Health Committee on Sept. 22nd, 2022

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Douglas and Mr. Davies.

Next is Dr. Ellis, please, for five minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Chair.

On that note, Ms. Douglas, just to underscore that, as we all know very clearly, or at least those of us who practise medicine do, children are not just little adults. Certainly, the Tylenol and Advil shortage that currently exists and the certain significant stress and anxiety that causes for parents really is a way to underscore the need for the development of specific pediatric formulations. I appreciate your efforts on that front.

Dr. Tomkins, perhaps you could talk a little bit more about this jurisdictional approach to the proposed dental program. I'm certainly loath to understand why I would believe that the federal government could administer a program in any way, shape or form that would be efficient or effective. That's beside the point, of course. That's political. But if these programs exist in 11 of 13 jurisdictions in Canada already, then why do we need a federal dental program?

[Dr. Lynn Tomkins]

What we have now is an interim program. The money is going to low-income families and children who need it. What we would say is that as part of the dialogue, we would want to be involved as we develop this program going forward. You are correct; there are programs in existence across the country and they are successful to varying degrees. Some are fairly well funded, work well and reach the populations they're designed to reach. Some of them are not. There really is a tremendous variation from jurisdiction to jurisdiction.

That will be part of the continuing conversation we have. We represent the provincial and territorial dental associations. They have had the opportunity to meet with the minister and make their concerns known. Each province is a little bit different. It's a lot like Confederation. I think if we keep our focus on the big outcome, which is ensuring that Canadians who don't currently have access to dental care.... If we can work together, we will find a system that works. Whether it's slightly different in every province, we don't know, or whether it ends up being a federal program, we don't know, but we are here to provide the information and the feedback on things going forward.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Dr. Tomkins.

Again, Dr. Tomkins, if I may, do you know which programs jurisdictionally are very successful and which are less successful? I guess the question is this: Why do we always have to move to the lowest common denominator? Why can't we help those who are less successful be more successful and model their care after those who are more successful? Again, the follow-on question is, why does the federal government have to get involved in a provincial issue?

[Dr. Lynn Tomkins]

Well, as I've been told and led to understand, the funding comes from the federal government and then the provinces decide how it will be used. If you look at provinces like Prince Edward Island and Newfoundland, they do have reasonably good programs. No program is perfect. For instance, as I understand it, in Newfoundland they cover certain things, but they don't cover prevention. In other provinces, they cover different things. I think from a public policy point of view, if we want something that will reach all of the populations, we need to have some sort of national agreed-upon standard that will be the basic dental care plan. That will then be part of the discussion.

The other part of your question is really part of the debate that's going on between the provinces and the federal government right now.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I guess that's the thing; if we're having a policy debate, that's one thing, but if we're creating legislation that's going to create more bureaucratic issues and cost to create an entirely new program, that seems kind of nonsensical to me in something that already exists. I just fail to understand what the need for that is and why we should be supportive of this.

That doesn't mean that dental care is not important. I've been a family doctor for 26 years. I see a plethora of dental problems that could be easily prevented and treated. As you well know, Dr. Tomkins, because I understand you're a practising dentist, you know what I treat them with—antibiotics, inappropriately.

That being said, then, I continue to fail to understand, if we have programs in 11 of 13 jurisdictions, why we don't make them better instead of creating a new program. If we want to have a strategy on this, wouldn't it make more sense to say, hey, let's make a strategy? Why do we need to spend all this money on a program that to me is looking for a home?

I guess I'm wondering what the CDA thinks of that.

[Dr. Lynn Tomkins]

Those are all very good points. As I understand it, with the current Canada dental benefit, this is something that has a finite lifespan. As I said, this will be part of the ongoing dialogue.

I don't know if Aaron wants to add to that.

[Dr. Aaron Burry]

No. I think you've outlined some of the things we would like to see, which is better coordination between the benefits and a conversation about improving programs right across the country at this particular point in time.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, both of you. I appreciate it.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

The last round of questions will be posed by Dr. Powlowski.

You have the floor for five minutes, sir.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Thank you.

I have questions for Dr. Ungar.

I was wondering about the available psychological support services for children who come from war zones. We've obviously had a big influx of such children in recent years, first with Syrians, then with people from Afghanistan and now, most recently, with people from Ukraine.

