de financement et de les remplacer par un seul programme de financement par habitant, appelé le Transfert canadien en matière de santé et de programmes sociaux (TCSPS). Ce faisant, il a mis fin à la conditionnalité qui contribuait au maintien d'un ensemble de normes nationales applicables à la prestation de l'aide sociale et des services sociaux, ce qui ne laissait que les normes comprises dans la Loi nationale sur la santé. Présentée comme une mesure de réduction des coûts et du déficit, il s'agissait néanmoins d'un changement majeur dans l'édification de la fédération. Au Québec, cela signifiait que le gouvernement fédéral serait moins impliqué dans les affaires provinciales; dans toutes autres provinces, cela voulait dire que des gouvernements néolibéraux pouvaient dorénavant introduire les mesures d'aide sociale, qu'elles avaient souhaité introduire depuis un bon moment déjà. Cela signifiait aussi qu'il n'y aurait plus de péréquation par le biais de mesures sociales72. Les provinces et le gouvernement fédéral ont bien tenté de jeter de nouvelles bases qui permettraient d'aller de l'avant par le biais de l'entente-cadre sur l'union sociale signée en 199973. En vertu de cette entente, le gouvernement fédéral ne peut plus introduire un financement de programme conditionnel, sans avoir reçu l'aval de la majorité des provinces. Bien que cela n'ait pas rendu impossible l'introduction de nouveaux programmes, cela signifie que le gouvernement fédéral ne peut plus procéder comme il le faisait par le passé, à savoir en introduisant un nouveau programme, puis en tentant d'obtenir la coopération individuelle des provinces par la suite. En outre, cette entente reconnaît que le gouvernement fédéral peut continuer d'entretenir une relation directe avec des particuliers en ce pays. Le gouvernement fédéral peut, comme il l'entend, introduire de nouveaux avantages à l'intention de particuliers. Même s'il appert que l'on a cessé d'utiliser cette entente, il semble que les principes qu'elle contenait servent toujours de base d'orientation en matière de nouveaux programmes sociaux fédéraux. Maintenant que les responsabilités des provinces sont beaucoup plus larges en ce qui a trait à la prestation de services sociaux dans des champs où le gouvernement fédéral était précédemment actif, il convient de se demander ce qu'on a gagné et ce qu'on a perdu. L'implication fédérale a-telle été utile? A-t-elle été convenable? 72 Toutes les provinces ne recevraient dorénavant qu'une seule subvention proportionnelle au nombre d'habitants à l'appui des programmes de santé et programmes sociaux. Et aucune province ne serait tenue de tenir compte de normes imposées par le fédéral, sauf une : celle de ne pas imposer de critère de résidence donnant droit à l'obtention des services sociaux. En 2004, le gouvernement fédéral a décidé de scinder ce transfert en deux : le transfert relatif à la santé et le transfert social. Cf. aussi le Rapport du Groupe de travail sur les arrangements fiscaux du Conseil de la fédération, rapport principal, juillet 2012; Hamish Telford, Peter Graefe et Keith Banting, Defining the Federal Government’s Role in Social Policy: The Spending Power and Other Instruments, IRPP, sptembre 2008,Vol.9, no. 3. 73 Un cadre visant à améliorer l'union sociale pour les Canadiens - Entente entre le gouvernement du Canada et les gouvernements provinciaux et territoriaux, le 4 février 1999.


Pour les tenants d'un fédéralisme fort, la réponse est manifestement oui. Pour ceux qui appuyaient le droit du Québec de faire ses propres choix ou le droit de toutes les autres provinces de récupérer les compétences en matière de programmes sociaux, qu'elles croyaient être les leurs en vertu de l'Acte de l'Amérique du Nord britannique, la réponse est non. La meilleure façon de caractériser le nouveau régime, postérieur à 1999, serait peut-être de parler d'un fédéralisme restrictif dans le cadre duquel les droits des provinces en matière sociale sont énoncés de manière ascendante. Les tenants de cette approche sont d'avis que les provinces sont les mieux placées pour déterminer ce dont elles ont besoin dans leur partie du monde et que, conséquemment, des programmes nationaux ne sont ni souhaitables ni utiles. Le gouvernement conservateur actuel, un gouvernement majoritaire, libéré des contraintes auxquelles il était soumis au cours de cinq années de gouvernement minoritaire, semble être de ceux qui partagent cette vision du fédéralisme. Il est très peu vraisemblable qu'il appuie une approche des négociations en 2014, qui impliquerait un retour à la vision des services sociaux que suppose le fédéralisme fiscal. Il est tout aussi peu vraisemblable qu'il s'engage dans toute nouvelle initiative fédérale de politique sociale au-delà ce de qui a déjà été fait : la prestation universelle pour la garde d'enfants74 et les changements graduels à l'âge d'admissibilité à la Sécurité de la vieillesse de 65 à 67 ans, devant prendre effet en 202375. Si la perspective du gouvernement conservateur actuel prévaut à l'avenir, l'État-providence canadien pour les citoyens ne faisant pas partie des Premières Nations et ne vivant pas sur une réserve sera constitué de deux parties : un programme national de base relevant d'une loi fédérale et administré par le gouvernement fédéral ainsi que d'une série de programmes de santé, d'aide sociale et de services sociaux, de même qu'un ensemble variable de services et conditions rattaché à ceux-ci. La citoyenneté sociale sera établie par la province de résidence et non par le gouvernement national76. Besoin de leadership fédéral L'appui du gouvernement conservateur aux droits et à l'autonomie des provinces est jumelé à deux autres principes clés : une croyance fondamentale en la valeur des marchés privés dans la 74

http://www.cra-arc.gc.ca/bnfts/uccb-puge/menu-fra.html

75

http://www.servicecanada.gc.ca/fra/services/pensions/sv/changements/index.shtml

76

Les peuples des Premières Nations vivant sur une réserve, seront en principe soumis aux mêmes conditions que les personnes vivant hors réserve. En pratique, toutefois, le gouvernement fédéral n'a pas garanti que les conditions applicables sur une réserve seront les mêmes que celles applicables à tous les autres citoyens de cette même province. Dans bien des cas, le financement étant insuffisant pour appliquer les mêmes normes. Bien que le gouvernement fédéral ait présenté des excuses pour les situations vécues dans les pensionnats, il n'a pas donné l'assurance que les personnes dans le besoin vivant sur les réserves autochtones auront accès aux services dont ils ont besoin.


restation de programmes de santé et de programmes sociaux, de même qu'une croyance en un État de taille réduite77.

Conséquemment, dans cette perspective, il n'existe pas de rôle pour le gouvernement fédéral dans la formulation des politiques ou dans la création d'un sentiment de citoyenneté partagée, découlant d'une offre de programmes de santé et de programmes sociaux de qualité sensiblement la même partout au pays78. Le seul rôle du gouvernement fédéral consiste à fournir sa part du financement et à exiger que les provinces rendent compte dans les grandes lignes de comment ces fonds sont dépensés. C'est dans ce seul champ que le gouvernement conservateur pourrait être disposé à agir. En revanche, l'ACTS est d'avis que le gouvernement fédéral doit jouer un rôle plus actif pour assurer le leadership dans la promotion de politiques sociales pancanadiennes et contribuer à l'avancement d'un sentiment de citoyenneté partagée. L'ACTS croit aussi qu'il est possible pour le gouvernement fédéral de jouer un rôle de chef de file, sans pour autant passer outre à la compétence des provinces et territoires, ou sembler le faire. Une façon d'y parvenir serait d'utiliser la méthode ouverte de coordination, adoptée par l'Union européenne (UE)79. En 2012, en collaboration avec un groupe d'universitaires et de praticiens, l'ACTS s'est penchée sur plusieurs rôles, politiques et pratiques historiques, actuels et potentiels, liés au Transfert canadien en matière de programmes sociaux, qui ont des incidences importantes sur le bien-être de l'ensemble des Canadiens et sur la pérennité des programmes sociaux au Canada80. 77 L'appui fédéral pour la réforme de l'assurance-maladie sera teinté par une croyance fondamentale en les marchés privés et l'entreprise privée. Bien qu'il soit peu probable que les principes de la Loi canadienne sur la santé soient modifiés, en raison de leur valeur symbolique, le gouvernement fédéral sera disposé à maintenir sa politique actuelle de désintérêt pour leur mise en application. Le nombre de cliniques privées ira en grandissant dans les provinces, même si cela viole directement l'un des cinq principes. Les procédures de radiation se poursuivront également, alors que des gouvernements provinciaux d'orientation néolibérale s'efforceront de réduire leurs dépenses en santé pour faire face aux pressions qu'occasionne une population vieillissante. 78 La croyance en un État de taille réduite, conjuguée au fédéralisme restrictif, l'empêchera de définir un rôle plus positif pour le gouvernement fédéral au sein de l'État providence. Il ne souhaitera pas non plus introduire un rôle de collaboration avec les provinces. Et ce, malgré le fait que l'art. 36 (1) (2) de la Loi constitutionnelle de 1982stipule que : « … le Parlement et les législatures… s'engagent à promouvoir l'égalité des chances de tous les Canadiens dans la recherche de leur bien-être… fournir à tous les Canadiens, à un niveau de qualité acceptable, les services publics essentiels.» Cette même Loi affirme en outre que : « Le Parlement et le gouvernement du Canada prennent l'engagement de principe de faire des paiements de péréquation propres à donner aux gouvernements provinciaux des revenus suffisants pour les mettre en mesure d'assurer les services publics à un niveau de qualité et de fiscalité sensiblement comparables. » 79 La méthode de coordination ouverte a été initiée en Europe, en 2006, en tant que mécanisme de coordination des politiques sociales, là où l'Union européenne ne disposait que d'un pouvoir limité. Cf. Bart Vanhercke and Peter Lelie, "Benchmarking social Europe a decade on: demystifying the OMC’s learning tools", in Fenna, A. and Knuepling, F. (Eds.), Benchmarking in Federal Systems: Australian and International Experiences, Productivity Commission : Melbourne 80 ACTS, Étude sur le Transfert canadien en matière de programmes sociaux - La reddition de compte, c'est important, 2012, http://defensedesprogrammessociaux.ca/


