Citizenship and Immigration Committee on May 31st, 2016

[The Chair, Liberal, Borys Wrzesnewskyj]

I call the meeting to order.

Good morning. Pursuant to Standing Order 108(2) and the motion adopted by the committee on March 8, the committee will resume its study on the federal government's initiative to resettle Syrian refugees.

Appearing before us today are Dr. Randall Croutze and Kevin Desjardins of the Canadian Dental Association. Welcome. We have Carolyn Davies of Catholic Crosscultural Services. Welcome as well. We also have Salahudin Khan and Mirza Hakeem Baig of the Islamic Foundation of Toronto, who are both appearing by video conference.

Witnesses are reminded that you have seven minutes for each grouping of panellists.

We'll begin with Dr. Croutze. You have seven minutes, please.

[Dr. Randall Croutze, President, Canadian Dental Association]

Thank you very much, Mr. Chair, and members of the committee.

My name is Dr. Randall Croutze, and I am president of the Canadian Dental Association. Here with me today is Mr. Kevin Desjardins, the director of public affairs at the association.

I want to thank you for inviting the CDA to appear before you on behalf of the dental profession to speak to you on this important issue. We had the chance to meet with some of you earlier this month, and we appreciate the opportunity for furthering the discussion.

The CDA is the national voice of dentistry dedicated to the promotion of optimal oral health, which is an essential component of general health. We represent the provincial dental associations, which represent over 18,000 practising dentists.

We are here to speak on the issue of dental care within the interim federal health program for Syrian refugees . With Canada welcoming 25,000 Syrian refugees in recent months, and 10,000 more to come, there is greater focus on the state of our refugee health care system.

As you may be aware, refugees who arrive in Canada are covered for a year under the IFHP, the interim federal health program, which covers the basic health needs. For dental care, this is limited to emergency or urgent care. This program currently covers emergency examinations; some diagnostic radiography; pre-approved restorations for severely affected teeth; extractions, with more complicated extractions requiring approval; emergency prescriptions; and anaesthesia.

To be clear, these are the most basic levels of dental care.

This recent significant influx of refugees has pressure-tested the interim federal health program, and we have heard from dentists across the country that the program has been unable to hold up to the test. Our members, the provincial associations, have been vocal about their concerns.

The limited manner in which oral health is covered under the IFHP creates challenges for patients and for health care providers. We have heard from dental offices that have been strained by the added effort that is required to work with the program, and the strict limitations of the program are not in line with the accepted best practices of care.

Among the issues identified to us are the requirement to receive pre-authorization for fillings. No other dental benefits program requires this. The criteria for having such a request approved are unknown and unavailable, which adds an unnecessary administrative burden. Even after having a procedure pre-authorized, there is a requirement to call to reconfirm eligibility for the program when the patient returns to the office.

Beyond the fact there should be no eligibility issues with this cohort of refugees, as they have been pre-screened and declared permanent residents, the time it takes to verify what should be evident can be as long as an hour on the day of the appointment.

That coverage does not always align with the generally accepted standards of care. For instance, large fillings are covered, but stainless steel crowns, which are roughly the same cost, are not. Stainless steel crowns are the standard of care for restoring two or more surfaces on baby teeth in high-risk children.

With regard to X-rays, there is no coverage for bitewing films unless they are part of a full mouth series of films, which may not be necessary. Bitewing films are necessary for diagnosis of cavities and should be covered as a stand-alone code.

There is no post-approval for surgical extractions of teeth. It is impossible to tell before you begin an extraction if it's going to be a simple extraction or a more complex surgical extraction.

I would note that in recent weeks, and in the time since we visited with some of you on the Hill, the Immigration, Refugees and Citizenship Canada has issued a bulletin that updates the list of services that can be offered, along with criteria and limitations. We have reviewed this bulletin and we see there have been some areas of improvement to the program.

We still believe it is necessary to consult with the dental profession if any changes are made to the policy to ensure they'll align with accepted practices of care.

Administration of the program should not drive patient care. Refugees, especially children who have been lacking consistent dental treatment, preventive care, or fluoridated water have a host of problems that may required further treatment beyond what the IFHP affords. Access to provincial social services programs is in most cases not immediate, and delays in treatment can exacerbate these health issues.

Moreover, public health and volunteer initiatives have been strained beyond limits in their attempts to deal with these issues.

