HomeMy WebLinkAboutFCS Agenda - 2018-04-09Finance & Corporate Services Committee
Agenda
Monday, April 9, 2018
1:30 p.m. - 4:30 p.m.
Office of the City Clerk
Council Chamber
Kitchener City Hall
nd
This is an approximate start time, as this meeting will commence immediately following
200 King St.W. - 2 Floor
the Community & Infrastructure Services Committee meeting.
Kitchener ON N2G 4G7
Page 1 Chair - Councillor S. Davey Vice-Chair - Councillor D. Schnider
Consent Items
The following matters are considered not to require debate and should be approved by one motion in
accordance with the recommendation contained in each staff report. A majority vote is required to discuss any
report listed as under this section.
1. CAO-18-007 - Regional Agreement - Patios Fronting ION Tracks
2. CAO-18-008 - City of Kitchener, Waterloo Region Small Business Centre
- Memorandum of Understanding with Pillar Network Inc.
- Re: Social Enterprise Southwest Project
3. CAO-18-011 - Kitchener Market Parking Initiative
4. FCS-18-028 - Request to Add Conditions to a Business Licence - 700 Strasburg Road
5. FCS-18-029 - Request to Add Conditions to a Business Licence - 108 Queen Street South
6. FCS-18-033 - 2018 Community Environmental Improvement Grant (CEIG)
edural By-law, delegations are permitted to address the Committee for a maximum of
5 minutes.
Item 8 - Dr. Hsiu-Li Wang, Region of Waterloo Public Health
- Karen Quigley-Hobbs, Region of Waterloo Public Health
7. CAO-17-028 - Launching the Film, Music and Interactive Media Office (60 min)
(Staff will provide a 10 minute presentation on this matter)
8. CAO-18-010 - Supervised Injection Site (SIS) Input to the Region of Waterloo (75 min)
(Staff will provide a 5 minute presentation on this matter)
CAO-18-012 - Collaborative Municipal Funding for Key Cultural Institutions: Year 2 Summary
Jeff Bunn
Manager, Council & Committee Services/Deputy City Clerk
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REPORT TO: Finance and Corporate Services
DATE OF MEETING: April 9, 2018
SUBMITTED BY: Hilary Abel,Manager, Downtown Community Development,
519-741-2200 ext. 7064
PREPARED BY: Hilary Abel,Manager, Downtown Community Development,
519-741-2200 ext. 7064
Erin Mogck, Associate City Solicitor, 519-741-2200 ext. 7060
WARD (S) INVOLVED: 9, 10
DATE OF REPORT: March 27, 2018
REPORT NO.: CAO-18-007
SUBJECT:Patio Agreements fronting ION Tracks
___________________________________________________________________________
RECOMMENDATION:
Waterloo, satisfactory to the City Solicitor, to allow the City to coordinate the licensing
of
BACKGROUND:
Through Council Policy I-1205, the City permits the use of City owned sidewalks in Downtown
Kitchener for outdoor patios, provided the patio operators enter into an encroachment agreement with
the City. This includes the approval of a patio plan/layout that meets various design requirements as
specified in the policy.
However, the Region of Waterloo has ownership over certain roads within the City. The City would like
to be allowed to coordinate the licensing of patios for businesses located along the Light Rail Transit
(LRT) ION tracks within the City.
REPORT:
The Region of Waterloo currently does not have a process for permitting outdoor patios on Regional
roads. However, the Region is willing to delegate responsibility to lower tier municipalities, provided
each municipality enters into an agreement which will specify the terms by which the patios would
operate. The City currently has one business interested in having a patio on Duke Street that would
front the ION tracks. The City anticipates there may be more patios on Regional Roads in the future,
along Duke Street, Victoria Street, Charles Street and potential Frederick/Benton Street.
Regional staff, in consultation with lower-tier municipal staff and the contractors/operators of the ION
system, are finalizing the specific provisions of the agreement. Given the additional safety concerns of
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1 - 1
locating a patio near the ION tracks, the Regional requirements will likely be more restrictive than the
y. When the agreement is finalized, staff will bring forward an update to Patio
Policy I-1205, for Council consideration, by adding any additional requirements for patios on Regional
Roads (specifically along the ION tracks).
e to see patios throughout the Downtown, City staff support the delegation
of authority to the municipality and recommend Council authorize the Mayor and Clerk to execute the
As patio season will soon
begin, authorization in advance of the final agreement will enable staff to accommodate the patio
operator on Duke Street without needing additional Council approvals.
FINANCIAL IMPLICATIONS:
None
COMMUNITY ENGAGEMENT:
As part of the Shape DTK 2020 consultation the public indicated that outdoor patios are a key
ingredient to a lively and dynamic downtown and are identified as a key deliverable of Priority #1
ACKNOWLEDGED BY: Dan Chapman, CAO
1 - 2
REPORT TO: Finance and Corporate Services
DATE OF MEETING: April 9, 2018
SUBMITTED BY: Chris Farrell,Manager Small Business Centre, 519 741 2200 x7294
PREPARED BY: Chris Farrell,Manager Small Business Centre,519 741 2200 x7294
WARD (S) INVOLVED: All
DATE OF REPORT: March 28, 2018
REPORT NO.: CAO-18-008
SUBJECT:Memorandum of Understanding with Pillar Network Inc.
___________________________________________________________________________
RECOMMENDATION: That the Mayor and Clerk be authorized to sign a one-year funding
agreement with Pillar Network Inc. for Waterloo Region Small Business Centre, to
deliver the Social Enterprise Southwest project. Said agreement to be to the
satisfaction of the City Solicitor.
EXECUTIVE SUMMARY:
The concept of doing good while earning a profit may not be new, but recent interest from
government, academics, and community organizations has pushed Social Enterprise into the
limelight.
The Waterloo Region Small Business Centre has an opportunity to implement the Social
Enterprise Southwest (SESW) project in this area with funding of $42,500 from Pillar Network Inc.
(Pillar). The funds will be used to hire a part-time staff to deliver training, workshops, events and
networking.
A Social Enterprise is a business with two goals: i) achieve social or environmental outcomes, and
ii)maximize revenue. The Government of Ontario states simply
organization that uses business strategies to maximize its soci
(Government of Ontario, 2013). The blending of business revenue generation with the drive to
generate measurable, positive impacts in society is
.
estimated there are more than 10,000 social enterprises in Ontario, employing an estimated
160,000 people and serving 3.4 million customers per year. (Social Enterprise Survey for Ontario.
Canadian Community Economic Development Network 2012). A social enterprise is a Non-Profit
Inc, Registered Charity, For-Profit Inc., Co-operative Corporation, or B(Benefit)-Corporation.
Examples:
Habitat for Humanity (National) recycle home building materials, purpose: unemployment,
building houses for disadvantaged people
Harvest Homes (Guelph) green design and construction, purpose: ecological construction
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2 - 1
Working Centre (Kitchener) projects & programs, purpose: reduce unemployment and
poverty
Grosche Tea (Cambridge/global projects) sustainable drinking water: purpose: health,
poverty
2019, identified a need
for business programing for Social Enterprise as a future deliverable. In 2016, WRSBC and
several organizations formed a local Social Enterprise Working Committee with a goal to improve
awareness and access to business services in the community. Together, with representatives from
Capacity Canada, Waterloo University, Sustainable Waterloo, Wilfrid Laurier University, Local
Health Integrated Network, Innovation Guelph, Communitech, University of Guelph, Pillar and
WRSBC, a SE event was held in Kitchener November 2017. The event featured 40 exhibitors,
panel discussions and a keynote speaker, attracting over 150 attendees. In February 2018 a
workshop for Starting a Social Enterprise was held in Waterloo.And recently a survey was
conducted list:
investment, funding, educational resources, workshops, training in leadership, management,
marketing, business planning and connections to experts, coaches, mentors and peers.
BACKGROUND:
WRSBC has an opportunity to deliver value added business services for So
by entering into a one-year Memorandum of Understanding (MoU) with Pillar Nonprofit Network
(Pillar), London ON. Pillar is a non-profit organization currently implementing a Social Enterprise
Southwest (SESW) project funded by the Ministry of Economic Development and Growth (MEDG)
for 2 years. Pillar has assured their funding partner, MEDG, the creation of a consortium of
partners with four Ontario Network of Entrepreneurs (ONE) members to deliver business services
out SW Ontario 2018-
I. Huron Small Business Centre,
II. Innovate Niagara and
III. EPICentre Windsor.
Acquiring a MoU - Waterloo Region Small Business Centre - would
complete the full consortium of ONE members for this SW Ontario project. An MoU with Pillar will
provide WRSBC with project funding to hire one part-time employee to co-ordinate activities in the
area until March 31, 2019, $42,500. (see Appendix 1 - Budget)
The objective of the Social Enterprise Southwest project is to enable new and existing Social
ental impact. The
networking and connections to funding, coaches, mentors and experts locally and throughout SW
Ontario.
Pillar Nonprofit Network, was established in 2001, strengthens individuals, organizations and
enterprises invested in positive community impact. It supports more than 610 nonprofits, social
2 - 2
enterprises and social innovators by sharing resources, exchanging knowledge and creating
meaningful connections across the three pillars of nonprofit, business and government.
Pillar will share its suite of resources, tools and training modules with its ONE members. WRSBC
-the-trainer sessions including: facilitation of seven SE workshops,
event planning, on-line chat/coaching platform training and record keeping of project impact.
st
practices. (see Appendix 2 - Milestones and Deliverables)
WRSBC will continue to collaborate with local partner organizations to meet the objectives and
deliverables. Community partners will help to provide connections to experts, coaches, researchers
and promotion of workshops and events to their networks. The key to success of this project is
collaboration with local partners.
REPORT:
economy, attracting rising amounts of money, talent and attention. They represent a new way to
solve the most challenging social and environmental issues.
A Social Enterprise is a business with two goals: i) achieve social or environmental outcomes, and
ii) maximize revenue. The Government of Ontario states
(Government of Ontario, 2013). The blending of business revenue generation with the drive to
generate measurable, positive imp
160,000 people and serving 3.4 million customers per year. (Social Enterprise Survey for Ontario.
Canadian Community Economic Development Network 2012). A social enterprise can be a Non-
Profit Inc, Registered Charities, For-Profit Inc., Co-operative Corporations, or B-Corps.
Capacity Canada has been investigating business supports for social enterprises in Waterloo
-
many of these would benefit from accessing the ONE and supports available to grow and scale
their business. Waterloo Region has one of the strongest entrepreneurship support systems in the
ccessed mentorship hours
-Profit Social Ventures in Waterloo Region: An
Exploratory Study (2010) Capacity Canada).
Social Enterprise operate in many industry sectors: agriculture, food, professional services, retail,
construction, Information and technology, health and wellness, education, clean technology, youth
services, financial services,
waste reduction, accessible health services, food security, sustainable farming, social justice,
energy, global issues and many more.
A Social Enterprise should not be confused with Corporate Social Responsibility (CSR). CSR
adapts a social or environmental cause as part of their community outreach program but the
2 - 3
Enterprise integrates its social value into its everyday business operations guiding its mission
statement, values, ethics, decisions in procurement, su
and business partners. Corporations with a CSR and Social Enterprises can collaborate to bring
aligning ethics and solving social and environmental problems.
Another driver for Social Enterprise ventures is the changing attitudes towards entrepreneurship
increasingly a
(Government of Ontario, 2015).
Impacts of Social Enterprises:
Fill niches that the market does not meet
Promote innovation
Enhance the delivery of social, environmental, and cultural services
Support the sustainability of notforprofit organization
Stimulate local job creation and skills development
Promote economic growth and neighborhood revitalization
Support an inclusive economy that provides employment and training opportunities for
marginalized individuals
The concept of doing good while earning a profit may not be new, but recent interest from
government, academics, and community organizations has pushed Social Enterprise into the
limelight
2019, identified a need
for business programing for Social Enterprise as a future deliverable. In 2016, WRSBC and
several organizations formed a local Social Enterprise Working Committee with a goal to improve
awareness and access to business services in the community. Together, with representatives from
Capacity Canada, Waterloo University, Sustainable Waterloo, Wilfrid Laurier University, Local
Health Integrated Network, Innovation Guelph, Communitech, University of Guelph, Pillar and
WRSBC, a SE event was held in Kitchener November 2017.The event featured 40 exhibitors,
panel discussions and a keynote speaker, attracting over 150 attendees. In February 2018 a
workshop for Starting a Social Enterprise was held in Waterloo. And recently a survey was
conducted
funding, educational resources, workshops, training in leadership, management, marketing,
business planning and connections to experts, coaches, mentors and peers.
Create new value-added services
Create awareness and understanding of what a social enterprise is, how to identify it, and
how to work with social entrepreneurs.
Integrate social enterprise entrepreneurs with traditional enterprise entrepreneurs
Encourage social enterprise to fill some of the gaps between the usual purview of
governments, traditional markets and nonprofits
Create jobs, generate revenue and impact the economy.
Enhance and leverage collaborative partnerships locally, regionally and provincially
2 - 4
The MoU with Pillar Nonprofit Network Inc. will provide WRSBC with project funding to hire one
part-time employee to deliver value added business services for Social Enterprises from April 2018
to March 31, 2019.
ALIGNMENT WITH CITY OF KITCHENER STRATEGIC PLAN:
Strategic Priority: Strong & Resilient Economy
Strategy: #2.2 Support the attraction, retention and development of existing and new
industries within the regional economy working in collaboration with the economic development
corporation for Waterloo Region.
Strategic Action: # 26 Make It Start
# 27 Make It Grow
FINANCIAL IMPLICATIONS:
None. The Project is funded by Pillar Network Inc.
COMMUNITY ENGAGEMENT:
Entrepreneurship and innovation contributes to economic growth in the community. The Centre
provides programs and services that support and compliment other community entrepreneurial
initiatives essential to the commercialization of small business as a collaborative partner within this
ecosystem.
INFORM
council / committee meeting.
COLLABORATE The City of Kitchener Waterloo Region Small Business Centre communicates,
consults and collaborates with a broad range of community groups, organizations, agencies,
secondary and post-secondary institutes, municipal, regional and provincial governments to ensure
the entrepreneurial services and programs address the needs of small business in the community.
The volunteers for the Waterloo Region Small Business Centre and the Board of Advisors are
representative of these community groups.
ACKNOWLEDGED BY: Dan Chapman CAO
ACKNOWLEDGED BY: Must be the CAO or a Deputy CAO
2 - 5
Appendix 1
Budget April 1, 2018 to March 31, 2019
Budget 2018-2019April 2018December Total
2018
Salaries
Part-time staff$15,750.00$11,250.00$27,000.00
Government regulated $2,100.00$1,500.00$3,600.00
employment expenses
Total$17,850$12,750$30,600
Additionally, funds will be disburse to cover the following Program expenses:
Budget 2018-2019April 2018December Total
2018
Program Expenses
Travel -Mileage expenses9006001500
Sub-regional administration140010002400
Programming local 1000
workshops
Programming regional 2000
workshops
Shift to the Middle Program10001000
Accelerator Program 40004000
Total$6,300$5,600$11,900
Total $21,500$18,350$42,500
2 - 6
Appendix 2
WRSBC Deliverables and Milestones April 1, 2018 to March 31, 2019
MilestoneActivityStart End DateDeliverables -KPI
Date
MoU with PillarSign agreementApr 15, Mar 31, Shared partnership Pillar and
201820194 ONE members ON
Staff hireRecruit and hire May 1, Mar 31, Part-time coordinator onboarded
PT employee20182019
Staff Intro to SW ON May 1, Mar 30, Staff meet all project members,
onboardingconsortium and 20182018Huron, Waterloo, Windsor,
partnersNiagara, London.
Staff and local Pillar project May 1, May 30, Familiarization with resources,
partners SE Train-the-Trainer 20182018tools, on-line platform, reporting.
training
ConsortiumPillar and ONE Apr 15, Mar 31, Monthly meetings
meetingsmbrs meetup20182019
PartnershipCommunity Apr 15, Mar 31, Monthly meetings
meetingsPartner meetups20182019
SEWorkshopsDeliver 5 June 1, Feb 28, Facilitate Workshops
workshops20182019
SESW101 Workshops (2)
Shift Workshop (2)
Social Finance (1)
Storytelling (1)
Digital Storytelling (1)
SE Accelerator Host SE EventMay 15, Nov 30,
Event e.g.: Agriculture,
Event20182018
Environmental, Social Impact
Develop Staff May 30, Mar 1, Onboard local community
stakeholder presentations / 20182019members to enrich SE network
partnershipscommunity andresources e.g.: Chambers
members that of Commerce, Foundations,
interact with SE Investors, etc.