Chacun des participants à ce projet était au courant des débats en cours relatifs au rôle limité du gouvernement fédéral en matière de soins de santé, de même que du manque quasi total de leadership fédéral relatif au Transfert canadien en matière de programmes sociaux. À l'heure actuelle, le Transfert canadien en matière de programmes sociaux contribue au financement de trois grands secteurs : l'enseignement postsecondaire, l'aide sociale et divers services sociaux. L'ACTS s'intéresse ici aux deux derniers secteurs. L'une des préoccupations principales des participants était le manque de reddition de compte lié au Transfert canadien en matière de programmes sociaux, tant de la part du gouvernement fédéral que des provinces et territoires. L'une des participantes espérait que le Transfert canadien en matière de programmes sociaux soit utilisé pour contribuer à l'avancement des normes internationales relatives aux droits de la personne, comme toile de fond à des programmes sociaux, puisque le Canada est un signataire du Pacte international relatif aux droits économiques, sociaux et culturels, qui garantit que les particuliers auront un niveau de vie convenable81. Un autre participant a suggéré que certains aspects du Transfert canadien en matière de programmes sociaux, notamment les éléments relatifs à la sécurité du revenu et à la réduction de la pauvreté, devraient être transférés entièrement au gouvernement fédéral qui est actuellement responsable de la majeure partie des transferts de revenu aux particuliers82. Le Caledon Institute of Social Policy est d'avis que, avant d'appliquer des conditions et des normes à un instrument de financement comme le Transfert canadien en matière de programmes sociaux, il faudrait en arriver à une vision partagée de ce à quoi le système de sécurité du revenu du Canada devrait ressembler83. De manière plus générale, les participants au projet de l'ACTS étaient d'avis qu'il existait plusieurs options pouvant être introduites par le gouvernement fédéral pour assurer un certain niveau de reddition de compte pour les milliards de dollars transférés aux provinces au moyen du Transfert canadien en matière de programmes sociaux, incluant une clarification des objectifs, des principes, des normes et des conditions84.

81 Shelagh Day, directrice générale, Poverty and Human Rights Centre, citée dans ACTS, Étude sur le Transfert canadien en matière de programmes sociaux - La reddition de compte, c'est important, 2012. 82 John Stapleton, Social Policy Consultant, Open Policy Ontario, cité dans ACTS, Étude sur le Transfert canadien en matière de programmes sociaux - La reddition de compte, c'est important, 2012, p. 41 83

Cf. Torjman, S., & Battle, K. (1995). Can we have national standards? The Caledon Institute of Social Policy. Ottawa, ON, et, plus récemment, Ken Battle, Sherri Torjman and Michael Mendelson, The 2014 Unbalanced Budget, 2014, Ottawa ON. 84 ACTS, Étude sur le Transfert canadien en matière de programmes sociaux - La reddition de compte, c'est important, 2012, http://defensedesprogrammessociaux.ca/, p.39 et suivantes.


Dans l'ensemble, les participants étaient d'avis que tant le gouvernement fédéral que celui des provinces et territoires pourraient assumer des rôles de chefs de file : le gouvernement fédéral, en ce qui touche l'élaboration d'une vision de la sécurité du revenu et des programmes sociaux en lien avec le Transfert canadien en matière de programmes sociaux; les provinces (et vraisemblablement les territoires), en ce qui touche la coordination d'un forum national sur le renouvellement et la modernisation des politiques sociales85.

Toutefois, certains participants ont affirmé que le Transfert canadien en matière de programmes sociaux ne devrait être assorti d'aucune condition restrictive, puisqu'il serait possible de recourir à d'autres moyens pour assurer des niveaux de sécurité adéquats et faire en sorte que les Canadiens aient accès à des niveaux comparables de sécurité du revenu et de services sociaux, quel que soit leur lieu de résidence86. Une façon de procéder pourrait être de s'inspirer de l'Union européenne (UE), une union économique et politique de 28 États membres. En matière de politique sociale, l'UE procède essentiellement à partir d'ententes volontaires de collaboration . Conséquemment, ni le parlement européen ni aucun autre organisme supranational connexe ne peuvent imposer de conditions aux États membres87. L'UE recourt plutôt à une « technique douce de gouvernance88 » comme mécanisme servant à coordonner les champs délicats de politique sociale, où l'UE n'a que peu ou aucun pouvoir. Par ailleurs, on reconnaît de manière assez large la nécessité d'un certain niveau d'adéquation et d'accessibilité dans trois champs de politique sociale : la protection sociale, l'inclusion sociale et les soins de santé. L'UE utilise essentiellement un ensemble de mesures de coordination pour favoriser la formulation de politiques sociales paneuropéennes plutôt que de recourir à des mesures législatives contraignantes. Il s'agit d'une gouvernance par persuasion plutôt que par coercition89.

85 ACTS, Étude sur le Transfert canadien en matière de programmes sociaux - La reddition de compte, c'est important, 2012, section 7.1 Instruments dont on dispose en matière de politique , p. 40 86 ACTS, Étude sur le Transfert canadien en matière de programmes sociaux - La reddition de compte, c'est important, 2012, section 7.1 Instruments dont on dispose en matière de politique , p. 40 87 La gouvernance de l'UE est beaucoup plus complexe et décentralisée que celle de la fédération canadienne. À un niveau supranational, elle inclut la Commission européenne (responsable des initiatives législatives); le Parlement européen (représentant les citoyens dans les processus législatif); le Conseil de l'Union européenne (représentant chacun des États européens participants et leurs différents ministères dans le processus législatif); le Conseil de l'Europe (représentant les chefs d'État). 88 Cf. Donna Wood, The Canada Social Transfer and the Deconstruction of Pan-Canadian Social Policy, page 28. http://www.vibrantcalgary.com/uploads/pdfs/Canada_social_transfer_Wood_brief.pdf. 89

Bart Vanhercke and Peter Lelie, “Benchmarking social Europe a decade on: demystifying the OMC’s learning tools”, in Fenna, A. and Knuepling, F. (Eds.), Benchmarking in Federal Systems: Australian and International Experiences, Productivity


Comme dans le cas de nos gouvernements fédéral et provinciaux, les États membres de l'UE conservent leur compétence sur les enjeux politiques de nature sensible.

