Affidavit of Michael Bear - Phoenix Sinclair Inquiry

March of 2003 she was in Kirkos House to try and meet those needs. She
was made a permanent ward in December 2003. She was in a number of
emergency resources, the four bed units both at Kitigas at Little Grand
Rapids and in Poplar River, in emergency shelters in the city. Because of
behavioural problems she kept being moved because placements seemed to
be unable to meet her needs until Project Neecheewam. Yet despite being
constantly in the Agency's eye little seems to have been done with respect to
long-term planning for Tracia Owen.
[143] The really frightening aspect is the view expressed by many that
despite these constant behavioural issues they were not sufficiently unique
or different from other youth to bring any particular attention to her file. Her
struggles were not unusual in the child welfare system.
[144] It was conceded there needs to be a strengthening of the governance
of the system, to improve oversight, compliance, monitoring and to build
capacity within the agency to do so. The Southern Authority is responsible
now for nine agencies as opposed to the 22 under the Child Protection
Branch. Therefore there should be a more focused workload, easier to
address shortages and deficiencies and to consider best practices.
[145] Exhibit 50 filed at the inquest is an audit conducted to examine areas
needed to be considered when the devolution was taking place. The
systemic problems of the old system needed to be addressed by the new
Authority. Ms Flett and the Authority are in the process of implementing
those recommendations some of which bear directly on the inquest which
have been mentioned and others which are important but less relevant to our
issues.
[146] One recommendation which I believe is extremely relevant and may
assist in preventing future tragedies is the mandatory requirement to use the
Child and Family Services Information System, the database system, to
maintain and track files. Although there are some system issues in some
locations the potential for the proper use of this system may be an answer to
the lack of information on a file and to keep the file current and updated. A
current central database provides a better tool for case management and
some of the information placed on a file may be used as a trigger or flag to
warrant review of the file.
[147] There should be some sort of criteria established such as too many
placements, sexual abuse disclosure, sexual exploitation, that flags that
particular case file for review and immediate attention.
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