Digital animation of the social
Digital Develop videos June 1, Mar 1,
enterprise community
Storytellingwith Pillar20182019
Regional SE Develop May 15, Mar 31, Regional collaboration model
Model collaboration 20182019developed with consortium and
Developmentmodel for regionpartners
Final Report to Program Mar 1 Mar 31, Consolidate regional outcomes
PillarOutcomes and 20192019and impact for SW ON report
Impact
2 - 7
Kitchener Market Parking Initiative
___________________________________________________________________________
Every week, Kitchener Market staff and Saturday market vendors receive feedback from
customers about their difficulties finding parking in the P2 garage (off Cedar St.) below the
Market building. In response to the Markets most recent community survey, 65per cent of
customers indicated they were unsatisfied with the availability of convenient and affordable
parking. Every Saturday staff closes the entry doors ofP2 about20 times when it becomes
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3 - 1
full, and the area around Kitchener Market is perpetually congested from 7am-2pm. Vendors
claim that their Saturday market business has declined steadily as other nearby parking
options have disappeared. Failure to address these challenges could result in a loss of Market
customers over time.
The Kitchener MarketsP2 level provides free parking on Saturdays. While this parking is
intended for customers, itis also heavily used by Market vendors and their staff. City staff
estimate that as many as25%of the 195 spaces inP2 are occupied on Saturdays by market
vendors and vendor staff. In order to displace these vehicles and free up more spaces for
Saturday market customers, we need to provide vendors and theirstaff with accessible,
affordable parking options that are close and convenient.
Based on input collected from vendors and their employees, and in consultation with the
Parking Enterprise, Kitchener Market staff has developed two options:
1\]
Staff would attempt to negotiate a flat rate parking arrangement with Europro, ownerofMarket
Square, for ground-level parking during Saturday Market hours at their garage on Scott St.
Saturday vendors expressed particular interest in parking their vehicles at Market Square for
two main reasons:
proximity to the Market, both for ease of transporting goods and currency, and safety of
their staff during dark, early mornings;
the garage can accommodate larger transport vehicles and pickup trucks;
Europro isopentoexploringthisoption,andpreliminarydiscussionshavebeenpositive.
Europrowouldprovideaccesscardstomarketvendors(atacost)andwouldofferaflatrate
pervehicleonSaturdays.EuroprowouldrequiretheKitchenerMarkettofacilitateallparking
fees,meaningthattheMarketwouldbebilledmonthlybasedonvendorusageandthen
recoupthosecostsdirectlyfromvendors.
2\]
For vendors willing to walk a further distance or wishing to have a more affordable option, the
City would provide accesstotheBenton-Charlesparkinggarageatadiscountedrateduring
SaturdayMarkethoursofoperation.
A flat rate of$3 per vehicle, per Saturday, would be provided using an OTR voucherprogram.
3 - 2
P1 Parking Considerations
There are also approximately 35 vendor vehicles that will continue to park in the P1 area of the
Market facility on Saturdays. This mixed-use portion of the building is partially occupied by
vendor stalls on Saturdays, completely separate from the P2 area. To standardize the cost of
parking to all Kitchener Market vendors, and to offset the cost of implementing, promoting and
managing the new off-site parking options, a nominal administrative parkingfee will also be
recouped from these vendors. An exception willbe extended to vendor farmers that have a
MyPick certification,to further incentivize this province-wide product transparency program.
Additional Parking Options for Customers
While this effort will increase parking availability at the Market, staff recommends providing an
additional affordable parking alternative for customers at the Charles-Benton Parking Garage.
In consultation with the Parking Enterprise, staff recommend a $2 flat rate be applied,
applicable only during Saturday Market hours (7am-2pm).This option will appeal to customers
looking for a less-congested parking option than P2at the Market.
Inaddition, providing this option should increase resident familiarity with the Charles-Benton
garage, increase usage of the garage, and increase pedestrian traffic between the Market and
Frederick Street.
Based on the customer parking improvement program outlined in this report, staff anticipate
the following financial implications:
A nominal increase inrevenue for parking enterprises at the Charles-Benton garage on
Saturdays;
A nominal increase inrevenue for the Kitchener Market as a result of charging vendors
a small fee to park on the Market premises outside ofP2 (customer parking)on
Saturdays, which willbe used to promote awareness and uptake of the parking options
and customer service goals outlined in this report.
INFORM This reporthas been posted to the Citys website with the agenda in advance of the
council / committee meeting.
CONSULT Vendorsandvendorstaffwillcontinuetobeconsultedpriortothelaunchofthese
parkingimprovementsviawrittencommunicationandinpersonmeetings.
COLLABORATE Ultimately this parking improvement program is a collaborative effort with
our vendors that aimstoenhancetheexperienceofregularMarketcustomerswhilealso
attractingnewones.
Dan Chapman, CAO
3 - 3
REPORT TO: Finance and Corporate Services Committee
DATE OF MEETING: April 9, 2018
SUBMITTED BY: Christine Tarling,Director of Legislated Services/City Clerk,519-
741-2200 ext. 7809
PREPARED BY: Helen Fylactou,Manager of Licensing,519-741-2200 ext. 7854
WARD(S) INVOLVED: 6
DATE OF REPORT: February 23, 2018
REPORT NO.: FCS-18-028
SUBJECT: REQUEST TO ADD CONDITIONS TO A BUSINESS LICENCE 700
STRASBURG ROAD
___________________________________________________________________________
RECOMMENDATION: That the business licence for Passion Flavour be approved
with the following conditions:
a)That the owner maintains a level of noise that is in accordance with the City
of Kitchener Noise By-law;
b)That the Business does not receive any further Provincial Offence Notices;
and,
c)That the owner complies with all City of Kitchener by-laws.
BACKGROUND:
The Passion Flavour (the Business) is a restaurant/nightclub licensed as a Place of
Refreshment under Chapter 584 and is located at Forest Glen Plaza at 700 Strasburg
Road. Until November 2016, the owner of the Business operated another licensed
Place of Refreshment called Island Grill which was located at 2934 King Street E.
REPORT:
During its operation as Island Grill, the licensed Place of Refreshment received 5 noise
complaint calls within one year. Each time, the owner of the Business was advised
directly of the complaints. Since moving locations and changing the name to Passion
Flavour, staff have received 12 complaints from November 2016 to March 2018.The
calls have resulted in speaking with the owner directly 4 times, 4 Provincial Offence
Notices (PONs) were issued, and 3 summons being issued. Despite several visits from
By-law Enforcement, there has been no effort by the owner to mitigate any of the noise
concerns and therefore, Municipal Law Enforcement Officers continue to respond to
complaints.
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4 - 1
Through By-law Enforcement staff, Licensing Services has been advised of all the
infractions against the Business. Licensing Services is working with By-law Enforcement
to ensure compliance is being met by the Place of Refreshment. A requirement under
the Chapter is that every licensed business shall ensure that the business is being
conducted in conformity with the provision of any applicable federal or provincial Act,
and any by-law of the City. The Business has continuously been in violation of the City
s Noise By-law, and therefore in violation of the above-noted requirement
under the Business Licensing By-law.
In order to protect public interest as it relates to nuisance control, staff recommends
adding the aforementioned conditions to the business licence for Passion Flavour for
the next year. If the Business does not comply with any of the conditions placed on the
licence, the Manager of Licensing may refer the application or licence to Council or a
Committee of Council to refuse, revoke, or suspend the licence, or to impose further
conditions on the licence.
ALIGNMENT WITH CITY OF KITCHENER STRATEGIC PLAN:
vision through the delivery of core service.
FINANCIAL IMPLICATIONS:
The cost of a 2018 Place of Refreshment Renewal is $67.00.
COMMUNITY ENGAGEMENT:
The Manager of Licensing met with the owner of Passion Flavour and has discussed
the noise violations and its potential impact on the business licence. The owner was
advised that the licence was under review and that conditions could be placed on the
licence. The owner will be contacted to discuss any conditions placed on the licence.
INFORM
advance of the council/committee meeting.
ACKNOWLEDGED BY: Lesley MacDonald, Acting Deputy CAO, Finance & Corporate
Services
4 - 2
REPORT TO: Finance and Corporate Services Committee
DATE OF MEETING: April 9, 2018
SUBMITTED BY: Christine Tarling,Director of Legislated Services/City Clerk,519-
741-2200 ext. 7809
PREPARED BY: Helen Fylactou,Manager of Licensing,519-741-2200 ext. 7854
WARD(S) INVOLVED: 9
DATE OF REPORT: March 8, 2018
REPORT NO.: FCS-18-029
SUBJECT: REQUEST TO ADD CONDITIONS TO A BUSINESS LICENCE 108
QUEEN STREET SOUTH
___________________________________________________________________________
RECOMMENDATION: That the business licence for Asian Health Centre be
approved with the following conditions:
a)That the owner ensures that the Business is not operating outside the
permitted hours;
b)That the Business does not receive any further Provincial Offence Notices;
and,
c)That the owner complies with all City of Kitchener by-laws.
BACKGROUND:
The Asian Health Centre (the Business) is an alternative massage parlour that is
licensed under Chapter 508 and is located at 108 Queen Street South. The Business
has been in operation and has been licensed with the City of Kitchener since 2009 as
an Alternative Massage Centre that offers shiatsu massage services.
REPORT:
As a requirement of the Alternative Massage CentresBy-law, the operator of the
business must ensure the business is not open to patrons or the public, that patrons or
the public cannot enter the alternative massage centre, and that no alternative massage
or other services are provided, available, or offered in the alternative massage centre
unless it is between the hours of 9:00 a.m. and 8:00 p.m. Upon inspection, the
Business has been in violation of the requirement and several Provincial Offence
Notices (PONs)have been issued. In the last year, the Business has had 4 PONs for
operating outside of the permitted hours. Each time, a Municipal Law Enforcement
Officers attends the premises in an unmarked SUV and in plain clothes. They are able
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5 - 1
to ring the bell for service and a massage attendant opens the doors, invites them in
and offers them a variety of services. By-law Enforcement continues to receive
complaints from neighbours of this Business that live in the residential units located
directly above the Business.In addition, Waterloo Regional Police Services have
contacted the Manager of Licensing about concerns with the business operation.
Despite several visits by By-law Enforcement, there has been no effort by the owner to
mitigate any of the concerns and therefore, Municipal Law Enforcement Officers
continue to respond to complaints.
Through By-law Enforcement staff, Licensing Services has been advised of all the
infractions against the Business and is working with By-law Enforcement to ensure
compliance is being met by the Alternative Massage Centre. The Business has
continuouslybeens Alternative Massage Centre By-
law.
In order to protect public interest as it relates to consumer protection and nuisance
control, staff recommends adding the aforementioned conditions to the business licence
for Asian Massage Centre for the next year. If the Business does not comply with any
of the conditions placed on the licence, the Manager of Licensing may refer the
application or licence back to Council or a Committee of Council to refuse, revoke, or
suspend the licence, or to impose further conditions on the licence.
ALIGNMENT WITH CITY OF KITCHENER STRATEGIC PLAN:
vision through the delivery of core service.
FINANCIAL IMPLICATIONS:
The cost of a 2018 Alternative Massage Centre Renewal is $141.00.
COMMUNITY ENGAGEMENT:
The owner of Asian Health Centre will be invited to meet in-person to discuss the
changes to the business licence and the conditions placed on the licence.
INFORM
advance of the council/committee meeting.
ACKNOWLEDGED BY: Lesley MacDonald, Acting Deputy CAO, Finance & Corporate
Services
5 - 2
REPORT TO: Finance and Corporate Services Committee
DATE OF MEETING: April 9, 2018
SUBMITTED BY: Environmental Committee
PREPARED BY: Jaclyn Rodrigues, Committee Administrator 519-741-2200
ext. 7275
WARD(S) INVOLVED: All
DATE OF REPORT: March 27, 2018
REPORT NO.: FCS-18-033
SUBJECT: ENVIRONMENTAL COMMITTEE RECOMMENDATION - 2018
COMMUNITY ENVIRONMENTAL IMPROVEMENT GRANT (CEIG)
___________________________________________________________________________
RECOMMENDATION:
That a total of $13,000.00 from the Community Environmental Improvement Grant
capital account be awarded as follows:
$3,000. to Busking for Change for a local fundraising campaign piloting
-to-
the applicant obtaining community of interest or not-for-profit status;
$2,000. to K-W Working Centre for a Sustainable Gardening Workshop
Series;
$1,750. to KW Habilitation and Rockway Mennonite Collegiate for an
inclusive agricultural-based in class and hands on learning opportunity;
$1,250. to Waterloo-Wellington Science & Engineering Fair DEAR:
Developing Environmental Advocates and Researchers for a CO2
Simulation Group Activity; and further,
$5,000. that the unused balance be carried forward to the 2019
Community Environmental Improvement Grant program.
BACKGROUND:
The Community Environmental Improvement Grant (CEIG) was created in 2004 to
foster a sense of environmental stewardship throughout the City. The aim of the CEIG
program is to encourage residents to actively participate in environmental initiatives, by
undertaking projects that meet the following objectives:
*** This information is available in accessible formats upon request. ***
Please call 519-741-2345 or TTY 1-866-969-9994 for assistance.
6 - 1
Increase awareness of how we view and treat air, water and land resources, and
encourage solutions to improve the quality of these resources;
Promote healthy lifestyle practices;
Foster a sense of environmental stewardship;
Promote and initiate the development of short-term, intermediate and long-term
community-based environmental programs; and,
Support environmental research.
REPORT:
The Environmental Committee received five (5) grant applications for the 2018
Community Environmental Improvement Grant (CEIG) from the following groups for the
following projects:
Busking for Change
Waterloo-Wellington Science & Engineering Fair DEAR: Developing
Environmental Advocates and Researchers
KW Habilitation and Rockway Mennonite Collegiate
KW Working Centre and Hacienda Sarria Market Garden Sustainable
Gardening Workshop Series
Trinity Village/Lutheran Homes Kitchener Waterloo Berm Revitalization and
Naturalization Project
To facilitate the evaluation process, the applications were emailed to the CEIG Sub-
Committee on February 21, 2018. On February 26, 2018, the 2018 CEIG Sub-
Committee evaluated all five applications received based upon the criteria for funding
and the merits of the applications. Based on its deliberations, the Sub-Committee
brought forward a recommendation as outlined in a memo dated February 28, 2018,
which was circulated to the Committee for consideration at the March 15, 2018 meeting.
Additionally, applicants were invited to attend the March 15, 2018 Environmental
Committee meeting to make short presentations on their grant requests.Four (4) of the
five (5) applicants opted to make presentations to the Committee at that meeting.
The CEIG Sub-Committee recommended 2018 grant allocations as follows:
Requested Recommended
Group
GrantGrant Funding
Busking for Change$3,000.$3,000.
KW Working Centre$3.000.$2,000.
KW Habilitation and Rockway Mennonite
$2,275.$1,750.
Collegiate
DEAR: Developing Environmental Advocates and
$500.$1,250.
Researchers
Trinity Village/Lutheran Homes Kitchener
$3,000.$0.
Waterloo
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At the March 15, 2018 Committee meeting, members expressed support for the sub-
committee recommendation.The CEIG Sub-Committee noted they did not recommend
Trinity Village for grant funding as the project did not meet the objectives of the grant
program as outlined in Council Policy I-590 (Community Environmental Improvement).
The Busking for Change grant is intended to be used for expenses related to graphic
designing, printing of promotional materials, a performing arts database, and the
-to-
used for workshop material, curriculum development, and marketing material. The KW
potting table, one trug vegetable greenhouse cover, two trug micro insect coverings,
soil, hand tools, seedling flats, and pots. The Waterloo-Wellington Science and
Engineering Fair grant will be used for printing the simulation board.
Based on deliberations, the Environmental Committee has
recommended a total of $8000. be allocated to four (4) of the five (5) CEIG applicants,
and the remaining funds be allocated to the 2019 CEIG program, as outlined in the
recommendation contained herein.
Council Policy 1-590 (Grant Program - Community Environmental Improvement) and
grant
ALIGNMENT WITH CITY OF KITCHENER STRATEGIC PLAN:
strategic vision through the delivery of core service.
Allocat Community Environmental Improvement Grant funds will
help implement the Community Vision for the Community Priority ENVIRONMENT, in
which our community focuses significant energy and resources on becoming more
environmentally friendly.
FINANCIAL IMPLICATIONS:
The Community Environmental Improvement Grant capital account has $13,000.
available for use toward the 2019 CEIG program. Once the funds have been provided to
the awarded grant recipients there will be a balance of approximately $5,000. remaining
in the account.
COMMUNITY ENGAGEMENT:
INFORM
advance of the Standing Committee.
Memos and other supporting materials including the applications were included in the
Environmental Committee agendas for the March 15, 2018 meeting.
6 - 3
In January, Planning staff provided the Environmental Committee with CEIG
informational brochures. In February, Planning staff sent an email to Environmental
Committee members with the CEIG process timeline. Staff also promoted the grant
At the March 15, 2018 Environmental Committee, four (4) of the five (5) applicants
made short presentations on their grant requests.
COLLABORATE This initiative was done in collaboration with a Sub-Committee of
community volunteers from the Environmental Committee.