Voulant promouvoir un certain degré de convergence des politiques sociales, on recourt à une méthode ouverte de coordination (MOC). Cette méthode se veut un moyen de répandre les pratiques sociales exemplaires dans les États membres et de parvenir à une convergence suffisante des politiques sociales pour atteindre les buts économiques que sont une croissance intelligente, une croissance durable et une croissance inclusive90. La MOC comporte six étapes : l'élaboration d'un cadre comportant des objectifs communs; le choix d'enjeux clés dans un domaine politique multidimensionnel; la construction d'une base de connaissances par le biais de l'élaboration d'indicateurs communs; des efforts visant à amener les parties prenantes essentielles gouvernementales et non gouvernementales à s'investir dans le processus; l'analyse comparative; la production de rapports conjoints. L'UE est plus complexe et plus diverse que la fédération canadienne sur le plan politique; si elle parvient à mettre en œuvre des processus de ce genre, des résultats semblables pourraient certes être atteints de ce côté de l'Atlantique! Il est important de noter que la stratégie sociale 2020 de l'UE est également articulée autour de trois grands objectifs politiques qui sont largement acceptés par les États membres : l'inclusion sociale, la protection sociale et les soins de santé. Il s'agit des mêmes objectifs que ceux décrits dans le présent rapport et les deux premiers – la protection sociale et l'inclusion sociale – correspondent à deux des trois composantes du Transfert canadien en matière de programmes sociaux, soit la sécurité du revenu et les services sociaux. Pour que le Canada parvienne à quelque chose de semblable – l'ACTS étant d'avis qu'il peut et doit le faire – il faudra que le gouvernement fédéral collabore avec les autres ordres de gouvernement pour assurer la durabilité financière et la modernisation des programmes de protection sociale et d'inclusion sociale. À cette fin, les éléments clés de ce processus requerront que les deux ordres de gouvernement définissent des objectifs communs et des indicateurs sociaux, qu'ils amènent les parties prenantes à s'investir et mettent au point des mécanismes conjoints pour la production de rapports. Cette approche de financement et d'élaboration des politiques a été répliquée dans une certaine mesure dans le cadre de l'analyse comparative menée en lien avec les soins de santé. L'analyse comparative consiste à établir des comparaisons en fonction d'un ensemble d'indicateurs

Commission : Melbourne\\ 90

Bart Vanhercke et Peter Lelie, page 173.


reconnus91. L'Institut canadien d'information sur la santé a été un joueur important sur la scène nationale dans l'élaboration d'indicateurs de rendement pancanadiens. Des organismes semblables existent dans certaines provinces. Le projet sur les indicateurs de santé est un exemple d'une approche d'analyse comparative de rendement visant à améliorer les soins de santé au pays. Ce projet fournit des données fiables et comparables sur la santé des Canadiens, sur le système des soins de santé et sur les déterminants sociaux de la santé. Des conférences pour un consensus national ont permis de mettre au point un mécanisme pour l'élaboration d'un cadre commun d'indicateurs de rendement. Des initiatives semblables ont été entreprises en lien avec la production de rapports par les hôpitaux. Selon Baranck, Veillard et Wright, le système canadien d'analyse comparative est en train d'ouvrir la voie aux pratiques en santé de l'avenir. Ils pensent aussi que les indicateurs de rendement constituent de plus en plus des bases de discussion sur les moyens d'améliorer les systèmes de santé92. En d'autres mots, ils semblent fournir de l'information sur les normes et pratiques, qui, au-delà d'informer, contribue en outre à influencer la coopération et la coordination intergouvernementales.

91

Baranck, Patricia, Jeremy Veillard et John Wright, “Benchmarkding health care in federal systems: the Canadian experience”, dans Fenna, A. and Knuepling, F. (dir..), Benchmarking in Federal Systems: Australian and International Experiences, Productivity Commission : Melbourne. 92 Baranck, Patricia, Jeremy Veillard et John Wright, “Benchmarkding health care in federal systems: the Canadian experience”, page 108.


Proposition de l'ACTS De l'avis de l'ACTS, il est possible d'appliquer l'approche d'évaluation comparative du rendement comme moyen d'améliorer les soins de santé et cette approche est souhaitable en rapport avec la sécurité du revenu et les programmes sociaux. La sécurité du revenu se traduit par un certain niveau de protection sociale pour les citoyens. Les programmes sociaux favorisent leur intégration dans la société plus large. Dans les deux cas, un leadership fédéral s'impose pour élaborer un cadre politique moderne qui s'étende aux provinces et territoires. Il faut qu'un leadership fédéral s'exprime pour assurer une reddition de compte. Nous recommandons que le gouvernement fédéral emboîte le pas à l'UE et entame la discussion au sujet du Transfert canadien en matière de programmes sociaux au moyen d'une méthode ouverte de coordination pour assurer un certain niveau de convergence des programmes dans l'ensemble du pays. En Europe, une telle méthode s'est avérée un moyen souple et efficace d'amener des gouvernements de perspectives et de convictions très différentes à collaborer dans le but de s'attaquer à des problèmes communs, tels que la réduction de la pauvreté ou l'exclusion sociale. À cette fin, le gouvernement fédéral devrait tenir des rencontres avec les provinces et territoires pour discuter de l'avenir du Transfert canadien en matière de programmes sociaux. Ces discussions ne devraient pas porter uniquement sur les montants transférés, mais aborder aussi les modalités des transferts. En d'autres mots, sans initialement fixer de conditions au Transfert canadien en matière de programmes sociaux, les deux ordres de gouvernement devraient d'abord et avant tout décider s'ils peuvent convenir d'objectifs communs et d'un cadre politique pour la sécurité du revenu et les programmes sociaux93. Il faudrait par la suite construire une base de connaissances intergouvernementale en élaborant des indicateurs communs et une approche d'analyse comparative quantitative – comme cela se fait actuellement dans le domaine des soins de santé. L'élaboration d'indicateurs devrait en retour faire appel à la participation d'experts et de parties prenantes non gouvernementaux dans le processus afin que celui-ci soit aussi inclusif que possible. L'ACTS recommande finalement que l'élaboration d'une méthode ouverte de coordination visant à moderniser la sécurité du revenu et les programmes sociaux soit guidée par les principes qui

93 Dans le cas de l'Europe, les mesures de sécurité du revenu et les programmes sociaux sont considérés come un domaine multidimensionnel. Conséquemment, ils ont d'abord travaillé à établir un consensus relatif aux principaux défis. Au chapitre de la protection sociale, les principaux enjeux avaient trait à l'adéquation du revenu et à la viabilité financière. En ce qui a trait à l'inclusion sociale, la pauvreté des enfants et le sans-abrisme constituaient les principaux enjeux.


suivent : le besoin; l'intégralité; l'accessibilité; l'équité; la transférabilité, l'universalité; une gestion publique ou sans but lucratif94.

x Un principe fondé sur le besoin présuppose que la sécurité du revenu et des programmes

sociaux seront offerts en fonction d'une évaluation personnelle ou financière d'un demandeur. x Un principe d'intégralité signifie qu'une gamme convenue de programmes de sécurité du

revenu et de programmes sociaux sont offerts dans chaque province et territoire et financés à même les dépenses publiques. Les provinces et territoires sont libres de lancer d'autres programmes qui excèdent la gamme convenue. x Un principe d'accessibilité sous-entend qu'une gamme convenue de programmes de

sécurité du revenu et de programmes sociaux seront offerts tous les Canadiens qui en ont besoin. x Un principe d'équité présuppose que tout citoyen a le droit de recourir à tout programme

soutenu par l'État et de voir sa demande examinée par un organisme approprié dans un délai raisonnable. Le demandeur a le droit de recevoir une décision écrite dans un délai raisonnable, le droit d'en appeler de toute décision, le droit qu'un tel appel soit entendu dans un délai raisonnable et le droit de recevoir une décision écrite dans un délai raisonnable. Au cours de la période d'appel, le demandeur a le droit de recevoir une aide financière temporaire ou des services.

x Un principe de transférabilité signifie que tous les Canadiens sont couverts par des programmes de sécurité du revenu et des programmes sociaux, là où ils se rendent et là où ils habitent au Canada.

x Un principe d'universalité signifie que des programmes de sécurité du revenu et des programmes sociaux seront offerts à tous les Canadiens qui en ont besoin.

94 Nous avons ci-après tracé les grandes lignes d'une approche de la sécurité du revenu et des programmes sociaux, qui utilise un langage s'apparentant à celui contenu dans la Loi canadienne sur la santé. Mais, dans cette Loi, les principes constituent en fait une série de conditions applicables au transfert de fonds du fédéral aux provinces. Toutefois, les sept principes énoncés dans notre proposition se veulent un guide seulement à des discussions préliminaires à l'élaboration d'un cadre conceptuel. Ceux-ci pourraient ou non devenir des conditions applicables aux transferts fédéraux.


x Un principe de gestion publique ou de gestion sans but lucratif présuppose que les programmes de sécurité du revenu et les programmes sociaux sont gérés par un organisme public et sans but lucratif et sont livrés soit par un organisme public ou un organisme privé sans but lucratif.