Before I conclude, I would be remiss if I didn't take a moment to recognize the dentists from across the country who have stepped forward to help these new refugees. This includes providing free screenings and providing pro bono care.

However, relying exclusively on pro bono work is not sufficient to address the oral health needs of this cohort of new arrivals. As health care professionals, Canadian dentists are concerned with patient quality of life and optimal oral health for all refugees.

We urge the government to further examine the dental policies of the interim federal health program so that it can be assessed and improved to ensure that refugees can have immediate access to basic dental care.

I thank the committee for their time and attention and I look forward to your questions.

[The Chair, Liberal, Borys Wrzesnewskyj]

Thank you, Mr. Croutze.

Go ahead, Ms. Davis. You have seven minutes.

[Carolyn Davis, Executive Director, Catholic Crosscultural Services]

Thank you, Mr. Chair and members of the committee.

Good morning. Thank you for the invitation to speak to you today regarding the government's initiative to resettle Syrian refugees.

My name is Carolyn Davis, and I am the executive director of Catholic Crosscultural Services, a settlement agency operating in Scarborough in the east part of Toronto and in Peel region in the communities of Mississauga and Brampton.

For over 55 years we have been providing a wide range of settlement services that assist over 30,000 newcomers annually to settle and integrate into life in Canada. Contrary to our name, we serve everyone, regardless of their country of origin, their religion, or their background.

We provide language classes, orientation, and employment programs. We have seven offices. We are in 50 different schools and 10 community locations.

In addition to being a settlement agency, we're also involved in the private sponsorship of refugees program. We administered the sponsorship agreement for the Toronto Catholic archdiocese until 2008, and for the past nine years have been delivering the refugee sponsorship training program, or RSTP, which provides training, information, and support to sponsoring groups across Canada.

Prior to the Syrian initiative, we focused primarily on supporting sponsorship agreement holders, but with the explosion in the general public's interest in sponsoring refugees, we've been overwhelmed with requests for training and support from new sponsoring groups. We were fortunate to receive additional funds from IRCC, the Province of Ontario, and the City of Toronto to hire additional staff, but we continue to struggle to meet needs.

We also administer the blended visa office-referred program, or BVOR, matching BVOR cases with sponsoring groups. This program has such a high demand that when a new group of cases becomes available, they are claimed within minutes. They're released by email and are claimed within minutes. In January we matched 500 BVOR cases, which is actually a year's worth of work, generally.

Since more often than not it's easy to run out of time in one of these presentations, I will move to some conclusions and recommendations and then circle back a bit to some of the background.

I want to stress three key points today.

One, the private sponsorship of refugees program is incredibly important. It augments the government's commitment to aid refugees and allows for the average Canadian to become involved in a life-changing humanitarian effort. The refugee sponsorship training program has a vital role in supporting Canadians' participation as sponsors in our refugee resettlement program.

Two, the Syrian refugee initiative identified gaps in the RSTP and in the private sponsorship program and clearly demonstrated the need for increased funds to meet the training, information, and support needs of these explosively expanding sponsorship groups.

Three, the settlement sector plays a vital role in supporting both the long- and short-term resettlement of Syrian refugees. For government-assisted refugees, the settlement sector is the primary source of support. For privately sponsored refugees, they have a role in working with sponsors to ensure that the refugees receive the settlement services they need.

The sector's role in supporting Syrian refugees applies from their first days in Canada through to month 13 and beyond. Attention needs to be paid to a better connection between the settlement sector and the sponsorship community so that they can best collaborate. The settlement sector requires immediate and targeted funding to support the needs of the Syrian refugees.

To put these recommendations into context, the private sponsorship program has been bringing refugees to Canada for more than 35 years. The refugee sponsorship training program has been providing private sponsors with training on everything from how to complete forms to how to understand the process to how to settle refugees in their new life.

Until recently RSTP has been working with sponsorship agreement holders, groups of five, and community sponsors only if they've had their applications rejected. We have no way of getting to them otherwise. This work was limited only by the funding and staff resources allocated to the program. Since the Syrian refugee resettlement initiative, RSTP has been attempting to respond to the demands of sponsors, old and new, in all categories, but it has been a bit overwhelming.

Settlement agencies across the country have a long history of supporting the settlement of refugees who have arrived as a result of war and forced migration, circumstances similar to those of the Syrian refugees. As a sector, we have the skills and experience to meet their needs.

Is the system perfect? No, but we are a skilled, resourceful, and committed sector able and willing to do the work.