ACKNOWLEDGED BY: Lesley MacDonald, Acting DCAO, FCS Department
Attachments
Appendix A - Council Policy 1-590 (Grant Program - Community Environmental
Improvement)
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REPORT TO:FINANCE AND CORPORATE SERVICES
COMMITTEE
DATE OF MEETING:APRIL 9, 2018
SUBMITTED BY:Cory Bluhm, Executive Director, Economic
Development, 519-741-2200 x7506
PREPARED BY:Silvia Di Donato,Manager, Arts & Culture, Economic
Development, 519-741-2200 x7392
WARD(S) INVOLVED:ALL
DATE OF REPORT:March 26,2018
REPORT NO.:CAO-17-028
SUBJECT:Launching the Film, Music & Interactive Media Office
RECOMMENDATION:
THAT
launched in 2018 for a two-year period, as described in Report CAO-17-028;
THAT staff, over the two-year period, work with regional stakeholders and partners,
such as the Waterloo Region Small Business Centre, area municipalities, Waterloo
EDC, etc. to develop a collaboarion model
advance the Film, Music & Interactive Media industry on an ongoing bases, as
described in Report CAO-17-028;
EXECUTIVE SUMMARY
This report recommends that Economic Development launch a Film, Music & Interactive
Media Office (FMIMO) that will provide focused industry development services to grow jobs
and business opportunities within these sectors. Priority activities in the first two years will
consist of delivering entrepreneurial services,programs and networking; inventory and
access to related resources; assistance with sector based provincial & federal funding; and
related city policy development.
The timing is ideal for these focused services, as local strengths are are well positioned to
take advantage of current technology trends requiring original creative content. Demand for
artistic content in film, music and interactive media increases with the broad spectrum of
distribution and platform delivery: mobile devices, home entertainment systems, through
wearable devices, in public venues, and often integrated with live performance
experiences. Revenue models have been disrupted entirely with streaming music, film and
interactive content as the preferred consumer experience. Together with local technology
industry advantages, FMIMO can maximize opportunities for networking, and the services
would help transform independent practitioners and local artists into growing businesses.
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To launch the office, a professional, experienced contract position will be created to lead
the Office, with access to additional resources to support program delivery.Working closely
with municipal partners and post-secondary institutions will complement individual
strengths and maximize resources over the course of a two-year launch period. After the
two year pilot phase, staff will work with the regional partners and stakeholders to
coordinate longer term collaboration.
This project will fulfill the Kitchener Economic Development Strategy (Make It Kitchener,
2016) action item,
officer to facilitate cluster development and provide professional, craft and entrepreneurial
And this project, by virtue of creative and cultural content creation, has
the added impact of fulfilling both of the main goals of the Kitchener Economic
Development Strategy: to generate careers and a diverse economy, and to make Kitchener
a compelling city in which to live.
BACKGROUND
Film, music and interactive media clusters are targeted in the Economic Development
Strategy (Make it Kitchener, 2016) because they make a strong contribution to the
economy and deliver cultural experiences to inspire the community. From wearable devices
to mobile platforms, to projections and live performances, there has been a transformation
in how the community connects with artists. Stakeholder engagement, industry research
and positive outcomes in other medium-sized cities indicate that now is the time to leverage
local strengths for growing opportunities through the launch of the Film, Music and
Interactive Media Office.
Why Film, Music and Interactive Media?
Locally there is an exciting opportunity for growth in these sectors, provided there is a
focused set of services to grow opportunities for creative production. There are indications
that, compared to similarly sized cities, these sectors may be under-represented locally.The
risk is that without support,entreprenuers and creative talent will need to to leave the
community for work in their chosen field.
Globally, the film, music and interactive media industries are undergoing complete
technological transformation. Production has been disrupted, as artists can now create,
capture and edit audio and visual content almost anywhere with smaller and more powerful
digital tools. Distribution is disrupted as independent artists can reach their audiences
online directly through multiple platforms, screens and devices. Consumption is disrupted
as online streaming replaces downloads and physical retail.
This rapid disruption creates both opportunities and a risk opportunity for innovative
companies and entrepreneurs to advanceplatforms, products, services and ultimately
employment and artistic growth. Conversely, disruption can leave practitioners and
companies open to becoming obsolete, and can result in communities missing the
opportunity to experience industry growth. By virtue of consistent focus, the office would
help cultivate an environment for success, to drive innovation and spark vitality in the
community.
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New revenue models within these industries also represent an immediate opportunity to
connect artists with technology. For example, local research and development in
blockchain technology included a recent hackathon that identified opportunities for digital
creative content to be permanently encrypted with artist agreements to deliver revenue
consistently. Any on-line use of film, music and interactive media (immersive games etc)
production would maximize fair revenue distribution.
See Appendix 1 for Industry Overview, summarized from the Ontario Media Development
Corporation. Each sector is described below, identifying global trends and local
opportunities for growth:
Film:
The Numbers - is
Angeles and New York City respectively, having contributed $1.7 billion to the economy,
and rising to 35,000 jobs in the province.
The Opportunity platform providers such as Netflix, Hulu, Fibe TV, etc. and major studios
like Time Warner, Discovery, etc., are investing billions of dollars to source and develop
new film and and television content. While historically, these investments were targeted at
existing production studios (in Hollywood, for example), today, these companies are
searching the globe for fresh content and emerging content creators. With favourable
Provincial tax credits available for production outside of Toronto, combined with decreasing
availability of production space in Toronto, Kitchener and nearby areas are well positioned
for spill over growth from the GTA.
The Risk failure to cultivate a local film industry could result in local companies, talent and
entrepreneurs exiting the region for other cities which provide the necessary services,
resources and ecosystem
Music:
The Numbers - in Ontario, the music sector is estimated at 13,400 jobs in Ontario
(MusicCanada 2013). Transformed by technologies in recording, production and
distribution, Canada has experienced a rapid growth in on-demand streaming with a 76%
growth in 2016 alone. Live music in Canada measures at 55% of music related consumer
spending, which aligns well with local festival and tourism strengths.
The Opportunity the region has a strong local music scene bolstered by numerous local
festivals (such as the Kitchener Blues Festival) together attracting nearly one million over
the course of a given year, with a majority based on music, and often located in Downtown
Kitchener. The opportunity for growth exists in audience development, while supporting
local musicians in gaining national and international profile.
The Risk - musicians and music industry businesses need a robust industry with multiple
opportunities to generate revenue, or they could be at risk of leaving the area to succeed in
their chosen field. Focused support is needed to foster collaboration within the local music
industry as there is an increasing market for integrated online, as well as immersive live
experiences. Ensuring cross-sector collaboration with film, interactive media increases
opportunity for film, online games development, marketing, advertising and other
collaborative revenue opportunities.
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Interactive Media:
The Numbers - interactive media refers broadly to content created for mobile devices,
tablets, game consoles and web applications. The industry represents $1.1 billion in
Ontario revenues alone with 472 game development companies in Canada.
The Opportunity globally, the rise of mobile devices and gaming consoles as primary
viewing/interactive platforms has created growth and demand for mobile content, gaming
and mobile based applications.Locally, the sector is gaining momentum through expanded
post-secondary training at Conestoga College, UW Games Institute graduate programs,
independent practitioners, and local leadership, by companies such as Electronic Arts.
The Risk there are two prominent sides to Interactive Media the front-end
creative/artistic work, and technology required to bring content to mobile devices and
consoles. While the region is renowned for technology, and in particular, an ability to
service the back-end, technology needs of interactive media, the region has struggled to
grow the creative/artistic side of this industry. Failure to grow and develop the creative side
of Interactive Media could result in lost job opportunities (an inability to capture the full
spectrum of jobs) and the potential loss of companies, should parent companies look to
consolidate their technolodgy and artistic operations in one location.
Local Strengths:
There are significant strengths to leverage in the community across film, music and
interactive media:
Strong technology sector: Technology continues to transform how creative content is
produced, distributed and consumed across a growing arrayof digital platforms. Creating
engaging, original content is more important than ever for technological success as artificial
intelligence and automation shift the landscape from STEM to STEAM. (Science,
Technology, Arts and Math) Another example of mutual benefit exists in digital
monetization through blockchain technology. Connecting local technology with local content
creators will further amplify mutual and unique benefit to the community, building resiliency
in both technology sector and among artists.
Start-up culture: A natural advantage exists with the local history of innovation and start-
up culture, a concept perfectly aligned with the entrepreneurial independent artist. The
natural advantage exists where content created for these sectors is increasingly consumed
on digital platforms and devices, a sector that has a strong representation in the local start-
up population. The connection with content is bound to strengthen entrepreneurial success
for all related sectors.
Talent: Each of three post-secondary schools has expanded their programming in the
areas of content creation for these sectors. Wilfrid Laurier Film Studies has expanded in
partnership with Vancouver Film School with joint credentials in academic study and film
production experience. WLU also has grown their user experience design program and
continue as leaders in music therapy -trauma therapy.
Institute Immersion facility, and UW Arts-Business degree including the music program.
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Festivals: As identified above, close to one million festival visitors are estimated region-
wide, with a substantial majority powered by community events based on live musical
performance in Downtown Kitchener. These events not only support the regional tourism
brand and city profile, but also develop audiences to grow performance opportunities in
venues across the region, many of which now integrate digital media experiences, film
projection, interactive media, online gaming and wearable devices such as the MYO
armband.
These strengths must be leveraged to grow the sector, but the opportunity is time-sensitive.
Launching the Film, Music and Interactive Media Office now with focused services will help
build on local strengths to strengthen and diversify the economy and culture.
Unique Regional Strengths: a significant benefit of Waterloo Region, is the unique assets
and strengths of the various communities. For example, Cambridge has developed
comprehensive strengths that support film production, Waterloo has developed strengths in
technology, etc. A key goal of a FMIMO is to understand how best to collaborate so as to
leverage the strengths of all of our communities.
Stakeholder Consultation and Pilot Programs
City staff has led, facilitated or consulted with stakeholders in each sector, beginning with
Music Works Action Plan recommendations in 2012 (CAO-12-034). In 2015, extensive
consultation occurred as part of the Economic Development Strategy (Make it Kitchener) to
further develop themes that support artists. Staff has continued to expand consultation to
include film and interactive media, based on stakeholder input. Specific feedback for film,
music and interactive media emerged as compatible growth opportunities.
To test the concept based on this consultation, staff has collaborated with community
experts as possible to deliver workshops, programs and networking events to support these
industries. Approximately 2,000 emerging and established practitioners and artists have
participated over the years. Workshops and programs were delivered with municipal,
academic and industry partners to serve the community as resources became available.
Participation and further research indicated that there is a demand for focused services and
resources, summarized in Appendix 2.
REPORT:
-
year pilot phase to develop and deliver programs to grow these sectors. The purpose is to
provide industry development services that capitalize on growth opportunities by building
on local strengths, retaining talent and increasing local job/company growth experienced in
the rest of Ontario and Canada. The office will develop metrics for the pilot period and
utilize additional resources to implement the programs.
Subsequently this report recommends that staff, over the two-year period, work with
regional stakeholders and partners, such as the Waterloo Region Small Business Centre,
area municipalities, Waterloo EDC, etc. to develop a collaboarion model to maximize the
bility to advance the Film, Music & Interactive Media industry on an ongoing
bases.
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Proposed Services and Deliverables:
Industry Development:
Entrepreneurial Services, facilitated through collaboration, to independent
practitioners and businesses in film, music, interactive media. Business skills
development, facilitated networking and programs, etc.
Sector Based Funding advocacy, identification and access to provincial (OMDC)
and federal levels to increase the local share of available funding.
Enhance National & International Profile through outreach and collaboration (e.g.
with Waterloo Region Tourism, Waterloo Economic Development Corporation)
Collaboration and Partnerships:
Support regional collaboration to maximize regional strengths (e.g. film location
database)
Enhance Post-secondary relationships to support talent development.
Industry engagement to connect independent practitioners for future growth.
Policies and Metrics:
Develop Industry Census & Results Metrics to survey and quantify practitioner
and industries to determine needs and measure impact
Municipal Policy and Programs, Review and recommend policies to support local
and grassroots creators (e.g. shared services agreements for online film and
media resources, music-on-hold, on-line
FMIMO Industry Working Group to provide advisory input and stakeholder
outreach.
Given the limited initial resources of the FMIMO, staff anticipate the focus of active work for
the first two years would be placed o
Collaborative Approach
Key to the success of the FMIMO, and key to advancing industry growth, will be to leverage
the key strengths that already exist within the region and develop strong partnerships with
key stakeholders neighbourhing municipalities, post-secondary instutitions, the Waterloo
Region Small Business Centre etc. Collaboration and partnerships also allows for a
spectrum of developing talent for robust industry growth. For example, local post-secondary
schools provide training for emerging practitioners and artists. The Kitchener Public Library
provides resources for developing artists, producers, filmmakers and musicians. As they
become working professionals and entrepreneurs, the Film, Music and Interactive Media
Office is there could support the next level of business development.
Given the importance of collaboration, staff have engaged regional partners in the
development of the FMIMO, to gain insight for the office and how best to coordinate service
delivery, including staff from the Cities of Waterloo and Cambridge, the Waterloo Economic
7 - 6
Development Corporation, Waterloo Region Tourism, Waterloo Region Small Business
Centre, Conestoga College, University of Waterloo, Wilfrid Laurier University and the
t in Waterloo Region Report,
local opportunities.
Staff has also consulted with other cities which have established a city office to serve film,
music and/or interactive or digital media industries. Focused service in medium sized cities
such as Hamilton, London, Austin and Seattle have not only grown local industries, sparked
investment and cultural opportunity, but have enhanced the national and international
profiles of those cities, as shown in Appendix 3.
Conclusion
Given the opportunities for local industry growth, the risk of not taking a leadership role
during a time of industry wide disruption, and the potential to leverage local strengths
through collaboration, staff recommend initiating and piloting a Film, Music & Media Office
for a two-year period.
What Would Success Look Like After Two Years
Three key outcomes of the FMIMO would be the following:
1) Clear and quantifiable local industry growth;
2) A firm understanding of the long-term regional growth potential for each of these
industries, to determine the long-term need/opportunity of the FMIMO; and,
3) A collaboration model among regional partners and stakeholders to understand how to
leverage existing local strengths.
ALIGNMENT WITH CITY OF KITCHENER STRATEGIC PLAN:
The Kitchener Economic Development Strategy (Make-It Kitchener) recognizes arts,
cultural workers and content creators (including music, interactive media, and film and user
experience design)as a vibrant economic cluster in and of itself, comprising a significant
segment of the labour force.
Specifically, this report implements the action item to "partner with regional municipalities to
establish a music, film and media officer to facilitate cluster development and provide
such as music, film, performing arts, and design."
Further, the report aligns with the strategy skill development
Development Strategy (Make-It Kitchener) and the Waterloo Region Economic
Development Strategy are aligned with Ontario strategies to grow cultural and creative
industries. The Federal government through Canadian Heritage has recently launched a
creative industry vision and strategy and this office would provide project readiness for
funding by other levels of government. Local provincial and federal funding will be
amplified by the focused attention of these resources.
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Arts and cultural industries leverage innovation throughout businesses as diverse as digital
media and advanced manufacturing design. A critical component to talent attraction,
retention and development, support for arts and culture activities helps to develop
Specific actions
Make it Spark-Support creative clusters such as
music, film, performing arts and design.
FINANCIAL IMPLICATIONS
The City of Kitchener has allocated funds from the Economic Development Reserve Fund
to take initial leadership of the project, subject to final Council approval. The Film, Music &
Interactive Media Office would be launched with a one-time investment allocated at
$260,000 for contract staff services and programming for a two-year pilot phase.
COMMUNITY ENGAGEMENT:
rts and
Culture Advisory Committee have provided positive feedback and support for the concept
of a Film, Music & Interactive Media Office. In-depth consultation engaged hundreds of
stakeholders from 2012 to 2017. Staff worked with local industry professionals to gather
panel experts and participants to produce multiple networking events, workshops and
conferences to suit those identified needs.
AACKNOWLEDGED BY:Dan Chapman, CAO
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Appendix 1
Industry Profiles
The following provides a summary of industry profiles and economic impact for Film, Music and
Interactive Media. Data defines the provincial and national context for local industry growth
potential. Data source provided by the Ontario Media Development Corporatin:
http://www.omdc.on.ca/collaboration/research_and_industry_information/industry_profiles
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FILM & TELEVISION INDUSTRY PROFILE
America including all aspects of audiovisual content production and delivery value chain.
The film and TV production sector in Ontario is mainly made up of small- to medium-sized
companies producing a combination of their own proprietary productions and service
productions with international partners. The province is also home to world-class animation and
visual effects studios. In 2014-15, Ontario generated 38% of the national film and television
production volume. Film and TV contributed $1.7 billion to the provincial economy in 2016
supporting 35,000 jobs.
140,600 full time jobs in Canada for screen-based media industry in Canada, film and television
production continued to be an important source of employment and GDP in Canada in 2015-16.