Équité en santé Introduction Le système des soins de santé se démarque de manière distinctive au chapitre des politiques sociales équitables au Canada. Mais, à défaut d'un leadership et d'un financement assurés par le fédéral sur une base soutenue, son avenir est menacé. La question de savoir comment financer et s'attaquer aux coûts croissants des soins de santé est à l'origine de nombreux débats et discussions au pays. En réaction, le gouvernement fédéral a tracé une ligne dans le sable et annoncé unilatéralement que sa contribution aux soins de santé allait décroître de manière substantielle au cours des 30 prochaines années. De l'avis de l'ACTS, il s'agit d'une position fondamentalement viciée, non seulement parce qu'elle transfert le fardeau du financement des soins de santé aux provinces et territoires, mais encore parce qu'elle contribue à miner la capacité de parvenir à des normes nationales de soins de santé, qui permettraient à tous les Canadiens d'être traités équitablement partout au pays, sans égard au lieu où ils habitent. Sans un leadership et un financement important du fédéral, il n'existera pas de système de soins de santé pancanadien. À défaut d'une vision nationale, le Canada continuera de glisser au classement international en ce qui a trait à son rendement en santé. L'absence de leadership fédéral contribuera à miner les conditions de la Loi canadienne sur la santé. Sans financement fédéral convenable, le système des soins de santé ne pourra pas survivre. Notre proposition pour pallier l'abdication d'un leadership et d'un financement nationaux est simple. Le gouvernement fédéral – l'actuel ou un autre – doit prendre ses responsabilités, mettre à exécution les conditions de la Loi canadienne sur la santé¸ restaurer à leur niveau préalable aux coupes des années 1990 les transferts fédéraux relatifs aux dépenses en santé des provinces et territoires, et offrir des incitatifs financiers destinés à promouvoir des réformes et une efficience économique dans la prestation des services de santé. Notre proposition, détaillée ci-dessous, est abordable et viable. Le gouvernement fédéral dispose de la capacité fiscale de s'impliquer. Il en a aussi le droit constitutionnel. La question en est une de choix et de priorités politiques et non de moyens financiers ou de viabilité.


Contexte Depuis la fin des années 1950, le fardeau du financement des soins de santé incombe aux deux ordres de gouvernement. Le premier mécanisme de financement mis en œuvre au niveau fédéral remonte à la Loi sur l'assurance-hospitalisation et les services diagnostiques de 1957. Le deuxième : à la Loi sur les soins médicaux de1961. En vertu de la Constitution, la santé ne relève pas de la compétence exclusive d'un seul ordre de gouvernement95. Bien que la Constitution reconnaisse la compétence première des provinces dans la prestation des soins de santé, le gouvernement fédéral a la responsabilité première de la prestation de soins de santé à certains groupes de personnes (p. ex. les autochtones, les militaires et les détenus des pénitenciers fédéraux), le contrôle des risques pour la santé publique et les questions liées aux urgences nationales. Toutefois, en ce qui a trait au financement des soins de santé, la compétence du gouvernement fédéral relève de sa compétence sur la dette publique et les propriétés publiques fédérales ainsi que de son pouvoir général de dépenser et de lever des impôts – ce qui lui permet de générer des revenus, de les dépenser comme bon lui semble et d'imposer des conditions de réception pour cet argent. Comme conséquence du chevauchement des compétences, la Cour suprême du Canada a statué en 1982 que « la santé n’est pas l’objet d’une attribution constitutionnelle spécifique, mais constitue plutôt un sujet indéterminé que les lois fédérales ou provinciales valides peuvent aborder selon la nature ou la portée du problème de santé en cause dans chaque cas96 ». La Loi sur l'assurance-hospitalisation et les services diagnostiques et la Loi sur les soins médicaux ont été remplacées par la Loi de 1977 sur les accords fiscaux entre le gouvernement fédéral et les provinces et sur les contributions fédérales en matière d'enseignement postsecondaire et de santé et les transferts y correspondants ont été combinés au Régime d'assurance publique du Canada (RAPC) pour créer le Transfert canadien en matière de santé et de programmes sociaux (TCSPS). Au cours de ce processus. Le gouvernement fédéral a modifié la nature de l'admissibilité et les arrangements financiers et, de ce fait, les transferts fédéraux, dorénavant divisés en transferts en espèces et en transferts en points d'impôt, ont diminué de quelque 35 % des coûts provinciaux en santé dans les années 1960 à environ 23-24 %, le niveau où ils se situaient dans les années 198097. 95

Les quelques paragraphes qui suivent sont extrait essentiellement de l'étude du Comité sénatorial permanent des affaires sociales, des sciences et de la technologie, intitulée : Un changement transformateur s’impose : un examen de l’Accord sur la santé de 2004 ; et de Marlisa Tiedemann Le rôle fédéral dans le domaine de la santé et des soins de santé, Division des affaires juridiques et sociales, Publications de recherche de la Bibliothèque du Parlement, 2011. 96

Schneider c. La Reine, [1982] 2 R.C.S. 112, p. 142. Cité dans Marlisa Tiedemann, note 83

97

Bureau du directeur parlementaire du budget, Renouvellement du Transfert canadien en matière de santé - conséquences pour la viabilité financière aux niveaux fédéral et provincial-territorial, p.3, figure 3-02. Officiellement l'entente prévoyait un partage


Suite à la fusion de divers programmes, le gouvernement a également adopté la Loi canadienne sur la santé (LCS) en 1984 dans le but d'assurer que les conditions établies en vertu de la Loi sur l'assurance-hospitalisation et les services diagnostiques et la Loi sur les soins médicaux ne soient pas perdues. À l'origine de la LCS, il y avait la reconnaissance que l'influence du gouvernement fédéral sur les normes afférentes aux soins de santé était moindre en raison des modifications aux ententes de financement. La LCS avait pour but d'établir des critères et conditions relatifs aux soins de santé assurés en vertu des lois provinciales, auxquels on devrait se conformer avant qu'une pleine contribution financière puisse être effectuée. Elle affirmait en outre que l'objectif premier des politiques canadiennes en matière de santé était de faciliter un accès raisonnable aux services de santé, sans obstacle financier ou autre98. Toutefois, en l'espace d'une décennie après l'adoption de la Loi, le Canada a eu à faire face à une grave récession. Réagissant à des déficits budgétaires croissants et à l'augmentation imminente des dépenses liées aux soins de santé, le gouvernement fédéral est passé à l'action. « Il en a résulté une ronde importante de coupes tant aux budgets d'exploitation des ministères qu'à leurs subventions et contributions – bon nombre dans une fourchette de 15 à 25 pour cent. Et encore plus dans certains cas. Les transferts aux provinces ont également été coupés de manière draconienne, de plus de 21 pour cent sur deux ans99. Une des conséquences majeures de ces coupes a été une baisse importante des transferts en santé aux provinces, une baisse telle que le partage des coûts afférents aux dépenses provinciales en santé a chuté à un niveau aussi bas que 10 %. Cela a eu des incidences graves sur les provinces et a entraîné des coupes dans le budget des hôpitaux et dans la rémunération des médecins, des temps d'attente plus longs, une baisse au chapitre des services électifs et des mises à pied dans l'ensemble des ressources humaines en santé. La sévérité des compressions a contribué à miner la confiance des Canadiens quant à leur système de santé et quant au leadership du gouvernement. Réagissant aux pressions publiques croissantes, le gouvernement fédéral a créé la Commission sur l'avenir des soins de santé au Canada100. Son rapport, publié en 2002, recommandait des changements profonds destinés à assurer la viabilité du système de santé. des coûts à 50-50, mais celle-ci ne s'appliquait qu'aux services hospitaliers et de médecins et non à l'ensemble des coûts de santé des provinces. 98

Canada, Loi canadienne sur la santé, L.R.C. (1985), modifiée pour la dernière fois le 29 juin 2012

99

Ontario, ministère des Finances, Commission de la réforme des services publics de l'Ontario, Des services publics pour la population ontarienne : cap sur la viabilité et l’excellence, chapitre 2, Le défi financier en contexte, http://www.fin.gov.on.ca/fr/reformcommission/

100

Commission sur l'avenir des soins de santé au Canada, Guidé par nos valeurs : l'avenir des sons de santé au Canada, Rapport final. 2002.