Syrian refugees, like those before them, need language, information, education, training, and employment supports. What marks the Syrian refugees resettlement initiative as different from other resettlement initiatives is the large number of refugees arriving in a very short period of time, placing an extraordinary demand on the system. Unfortunately, the refugees and their sponsors are looking for supports and resources from a system that has experienced funding cuts every year for the past five years at least. We don't need to reinvent or recreate the sponsorship or settlement sector to meet the needs of Syrian refugees, but the government does need to fully fund the existing services so they can ramp up enough to meet the needs of this group, which is unprecedentedly large.

With respect to the private sponsorship program and RSTP supports, the demand for information, supports, and matching to available refugees increased so fast it was impossible to keep up with the demand. Without exaggeration, each of our RSTP workers was receiving somewhere in the vicinity of 150 to 200 emails a day with questions, requests for workshops, and detailed process questions. It was next to impossible to keep up. We did receive the additional funding to double the staff, but the requests were also increasing at about the same rate or more. We don't expect that this will drop off as the refugees arrive and the sponsors, especially new ones, begin to deal with the reality of their sponsorship responsibilities. There are a high number of new sponsors who are connected to some very complex cases, and they will need support over the next while.

To give IRCC credit where it is due, we were contacted a couple of weeks ago and asked to submit our ideas for an expanded and reimagined sponsorship support service. They were clear that there was a commitment to building the program to better serve the needs of sponsors. Our plan will be submitted to them today, and we expect to hear from them in the near future.

An important change to the refugee program that would make a huge difference to Syrian refugees would be an increase to GARA, the government-assisted refugee allowance.

[The Chair, Liberal, Borys Wrzesnewskyj]

Ms. Davis, your time is almost up.

[Carolyn Davis]

Okay.

It is based on provincial welfare rates, and it also sets the financial support scale for the private sponsors. It is completely inadequate in this time period.

Thank you, and I look forward to your questions.

[The Chair, Liberal, Borys Wrzesnewskyj]

Thank you, Ms. Davis.

Mr. Baig, you have seven minutes, please.

[Mirza Hakeem Baig, Joint Secretary, Islamic Foundation of Toronto]

I would like to thank you for inviting us to this session.

The Islamic Foundation of Toronto has been in existence as a SAH, a sponsorship agreement holder, for the past 15 years, but we have aggressively worked on the private sponsorship of Syrian refugees and the BVOR categories since January 2016. Until March 31, when there were no restrictions on how many applications we could submit, we submitted around 187 applications for 187 families, and that is approximately 8,500 persons, with a financial commitment from outside of $6 million. Without government support, without the IRCC, and without our bureaucrats, this would not have been possible.

The other category is BVOR, whereby the government supports each of the families for six months. We have sponsored approximately 27 families. As part of the continuation of the process, there are some family members who remain there for whom we have to apply. Other families have been divided, with some left in Turkey, Jordan, or other countries.

We have a challenge, because we have been allocated only six people for the rest of the year, from March 31 onwards, and we're not able to meet the demand of our congregations. Our congregations are ready with the money in addition to the $6 million we have committed, and we have more than 67 families who are waiting in line to sponsor their near and dear ones, with their financial commitments in place. We are taking it up with different levels of the government and taking it up with IRCC, but unfortunately we are not getting any help on that.

We would like to be part of this process to help the government and to reduce the financial commitment of the government. We would like to pitch in with money. However, we need the IRCC to look into the issue of the allocations. If we have submitted applications for 8,500 people from January until March 31—in three months—we should get a fair distribution of the allocation for the rest of the year, and this has not happened. For this reason we request that the private sponsorship of refugee allocations be revamped in terms of how the number of people to be sponsored by each of these SAHs is allocated.

Also, when there is a process of BVOR allocation and a communication is sent to all the SAHs, we respond within three, four, or five minutes' time. Sometimes we'll get one family and sometimes we don't get any. Something has to be looked into. What is the problem? If there are 25 families, why would we not get at least one family? That has to be revamped.

We have a complete settlement process in place. We ensure that the families who are coming in don't just do some odd jobs. We train them. We take them for training first. There is a group of five or six people working with each of the family members. They plan for the whole year. They have one year to see that this family gets settled in Canada and doesn't go on welfare. We work hard.