The production industry generated 140,600 full-time jobs
The screen sector value chain generated $20.1 billion in GDP for the Canadian economy
35,000 jobs in Ontario
$1.7 billion to Ontario's economy, fueled in part by significant provincial investments and
the province's highly skilled workforce, increase of 3,200 jobs over the previous year
$7.45 million in web series revenue, not included in Film/TV data
24% of creators report working exclusively in web series
New monetization models have been emerging for interactive digital media in tandem
with growth of new technologies and platforms. There is a proliferation of approaches to
monetization of interactive digital media, from consumer-paid subscription models to
content funded by brands. The videogame industry in particular has early adopters
experimenting with models.
In 2015, government-
exceeded the $1 billion mark for the fifth year in a row, hitting an all-time high of $1.52
billion according to OMDC figures.
Television was responsible for 83% of all expenditures, with $1.26 billion spent on
domestic and foreign series, TV movies, mini-series, specials and pilots.11
Spending associated with foreign TV movies and mini-series production continued to grow
(96%), buoyed by a number of high-value television series, including Suits, Beauty and the
Beast, and Heroes Reborn.
Domestic TV production remains an important component of these annual results with a
contribution of $704.8 million in 2015. Notably, while the number of TV movies, mini-
series, specials, and pilots only increased 5% over 2014 levels, budgets increased by 42%
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MUSIC INDUSTRY PROFILE
The Canadian music industry includes a wide range of artists and entrepreneurs, who create,
write, produce, publish, and distribute original music. The industry includes musicians,
songwriters, record labels, managers, agents, concert promoters, and music publishers.
The market in Canada is dominated by the large foreign-owned record and publishing companies
but has a strong independent sector comprising mainly small- to medium-sized companies
whose lines of business range from artist development to publishing, managing, and touring.
The vast majority of Canadian content is commercially released by Canadian-owned and
controlled independent music companies.
$45.6 million in Ontario wages, salaries, commission in Ontario record production industry
alone
usic industry was measured at 10,500 FTEs in 2013 (including direct,
indirect and induced impacts), and resulted in $305.5 million in labour income
In 2013, the Canadian sound recording and music publishing industry generated $165.4
million in total music publishing royalties and rights.16 From this amount, $64 million was
generated from performing rights (38.7%), followed by $25.3 million from mechanical
rights (15.3%).
revenues
Live music alone in Ontario generated $628 million from live music related activities, with
almost 40% of those revenues generated via ticket sales
http://www.omdc.on.ca/collaboration/research_and_industry_information/industry_prof
iles/Music_Industry_Profile.htm
The 2013 SOCAN annual report noted that it was the first year that the collective
distributed Internet streaming revenues ($3.4 million in revenue), which coincided with a
performing rights licence for YouTube and an agreement that made it easier to members
to receive additional money for music posted to the video site.
Tracking the growth of revenues through the annual reports for 2014 ($12.4 million), 2015
($15.5 million) and 2016 ($33.8 million), Internet s
fastest growing revenue source having overtaken cinema, private copying, and satellite
radio revenues and likely to surpass concert revenues in the coming year.
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INTERACTIVE DIGITAL MEDIA (Source, OMDC)
The term interactive digital media (IDM) accounts for a range of digital content and experiences
available through a variety of digital platforms such as mobile devices, tablets, game consoles,
and Web applications. IDM in Canada is a growth industry that is quickly changing, driven by
shifts in consumer behaviour and technology. The broader IDM sector includes companies that
produce interactive content as well as firms that provide various types of products and services
to enable the production of interactive content. These
1
Core IDM content includes, but is not limited to, video and mobile games,
cross-platform entertainment, virtual and augmented reality content, web series, e-learning,
and training products.
472 active studios in Canada, 20,400 directly employed and with an average salary of
$71,300 per year for full-time workers
Canadian interactive digital media products were responsible for $3.3 billion in Gross
Domestic Product (GDP)
surrounding area, with additional clusters of activity in Ottawa, Kitchener-Waterloo,
London, Hamilton, and St. Catharines/Niagara Falls.
million
f 472 studios in
2015 worth $2.4 billion in 2015, up 50% since 2013 employing 20,400 FTEs directly
employing 2,500 people with the provincial industry spending an estimated $265 million.
In spite of its economic importance, recognition of interactive digital media as a distinct
sector has lagged behind some of the other creative industries.
Interactive digital media had not been part of the standard series of North American
Industry Classifications and Codes (NAICS, NAPCS) tracked by Statistics Canada until the
creation of NAICS codes for some digital media activity in 2012.
Industry figures to date for interactive digital media have been captured by a combination
of existing categories such as Software Publishing, Internet Publishing and Broadcasting as
well as Computer Systems Design and Related Services. Most recently, through the
Culture Satellite Account, Statistics Canada and its partners are measuring and reporting
industries. However, the most recent data currently available is from 2010. The industry is
attempting to address data gaps through the periodic publication of the Canadian
Interactive Industry Profile, which surveyed the industry in 2006, 2008, and 2011 in an
attempt to acquire baseline data about the industry on which to build. Additional efforts
on a provincial level have included Interactive Ontario
Economy (MODE) project, which is a database of companies creating IDM content in
Ontario.12
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Appendix 2
Consultation and Pilot Programs
Since 2012, close to 600 artists, practitioners and industry professionals have participated in
consultation or business develoment events related to film, music and interactive media. Many
are community-driven, collaborative events that are based on expressed interest.More than 600
artists, practitioners, agencies and industry professionals attending one or more times to events.
Total community participation is currently at close to 2,000 visits, excluding academic and
ongoing events. Highlights include:
2012-2014:
Music Cluster Action Plan 2012
OMDC tour of Kitchener and region, facilities and services
MusicCanada
EA Content Creators Roundtable, Site Selectors Tour of Kitchener
Minister Chan Roundtable at 44 Gaukel (Ontario Music Fund)
KOICon Music Industry Conferences
ICTC National launch of Music A Catalyst for Technology Hubs
KOIPlay Gaming Conference
44 Gaukel Post-Secondary academic curriculum and events (Conestoga, UW, WLU)
CreateRegion Content Creator Workshop, 44 Gaukel
Fluxible Conference launch support (ongoing)
e
Expanding Downtown Live concerts (ongoing)
Kitchener Music City Roundtable at NXNE with MusicCanada
2015-2017:
Make it Kitchener Arts & Creative Industry recommendations launched
Kitchener Artist-in-Residence expanded to include music & performing arts (ongoing)
Mastering of the Music Cities (Kitchener as one of 22 cities in focus groups)
Waterloo Region Tourism collaboration projects (festivals, film, event calendars)
OMDC Digital Media Content Creators Study (CEI, CoK, SBC)
Music Mentorship Industry Workshops (CEI, CoK, SBC)
Music Cities Workshops with Music Canada
OMDC Kitchener Tour & Meetings
OMDC/InteractiveONTARIO Workshops (annual)
44 GAUKEL, CRITICAL MEDIA LAB EVENTS (ongoing)
BUSINESS OF SONG Workshops, including digital monetization, business process
OMDC, Interactive Ontario Funding Workshops, Digital Dialogue (2016, 2017)
FILMMAKING, MICROBUDGET Workshop SBC and KPL
Bell/FIBE TV Community Programming Information and PitchFest
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Appendix 3
Collaboration List
The following image represents many of the organizations with which staff have
collaborated over the years. Working together, hundreds of participants, attended
stakeholder consultation, entrepreneurial workshops and informative events
related to film, music and interactive media.
7 - 14
Appendix 4
Sample City Offices
The following screen images give an overview of similar offices in other
municipalities where there is a focus on film, music and/or interactive media as a
business development services.
Music Office
LONDON, ONTARIO
7 - 15
Music Office
TORONTO, ONTARIO
Film Office
TORONTO, ONTARIO
7 - 16
Digital Entertainment & Interactive Office
VANCOUVER, BRITISH COLUMBIA
7 - 17
Office of Music & Film
SEATTLE, WASHINGTON
7 - 18
ONTARIO FILM LIBRARY DATABASE
7 - 19
ONTARIO MEDIA & DEVELOPMENT CORPORATION
7 - 20
REPORT TO: Finance and Corporate Services Committee
DATE OF MEETING: April 9, 2018
SUBMITTED BY: Dan Chapman, CAO, X7350
PREPARED BY: X7231
WARD (S) INVOLVED: All
DATE OF REPORT: March 23, 2018
REPORT NO.: CAO-18-010
SUBJECT:Supervised Injection Site (SIS) Input to the Region of Waterloo
___________________________________________________________________________
RECOMMENDATION:
That, should the Region of Waterloo decide to move forward with asupervised injection
service within the City of Kitchener,Regional Council be requested to give
consideration to the following when designing the service:
1. The Important Ongoing Leadership Role of the Region:
o Region of Waterloo Public Health and Emergency services make
application to operate the service.
o Staff the service with Region of Waterloo Public Health and Emergency
Services employees ideally in a Regional facility
o Commit to the development of an integrated supervised injection site
where a range of other social services are also embedded
o Adopt a fair and equitable approach with some form of supervised injection
2. Operating Model: Establish the service in a fixed locationwith a commitment to a
comprehensive review after two years including citizen,community agency and
municipal input that would lead to refinement of the in that, or another, location
3. Site Selection Criteria: Work with City of Kitchener staff, including those with
neighbourhood consultation expertise, to determine site selection criteria and
further consult with respect to the identification and review of potential location
options to ensure a mutually agreeable site is selected
4. Site-Specific Design Considerations: Work with City of Kitchener staff to
determine internal and external site-specific design criteria
5.Ongoing Public Education and Consultation: Develop a co-ordinated public
education effort for the broader community,specific training for targeted
audiences, and communications related to any supervised injection service site
*** This information is available in accessible formats upon request. ***
Please call 519-741-2345 or TTY 1-866-969-9994 for assistance.
8 - 1
BACKGROUND:
On February 28, 2018, Waterloo Region Council received the recommendations from the
Waterloo Region Supervised Injection Services Feasibility Study, which was recently
conducted by the Region of Waterloo Public Health and Emergency Services. The study,
which represented phase one of a two-phased public consultation approach, explored the
need for supervised injection services in the Region and gathered broad community input to
understand the perceived benefits and concerns of establishing sites locally.
Subsequent to receiving the recommendations, Regional Council sought additional public input
with respect to the recommendations through two public meetings. It is within this context that
Kitchener Council has an opportunity to provide input to the Region with respect to the
recommendations of the Feasibility Study prior to Regional Council giving final consideration to
the recommendations.
As a potential framework for Council discussion, staff have outlined potential considerations for
Council to give input in five broad areas:
1. The important ongoing leadership role of the Region
2. Operating model
3. Site selection criteria
4. Site-specific design considerations
5. Ongoing public education and consultation
REPORT:
According to the conclusions of the Waterloo Region Supervised Injection Services Feasibility
Study, substantial support exists for supervised injection services in Waterloo Region.
Residents are genuinely concerned about those who suffer from addiction and they are equally
concerned about the implications of drug use on the community. However, the study also
concludes that while most feel that supervised injection services are needed in the region,
some people do not support this strategy, in particular raising concerns about where sites
would be located and the potential impacts on the surrounding community.
The study identifies central Kitchener and south Cambridge (Galt) as the most important
locations for supervised injection services; however a third site (temporary or mobile) was also
recommended to address potential need in other areas. It was strongly recommended by all
groups who participated in the study not to concentrate supervised injection services in one
area by establishing one site in the region. Additionally, there was strong support for service
integration within a supervised injection service model, which could ensure that users have
access to a range of other social services during a site visit.
Supervised injection services sites are one tool that cities are increasingly using to address the
opioid crisis, but they are not asolution in themselves. A responsive, co-ordinated, integrated
8 - 2
and adequately-resourced suite of treatment and rehabilitation options is required. This report
does not take a position on whether or not supervised injection services should be established
in Kitchener given that the mandate for this service rests with the Regional Municipality of
Waterloo. Instead, it outlines specific considerations that the City could request of the Region
as part of establishing such services, should Waterloo Region decide in the future that this is
the right decision for the community.
responsive, co-ordinated, integrated and
adequately-resourced suite of options for this vulnerable population.
The Region play a strong leadership role in the operation with facilities being staffed by
Waterloo Region Public Health and Emergency Services employees ideally within
Regional facilities.
In keeping with the feasibility study conclusions, there be a strong commitment to the
development of an integrated supervised injection site where a range of other social
services are also embedded perhaps through innovative community partnerships.A
fair and equitable approach be taken that would see the distribution of some form of
supervised injection three
are experiencing the impacts of the opioid crisis.
There are many approaches to supervised injection services in communities around the world
including fixed sites (supervised injection only), integrated sites (injection and other social
8 - 3
services) and mobile (moveable) outreach options. The feasibility study concluded that central
Kitchener and south Cambridge (Galt) are the most important locations for (permanent)
supervised injection services; however a third site (temporary or mobile) was also
recommended to address potential need in other areas. Staff reviewed four specific options for
how supervised injection services could be introduced in Kitchener, including:
Do nothing
The primary data collected through the Waterloo Region Supervised Injection Service
Feasibility Study strongly indicates that supervised injection services are needed in
Waterloo Region. This community response is also supported by local opioid-related
data that shows rising numbers of overdose deaths in Waterloo Region. Staff agree that
these facts make it incumbent on community leaders to look at options for addressing
this issue. Additionally, staff accept the feasibility study conclusion that there has been
extensive support for supervised injection services expressed by the public through the
consultation campaign.
Mobile service
For supervised injection services sites to have the most benefit to users and the best
chance at increasing successful outcomes for them,it is important that they be
integrated with other key social services for example, mental health services, medical
services, addiction treatment and counselling, etc. While they can be more socially
acceptable to the community because of their mobile nature, mobile units typically have
limited capacity to deliver service and can see far fewer clients each day compared to a
larger, fixed site. Additionally, it is difficult to integrate other services within this model
and to do so requires the same staffing levels as a fixed site, resulting in a much higher
cost per client.
Fixed location with commitment to a formal review after two years
The Waterloo Region Supervised Injection Services Feasibility Study concluded that
while there is substantial support for supervised injection services locally, there are also
some citizens who do not support this strategy, expressing concerns about site
locations and the potential impacts it would have on the surrounding neighborhood and
community. If a supervised injection service is to be established in Kitchener, it is clear
that the solution must create a balance between responding to the local crisis and
ensuring the ability to review, assess and refine the solution with community input
before it becomes a permanent social service.
To ensure this balance, staff recommend that, if a supervised injection service site is to
be established in Kitchener, it be done in a fixed location initially for a two year period,
ideally within a regional facility already offering other key social services that can be
integrated, with a commitment to a comprehensive review after two years including
citizen, community agency and municipal input that would lead to refinement of the
model before a decision is made to make it permanent in that, or another, location.
Because it is important to understand the impact of the site from both a health
perspective and a community impact perspective, the review should include a
component of data collection and analysis related to crime rates, drug usage and
8 - 4
overdose, and other impacts.
Permanent, long-term option
The immediate establishment of a permanent supervised injection service in Kitchener,
like has been done in other cities, represents a long-term commitment
address or the time
required for the community to adjust to the decision. Despite the fact that citizens may
support the introduction of this service, many continue to express concerns about where
sites would be located and the potential impacts of them on the surrounding community.
An immediately permanent option may be viewed as dismissing these concerns and
does not provide sufficient opportunity for future review or assessment, nor does it allow
for ongoing community input to refine the model.
For the reasons outlined above, undertaking a pilot project in a fixed location, with a formal
review after two years appears to strike a balance between the relevant considerations should
the Region of Waterloo decide to proceed with a supervised injection service.
Consideration #3 Site Selection Criteria
Given the concern expressed by study participants about future site location, the establishment
of site selection criteria and ongoing public consultation throughout the selection process will
be key. Any future site selection in Kitchener needs to balance ensuring that the site can
achieve its health care objectives with the impacts on the neighbourhood it is located in.
Additionally, if these services are to be established within Kitchener, staff recommend that the
Region work with City of Kitchener staff, including those with neighbourhood consultation
expertise to determine site selection criteria and further consult with respect to the
identification and review of potential location options, and to ensure a mutually agreeable site
is selected. Pre-established selection criteria could be developed with respect to the residential
and commercial character, population and density of the area as well as proximity to:
Other social service supports
Sensitive uses and location of public gathering places
Transit services and other key routes
Consideration #4 Site Specific Design Considerations
To ensure the safety of both clients and staff at any potential supervised injection site, there
are important site specific design considerations that should be taken into consideration.
Regional staff should work with City of Kitchener staff on the development of site specific
criteria which could draw on past experience with the local establishment of methadone clinics
and the experiences of other cities where supervised injection services already exist.
Some site-specific design considerations that should guide any site selection should include:
8 - 5
External: controlled access that ensures ability to control client flow, security measures,
sight lines and other Crime Prevention Through Environmental Design (CEPTED)
criteria, access to parking, etc.