En 2003, les dirigeants des niveaux fédéral et provincial se sont rencontrés et ont convenu de priorités visant à rétablir la confiance de la population. Ils ont convenu d'un plan d'action fondé sur les principes suivants : x Universalité, accessibilité, transférabilité, intégralité et gestion publique; x Accès à des services médicalement nécessaires fondés sur le besoin et non pas sur la capacité de payer; x Réformes axées sur les besoins des patients afin de veiller à ce que tous les Canadiens et les Canadiennes aient accès aux services de santé dont ils ont besoin, quand ils en ont besoin et où ils en ont besoin; x Collaboration entre tous les gouvernements qui travaillent ensemble dans un but commun qui est de répondre aux besoins changeants de tous les Canadiens et Canadiennes en matière de soins de santé; x Réalisation de progrès par la mise en commun des pratiques exemplaires; x Reddition de comptes et transmission d'informations en permanence aux Canadiens et aux Canadiennes afin de les renseigner sur les progrès accomplis; x Allocation d'une certaine souplesse aux provinces et aux territoires101. En 2004, le premier ministre a annoncé qu'un nouveau financement de 41 milliards de dollars allait être attribué sur 10 ans pour soutenir le nouveau plan d'action en santé. Ce financement devait notamment servir à renforcer l'appui financier soutenu du gouvernement fédéral en matière de santé; à satisfaire aux recommandations financières de la Commission; à améliorer la qualité des soins; à réduire les temps d'attente. Le gouvernement a également scindé les transferts en espèces, créant le Transfert canadien en matière de santé et le Transfert canadien en matière de programmes sociaux, ceux-ci avaient préalablement été fusionnés. En 2005, une clause d'indexation automatique a été introduite, ce qui a eu pour effet d'accroître le transfert en santé de 6 % par année. Toutefois, en 2011, soit 3 ans avant la fin de l'entente décennale, le gouvernement fédéral a annoncé unilatéralement que l'augmentation de 6 % prendrait fin en 2017, après quoi le financement fédéral serait fondé sur une moyenne mobile sur trois ans du Produit intérieur brut (PIB), avec un minimum de 3 %. Les réactions des provinces et territoires à cette action unilatérale du gouvernement fédéral ne se sont pas fait attendre. Les premiers ministres provinciaux en appellent au gouvernement fédéral d'éviter d'apporter des changements unilatéraux affectant les provinces et territoires, « surtout des mesures comportant des réductions d'appui financier, amenant le gouvernement fédéral à se dégager ou se délester de ses responsabilités sur leur dos102». 101

Santé Canada, Un plan décennal pour consolider les soins de santé, http://www.hc-sc.gc.ca/hcs-sss/deliveryprestation/fptcollab/2004-fmm-rpm/index-fra.php 102 Conseil de la fédération, Communiqué, Les premiers ministres des provinces et des territoires continuent de travailler à la modernisation des transferts fédéraux, 26 juillet 2013.


Les médecins et autres professionnels de la santé n'ont pas non plus aimé cette proposition, non seulement parce qu'elle entraîne un sous-financement des services de santé, mais aussi parce qu'elle apparaît comme une abdication par le gouvernement fédéral de son rôle de chef de file dans la promotion d'un accès équitable et juste à des services de santé de grande qualité partout au pays103. La pérennité du système de santé La pérennité du système de santé est un enjeu de politique publique depuis les débuts du système. La Commission royale d'enquête sur les services de santé (Emmett Hall) de 1964 s'est concentrée sur le financement et les priorités publiques et a favorisé qu'une gamme limitée de services soient assurés afin de limiter les coûts104. En 2002, la Commission sur l'avenir des soins de santé au Canada, présidée par Roy Romanow, s'est penchée sur la viabilité à long terme du système105. Chacune des commissions a conclu qu'un financement public des soins de santé était préférable à un financement privé. Pourtant, en dépit des recommandations de la Commission, le débat fait toujours rage quant à savoir si l'on a les moyens d'assurer ou de soutenir le financement public des services de santé. Bien qu'il ne s'agisse pas d'un nouveau débat, il prend de l'ampleur au moment où les gouvernements ont à se débattre avec des insuffisances de revenu, une croissance économique lente et une baisse des revenus. Les opposants au système de financement actuel soutiennent que les coûts des soins de santé atteignent graduellement des niveaux qu'on ne pourra pas soutenir. Leur analyse s'appuie en grande partie sur le fait que la croissance des coûts des soins de santé excède le taux de croissance des recettes gouvernementales et, si rien n'est fait, ceux-ci constitueront une part croissante de toutes les dépenses. Prenons comme exemple un rapport de 2011 de l'Institut Fraser. On y présente une illustration frappante de la situation : le total des dépenses provinciales en santé a augmenté de 7,5 % en moyenne au cours des dix années précédentes, comparativement à une croissance de 5,7 % seulement du total des revenus provinciaux (incluant les transferts fédéraux). Les dépenses en santé des deux plus grandes provinces du Canada (Ontario et Québec) grugent plus de 50 % de leurs revenus totaux et, dans les faits, la plupart des provinces consacrent plus de 60 % de leurs recettes propres aux soins de santé, si on exclut les transferts fédéraux du calcul106. 103

En 2012, le Dr John Haggie, alors président de l'Association médicale du Canada, disait : « Ottawa a un rôle de surveillance essentiel pour assurer que des soins comparables sont offerts dans l'ensemble du Canada --- les Canadiens nous ont dit qu'ils souhaiteraient que certaines normes d'équité et de justice s'appliquent partout au pays. » Tiré d'un article d' André Picard, Aglukkaq defends Ottawa’s hands-off role in health care funding, Globe and Mail, August 13, 2012.

104

Commission royale d'enquête sur les services de santé, volume 1, 1964.

105

Commission sur l'avenir des soins de santé au Canada (Romanow), Guidé par nos valeurs : l'avenir des soins de santré au Canada, Rapport final, 2002. 106 Brett Skinner et Mark Rovere, Canada’s Medicare Bubble: Is Canada’s Health Spending Sustainable without User-based Funding?, Studies in Health Care Policy, 2011, Cf. aussi, Brett Skinner, Canadian Health Policy Failures: What’s Wrong? Who Gets Hurt? Why Nothing Changes, Fraser Institute, 2009.


Un rapport de 2001 du Conference Board of Canada soulève des préoccupations semblables et arrive à certaines conclusions semblables. Bien que la formule de calcul des dépenses par rapport aux revenus soit différente, la même tendance s'en dégage. Le Conference Board conclut que les dépenses publiques en santé augmenteront de 31 % des revenus en 2000 à 42 % d'ici 2020. On y prévoit aussi que les dépenses en santé par habitant augmenteront de 58 % au cours de cette même période, alors que la croissance afférente aux autres services gouvernementaux ne sera que de 17 % 107. Un examen des dépenses gouvernementales en santé par rapport aux revenus, ne correspond toutefois qu'à une partie de l'équation. On pourrait obtenir un portrait plus juste en comparant les dépenses au Produit intérieur brut (PIB) et à la croissance économique (une mesure plus juste de notre capacité globale de payer). Par exemple, la Fédération canadienne des syndicats d'infirmières/infirmiers affirme que des organisations comme l'Institut Fraser et le Conference Board surestiment l'échelle du problème. En 2011, les dépenses totales en santé du Canada correspondaient à 11,6 % du PIB et les dépenses publiques, à 8,1 %. Les dépenses en santé concordaient avec celles de la plupart des autres pays développés et étaient considérablement inférieures à celles des États-Unis108. La Fondation canadienne pour l'amélioration des services de santé (autrefois la Fondation canadienne de la recherche sur les services de santé) va dans le même sens, affirmant que l'argument voulant que les soins de santé du système public ne soient pas viables est un mythe. La Fondation reconnaît que, si l'on mesure les dépenses par rapport au PIB, celles-ci ont effectivement augmenté avec le temps, mais elle souligne que celles-ci ont augmenté en concordance avec celles des autres pays développés et, de fait, de façon plus modérée que dans bon nombre de ceux-ci109. Le groupe Médecins canadiens pour le régime public affirme que le mythe entourant la nonviabilité du régime public de soins de santé est à fois bien défini, plausible et erroné. Ils font une distinction entre les coûts afférents au système d'assurance-maladie (les services médicaux assurés) et le total des dépenses gouvernementales en santé. Bien que les coûts afférents au système d'assurance-maladie soient demeurés remarquablement stables au cours des trente-cinq dernières années, soit de 4 % à 5 % du PIB, les autres dépenses en santé ont augmenté de manière plus substantielle. Mais, même en tenant compte de ces augmentations, les dépenses

107

The Conference Board of Canada, The Future Cost of Health Care in Canada, 2000 to 2020, Balancing Affordability and Sustainability. Analyse détaillée des constatations par Pedro Antunes, Glenn Brimacombe, et Jane McIntyre, 2001. 108

Fédération canadienne des syndicats d’infirmières/infirmiers, Fiche d’information : Viabilité du système de soins de santé, novembre 2011.

109

Fondation canadienne pour l'amélioration des services de santé, Mythe : Le financement des services de santé au Canada est non viable, 2010.


totales n'ont augmenté que de 5 % de PIB en 1980 à 7 % en 2009, ce qui, selon eux, est loin d'être non viable110.