For this reason the government should also consider giving some secondary funding to the SAHs that are doing the settlement activity. Without a complete comprehensive action plan, we cannot settle these families. We have to ensure that the family members—the kids and all—are settled in life here in Canada. We say each time—and we don't have to repeat it here—that we feel proud that our country has taken up this challenge and has done this great job.

Thank you.

[The Chair, Liberal, Borys Wrzesnewskyj]

Thank you, Mr. Baig.

Ms. Zahid, go ahead for seven minutes, please.

[Salma Zahid, Liberal, Scarborough Centre, ON]

Thank you, Mr. Chair.

I'd like to thank all our witnesses for all the work they are doing in helping to settle these Syrian refugee families here in Canada and for joining us today.

My first question is for Ms. Davis.

Previously in the committee we have heard that the integration of newcomers who are teenagers can be particularly challenging. It is a difficult time for any teenager, let alone for one adapting to a new country and culture. I understand that your organization has been engaged a lot in this area and you have a lot of offices in schools.

Can you discuss the challenges this age group is facing and how we can help? What can we do?

[Carolyn Davis]

Thank you for that question.

We are involved in quite a number of high schools in Scarborough and are very involved with the newcomer community in the secondary schools. There are a number of issues with that particular group. Some of it is simply that it's difficult enough being a teenager, with all it includes, let alone in a new country and a new language, and maybe not even necessarily wanting to be here.

On top of that, you have no way to communicate with your peer group, and you may have been out of school for a while. Imagine all of those factors piled together, with an 18-year-old sitting in a classroom with 14-year-olds and not necessarily feeling like they belong. Our grave concern is that we need to provide these Syrian youth with a sense of belonging outside that classroom, which is challenging.

Through group activities.... We have a plan out with IRCC that hasn't been approved yet for a matching program. It would potentially match Syrian youth with youth who have gone through the settlement process but have been here for a while, who would bring them along and give them a sense that there is life after some of the more difficult initial stages.

We also are looking at providing some academic enrichment to help this particular youth cohort catch up on their academics, given that they may well have missed a number of years of school.

[Salma Zahid, Liberal, Scarborough Centre, ON]

I understand that some of the services provide are counselling, referral, and filling out paperwork for the families. How important are some of these softer skills to helping Syrian newcomers integrate successfully in Canada?

[Carolyn Davis]

They're incredibly important. Even just filling out paperwork and explaining how systems work and connecting them with other resources is really the heart and soul of settlement, in that it helps with everyday living. It's the ability to get things done in your life. It is to help the refugees have a sense of a plan for themselves and a sense of how to accomplish that plan in order to settle, and it's to work with them along the way while they experience good moments and bad moments as they work their way through a settlement plan. We provide the backdrop for them to come back and ask further questions and we provide that support on a ongoing basis.

[Salma Zahid, Liberal, Scarborough Centre, ON]

You also provide targeted employment services and training for immigrants and refugees in the Scarborough area. Going back well before the current wave of Syrian newcomers, in your experience, what are the fundamental elements and supports that need to be in place for the newcomers to successfully integrate into the employment market?

[Carolyn Davis]

The program that you're referring to is a program that is called enhanced language training. It is for internationally trained medical professionals to help them bridge into the medical technology fields and use their training and background.

A couple of the elements that make that program so successful are that there is a lot of language training to help them use professional language and translate what they know into English so that they can get through interviews and operate in the workplace.

It also provides a volunteer work placement in order to help people connect with the realities of the work world in Canada. They may be familiar with what it's like to work in a hospital in their home country, but it may be significantly different in Canada. It's important, therefore, to give people a sense of a volunteer placement. We'd like to be able to pay them for that placement, but we don't have the funds to do that. This is probably one of the most important elements of that program.

[Salma Zahid, Liberal, Scarborough Centre, ON]

My next question is for Mr. Khan or Mr. Baig.

As we know, youth can face some of the biggest challenges when it comes to integration, although in time they can also be the most successful, serving as a generational bridge between their family and the new Canadian society. I know your group offers free tutoring, life skills lessons, and Quranic school classes, all specifically catering to youth.

How have these programs assisted in ensuring that Syrian children are able to enter the educational system and successfully integrate into Canadian society, all while retaining their cultural and religious heritage?

[Mirza Hakeem Baig]

Simultaneously with the ESL classes, we have activities for the youth and the children at IFT every weekend. It's not specific to the Syrian kids; they sit with the other kids, who are from different backgrounds, different ethnicities. The diversity of Canada is represented in each of those classes. It helps them to be comfortable in interacting, in knowing how to interact.