Internal: designed in accordance with best practices including considerations such as
adequate waiting room space and hours of service to minimize loitering in public
spaces.
Additionally, aside from specific design considerations, the operation of any site should be
guided by thoughtful and robust operating procedures including: referral pathways, eligibility
criteria, intake procedures, client code of conduct, protocol for refusal of service, procedure for
contacting police for safety related issues and other key protocols and procedures.
Consideration #5 Ongoing Public Education and Consultation
Most, if not all, communities that have successfully integrated supervised injection services
into their neighbourhoods have done so through extensive public awareness, education and
consultation with key stakeholders including residents, business, partners, community
agencies and the community at large. Given that extensive work is underway on the
development of the Waterloo Region Integrated Drug Strategy, the City should request that a
co-ordinated public education effort for the broader community along with specific training for
targeted audiences including businesses and public agencies (e.g., libraries and community
centres) dealing with individuals impacted by opioids be developed and implemented as part
of this strategy.
The City should also request that communications and public education and awareness
specifically related to any supervised injection service site should include the following:
Develop partnerships with community agencies, residents etc., to determine, address
and communicate mitigation strategies for key community concerns
Create an Advisory Committee of partners, business, residents from the vicinity of the
supervised injection services site
Host community forum/open houses to share information and receive ongoing feedback
Host tours of the site for the community
Provide an annual presentation about the site (and its impact) to Council, community
groups, neighbourhood associations etc.
Create easy-to-understand online resources about the facility, addiction, supervised
injections services, etc.
ALIGNMENT WITH CITY OF KITCHENER STRATEGIC PLAN:
8 - 6
FINANCIAL IMPLICATIONS:
None
COMMUNITY ENGAGEMENT:
INFORM
council / committee meeting.
ACKNOWLEDGED BY: Dan Chapman, CAO
8 - 7
1
8 - 8
Acknowledgements
This study was conducted by Region of Waterloo Public Health and Emergency
Services with support from a number of agencies and organizations that work on issues
related to problematic substance usein Waterloo Region.
We would like to extend our sincerest thanksto individuals from the groups, agencies
and organizations thatwere willing to share their experiences and opinions to inform
this work.We are especially grateful to the individuals living with substance use who
shared details of their drug use as well as their opinions about substance-use related
services.
A number of individuals were involved in the development and execution of the
Waterloo Region Supervised Injection ServicesFeasibility Study. They include:
Alyshia Cook, Health Promotion and Research Analyst
Grace Bermingham,Manager of Information, Planning and Harm Reduction
Eve Nadler,Health Promotion and Research Analyst
Aaron Fisher, Community Researcher
Lisa Hillion, Community Researcher
Kathy McKenna, Public Health Nurse
Cheryl Luptak,Health Promotion and Research Analyst
Special thanks to the members of the Supervised Injection Services FeasibilityStudy
Work Groupwho providedconsultative expertise on the approach to explore the
feasibility of supervised injection services in Waterloo Region:
Brad Berg, Region of Waterloo Housing Services
Grace Bermingham, Region of Waterloo Public Health
Marian Best, Simcoe House
Ruth Cameron, AIDS Committee of Cambridge, Kitchener, Waterloo & Area
Natasha Campbell, Community Member
Aaron Fisher, Community Member
Arianne Folkema, Region of Waterloo Public Health
Stephen Gross, Kitchener Downtown Community Health Centre
Shirley Hilton, Waterloo Regional Police Services
Lindsay Klassen, House of Friendship
Kathy McKenna, Region of Waterloo Public Health
Eve Nadler, Region of Waterloo Public Health
Jeff Spence, Ontario Addiction Treatment Centres
Violet Umanetz, Sanguen Health Centre
Stephanie Watson, Region of Waterloo Public Health
2
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We would also like to extend our thanks to the City of Hamilton Public Health Services
for providing us with the community survey tool and adapted data collection materials
from the British Columbia Centre on Substance Use Supervised Consumption Services
Guidance Document.
Report Author
Alyshia Cook
Contributors
Eve Nadler, Cheryl Luptak, Stephen Drew
Editors
Grace Bermingham, Arianne Folkema, Eve Nadler
Suggested Citation
Region of Waterloo Public Healthand Emergency Services(2018). Waterloo Region
Supervised Injection Services Feasibility Study. ON: Author.
3
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Table of Contents
1.0Introduction.......................................................................................................10
1.1 What is the Opioid Crisis?...................................................................................10
1.2 What are supervised injection services?..............................................................11
1.3 How do supervised injection services fit with other strategies to address
problematic substance use?......................................................................................11
1.4 Study Objectives..................................................................................................12
2.0 Study Design.........................................................................................................13
2.1 Methodology........................................................................................................13
2.2 Limitations...........................................................................................................19
3.0 Findings.................................................................................................................22
3.1 Prevalence of Injection Drug Use and Overdose – A Review of the Secondary
Data...........................................................................................................................22
3.1.1 Injection Drug Use in Waterloo Region.........................................................22
3.1.2 Fatal and Non-Fatal Overdoses....................................................................23
3.1.3 Naloxone Distribution....................................................................................24
3.1.4 Impact on Local Health Care System............................................................25
3.1.5 Rates of Hepatitis C and HIV........................................................................27
3.2 Survey of People who Inject Drugs......................................................................28
3.2.1 Characteristics and Drug Use Patterns.........................................................28
3.2.2 Supervised Injection Services and Factors Influencing their Acceptability....31
3.3 Interviews with Harm Reduction Service Providers: The Need forSupervised
Injection Services and Considerations for Implementation........................................35
3.4 Information and Consultation Sessions: Concerns, Benefits and Implementation
Considerations according to Key InterestGroups in Waterloo Region......................40
3.5 Community Survey: Community Perceptions of Supervised Injection Services...47
4.0 Discussion.............................................................................................................53
4.1 Are supervised injection services supported in Waterloo Region?......................53
4.2 What concerns does the community have regarding supervised injection services
and how can they be addressed?..............................................................................53
4.3 What services should a supervised injection service location offer?....................54
4.4 What geographic areas are most impacted by injection drug use?......................55
4
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4.5 Are supervised injection services needed and will they be used?.......................55
5.0 Appendices............................................................................................................56
Appendix A. Secondary Data Extraction Data Sources..........................................56
Appendix B. Key Informant Interview Questionnaire..............................................57
Appendix C. Information and Consultation Questions............................................59
Appendix D. Number of valid responses for each question of the survey conducted
with people who inject drugs..................................................................................60
Appendix E. Key Informant Interview Participants by Organization........................66
Appendix F. Information and Consultation Session Group Participants.................67
Appendix G. Number of valid responses for each question of the community survey
...............................................................................................................................68
Works Cited.................................................................................................................69
5
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Executive Summary
Across Canada, rising numbers of overdose and overdose-related harms has spurred
communities to bolster strategies to address problematic substance use.
Comprehensive strategies that include a combination of prevention, harm reduction,
treatment and enforcement measures tackle the issues frommultiple levels. This
approach is called a “four-pillar”model and has been the adopted strategy of the
Waterloo Region Integrated Drugs Strategy. Activities to address problematic substance
use have been implemented across all four pillars in Waterloo Region. A supervised
injection service is a healthcare service operated according to harm reduction principles
with the goal of reducing the negative health outcomes of substance use, including
death.Exploring whether supervised injection services are needed was prioritized
because of the rising number of overdose and overdose-related deaths in Waterloo
Region.
What are Supervised Injection Services?
Fundamentally, a supervised injection service is a health care service. Locationsare
established toprovide support, healthcare and a placefor people to inject pre-obtained
substances without fear of dying from an opioid-related overdose. At a supervised
injection site, people may use drugs intravenously under the care of a trained health
care provider. These locations can be small, allowing for two or three people to use the
service at one time; but they can also be larger in scale. In Ontario, supervised injection
services must be integrated with other services in order to be funded. First aid, referrals
to treatment, access to clean needles and safe disposal ofneedles must also be
available at the site.
Description of the Waterloo Region Supervised Injection Services Feasibility
Study
Region of Waterloo Public Health and Emergency Services, in consultation with
community partners, undertook a multipronged research study to determine the
feasibility of supervised injection services for Waterloo Region. The study included:
A review of secondary data sources related to opioiduse in Waterloo Region;
In-person surveyswith people with experience of injection drug use;
Key informant interviewswith harm reduction service providers;
Information and consultation (focus group) sessions with groups interested in the
opioid response forWaterloo Region; and
An online survey to gather public input.
Supervised injection services are being explored in Waterloo Region as part of a
community response tosocial service issues as a result of increasedopioid use.In
order to legally operate supervised injection services, a federal exemption is required.
6
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The application for exemption requires broad community consultation and a description
of the local context supportedby data.
The goal of phase one of the Waterloo Region Feasibility Study was to document and
describe issues related to overdose and injection drug use in Waterloo Region; to
determine if supervised injection services would be used by people at risk for overdose;
to gain community input on how supervised injection servicesmay be of benefit to the
community, and to uncover concerns about such services being implemented in
Waterloo Region. The study also aimed to understand how such concerns can be
addressed.
Key findings of the Waterloo Region Supervised Injection Services Feasibility Study
include:
An estimated 4,000 people in Waterloo Region inject drugs.
About half (47.8%) of the people surveyed who inject drugsinject daily and 75.6
per cent reported injecting in publicin the last six months.
The most commonly reported reason for public drug use was homelessness.
Respondents reported injecting most often in downtown Kitchener, and in Galt
City Centre/South Galt.
About four out of five (78.6%) people reported injectingdrugs alone, increasing
their risk forfatal overdose.
Accidental overdose was reported by 39.0 per cent of respondents and 47.1 per
cent of respondents have administered naloxone to someone who was
overdosing.
Most people who inject drugs(86.3%) said that they would use or might use
supervised injection services if they were available in Waterloo Region. Half
(51.3%) indicated they would use a supervised injection site always(100% of the
time)or usually(75% of the time)for their injections.
The most commonly mentioned benefits of supervised injection services included
a reduction in public drug use, a decrease in the number of overdoses, and a
reduction in the spread of blood borne infections.
Community concerns regarding supervised injection services centred on
questions of whether supervised injection services would compromise the safety
of dependants, people who may use the services, and the surrounding
neighbourhood
Participants across all methodologies recommended the following strategies to
address the concerns of the community about supervised injection services:
o improving communication about the process to consider supervised
injection services;
o educating the community on addiction, mental health, and harm reduction
to build understanding and reduce stigma; and
7
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o creating an advisory group to oversee and respond to issues that may
arise during implementation of supervised injection services.
Conclusions:
Substantial support exists for supervised injection services in Waterloo Region as
a strategy to reduce the occurrence of overdose, reduce public injecting, connect
individuals with health and social services in the community, and provide access
to clean and sterile injection drug use equipment.
Residents of Waterloo Region are genuinely concerned about those who suffer
from drug addiction and are equally concerned about the implications of injection
drug use on the community.
There was strong support for service integration within a supervised injection
service model. Access to addiction treatment options, either through referral or
onsite, was seen as essential by all respondents including those who use
substances.
While most feel that supervised injection services are needed in Waterloo
Region, some people did not support this strategy. Concerns were raised about
where sites would be locatedand thepotential impacts on the surrounding
community including safety of children and dependents, property values, drug
trafficking, and the effect on businesses.
Increasing communicationin the community about addiction, harm reduction, and
supervised injection services was identified as a key strategy to addressing
community concerns.
Downtown Kitchener and South Cambridge (Galt) were identified as the most
important locations for supervised injection services; however a third site
(temporary or mobile) was also recommended to address potential need in other
areas. It was strongly recommended by all groups not to concentrate services in
one area by establishing one site in the region. There is fear that a single location
would stigmatize an area, and overtime may result in more people moving to that
area in order to access services.
8
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List of Figures
Figure 1. Supervised Injection Services feasibility study consultation phases..............14
Figure 2. Summary of data types and methodology for Phase 1...................................16
Figure 3. Community consultation methodology...........................................................17
Figure 4. Total number of opioid overdose calls by location, Waterloo Region.............24
Figure 5. Number of naloxone kits distributed in Waterloo Region, excluding pharmacies
(2016-2017)...................................................................................................................25
Figure 6. Number and rates per 100,000 population for opioid related emergency
department visits, Waterloo Region and Ontario, 2003-2016........................................26
Figure 7. Triage time of opioid related emergency department visits, Waterloo Region,
2016..............................................................................................................................27
Figure 8. Most commonly injected drugs among survey participants in the last six
months (n=146).............................................................................................................30
Figure 9. Age distribution of survey respondents by distribution of Waterloo Region
population (n=3,458).....................................................................................................47
Figure 10. Distribution of survey respondents residence by distribution of Waterloo
Region population (n=3,463).........................................................................................48
Figure 11. Extent to which supervised injection services would be helpful in Waterloo
Region (n=3,568)..........................................................................................................49
List of Tables
Table 1. Reasons for public drug use in the last six months (n=110)....................29
Table 2. Reasons for using supervised injection services (n=119)................................31
Table 3. Community outcomes of a supervised injection service location, as identified by
people who inject drugs (n=146)...................................................................................32
Table 4. Acceptability of guidelines under consideration for supervised injection
services, as perceived by peoplewho inject drugs.......................................................33
Table 5. Top ten most important services under consideration for supervised injection
services, as identified by people who inject drugs.........................................................34
Table 6. Suggested services to be offered alongside supervised injection...................39
Table 7. Ways in which supervised injection services would be helpful in Waterloo
Region (n=3,579)..........................................................................................................50
Table 8. Questions and concerns about supervised injection services in Waterloo
Region (n=1,441)..........................................................................................................50
Table 9. Proportion of respondents indicating questions/concerns by location of
residence.......................................................................................................................51
Table 10. Strategies to address questions and concerns of the community (n=3,509) . 51
9
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1.0Introduction
1.1What is the Opioid Crisis?
Opioid overdose-related deaths are on the rise in Canada. Health Canada reported
more than 2,800 suspected opioid-related deaths across the country in 2016 and
preliminary data suggests that the number of lives lost will most likely surpass 3,000 in
2017(Health Canada, 2017).Across Canada, communitiesare planning and
implementing comprehensive harm reduction strategies to address rising numbers of
overdose and overdose-related deaths nationwide. The FederalMinister of Health
reported in 2016 that Canada was facinga serious and growing opioid crisis signaled by
high rates of addiction, overdoses and deaths across Canada. The opioid crisis is a
complex health and social issue with devastating consequences for individuals, families,
and communities(Health Canada, 2016).
Opioids are a family of drugs used to treat acute and chronic pain. Over the past several
years there has been increasing concern regarding the misuse of prescription opioids,
including overprescribing and the appearance of these medications in the illicit drug
market. While fentanyl can enter the market through diversion of pharmaceutical
fentanyl products in pill, powder or patch form, more and more, fentanyl and its
analogues including Carfentanil and Cyclopropyl Fentanyl are imported or smuggled
from abroad. In turn, these substances are used to create illicit products or added to
other substances such as cocaine or heroine. When fentanyl is combined with other
substances, the potency of the drug is increased and can be lethal, even in minute
doses. When the person using the substance is unaware that they are taking fentanyl,
the risk of overdose, particularly fatal overdose, is increased.
Addiction is characterized by the inability to stop usingdespite knowing the harmful
consequences and wanting to stop. In 2016, more than 40,000 Ontarians were newly
1
started on high doses of prescription opioids(Kudhail, 2018)and 29 per cent of
Canadians aged 18 years and older recently reported having used some form of opioids
2
in the last five years(Statistics Canada, 2018). Continued opioid use can cause
dependence, which may lead to addiction. According to the National Institute on Drug
Abuse, addiction is a “chronic, often relapsing brain disease that causes compulsive
drug seeking and use, despite harmful consequences to the addicted individual and to
those around him or her” (National Institute on Drug Abuse, 2016).Research shows that
addictive disordersare health conditions and can be treated(Notarandrea, 2018).
1
Over 90 mg of morphine per day, or the equivalent dose of a different opioid.
2
Opioids are medications that relieve pain. Common opioids include fentanyl, OxyContin, morphine, and
codeine.
10
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1.2What aresupervised injection services?
Supervised injection services are legally-sanctioned, medically-supervised services
where individuals can consume pre-obtained illicit drugs intravenously. Supervised
injection services create a supportive environment for those suffering from addiction and
are available worldwide, including in Canada.
In Ontario, the Ministry of Health and Long-Term Care established the supervised
injection services program to complement and enhance existing harm reduction
programming in response to growing public health concerns in Ontario related to opioid
misuse and overdose. The Ministry lists the following impacts related to the
establishment of supervised injection services (September 2017):
Reduced overdose related morbidity;
Improved community safety by decreasing public injecting anddiscarded
needles,and noincrease in drug-related crime;
Increased referrals to health and social services including detoxification and drug
treatment programs; and
ReducedHIV and Hep C transmission as a result offewer needlesbeing shared
3
and/or reused.