Robert Evans, un économiste bien connu du domaine de la santé, suggère que le système public de santé est aussi viable que nous souhaitons qu'il soit – cela dépend des choix politiques que nous faisons. Il reconnaît que les dépenses provinciales en santé ont consommé une part de plus en plus grande des budgets provinciaux au cours des dernières années, mais ce virage est simplement attribuable à des coupes substantielles au chapitre de l'impôt des particuliers et des sociétés, ce qui a entraîné des revenus plus faibles. Les réductions d'impôt entre 1997 et 2004 ont, à elles seules, entraîné une perte de revenu de 470,8 milliards de dollars pour l'État111. Il y a eu d'autres réductions d'impôt depuis. Pour une comparaison internationale complète des dépenses en santé au Canada et dans d'autres économies développées, il est utile d'examiner les statistiques fournies par l'Organisation de coopération et de développement économiques (OCDE). Les plus récentes statistiques comparatives, celles de 2011, révèlent que les dépenses totales en santé du Canada correspondaient à 11,2 % du PIB, étaient supérieures à la moyenne de l'OCDE et constituaient les cinquièmes plus élevées de trente-huit pays. Les dépenses publiques en santé, à 70,4 % du PIB, se situaient en deçà de la moyenne de l'OCDE et en deçà des celles de vingt et un autres pays112. Il est intéressant de noter que les pays ayant les dépenses publiques les plus élevées avaient en règle générale des dépenses globales moindres en santé. Aussi, en 2010, et encore une fois en 2011, les taux de croissance des dépenses en santé des pays de l'OCDE ont commencé à stagner. Au Canada, la croissance des dépenses en santé a ralenti de 3,0 % en 2010 et de 0,8 % en 2011 en termes réels113 Ce rythme de croissance plus lent des dépenses depuis 2010 est également souligné par l'Institut canadien d'information sur la santé (ICIS). Toutefois, dans l'ensemble, les coûts en santé ont eu une croissance plus rapide que celle de l'économie entre 2000 et 2010114. L'Institut dégage trois phases distinctes dans la croissance des dépenses en santé (publiques et privées) : une phase de

110

Canadian Doctors for Medicare, Neat, Plausible and Wrong: The Myth of Health Care Unsustainability, février 2011. Toutefois, si l'on tient compte à la fois des dépenses privées et publiques en santé, la proportion du PIB consacrée à la santé et de beaucoup plus élevée. Cf. C.D. Howe Institute Commentary: The Health Papers, Chronic Healthcare Spending Disease, des auteurs David Dodge et Richard Dion, 2011. 111 Robert G. Evans, Public health care as sustainable as we want it to be, The Star, Editorial Opinion, le 1er juin 2010. Cf, aussi Robert G. Evans, Economic Myths and Political Realities: The Inequality Agenda and the Sustainability of Medicare, UBC Centre for Health Services and Policy Research, juillet 2007. 112

Statistiques de l'OCDE sur la santé 2013 - Données fréquemment demandées, http://www.oecd.org/fr/els/systemessante/basededonneesdelocdesurlasante2013-donneesfrequemmentdemandees.htm 113

Communiqué de l'OCDE, Les dépenses de santé continuent de stagner dans les pays de l’OCDE, le 27 juin 2013.

114

Institut canadien d'information sur la santé, Tendances des dépenses nationales de santé, 1975 à 2012, figure 7


croissance entre 1975 et 1991; une brève période de repli et de désinvestissement de 1991 à 1996; une autre phase de croissance 1996 à 2010115. La croissance lente des dépenses en santé, observée récemment, ne signifie pas que celles-ci n'augmenteront pas à l'avenir. Un rapport de l'Institut C. D. Howe nous fournit un aperçu des dépenses en santé (publiques et privées) entre 2013 et 2031. S'appuyant sur des facteurs que l'on sait contribuer à l'augmentation des coûts (tels les changements démographiques, la technologie et le personnel), cette étude prévoit qu'en 2031 les coûts de santé feront en sorte que le ratio des dépenses au PIB se situera dans une fourchette de 15 % à 19 %116. Cela ne veut pas dire que cette augmentation est accablante; cette augmentation ne consomme pas l'ensemble, ni même une majorité des gains réalisés au chapitre des revenus au cours de cette même période117. En outre, le niveau le plus bas de la fourchette prévue demeure toujours inférieur au pourcentage du PIB consacré aux soins de santé aux États-Unis. Mais cela sousentend que les gouvernements devront générer plus de revenus et améliorer la prestation des soins de santé, s'ils souhaitent continuer de financer les soins de santé au niveau de service actuel ou à un niveau supérieur. Ce qu'il y a de plus inquiétant à cet égard, c'est la récente annonce d'un transfert du fardeau des coûts de soins de santé du fédéral vers les gouvernements provinciaux et territoriaux. Si les contributions fédérales aux soins de santé étaient maintenues au rythme des augmentations prévues dans l'accord de 2004 sur la santé, soit 6 % annuellement, le directeur parlementaire du budget estime que le transfert fédéral en espèces s'établirait en moyenne à 21,6 % des dépenses provinciales/territoriales en santé de 2011 à 2035, et même davantage par la suite. En revanche, la décision unilatérale du gouvernement fédéral de modifier les transferts en espèces signifie que la contribution du fédéral aux provinces et territoires n'augmentera que de 3 % ou 4 % par année et que la contribution aux dépenses provinciales-territoriales diminuera de manière substantielle de 20,4 % en 2010-2011 à une moyenne de 18,6 % de 2010-2011 à 20362036 et encore moins (13,6 %) au cours des années subséquentes118. Besoin de leadership fédéral Il existe un manque de leadership fédéral dans le domaine des soins de santé. Ce manque est intentionnel. S'adressant à l'Association médicale canadienne en 2012, l'ancienne ministre de la Santé, Leona Aglukkak, a défendu ainsi l'approche du laisser-faire du gouvernement : « Il est 115

Institut canadien d'information sur la santé, Tendances des dépenses nationales de santé, 1975 à 2012, figure 2

116

C.D. Howe Institute Commentary: The health Papers, Chronic Healthcare Spending Disease, auteurs : David Dodge et Richard Dion, 2011. 117

C.D. Howe Institute Commentary: The health Papers, Chronic Healthcare Spending Disease, auteurs : David Dodge et Richard Dion, 2011, page 8.. 118

Bureau du directeur parlementaire du budget, Renouvellement du Transfert canadien en matière de santé : conséquences pour la viabilité financière aux niveaux fédéral et provincial-territorial, Ottawa, 12 janvier 2012 (révisé le 19 janvier 2012).


préférable de laisser les décisions relatives aux soins de santé entre les mains des administrations provinciales, territoriales et municipales. Je ne dicterai pas aux provinces et aux territoires comment fournir leurs services ou établir leurs priorités119. » Comme nous l'avons souligné précédemment, l'approche du laisser-faire en matière de soins de santé et d'autres programmes a bien servi le gouvernement conservateur actuel sur le plan politique. Comme la compétence constitutionnelle en matière de santé et de services sociaux revient aux provinces et territoires, cette approche a contribué dans une certaine mesure à atténuer les tensions entre divers ordres de gouvernement, notamment avec le Québec. À notre avis, ce manque de leadership constitue de fait une abdication de responsabilité de la part du gouvernement fédéral qui refuse de s'engager à œuvrer en vue de parvenir à l'équité nationale, tant horizontale que verticale. L'équité horizontale suppose que tous les citoyens, où qu'ils habitent, ont accès à des niveaux comparables de soins de santé d'envergure nationale. L'équité verticale est de nature plus générale et sous-entend au minimum l'égalité des chances, mais, pour y parvenir, les soins de santé se doivent d'être transférables et accessibles dans toutes les sphères de compétence afin que les particuliers soient libres de circuler comme il convient en vue de leur développement personnel. Le gouvernement fédéral s'éloigne du principe d'équité nationale et des normes rattachées à sa réalisation. Il semble plutôt résolu à mettre en place une stratégie visant à démanteler le système des soins de santé du Canada et à balkaniser la prestation des services de santé au sein des provinces et territoires, En 2011, il a annoncé unilatéralement que l'accord décennal sur la santé ne serait pas renouvelé lorsqu'elle viendrait à terme en 2014. Il a également écarté la notion d'une stratégie pharmaceutique nationale, une composante de l'accord. Le gouvernement fédéral ne participe aucunement au Groupe de travail sur l'innovation en matière de santé (GTIMS) du Conseil de la fédération (qui représente les provinces et territoires). En outre, le Conseil canadien de la santé a été démantelé en mars 2014120. Au cours de la dernière décennie, de nombreux professionnels et organismes non gouvernementaux ont tenté sans succès de persuader le gouvernement fédéral de réaffirmer son engagement envers les soins de santé et de promouvoir la réforme des soins de santé. L'Association médicale canadienne et l'Association des infirmières et infirmiers du Canada ont énoncé six principes visant à orienter la transformation des soins de santé au Canada. Ces principes ont reçu l'aval de plus de 125 organisations, dont l'ACTS.