Certainly, you know and will appreciate that the vast majority of kids are really resilient. I know of kids from Afghanistan who have seen their close relatives die in front of them. I know of Ukrainians who have close family members on the front line. They seem to be doing all right. Obviously, I don't think all of the kids need psychological services.

One, do we have enough services to serve their needs? I guess I'm also thinking of all those people—for example, schoolteachers—who aren't used to this situation and how to identify somebody who maybe needs help, and whether there ought to be any kind of screening to see who among those kids needs help.

[Dr. Michael Ungar]

Thank you for the question. You raise lots of great issues here.

What I can tell you is that for younger children, I think there is a bit of an assumption, not that you're making it at all.... You seem very clued into this, and I thank you for that, but there is sometimes an assumption that a child will come out of a war zone and in fact somehow that has always resulted in a mental health challenge. That's not actually supported by the evidence.

Actually, what many children do experience, especially adolescents, is a lot of difficulty transitioning or integrating in during this phase of their resettlement, but because they maintain connections with family and a positive identity, they feel that they're not necessarily the cause of their being dislocated—it's not like they did something personally wrong—and a lot of those attributions and patterns of thinking actually are quite protective.

I just want to reassure the panel here that a lot of these children do need care, but many actually come with many of the resources to cope well. Our wonderful settlement organizations that are national in scope, many community groups, our religious organizations that adopt these families in their communities, the service clubs and educators, all of that creates, if you will, an environment rich in that kind of mental health supports. My estimate is that maybe one in 10 of these children, or perhaps two or three in 10, may need some sort of tertiary-level mental health intervention, and then you're right: It is a challenge to find culturally competent, linguistically appropriate interventions that would actually match.

Now, the good news is that across the country there are people, such as social workers, who act as cultural brokers. There are community organizations through faith communities that are reaching out to families and children. There are a lot of grassroots initiatives. I like that, because it takes away the necessity to always focus on a Ph.D. in child psychology who has to treat.... What we're actually understanding is that there's a relatively small number of children who would need that level of care, mostly because we as a Canadian society are incredibly good at wrapping communities and educational facilities around the children who are coming. We're seeing that. We saw that with the Syrians, and we certainly have seen that with the Ukrainians as well.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Maybe there's no quick answer to this. Most kids are resilient, but some not so much. Why the difference? Which kids aren't resilient, and how can the system try to encourage whatever it is that makes kids more resilient?

[Dr. Michael Ungar]

Actually, what we see is that the children who tend to show more of those patterns of coping successfully have internal strengths—sometimes it's just the genetic lottery, if you will—but more often it's about patterns of extended family, opportunities in their communities to use their talents, recreational spaces, access to a cellphone and technology so that they can remain connected to their extended peer group, language skills, and an education system that adapts. There are a lot of factors that you can actually put in place that are well researched and that actually create the optimal conditions for children to survive well.

Of course, as your questions indicate, there are also children whose past risk exposure is so severe or so unique, or they have a constellation of risk problems, that you do need to tailor an intervention specifically for them. This is not related to refugee children, but if you look, for instance, at the Kids Help Phone, which is a national effort, you will see that it's actually overused or used disproportionately by children in rural communities and by indigenous children, largely because it's a protective factor that is very adaptable to people living in more marginalized communities and rural communities. I think that's where we get thinking about protective factors as really tailored to the risks that a child experiences, while not forgetting that most children respond really well simply to all the good things that we tend to give kids through communities that care about the newcomers who arrive.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ungar.

Thank you, Dr. Powlowski.

That concludes our rounds of questions.

To all of the panellists, thank you so much for being here with us today. This is our first witness panel on this study, the first of six we have planned. It's a very broad topic, and I think the diversity of expertise that we had in the room today reflects how broad the topic is.

Thank you very much for sharing your expertise and experience with us. I have no doubt that it will be of great value in framing our thinking as we move through this work. We are, indeed, grateful to you for the time that you've given us and the thoughtful and comprehensive way in which you've addressed all of the questions.

Is it the will of the committee to adjourn the meeting?

[Some hon. members]

Agreed.

[The Chair, Liberal, Sean Casey]

We're adjourned.