In Ontario, supervised injection services must be integrated with other harm reduction
services which at a minimum must include first aid, education on safer injection,
provision (and disposal) of sterile injection supplies, distribution of naloxone, and
referrals to other health and social services.
1.3 How do supervised injection services fit with other strategies to
address problematic substance use?
Drug strategies in Canada aim to address problematic substance use through
interventions that fallinto four general categories: (1) prevention, (2) treatment and
rehabilitation, (3) justice and enforcement and (4) harm reduction. When implemented in
tandem, the four categories (or pillars) form a comprehensive strategy. While
prevention-based strategies aim to educate and prevent addiction from occurring, harm
reduction strategies aim to support people who are struggling with addiction. According
to the Centre for Addiction and Mental Health, harm reduction programs do not only
benefit individuals who use substances but also the community(2002):
3
These reported impacts are supported by evidence gathered from supervised injection services located
in Canada and Australia (Potier, Laprevote, Dubois-Arber, Cottencin, & Rolland, 2014).
11
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There is evidence that programs that reduce the short and long term harm to
people who usebenefit the entire community through reduced crime and public
disorder, in addition to the benefits that accrue from the inclusion into
mainstream life of previously marginalized members of society. The improved
health and functioning of individuals and the net impact on harm in the
community are notable indicators of the early success of harm reduction(Centre
for Addiction and Mental Health, 2002).
Supervised Injection is a health-based strategy that aims to reduce harms facing people
who use substances, including overdose, blood-borne infections, and other health care
issues.
1.4 Study Objectives
To operate legally in Canada, supervisedinjection servicesrequire an exemption under
Section 56 of the Federal Controlled Drugs and Substances Act (CDSA).In order to
receive an exemption from Health Canada, the applicant is required to provide
information regarding the intended public health benefits of the site and must include a
description of local conditionsindicating a need for the site and “expressions of
community support or opposition”. Funding for supervised injection services in Ontario
is provided by the Ministry of Health and Long-term Care. Applications for funding must
contain similar data submitted through the federal application. A multi-pronged feasibility
study was designed in order to gather the required informationfor Waterloo Region. The
following objectives guided the study:
1.To determine the needfor supervised injection services in Waterloo Region;
2.To determine the conditions under whichsupervised injection serviceswould be
used and judged as suitable or attractive byprogram deliverers and potential
clients;
3.To determine the extent to which supervised injection services are seen as
helpful to Waterloo Region by community stakeholders and the community, to
uncover any concerns about supervised injection services, and to discuss
mitigation strategies related to concerns;
4.To determine howsupervised injection servicescouldbe integrated within
existing harm reduction services in Waterloo Region; and
5.To determine potential locations for supervised injection services.
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2.0Study Design
2.1 Methodology
4
In July 2017, the British Columbia Centre on Substance Use(BCCSU)released the
5
document. This document
Supervised Consumption Services Operational Guidance
providesevidence, best practices, and lessons learned from areas thathave supervised
consumption services in operationand recommends conducting a feasibility study with
a mixed methods approach to ensure that key stakeholder groups are consultedwhen
exploring the need for such services.
Region of Waterloo Public Health,in consultation with the Supervised Injection Services
Feasibility Workgroup, employedthis methodology for the following reasons:
The methodology was developed using the best available research relating to
harm reduction and supervised consumption services;
The methodology was successfully usedin London, Thunder Bay, and Hamilton;
and
The consultation materials had been piloted on the target sample populations
and the materials were easily modifiable to support the local context.
The Waterloo Region Supervised Injection ServicesFeasibility Study has two phases
(refer to Figure 1). In the first phase, the need for supervised injection services is
explored and broad community input is gathered in order to understand the perceived
benefits and concerns of establishing supervised injection services in Waterloo Region.
Subject to Regional Council’s consideration and approval of the Phase 1 study findings,
the second phase of the study would involve identification and exploration of potential
locations for safe injection services, and further consultationwith those who live, work,
or go to school in close proximity to a proposed location. Implementation of this second
phase would only occur if approval from the Community Services Committee of
Regional Council is received on the Phase 1 recommendations.
4
The British Columbia Centre on Substance Use is made up of various levels of academia (e.g. associate
faculty members, research scientists, postdoctoral fellows) whose mandate is to develop, help implement,
and evaluate evidence-based approaches to substance use and addiction.
5
Operational Guidance document can be found on the British Columbia Centre on Substance Use
website: http://www.bccsu.ca/wp-content/uploads/2017/07/BC-SCS-Operational-Guidance.pdf
13
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Figure 1. Supervised Injection Services feasibility study consultation phases
Currently, the Ministry of Health and Long-term Care only provides funding to operate
supervised injection services, therefore this study focused solely on the feasibility of
supervised injection and did not explore the feasibility of consumption of illicit
substances by other means. The methodology for the study was reviewed and
approved by the Region of Waterloo Public Health Research Ethics Board on October
16, 2017. Data collection began October 25, 2017.
A combination of secondary and primary data informed the findings. Secondary
quantitative data sources were examinedto understand the context of drug use and
related consequences in Waterloo Region. These included data from harm reduction
14
8 - 21
programs, data from first responders including Waterloo RegionalPolice Services and
Region of Waterloo Paramedic Services, and infectious disease rates. Primary data
collection was used to documentdrug use patterns among people who inject drugs, as
well as to gather opinions of people who use substances and harm reduction service
providers regarding the need for supervised injection services. Additional qualitative
methods were used to understand the extent to which such services are supported or
opposed as a strategy to address opioid-related issues and substance use harms more
generally.Figure 2 provides an overview of all data typesused for Phase 1 of the
WaterlooRegion Supervised Injection Services Feasibility Study.For a list of data
sources used, please see Appendix A.
15
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Figure 2. Summary of data typesand methodologyfor Phase 1
Consultation with community stakeholders wasan important component of the study.
Engagement of individuals who may use injection services was not only used to
determine if such services would be used in Waterloo Region, but also helped to
describe the conditions that would promote their use by those who would need them
most. Further engagement of other community stakeholders including harm reduction
service providers, community groups with an interest in addressing problematic
16
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substance use, and the general population wasprovided with an opportunity for input
regarding supervised injection services. The community consultations were effective in
their goal of reaching a broad cross-section of people. Figure 3 lists the methods used
for community consultation and their reach.
Figure 3. Community consultation methodology
MethodSector reached
In-person surveys with people who N/A
inject drugs (146conducted)
Key informant interviews with harm AIDS organization
reduction service providers (11 Addictions treatment
conducted)Counselling organizations
Emergency shelters (adults and youth)
Health services
Withdrawal management
Informationand consultation Community interest groups
sessions – focus groups (28 BusinessImprovement Areas
conducted)Police and Emergency Services
Health services
Housing
Local Health IntegrationNetwork
Municipal Services
Outreach organizations
Social Services
Communityonline survey(3,579N/A
responses)
a)Survey with People Who Inject Drugs
Surveys were conducted with people who self-identified as having injected drugs in the
last six months. The survey instrument, adapted from the British Columbia Centre on
Substance Use guidance document, aimed to capture the following:
Demographic information;
Drug use and injection practices;
Attitudes and opinions towards supervised injection services;
Potential community impact of a supervised injection services;
Overdose experience; and
Drug treatment.
Community researchers with lived experience of substance use were hired by Region of
Waterloo Public Health to visit agencies who serve people who inject drugsin the region
between November 9, 2017 and December 8, 2017 to recruit participants to complete
17
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the survey. Participants were eligible to complete the survey if they were 16 years of
age or older; lived, worked orwent to school in Waterloo Region; and had self-identified
as having injected drugs in the last six months. Participants were also required to
provide consent to participate in the study. The survey had 96 questions and took
between 30 and 60 minutes to complete. Participants received a $25 cash honorarium
for their time.
Surveys were completed in person on paper, and promptly entered into an online
survey tool (Enterprise Feedback Management) supported by Public Health. Region of
Waterloo Public Health then exported the data to Microsoft Excel and SPSS for
analysis.
b)Key Informant Interviews with Service Providers
Key informant interviews were held with harm reduction service providers in Waterloo
Region from November 6-30, 2017. Harm reduction service providers have first hand
experience of working with people who inject drugs and can provide valuable insight
into the needs of this population.
Recruitment was done through email and interviews took place over the phone or in
person. On two occasions, there were multiple attendees at the interview. Key
informants were provided with an information and consent letter to participate in the
study prior to beginning the interview. Following informed consent, a standardized set of
questions adapted from materials developed by the BCCSU(refer to Appendix B for key
informant interview guide), were used for each key informant interview. Interviews were
approximately 30 minutes in length (except for the two group interviews which lasted
over an hour).
Most responses were recorded electronically. In cases where this was not possible,
hand written notes were transcribed in Microsoft Word upon completion of the interview.
Responses were then summarized by question and points of commonality are shared in
this report.
c)Information and Consultation Sessions
Information and consultation sessions were held with interest groups in the community
between November 9, 2017 to December 20, 2017.Groups consulted consisted of
stakeholders with a vested interest in the community opioid response or groups who
possibly would be affected by implementationofsupervised injection services in
Waterloo Region. Selection of interest groups was informed by the BCCSU guidance
7
,and by direction provided from the Supervised Injection Services Feasibility
document
Workgroup as well as the Community Services Committee of Regional Council.
Sessions were arranged through email and delivered at a location of the group’s
choosing. The sessions consisted of an information component about supervised
18
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injection services, harm reduction, and the purpose of the community consultation. This
was followed by the consultation component(refer to Appendix C).
Sessions were facilitated by Region of Waterloo Public Health and Emergency
Services. At a minimum, sessions were attended by the facilitator and note taker. For
the majority of sessions, a subject matter expert was also present for questions. On five
occasions, the lead researcher also attended the session. Word for word responses to
the questions were recorded electronically in Microsoft Word.Sessions were between
one and three hours long.
The qualitative data were analyzed for themes until saturation (until no new insights
emerged). A second researcher involved in the information and consultations sessions
validated the thematic analysis after it was conducted.
d) Community Survey
An online survey was developed in consultation with City of Hamilton Public Health
Services who surveyed Hamiltonians in late 2016. Region of Waterloo Public Health
adapted andlocalized their survey for use in this study.
The survey was developed using Enterprise Feedback Management software supported
by Public Health. The survey took approximately 10 minutes to complete and was open
from October 25, 2017 to December 1, 2017.
Participants were eligible to complete the survey if they were 16 years of age or older
and lived, worked, or went to school in Waterloo Region. Participants were also required
to provide consent to participate in the study prior to beginning the survey.
The survey was promoted to residents through a variety of means: emailsto community
networks, social media, print media, Public Health’s website, and radio interviews.
The survey asked participants about the helpfulness of supervised injection servicesin
Waterloo Region; whether or not they had any questions or concerns about supervised
injection services; how those concerns could be addressed; the model of service (i.e.
integrated, mobile) they believe should be provided in Waterloo Region; and basic
demographic information. Participants were also provided a space to leave general
comments about supervised injection servicesin Waterloo Region.
Region of Waterloo Public Health then exported the data to Microsoft Excel and SPSS
for analysis.
2.2 Limitations
It is important to note that all research contains some limitations. This section
documents the limitations of each method used within the study.
a)In-person survey with people who inject drugs
19
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6
The survey of people who inject drugs used convenience sampling.People who inject
drugs were recruited though organizations who serve this population. Community
researchers visitedtwo agencies that are located downtown Kitchener, one agency in
Waterloo, and two agencies in South Cambridge. While the researchers were easily
able to recruit participants at these locations, no attempt was made to reach individuals
who inject substances but do not access servicesthrough the identified agencies.Also,
because of the volume of clients at these agencies, some potential participants were
turned away due to time constraints.
Given that there is unreliable baseline data on the number and demographics of people
who inject drugs in Waterloo Region, the sample surveyed for this study cannot be
assumed to be representative of all people in Waterloo Region who inject drugs.
Furthermore, the survey relied on self-reported information which may be subject to
response biases including socially-desirability bias (answering in a way that makes the
responder look more favorable to the experimenter)and recall bias (trouble recalling
details of injection and overdose events).
b)Interviews with service providers
7
was used to select participants for the key informant interviews.
Purposive sampling
Members of the Supervised Injection Services Feasibility work group brainstormed harm
reduction service providers in Waterloo Region to be interviewed. This process may
have excluded some harm reduction service providers in the region. Therefore the
findings are not representative of all harm reduction service providers in the region.
c) Information and consultation sessions
Purposive sampling was used to recruit interest groups for the information and
consultation sessions. Responses are therefore not representative of the broader
population. Some attempts to includepriority groups experiencing barriers to services
such as, Indigenous Communities and First Peoples, and Lesbian, Gay, Bisexual,
Transgendered, and Two-Spirited communities were unsuccessful. As such, findings
may not reflect experiences of people within those groups. While efforts were made to
discourage people from attending more than one session, this occurred in fewer than
ten instancesand therefore those individuals had the opportunity to contribute their
ideas more than once.Finally, it is important to note that while the consultation sessions
sought opinions about supervised injection services, it also provided a platform for
people to share concerns on others issue related to harm reduction interventions.
Thematic analysis reflects all of the content from the information and consultation
sessions; however, specific questions and concerns related to the broader contextof
6
Sample units are selected on the bases of availability and not by a probability sampling method.
7
Respondents were selected based on characteristics of the population of interest and the objective of
the study.
20
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substance usemay not be reflected in this report as the vast amount of content
obtained was specifically related to supervised injection services.
d) Community Survey
The community survey used convenience sampling in order to provide universal access
for residents of Waterloo Region to share their thoughts and concerns about supervised
injection services. Despite extensive survey promotionto various demographic groups
across Waterloo Region,there were low response rates from some groupsincluding
people aged 55 years and older, and people living in the townshipsof Waterloo Region.
Therefore, the results shared in this report cannot be assumedto represent all people
living in Waterloo Region.
While the survey was open, harm reductionservices were garnering higher than normal
media attention in the City of Cambridge. This may explain high response rates among
Cambridge residentscompared to any other City or Township in the region.
Finally, the Region of Waterloo intentionally used survey software that does not limit the
number of times a survey can be filled out to a single Internet Protocol (IP) address.
This wasto ensure access for people who rely on public use computers such as those
available at libraries or workplaces.As a result, the software does not prevent
individuals from completing the survey multiple times in an effort to skew results.
Responses by IP address were analyzed to explore this effect. Distribution of resultsby
respondent with the same IP address was not substantially different from the distribution
of results from the overall survey. Analysis also revealed that there were similar
numbersofrepeat respondents who were either very much in support of supervised
injection services or not at all in support of supervised injection service, resulting in
negligible impact on the findings overall.
21
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3.0 Findings
3.1Prevalence of Injection Drug UseandOverdose – A Review of the
Secondary Data
Waterloo Region is made up of three municipalities and four townships and has a
population of 583,500 people(according to the Canada 2016 census).Region of
Waterloo Public Health is mandated to provide harm reduction programs including the
Needle Syringe Program and the Naloxone Distribution Program. Public Health is also
responsible formonitoring the health of the population as it relates to substance use.
Opioid related issues have been increasing across the province including Waterloo
Region. The following sections will illustrate the extent of opioid crisis in Waterloo
Regionas indicated by thefollowing data:
The estimatednumber of people who inject drugs in Waterloo Region
Confirmed opioid related deaths(2015-2016)
Suspected overdose deaths (2017)
Opioid related Paramedic Service calls
Naloxone kit distribution
Opioid-related emergency department visits
Rates of hepatitis C and HIV
3.1.1 Injection Drug Use in Waterloo Region
Although limited information is available on illicit drug use in Waterloo Region, it is
estimated that approximately 3,919residents inject drugs (current as ofDecember 31,
2017). This estimate was calculated by counting the number of unique clients who visit
needle syringe programs in Waterloo Region. It is important to note that this number is
an underestimation as not all people who inject drugs access Needle Syringe Programs
in Waterloo Region. In Canada, it has been reported that approximately94.5 per cent of
people who inject drugs used sterile injecting equipment at last injection(Stone, 2016)
indicating that our needle syringe programs are servicing most but not all people who
inject drugs in Waterloo Region. The 2017 estimate of 3,919is a166.6 per cent
increase from an estimate reported in the Baseline Study of Drug Use in Waterloo
Regionconducted in 2008, where it was estimated (albeit through different
methodology) that 1,470 residents injected drugs(Taylor, 2008).
Limited information is available to compare the proportions of people who use drugs in
Waterloo Region to other areas of Canada.Typically, areas report on the range of
people they believe inject drugs in their jurisdictions. For example,it is estimated that
between 1,200 and 5,600 people inject drugs in Ottawa(Levy, 2016). Ottawa
implemented supervised injection services in November 2017. In Lethbridge Alberta,
22
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where supervised consumption services are slated to open in February2018,
approximately 3,000 of their residents inject drugs(Cotter, 2017).