119

Globe and Mail, Aglukkaq defends Ottawa’s hands-off role in health care funding, le 13 août 2013.

120

Jeff Morrison, “Health care in Canada and the role of the federal government”, Canadian Pharmacists Journal, juillet/août 2013.


En lien avec ces principes, on trouve l'affirmation : « Le système de soins de santé a un devoir envers la population canadienne : il doit préconiser pour elle, et lui offrir un accès équitable à des soins de santé de qualité ainsi que des politiques multisectorielles qui tiennent compte des déterminants sociaux de la santé. » Et encore : « Des soins de santé durables passent par un accès universel à des services de santé de qualité, dotés de ressources adéquates et fournis en continuité, de façon opportune et rentable121. » Le Medical Reform Group (MRG) est un autre regroupement de professionnels insistant sur la nécessité d'un rôle fédéral dynamique dans l'élaboration des politiques en santé. Le MRG croit, tout comme l'ACTS, que « la question de savoir si le gouvernement fédéral devrait être impliqué dans l'élaboration et le maintien de normes relatives à la prestation de services sociaux est essentiellement une question portant sur le modèle de société que nous voulons au Canada122 ». Dans le domaine de la santé, il s'agit d'un débat visant à déterminer si nous voulons maintenir un système à payeur unique, accessible à tous, nous orienter vers un système de privatisation à l'américaine ou y intégrer une formule de copaiement des utilisateurs. Les désavantages du système américain sont bien connus. Il s'agit du plus dispendieux du monde développé et le moins universellement accessible. Conséquemment, peu d'organisations au Canada militent ouvertement pour l'adoption d'un tel système. Les représentations en faveur du copaiement des utilisateurs ou une assurance à l'européenne sont une autre histoire. Janice MacKinnon, une ancienne ministre des Finances de la Saskatchewan, est une fervente partisane de la formule du copaiement. Dans un récent rapport, publié par l'Institut MacDonaldLaurier, elle proposait l'instauration d'un régime de copaiement fondé sur la fiscalité, qui ferait le lien entre le système des soins de santé et la capacité de payer de l'utilisateur. Selon elle, un tel régime serait équitable, du fait que les citoyens à faible revenu n'auraient rien à débourser. L'avantage de se lier au régime d'impôt sur le revenu est que cela contribuerait à générer plus de revenus et à réduire l'utilisation des services. Le désavantage pour les patients est que ceux qui utiliseraient le plus le système, pour des raisons indépendantes de leur volonté, seraient les plus pénalisés123. De l'avis de l'ACTS, d'autres recommandations formulées par Mme MacKinnon sont plus propices, notamment celles qui traitent de mettre un accent accru sur les soins à domicile, de relocaliser les services d'urgence dans des cliniques communautaires, là où cela est réalisable, et 121

Principes devant guider la transformation des soins de santé au Canada, Association médicale canadienne et Association des infirmières et des infirmiers du Canada, juillet 2011. Les six principes énoncés sont : un système centré sur le patient; des soins de qualité; la promotion de la santé et la prévention des maladies, l'équité, la durabilité et l'imputabilité.

122

Medical Reform Group, Principles and Policy Statements, Statement on the Necesssity for a Strong Federal Role in Setting Health Policy, http://www.medicalreformgroup.ca/principles/federal_role_in_canadian_health_policy/

123

Janice MacKinnon, Health Care Reform from the Cradle of Medicare, MacDonald Laurier Institute, 2013, pages 15-17. Les recommandations de réforme de Mme MacKinnon s'appuient sur deux études: Aba, Shay, Wolfe D. Goodman, et Jack M. Mintz. 2002. “Funding Public Provision of Private Health: The Case for a Copayment Contribution through the Tax System.” Health Law Canada 22 (4): 85-100; et Stabile, Mark. 2003. “The Role of Benefit Taxes in the Health Care Sector.” University of Toronto Working Paper. http://www.law-lib.utoronto.ca/investing/reports/rp14.pdf


d'améliorer la couverture relative aux produits pharmaceutiques124. Il manque à l'analyse de Mme MacKinnon une vision pancanadienne des soins de santé. En revanche, le Groupe d'intervention en santé (HEAL) favorise un rôle actif du gouvernement fédéral dans les soins de santé – l'ACTS est membre de HEAL, une coalition de 34 organisations nationales préoccupées par les questions liées à la santé et aux utilisateurs de services. Dans un rapport intitulé Le fédéralisme fonctionnel et l'avenir du régime d'assurance-maladie au Canada, HEAL a constaté qu'il existait un appui solide de la part des parties prenantes interviewées pour une approche de fédéralisme pratique axé sur ce qui s'avère le plus efficace pour améliorer l'accès au système de santé et en améliorer la qualité125. En ce qui a trait à la réforme des soins de santé, HEAL insiste avec vigueur sur la nécessité d'une gestion des maladies chroniques, sur les soins à domicile, les soins de longue durée, l'accès aux soins et la santé mentale. La Coalition canadienne de la santé est un organisme de défense des intérêts du public, qui s'est engagé à préserver et à améliorer le régime d'assurance-maladie. La Coalition affirme sans détour son appui pour un leadership fédéral. Dans un rapport présenté à un comité sénatorial en 2011 la Coalition recommande qu'on renouvelle l'entente décennale en y consacrant un financement adéquat, incluant le prolongement de l'indexation à 6 %; qu'on adopte un plan global visant à combler le fossé existant au chapitre de la santé des Autochtones; qu'on adopte une Stratégie nationale relative aux produits pharmaceutiques; qu'on offre une gamme complète de soins à domicile et des soins continus; qu'on apporte les réformes nécessaires en vue de réduire les temps d'attente126. John Millar, professeur clinicien à la School of Population and Public Health de l'Université de la Colombie-Britannique, insiste aussi sur la nécessité d'un leadership fédéral pour transformer le système des soins de santé. Soulignant que l'augmentation des coûts est subordonnée aux avances technologiques, aux médicaments et aux ressources humaines, il affirme qu'il nous faut mettre en place des ressources communautaires qui contribueront à améliorer la santé de la population, à réduire les inégalités ainsi que les dépenses liées aux soins de santé. Selon lui, « une étape essentielle de cette transformation serait le déploiement d'efforts pancanadiens coordonnés en vue d'élaborer des indicateurs et des bases de données pouvant soutenir la reddition de compte en santé et provoquer les changements qui s'imposent127». 124

Il est intéressant de noter qu'elle ne recommande pas la mise en place d'un régime pharmaceutique national, mais plutôt que les provinces collaborent entre elles dans le but de réaliser des économies et d'assurer un meilleur approvisionnement. Elle soutient que le gouvernement fédéral n'a pas les moyens de mettre sur pied un régime national, sans accroître sa dette. Il n'est pas clair pourquoi les provinces seraient dans une meilleure position d'agir. Qui plus est, ses préoccupations relatives aux coûts croissants est fondée sur un excédent des dépenses sur les revenus et non sur la capacité globale de l'économie.

125 Tholl, Bujold et Associés, Le fédéralisme fonctionnel et l'avenir du régime d'assurance-maladie au Canada – rapport au Groupe d'intervention Action santé, 2012 http://www.healthactionlobby.ca/images/stories/publications/2012/ThollBujoldResumeFinalJanvier2012.pdf. On entend par fédéralisme fonctionnel un leadership partagé entre le gouvernement fédéral et ceux des provinces et territoires. 126

Mémoire de la Coalition canadienne de la santé, présenté au Comité sénatorial permanent des Affaires sociales, des Sciences et de la Technologie dans le cadre de son examen des progrès réalisés dans la mise en œuvre de l'Accord de 2004 sur la Santé, Protéger l'avenir de l'assurance-maladie : un appel aux soins, le 10 novembre 2011. 127 John Millar, Canadian health care needs a massive transformation, lettre d'opinion, The Star, edition du mercredi 14 mars 2012.