There are some challenges with the language, and those things are going on simultaneously. We have resources at hand for Arabic. In the classes, they speak English. Slowly, we see dramatic improvement in the kids. They were very shy, they were not talking to other kids, and now they are.

It's a slow process. It will take some time for them to get used to Canada.

[The Chair, Liberal, Borys Wrzesnewskyj]

Thank you.

Mr. Tilson, take seven minutes, please.

[David Tilson, Conservative, Dufferin—Caledon, ON]

Thank you, Mr. Chairman.

I want to thank you all for coming. I particularly thank the Islamic Foundation for your generosity in helping these people.

I have a few questions for the dentists.

Dr. Croutze, I met you several weeks ago, of course, when the dentists arrived on Parliament Hill, and I have a special interest. My late daddy was a dentist, and so I understand some of your concerns.

You talked about the list of services being inadequate. I'd like you to elaborate on that. You said some services aren't covered. Is there a liability concern of dentists? What happens when something has to be done that is not covered in this list?

[Dr. Randall Croutze]

Thank you very much. I appreciated your attendance at our function, and thank you so much for the comments.

Absolutely, when we take a look at the list of services that are provided, we see that it is the bare minimum. It falls outside of what we would consider good care. You're absolutely right. When I take a look at a cavity on a tooth and there's no coverage for it, it would be like a medical doctor taking a look at some cancer and saying, “Well, that cancer is not quite big enough for me to operate on. I'm going to have to wait until it gets bigger.” That's the dilemma we face all the time in dealing with these sorts of situations.

The situations we face are life and death. These people are coming with incredible loads of disease—things we don't see in Canada—because of the poor nutrition, the poor preventative care they've had. They've had no fluoridated water. They have rampant cavities that infect nerves and cause abscesses in the tissues around.

The liabilities are more than just a case of someone coming in with a chipped crown. These are people who, if we don't treat them, are going to end up in the hospital. People die of dental infection. We don't realize that in this country, but in the countries these people come from, it's a common enough occurrence. Absolutely we can't let these people exit our offices without providing them treatment.

It's inappropriate to have to pre-authorize for a surgical extraction for someone coming in with a facial abscess. The kinds of things we're looking at are open-and-drain, and there's a fee code for that, but It's not covered here. That's a basic minimum service. If someone comes with a facial abscess, we want to be able to get them out of it. Giving them an antibiotic and a painkiller and sending them out is not good treatment. It is something our regulators would look at poorly and it goes beyond what our ethics would dictate.

We need to provide better care than what is provided here, and that care is being provided. Dentists are providing it at no cost, which makes it sound as though we're not making money. The fact of the matter is that the overhead in our office is about 70%. What ends up happening is that if it's $1,000 worth of work, we've paid $700 towards that and done it for free, so we're losing money.

It's something that dentists do all the time. We generally don't complain about it, but when the load is increased to this extent, it's beyond our capacity to accept those sorts of numbers.

[David Tilson, Conservative, Dufferin—Caledon, ON]

Is there a language issue?

[Dr. Randall Croutze]

Absolutely. Fortunately, we have either staff or dentists who are capable and able to speak. Yes, the language issue is significant. People will come with interpreters; that does happen. It is a bit of a barrier, but it's not the most significant barrier.

[David Tilson, Conservative, Dufferin—Caledon, ON]

How long does it take to get payment from the government?

[Dr. Randall Croutze]

First you have to examine the person; then you'd have to pre-authorize for the work. That process is going to take four weeks. You take a look at the patient coming in with an abscess, in pain, and you send off a request to do some work. Then you sit back and wait for four weeks; then the patient presents. At that time, you get on the phone and re-verify their participation in this and then do the work and submit for it. It's going to be about four weeks before you are paid.

We're not concerned about that. We want to make sure that we're providing good service.

[David Tilson, Conservative, Dufferin—Caledon, ON]

I'd like to ask this question of all witnesses, starting with Dr. Croutze. It is on the issue that has cropped up with previous witnesses, the issue of the 13th month. In other words, after a year the government assistance stops. I remember asking a question of the minister, and the minister's answer was, well, there's social service, there's social assistance.

I'll start off with you and then move to Ms. Davis as to how this will affect the work you're doing, when all of a sudden there is no more financial assistance from the government.