3.1.2 Fatal and Non-Fatal Overdoses
The growing severity of opioid use in Waterloo Region is evident inthe suspected
number of overdosedeaths reported by Waterloo RegionalPolice Services and
confirmed opioid related deaths reported by the Office of the Chief Coroner for Ontario.
The Coroner reported that there were 23 opioid related deaths in Waterloo Regionin
2015 and 38in 2016. At the end of 2017, Waterloo RegionalPolice Services reported
that there were 71 calls for service where a death had occurred and a drug overdose
was suspected (this number includes all suspected drug overdoses and is not limited to
opioids and thus cannot be directly compared to the Coroner data); 32 of these deaths
occurredin Kitchener, 29 inCambridge, and 10 in Waterloo.
Region of Waterloo Paramedic Services responded to 197 opioid-related calls in 2015,
410 in 2016 and 795 in 2017. This representsa 303.6 per cent increase in the number
of opioid related overdose calls in Waterloo Region between 2015 and 2017. Paramedic
Servicesopioid related overdose calls are higher in Cambridge and Kitchener,
comparedthe rest of Waterloo Region. Figure 4 showsthe total number of opioid
overdose calls by location.
23
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Figure 4.Total number of opioid overdose calls by location, Waterloo Region
Source:Region of Waterloo Paramedic Services, January 1, 2017 to November 15, 2017.
3.1.3 Naloxone Distribution
Naloxone is a life saving medication used to temporarily reverse the effects of anopioid
overdoseand is available as a nasal spray or as an injection. In late 2013, Region of
Waterloo Public Health and Sanguen Health Centre beganofferingnaloxone kits to
people with a history of past or current opioid use. In 2017, the program was expanded
to include family and friends of a person at risk for an opioid overdose. In 2016, the
Ontario Addiction Treatment Centres began distributing naloxone as well and in late
2017, Bridges, oneROOF, and the AIDS Committee of Cambridge, Kitchener, Waterloo
and Area came on board. Region of Waterloo Public Health is currently exploring
additional agencies to distribute naloxone.Naloxone is also available at pharmacies.
Naloxone distribution in Waterloo Region increased significantly between 2016 and
2017. Figure 5 shows the number of naloxone kits distributed by agencies in Waterloo
Region, excluding pharmacies.
24
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Figure 5. Number of naloxone kits distributed in Waterloo Region, excluding pharmacies
(2016-2017)
5,000
4,000
3,000
2,000
1,000
0
20162017
Number of naloxone kits
6774,703
distributed
Source:Region of Waterloo Public Health and Emergency Services data, extracted January 9, 2018.
3.1.4 Impact on Local Health Care System
Local emergency departments have also seen the effects of the opioid crisis. In 2016,
opioid related emergency department visits increased by 68.5 per cent compared to
2015.In 2016, the rate of opioid related emergency department visits in Waterloo
Region was higher than that of Ontario (refer toFigure 6).
While data for 2017 is not complete, there were 169 opioid related emergency
department visits reported by June 2017. The number of opioid related hospitalizations
remains stable.
25
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Figure 6. Number and rates per 100,000 population for opioid related emergency
department visits, Waterloo Region and Ontario, 2003-2016
30050.0
45.0
250
40.0
35.0
200
30.0
Number of
Rate per
Visits
15025.0
100,000
20.0
100
15.0
10.0
50
5.0
00.0
20032004200520062007200820092010201120122013201420152016
Waterloo Visits
7684849611212411511114314399126149251
Waterloo Rate16.117.417.119.322.324.422.421.427.327.018.523.327.345.8
Ontario Rate
15.216.516.717.017.518.822.221.722.223.622.624.526.331.7
Source:Ambulatory All Visit Main Table, Ontario Ministry of Health and Long-Term Care. IntelliHEALTH
ONTARIO, extracted January 16, 2018. Estimates of Population (2003-2016), Ontario Ministry of Health
and Long-Term Care. IntelliHEALTH ONTARIO, extracted September 27, 2016.
In 2016, opioid related visits to the emergency department were highest between 12:00
noon and 4:00 p.m. and 8:00 p.m. and 12:00 midnight (refer to Figure 7).
26
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Figure 7. Triage time of opioid related emergency department visits, Waterloo Region,
2016
21.5%
20.3%
19.9%
14.3%
13.1%
10.8%
8 a.m. to 12 p.m.12 p.m. to 4 p.m.4 p.m. to 8 p.m.8 p.m. to 12 a.m.12 a.m. to 4 a.m.4 a.m. to 8 a.m.
Time Period
Source:Ambulatory All Visit Main Table, Ontario Ministry of Health and Long-Term Care. IntelliHEALTH
ONTARIO, extracted January 16, 2018
The Canadian Institute for Healthcare Information also reported that the rate of
hospitalizations of babies with neonatal opioid abstinence syndrome in Canada has
risen from 1,448 in 2012-2013 to 1,846 in 2016-2017 fiscal year, an increase of 27.5 per
cent in just four years(Fitzgerald & Gruenwoldt, 2017).
3.1.5 Rates of Hepatitis C and HIV
Hepatitis C infection is an infection of the liver caused by the Hepatitis C virus (HCV).
HCV spreadsthrough contact with the blood of an infected person, mainly through
sharing of contaminated needles, syringes or other drug equipment; blood transfusions
prior to 1992 before screening became available; unsafe tattoos/piercings; sexual
contact with an infected person; and/or, being born to an infected mother(Folkema,
8
2017).In 2017, the rateof HCV in Waterloo Region was 25.2cases per 100,000
9
(N=135).
8
Crude incidence rate.
9
Source: iPHIS (2017), Region of Waterloo Public Health and Emergency Services, Extracted January
15, 2018. These estimates are preliminary and subject to change once the data has been finalized.
27
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Human immunodeficiency virus (HIV) is a blood-borne infection that attacks the immune
system (the body’s internal defence system). HIV can lead to acquired
immunodeficiency syndrome (AIDS) which is a disease of the immune system that
makes the person at risk of getting other infections and diseases(Folkema, 2017).One
of the risk factors for HIV is injection drug use.In 2017, there were 11HIV/AIDS cases
in Waterloo Region or 2.1 cases per 100,000.
Since 2006, local incidence rates of Hepatitis C and HIV have remained significantly
lower than provincial rates, however quality of life consequences for those infected are
significant.
3.2 Survey of People who Inject Drugs
3.2.1 Characteristics and Drug Use Patterns
A total of 146 people who self-identified as having injected drugs in the last sixmonths
completed the survey.Respondents indicated living, working or going to school in
Waterloo Region and were at least 16 years of age or older.
Data analysis note:Given the length of the survey, not all questions were answered by
every participant.Therefore, the denominator for each question varies. Proportions are
presented based on the number of valid responses for each question and not a
proportion of the total sample (n=146).The number of valid responses for each question
can be found in Appendix D.
Demographic Information
Among survey participants, three quarters identified as male (73.1%)and the median
age was 37 (range: 19 to 70). The majority of respondents resided in Kitchener (51.0%)
or Cambridge (44.8%) and identified as Caucasian (85.6%). In the last six months,
respondents reportedliving in a house or apartment most of the time (33.6%) followed
10
by shelter or welfare residence (17.2%) and on the street (13.4%). Over half of
respondents (57.9%) indicated that they currently live with someone who injects drugs.
While 60.6per cent ofrespondents indicated having completed high schooland 22.5
per cent completedany college/university, 64.1 per centreported a yearly personal
income of less than $20,000. Ontario Works (50.0%) and the Ontario Disability Support
Program (35.6%) were most commonly reported sources of income.Close to one in five
respondents (17.8%) reported engaging in sex work or exchanging sex for resources in
the past six months.
10
On the street includes abandoned buildings, cars, and parks.
28
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Drug Use and Injection Practices
The majority of respondents (81.9%) reported having injected drugs in the last 30 days
and 47.8 per cent of respondents reported injecting on a daily basisin the last six
months.
Respondents also reported high rates of public drug use (75.6%) in the last six months.
Ofthose who reported injecting in public(n=102),38.2per centnoted that they inject
publically over 75% of the time.The most commonly reported reason for publicdrug use
was homelessness (See Table1).
Table 1. Reasons for public drug use in the last six months(n=110)
Reason for public drug useN (%)*
I'm homeless64 (58.2)
It's convenient to where I hang out42 (38.2)
I'm too far from home40 (36.4)
There is nowhere to inject safely where I buy drugs34 (30.9)
I don't want the person I am staying with to know I use/am still using22 (20.0)
I prefer to be outside18 (16.4)
I need assistance to fix12 (10.9)
Dealing/middling (connecting sellers to purchasers)/steering (guiding 12 (10.9)
potential buyers to selling)
Guest fees at friend's place, but I don't want to pay7 (6.4)
Other9 (8.2)
*Respondents could choose more than one answer; the total proportions for this question can
exceed 100%.
Participants were also asked to indicate which neighbourhoods they injected drugs in
most often in the last six months. Respondents who identified living in Kitchener noted
frequent injection drug usedowntownKitchener (44.6%) andinCountry Hills (10.8%).
Cambridge respondents reported frequent injection drug use in Galt City Centre/South
Galt (40.0%).
Notably, 83.3 per cent ofrespondentsindicated having accessed a local harm reduction
program to exchange or obtain needlesin the last six months. Respondents also
indicated accessing supplies from their friends (78.9%) and from a dealer or someone
on the street (59.4%). Risk for infectious disease transmission was also evident, with
20.8 per cent ofparticipants noting that they had injected with needles knowing they
had already been usedin the last six months.Furthermore, 17.9per cent of
respondentshad alsoloaned used syringes to other people. Many respondents (53.7%)
noted not knowing where to get a clean needle in the last six months. This response
was not qualified by time of day or day of the week which may explain the high
proportion.
29
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Most Commonly Injected Drugs and Drug of Choice
The most commonly injected drugs in the last six months were crystal meth (44.5%) and
hydromorphone (8.9%). Thirteenper cent of respondentsdeclined to answer.
Figure 8. Most commonly injected drugs amongsurvey participants in the last six
months(n=146)
*Other includes morphine, Ritalin or Biphentin, Speedball, Wellbutrin, and combinations of drugs
identified by participants (e.g. crack and crystal meth, crystal meth and fentanyl, fentanyl and
heroin).
The top three drugs most preferredby clients are crystal meth (54.1%), hydros(22.6%),
and heroin (18.5%).
Accidental Overdose
Injection practices among participants illustrated the likelihood of overdose. Overthree
quarters of participants (78.6%) indicated they had ever injected alone, and 97.3 per
centreported that this occurred in the last six months. Of these participants(n=107),
60.7per centindicated that they injected alone at least 75% of the time in the last six
months. Over three-quarters (78.0%) of respondents indicated that they have used a
drug they believe was cut with another substance and of those, 41.1 per cent reported
they were trying to use crystal meth at the time.
Accidental overdose was reported by 39.0 per cent ofparticipants and64.9per cent of
those reportinghaving ever overdosed, overdosed in the last six months. Of those
respondents who had ever overdosed(n=57),19.3per centindicated that they were
alone when the overdose occurred. Fentanyl was reported having been injected prior to
their last overdose by 67.3per cent of respondents. More than half (60.0%) of
respondents indicated that an ambulance was called the last time they overdosed,and
in those instances, the police showed up 72.7 per centof the time. The majority (87.5%)
were taken to an emergency department/hospital. Of those who provided a location for
30
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their most recent overdose (n=43), 44.2 per cent indicated a neighbourhood in
Kitchener, and 39.5 per cent noted a neighbourhood in Cambridge.
The majority of respondents (78.8%)reported having heard of naloxone(n=115)and of
those 95.7per cent have heard about take-home naloxone kits; mainly through a friend
(42.5%). More than half (62.7%) reportedcurrently havinga naloxone kit and of those,
56.4percent got it from the Sanguen Van. Naloxone has been administered by 47.1
per cent of respondents.
3.2.2Supervised Injection Servicesand Factors Influencing their Acceptability
Survey participants were asked a numberof questions about supervised injection
services. Many respondents (71.2%) reportedhaving heard of supervised injection
services and most (86.3%) said that they would use them or might use them if they
were available in Waterloo Region (66.7% and 19.6%, respectively). Reasons for using
supervised injection services are presented in Table 2.
Table 2. Reasons for using supervised injection services(n=119)
ReasonN (%)*
I would be able to get clean sterile injection equipment86 (72.3)
I would be able to inject indoors and not in a public space73 (61.3)
Overdoses can be prevented 70 (58.8)
Overdoses can be treated64 (53.8)
I would be safe from crime63 (52.9)
I would be injecting responsibly62 (52.1)
I would be able to see health professionals61 (51.3)
I would be safe from being seen by the police61 (51.3)
I would be able to get a referral for services suchas detoxification or 40 (33.6)
treatment
*Respondents could choose more than one answer; the total proportions for this question can
exceed 100%.
When respondents were asked what the most important reason would be forusing
supervised injection services, 27.2 per centindicated that they would be able to get
clean sterile injection equipment, followed by overdose prevention (18.4%).
Participants who indicated they might or would not use supervised injection services
(n=46; 33.3%) provided the following top 3reasons:
“I do not want to be seen” (91.3%);
“I do not want people to know I am a drug user” (67.4%); and
“I am afraid my name will not remain confidential (63.0%).
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Supervised Injection Services – Impact on the Community
Survey participants were asked about the likelihood of particular thingshappening in the
community ifsupervised injection serviceswere to open in Waterloo Region. Table 3
presents potential outcomesand the number and proportionof respondents who
believed it would be very likely or likely to occur.
Table 3. Community outcomes of a supervised injection service location, as identified by
people who inject drugs(n=146)
If supervised injection serviceswere to open in Waterloo N (%) Indicating Very
Region:Likely or Likely
The number of used syringes on the street would be reduced120 (82.2)
People would learn more about drug treatment118 (80.8)
Overdoses would be reduced118 (80.8)
The number of people injecting outdoors would be reduced115 (78.8)
Injection with used needles would be reduced111 (76.0)
Users would visit the area more90 (61.6)
Users would move to the area80 (54.8)
Street violence would be reduced77 (52.8)
Drug dealers would be attracted to the area71 (48.6)
Crime would be reduced in the area67 (45.9)
Preference for Supervised Injection Service Location
Respondents indicated that they would use a supervised injection service if it was
located in a community health centre (76.0%) or Public Health clinic (71.2%).
Respondents indicated preference for the service to be located with other health and
social services (53.4%)followed bymobile unit/van (40.4%).
Survey participants were asked to identify where in Waterloo Region supervised
injection services should be located. Downtown Kitchener (38.6%) and downtown Galt
(33.7%) were identified as leading choices for location. Other locationsthatwere
mentioned includePreston(11.5%), Country Hills(8.0%), and
Bridgeport/Breithaupt/Mount Hope(8.0%).Survey participants were asked how many
supervised injection service locations are needed in Waterloo Region. Of those who
responded (n=87), 83.9 per cent believe that between two and six locations are needed
region wide.
Hours of Operation
Respondents were asked what time of day would be their first choice to use supervised
injection services. Morning hours between 8am and 12pmwere picked by the majority
(41.1%), followed by afternoon hours of 12pm until 4pm (15.8%) and early evening
between 4pm and 8pm (6.2%). Respondents were then asked to indicate their second
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choice for when they would use supervised injection services. Overnight (midnight until
8am) was preferred by 30.4per cent of respondents,followed by afternoon hours
(29.4%). While a single “24/7” option was not available as a selection, interviewer
comments at the end of the survey indicated a number of requests from clients for this
model.
Use of Supervised Injection Services and DesignPreferences
Similar proportions of respondentsindicated that they would use a supervised injection
11
service locationalways and usually (25.3% and 26.0%, respectively). Over half
(51.4%) believe the best set up would be private cubicles for injecting spaces and 56.8
per cent of respondents noted that people who use drugs should be involved in running
the site. These individuals could be involved by monitoring the entrance and
surrounding area (72.3%), greeting clients (73.5%), and being available in the chill-out
room (68.7%) and in the waiting area (59.0%).
In order to understand how supervised injection services might be implemented if need
is determined, participants were asked to rate the followingguidelines in terms of very
acceptable to very unacceptable. The proportions of those indicating very acceptable or
acceptable are presented in Table 4.
Table 4.Acceptability of guidelines under consideration for supervised injection
services, as perceived by people who inject drugs
GuidelineN (%) Indicating Very
Acceptable or Acceptable
Injections are supervised by a trained staff member who 119 (90.2)
can respond to overdoses
Have to hang around for 10 to 15 minutes after injecting88 (60.3)
so that your health care can be monitored
30 minute time limit for injections88 (60.3)
Not allowed to have others assist in the preparation of 67 (45.9)
injections
Not allowed to assist each other with injections66 (45.2)
Not allowed to share drugs66 (45.2)
Register each time you use it65 (44.5)
May have to sit and wait until space is available for you 65 (44.5)
to inject
Video surveillance cameras onsite to protect users61 (41.8)
Required to show client ID number57 (39.0)
Not allowed to smoke crack/crystal meth57 (39.0)
Have to live in the neighbourhood where the SIS is43 (29.5)
Required to show government ID33 (22.6)
11
Usually was defined as use of a supervised injection service over 75% of the time.