Proposition de l'ACTS L'ACTS est généralement d'accord avec bon nombre des suggestions formulées. Considérées dans leur ensemble, elles contribuent à compléter le système des soins de santé de ce pays et à le rapprocher de la gamme des services complets offerts dans certains des pays développés de l'Europe. L'ACTS est également opposée à un financement privé plus élevé du système, car il existe peu d'éléments probants permettant de conclure que le financement privé donne lieu à des économies substantielles pour l'État128. Il semble en outre que notre système de soins de santé soit à la fois viable et relativement stable par rapport à notre économie globale et notre capacité de payer. La principale lacune vient du manque de volonté politique de le financer. Pour ces raisons, la position de l'ACTS est qu'un leadership fédéral dynamique et un financement fédéral substantiel sont essentiels pour assurer la survie de notre système de soins de santé. À défaut de ces deux éléments, le système sera de plus en plus balkanisé. Par leadership, l'ACTS entend au minimum que le gouvernement fédéral doit agir dans le but d'assurer que les cinq conditions énoncées dans la Loi canadienne sur la santé (administration publique, intégralité, universalité, transférabilité et accessibilité) sont respectées avant que les provinces et territoires ne reçoivent un financement fédéral. L'ACTS croit en outre que le gouvernement fédéral devrait être le fer de lance et offrir des incitatifs aux provinces et territoires dans le but de les amener à transformer le système des soins de santé en un système centré sur le patient, ancré dans la collectivité et offert à moindre coût. Par financement fédéral substantiel, l'ACTS entend que la part fédérale des coûts du système de santé devrait, à court terme, demeurer à 20 % des dépenses totales de l'État et que la proportion des dépenses publiques en santé ne devrait pas chuter à moins de 70 % des dépenses totales en santé. Ces deux cibles sont réalistes dans le cadre de l'environnement économique actuel. Elles ont été atteintes au cours des dernières années et dépassées précédemment. À plus long terme, l'ACTS recommande que la part du fédéral augmente à 23 % ou 24 % des dépenses totales, un niveau atteint dans les années 1980 et une cible qui pourrait être gérée de manière réaliste, si le gouvernement fédéral maintenait l'indexation à 6 % au-delà de 2017. Par la même occasion, la proportion des dépenses de l'État par rapport aux dépenses totales en santé pourrait être haussée à 72 % – la moyenne actuelle des pays de l'OCDE.

128

Certains éléments de cette question font l'objet d'un article de R. Sacha Bhatia, “Alternative Financing for Health Care: A Path to Sustainability?”, Canadian Medical Association Journal, édition du 17 avril 2012. Cf. aussi D. Drummond and D. Burleton, “Charting a path to sustainable health care in Ontario: 10 proposals to restrain cost growth without compromising quality of care”, TD Economics Special Reports. Toronto, Groupe Financier Banque TD.


Conclusion Depuis les années 1990, des allégements fiscaux et un fédéralisme restrictif ont réduit la capacité du gouvernement fédéral de jouer un rôle dans les programmes sociaux et on s'attend à ce que la contribution fédérale aux programmes sociaux provinciaux diminue. Le gouvernement conservateur actuel a comme conception celle d'un fédéralisme restrictif dans le cadre duquel les programmes offerts par les divers ordres de gouvernement seraient distincts au sein de leur compétence respective. Une telle décentralisation contribuerait à réduire la reddition de compte du gouvernement fédéral à l'endroit des provinces et créerait des disparités de services entre les provinces. Cela contribuerait, en outre, à miner le contrat social entre le gouvernement fédéral et la population canadienne, un contrat fondé sur la notion de droits et responsabilités partagés. L'ACTS est profondément préoccupée par les incidences qu'auront les politiques et les pratiques non interventionnistes sur les soins de santé, l'inclusion sociale et la protection sociale des Canadiens. L'ACTS imagine un fédéralisme coordonné dans le cadre duquel le gouvernement fédéral négocie avec les provinces et territoires et adopte un cadre d'équité pour les politiques sociales. Une telle vision assurerait que tous les Canadiens ont un droit fondamental à des normes communes de service minimal partout au pays. L'ACTS affirme qu'une telle approche pourrait être soutenue par l'adoption et l'imposition de normes nationales, de même qu'en misant sur des mécanismes d'impôt négatif pour assurer un revenu de base global. Les pays ayant les dépenses publiques les plus élevées ont généralement des dépenses globales inférieures en santé; cela dit, les suggestions formulées par l'ACTS permettraient d'assurer une dépense efficiente du revenu de l'État et de réduire les coûts sociaux et financiers à long terme de la pauvreté dans des champs tels que les soins de santé, l'éducation et la justice pénale. Pour parvenir à ces fins, l'ACTS propose que le gouvernement fédéral adopte une politique en matière de santé et de services sociaux, fondée sur les principes de besoin, d'intégralité, d'accessibilité, d'équité, de transférabilité, d'universalité et de gestion publique ou sans but lucratif.


RESOURCES/RESSOURCES

List of Readers/Liste des lecteurs We appreciate the co-operation of the following colleagues who have reviewed articles intended for publication in this edition. Nous tenons à souligner la collaboration des collègues suivants qui ont revu les articles publiés dans cette édition.

Arseneault, Rina, New Brunswick/Nouveau-Brunswick Augusta-Scott, Tod, Nova Scotia/Nouvelle-Écosse Baldwin, Clive, New Brunswick/Nouveau-Brunswick Bidgood, Bruce, British Columbia/Colombie-Britannique Cadell, Susan, Ontario Cooper, Kelly, Yukon Csiernick, Rick, Ontario Decker-Pierce, Barbara Ontario Este, David, Alberta Fudge Schormans, Ann, Ontario

Gorman, Eunice, Ontario Heinonen, Tuula, Manitoba Lanteigne, Isabel, New Brunswick/Nouveau-Brunswick Oldford, Jim, Newfoundland and Labrador/Terre Neuve et Labrador Preyde, Michèle, Ontario Rambharack, Heather, Ontario Ronan, Donna, Newfoundland and Labrador/Terre Neuve et Labrador Shankar, Janki, Alberta Sheppard-Hewitt, Elizabeth, Newfoundland and Labrador/Terre Neuve et Labrador

Books Received/Livres reçus Books received at the CASW national office, are open to a lottery (to members of CASW member organizations only). Check the list on the Members’ Site. Ces livres, reçus au burau national de l’ACTS, sont offerts en loterie. Seuls des members des organizations members de l’ACTS peuvent participer. Prière de verifier la liste sur le site réservé aux membres.

Coming Events/Événements à venir For international and national conferences please click here: To post your conference contact the CASW national office. Please note that information submitted will be published in the language that it is received.

Pour les conferences internationals et nationales, veuillez cliquer ici. Communiqué avec le Bureau national de l’ACTS pour faire afficher la conference que vous proposez. Prière de noter que l’information soumise sera publié dans la langue officielle dans laquelle nous l’aurons recue. 211 Canadian Social Work/Travail social canadien

RESOURCES/RESSOURCES

An Invitation We would like to invite you to review a book/video for possible publication in the CSW online Journal. You will be allowed to keep the copy of the book or video that you select. And if the review is published in the next issue, we will send you a complimentary CD with the Journal issue in which the review appears. Please take a few moments to review the list below and then email us at [email protected] with the title of your preferred book or video. We will mail it to you, along with the writing guidelines. Thank you very much for volunteering your time and collaborating with the work of the Canadian Association of Social Workers. Books/Videos available for review: Canadian Criminal Records: and How to Start Fresh. Antree Demakos. Fitzhenry & Whiteside Limited. ISBN 978-55455-167-5

Orphan Care: A Comparative View. Jo Daugherty Bailey. Kumarian Press. ISBN 978-1-56549-484-8 Airdries Boys: Fostering as a Family Form. Airdrie ThompsonGuppy. I Universe Editor’s Choice. ISBN 978-1-4759-3048-1

Narrating Social Work Through Autoethnography. Stanley L. Witkin. Columbia Univesity Press. ISBN 9780231158817

Théorie et pratique de conscientisation au Québec. Gisèle Ampleman, Linda Denis et Jean-Yves Desgagnés. Presse de l’Université du Québec. ISBN 978-2-7605-3602-9

CHI. A film by Anne Wheeler, featuring Babz Chula. Production 2013, National Film Board Like a Child to Home. Bill Engleson. Friesen Press. ISBN 978-1-4602-1928-7

The Equal Parent Presumption: Social Justice in the Legal Determination of Parenting after Divorce. Edward Kruk. McGill-Queen’s University Press. ISBN 978-0-7735-4291-4

With Children and Youth. Emerging Theories and Practices in Child and Youth Care Work. Wilfrid Laurier University Press. ISBN 978-1-55458-966-1 212



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