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Respondents were asked how often they would use drug testing services prior to
injecting at a supervised injection siteif it were available. Manyrespondents (61.6%)
indicated that they would use drug testing services over 75% of the time but would only
be willing to wait less than 10 minutes for the results (72.2%).
Respondentswere alsoasked how long they would be willing to walk to a supervised
injection servicein the summer and winter months. The majority of respondents
reported being willing to walk up to 20 minutes (59.6%)in the summer and between 5
and 10 minutes (52.7%)in the winter to a supervisedinjection site.
More than half of respondents (57.5%) indicated they would travel by bus to a
supervised injection siteand 72.6 per cent indicated they would travel by bike.
Respondents were also asked to rate the importance of services under consideration for
supervised injection services. Table 5 shows the ten most important services identified
by respondents.
Table 5.Top ten most important services under consideration for supervised injection
services, as identified by peoplewho inject drugs
ServiceProportionIndicating Very
Important or Important
1.HIV and hepatitis C testing89.4
2.Nursing staff for medical care and supervised 87.9
injection teaching
3.Washrooms87.4
4.Needle distribution87.1
5.Referral to drug treatment, rehab, and other 82.6
services when you’re ready to use them
6.Assistance with housing, employment and basic 81.2
skills
7.A ‘chill out’ room to go to after injecting80.3
8.Injection equipment distribution77.4
9.Access to general health services77.4
10.Drug testing 77.4
History of Drug Treatment
Close to half of respondents (45.2%) indicated having been in a detox or drug treatment
program at some point in their lifetime and of those, 37.9 per centattended a program in
the last six months. The most commonly reported drug program attended in the last six
months was a detox programwith other prescribed drugs (20.0%).
Almost one in ten (9.6%)respondentsreported thatthey had tried to get into a
treatment program in the last six months but were unsuccessful.
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3.3Interviews with Harm Reduction Service Providers: The Need for
Supervised Injection Services and Considerations for Implementation
Harm reduction services providers were asked a series of questionsto determine
whether supervised injection services are needed in Waterloo Region along with other
questions that would inform how the service should be offered and how to address
challenges to implementation. The responses are organized by the question asked.
A total of 11 key informant interviews were completed with harm reduction service
providersin Waterloo Region(refer to Appendix E for the list of key informant interviews
by organization).
Need for Supervised Injection Servicesin Waterloo Region
Overall, key informants were knowledgeable of supervised injection services including
their intended purpose, how they are operated, and outcomes experienced by the client
and the community at large. Outcomes for the clientincluded connecting individuals
with health and social services, facilitating treatment, reducing fatal and non-fatal
overdoses, and decreasing the spread of blood borne infections including Hepatitis C
and HIV.Outcomes for the community as a whole included a reduction in public drug
use and needle litter. One service provider described the development of supervised
injection services as “creating a path to wellness” for those in the community who
require health and social services but are often unable to access them.
All key informants indicated that supervised injection services have been needed in
Waterloo Regionfor some time.As one participant stated,
“We need them today, not six months from now”
Service providers believe that supervised injection services would not only reduce the
number of fatal overdoses in Waterloo Region but would also result in other important
outcomes. These include:
Reducing the stigmaassociated with addictionin the community;
Keeping people alive and reducing health risks associated with injection drug
use;
Facilitating access to treatment and providing users with basic health and social
services;
Providing hope for life and a place where people feel comfortabletalkingwith
someoneabout their situation;
Providing health care providers with a window of opportunity to support an
individual when they areready for treatment;
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Providing service providers with the opportunity to make connections with this
vulnerable population and get them the services that they need. Supervised
injection serviceswould allow for deeper conversations that would lead to
recovery and further help; and
Increase properdisposal of used needles, decrease drug use in public places,
and positively impactcrime rates.
Perceived Challenges of SupervisedInjection Servicesin Waterloo Region
Key informants identified potential challenges with having supervised injection services
in Waterloo Region. These included:
Stigma – Key informants cautioned that if service users were shamed or judged
for attending a supervised injection service location,they will not use it. In
addition,it was shared that the location of a site may stigmatize the surrounding
neighbourhood.
Nimbyism (Not in my backyard) –Key informantsnoted that while community
members may support supervised injection services, the selection of
neighbourhood will be difficult as there are perceived notions that this type of
service will have negative impacts on the area.
Community support – Key informants suggested there is a lack of information
circulating in the community about addiction, harm reduction, and the supervised
injection services program model. They encouraged morepublic education.
Limited treatment options available – Key informants noted that while supervised
injection services are important to support people experiencing harms related to
substance use,better access to treatment is needed.
“We must help people find ways to relate to the issue on an individual level.
Every single person will be affected if we don’t do something”
Acceptance and Useof Supervised Injection Services in Waterloo Region
Key informants believe that supervised injection services would be used by the majority
of people who inject drugs.Respondents sharedthat clients have been askingfor this
service for some time as manyare scared with the amount of overdoses and deaths
happening in the community. More difficult to reach populations (i.e. youth, people who
use occasionally, and those that hide their use) would require outreachto encourage
use of the service. It washypothesized by key informants that a supervised injection
service location would be successful if it was easily accessible, run by peers and other
trusted individuals, and it was proven to be a safe place without worry of legal
repercussions.
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“We don’t want youth fatalities to be what pushes people to agree with this”
“A site would be empowering to a population who has never had a place
specific for their needs. This population wants to do healthy things but has
notyet been provided with the opportunity to do so”
Addressing Community Concerns
Harm reduction service providers acknowledged that community residents have
concerns about the possibility of supervised injection servicesbeing established in
Waterloo Region. It was shared that residents are worried that:
A supervisedinjection site in close proximity to their home will have implications
on property values;
Their children’s safety will be at risk, especially if a supervised injection site is
located near a school;
Thesurrounding neighbourhood will experience more loitering, crime, increased
presence of drug dealers and needle litter; and
Supervised injection serviceswould encourageand supportdrug usein the
communityand clients would not seek treatment.
Providers suggested variousstrategies to mitigate community concerns of supervised
injection services, including:
Education - Service providers described the importance of addressing
misconceptions about supervised injection services including the belief that
supervised injection services will encourage people to use drugs instead of
seeking treatment. It was suggested that education about addiction and
substance use is needed and that sharingstories is an important way toenhance
understanding and increase empathy.
Communication – Service providers stressed the importance of communicating
with the public during all phases of the Supervised Injection ServicesFeasibility
Study using a variety of approaches. It was recommended that a spokesperson
thatiswell known be a consistent voice for supervised injection services in
Waterloo Region.
Mitigation Advisory Group - Several providers described the need for a group to
oversee the implementation of supervised injection services that wouldrespond
to any issues a site experiences after implementation. Providers agree that
building trust between clients of a potential site, the community, and service
providers is critical to the success of any future site.
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Preferences for Supervised Injection Services Implementation: Lead Agency,
Locations and Integration
a)Lead Agency
There was overwhelming support from key informants forSanguen Health Centreto
operate supervised injection servicesin Waterloo Region. Sanguen was identified as
having the appropriate medical model to support the needs of those who will use the
site. In addition, respondents encouraged involvement from Public Health, shelters in
the area, and people with lived experience.
b)Number and Location of SISs Needed
When asked how many sites are needed in Waterloo Region, responses ranged from
one to 12 sites. The majority indicated that three sites were needed at this time; one in
each municipality (Kitchener, Cambridge, and Waterloo).While most respondents
agreed that all of Waterloo Region is impacted by drug use, the areas of King and
Fairway, Kitchener downtown,andSouth Cambridge (Galt)were mentioned as needing
supervised injection services sooner than others. Several respondents suggested
locating supervised injection servicesin locations that are frequented by the public
including libraries, shopping centresand strip malls, and around Waterloo Region’s post
secondary institutions.
c) Days and Hours of Operation
When asked which days and hours a siteshould operate, the majority of respondents
indicated 24 hours a day, sevendays a week. This was followed by statements that
drug use patterns are unique for each individual and it would be difficult to select hours
in the day that would meet everyone’s needs. Respondents were mindful that a 24/7
operation may not be feasible with the resources available, and suggested to track
usage patterns and tailor operating hours to the hours that the siteis used most often.
In the event that a 24/7 operation was not initially feasible, key informants noted that
focusing on evenings, overnight and weekend hours would be most beneficial as other
health and social services are not available during those times.
d)Service Integration
Key informants were asked which services should be offered atasupervised injection
site. Their responses are summarized in Table 6.
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Table 6. Suggested services to be offered alongside supervised injection
Types of Services
Services
Harm Reduction
Access to clean supplies, proper disposal of used equipment,
and naloxone
Health Services
Access to a nurse practitioner or general practitioner
Nurse on site
Basic health care including testing for blood-borne infections,
pregnancy, and abscess and wound care
Methadone clinic
Mental Health
Access to a counsellor
and Addictions
Pathways for psychiatric supports, harm reduction
Services
psychotherapy, rehabilitation
Support groups they can participate in
Social Services
Outreach worker who can provide referrals to community
supports
Housing and income supports
Involvement of peer workers (people with lived or living
experience of drug use)
Basic Needs
Snacks and water for clients
Access to basic needs (e.g. deodorant, toothbrushes),
laundry facilities, showers, and a washroom
Drop-in space or lounge area
“The drug use community is experiencing a lot and it’s being internalized. It
will perpetuate more harmful drug use. They need a safe place to talk about
what’s going on”
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3.4Information and ConsultationSessions: Concerns, Benefits and
Implementation Considerations according to Key Interest Groups in
Waterloo Region
Information and Consultation (focus group) sessions were held with interest groups from
across Waterloo Region (refer to Appendix F for a list of participant groups). Findings
are organized into seven themes, including:
Support for supervised injection services in Waterloo Regionwith “not in my
backyard” cautions
The need for supervised injection services to provide a safe space
Communication is key for concerns with supervisedinjection services
Supervised injection services andeducation creating a cultural shift with respect
to addiction
Service integration is key for concerns with supervised injection services
Ahybrid service model for supervised injection services in Waterloo Region
Locations: equity, access, safety
Support for supervised injection services in Waterloo Region with “not in my
backyard” cautions
Qualitative analysis revealed a theme of strong support for the notion that if Supervised
Injection Services wereimplemented in some form in Waterloo Region, it would benefit
the community. The majority of those providing responses were supportive of
supervised injection services and were looking for implementation solutions that allow
us to be a caring community while still addressing and managing valid concerns about
impact on safety, families, businesses, and culture. For instance, support was
sometimes provided with a “not in my backyard” mentality. Although analysis revealed
strong support for supervised injection services implementation in some form, some did
not believe supervised injection services are right for their neighbourhood or to have in
Waterloo Region overall. They still, however, expressed concern with the issues of
overdose deaths and drug use, andwanted efforts to focus on prevention, treatment,
and identification of root causes.
“It’s health. It’s not just harm reduction, but your health matters to us. Seeing
someone overdose is traumatic. Having a site will help community members in
general.”
“Safety – for both individuals \[who inject drugs\] and the community – as much
as the NIMBY \[not in my backyard\] is an issue, it’s helpful to have information,
education, support, intervention, an attempt at counselling.”
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“When you protest and say this will have an impact on my community, you’re
labeled that you don’t care about drug users and that you have a stigma
against them. I don’t want to see anyone overdose, die, get AIDS.”
The Need for Supervised Injection Services to Provide a Safe Space
Many participants discussed the importanceof providing a safe space for people with
lived experience of injection drug use. Having asafe, non-judgemental space where
people with lived experience feel included in the community and where injection drug
use is not associated withfear of reprisal and shamebut rather with safety and support,
was believed to be a significant outcome of supervised injection services. Participants
described such a location as not only decreasing overdose deaths and reducing other
harmsto those with lived experience, but alsoproviding acceptance and inclusionfor
people whooften experience marginalization.It was felt that when services meet people
where they are in their drug use, it opensdoorsfor relationship developmentwith peers
and service providers and cansupport peopletoimprove their health over the long
term, including accessing treatment if they are ready.
“There is a feeling of insecurity. A space like this is opening a door. That
carries a lot more weight than is understood. People knowing that where they
are in life is okay in the moment changes a community dynamic. Those volatile
and insecure feelings trickle out into the community.”
Communication is Key for Concerns with Supervised Injection Services
Communication was considered a key factor in addressingquestions and concerns and
to ensure success of supervised injection services. It was shared thatcommunication
shouldbe multipronged, interactive, frequent, and transparent, including honest
informationabout risks, unknowns, and the potential community impacts. It was felt that
various topics require better communication including information about safe zones,
whether supervised injection services enable or encouragedrug use, how the
community’s safety will be addressed, the cost-benefitanalysis of supervised injection
services, and site logistics, including needle litter and disposal.Commonly heard
suggestions included:
Having a dedicated public relations person
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Having an approach to community relationship development that breaks down
barriers by allowing people to be heard and draws on the commonalities amongst
differing perspectives
Provision of information abouthow supervised injection services fit within the
broader Waterloo Region Integrated DrugsStrategy’sfour pillared approach
Having an up-to-date website for information on the feasibility study with social
media
Having a mechanism for questions and answers
Having responsive education and communication via Forums/Town Halls or other
method of large public meetings
Sharingstories of peopleand families who have been personally impacted by
substance use
Sharing and learning from other communities and ours about implementation of
similar services
Engaging the community in addressing concerns
“People want to hear what it’s all about, the options, and what some
community impacts are. It’s really more from what is the community impact,
not so much from the technical standpoint. I think the community is really
interested in understanding this as well. That’s really key.”
Supervised Injection Services and Education Creating a Cultural Shift with
Respect to Addiction
Participants discussed how supervised injection services can be a platform for a strong
education strategy aimed at reducing the stigma of addiction, and shiftingthe culture to
reframe it as a health issue.Many questions and concerns reflected a lack of
understanding and stereotypingof people with living or lived experience of injection
drug use,misconceptions of how they came to use drugs, and of the path to treatment
and recovery. It was felt that a larger education strategy would reframe addiction as a
health issue, and include strategiessuch as humanizing people with lived experience,
highlighting their diversity, myth busting, and sharing of personal experiences to help
shift the culture. Education and communication would highlight root and underlying
causes, the complexity of addiction, and convey the diversity of people with lived
experience.
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“I think there’s still a misconception in the community about who the user is.
But you can give some people all the data in the world, and it’s very easy to do
the ‘us vs. them’. It’s difficult for people with lived experience to make their
story public, but some people will never be swayed by empirical stuff. It would
help to get support from people to weave into the story. \[Otherwise\] it will be
NIMBY \[not in my backyard\], I don’t care about ‘these people’.”
Service Integration is Key for Concerns with Supervised Injection Services
Integrating other services with supervised injection services was seen to be one of the
most important benefits as it would provide people with access to services that they
may not have sought out otherwise.Participants defined service integration as service
provider interaction and connection, referrals, co-location of services, and ease of
movement between services. The following were considered priorities:
Counselling (mental health and addictions)
Primary care
Access to treatment and recovery
Housing services
Community/Peer support
Provision of a safe space
Substance testing
Community and social services
Employment
Community policing
Food security
It was indicated that supervised injection services should not be implemented unless
there is service integration with and bolstering of access to rapid treatment. Expansion
to supervised consumption services and consideration for provision of drugs, such as
prescription hydromorphone, also emerged in the service integration discussion.
“Access to treatment services on site – we’re gonna sell this as harm
reduction, then it’s on a continuum so part of that harm reduction is offering
treatment service, and safe injection is part of that package, so sell the whole
package and not justthe safe injection site. It will be easier to grasp if a
person can go in and access harm reduction and services rather than just
safe injection.”
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A Hybrid Service Model for Supervised Injection Services in Waterloo Region
Participants discussed the need to consider ahybrid model would combine aspects of
mobile or temporary supervised injection services in addition topermanent locations of
supervised injection services. It was indicated that this would best serve our geography,
meet the needs of the community, and allow for agility and responsiveness.
Several considerations for hybrid models came forward:
Testing locations by establishing a temporary locationsfirst
Have permanent locations and use mobile for outreach (data informed and client
request based)
Have an agile model that can be responsive to changes in injection drug use,
weather, and other factors contributing to patterns of movement throughout the
community
Suggestions for hybrid models centred on concerns that injection drug use is complex
and ever changing and that supervised injection services need to be implemented in a
way that they can easily be assessed and modified to responsively meet the needs of
the community.
“Mobile \[supervised injection services\] or a network makes a lot of sense.
Neighborhoods change. Something gets established and the neighbourhood
can be completely different five years later. There could be a more nimble way
to approach it logically.”
Locations: Equity, Access, Safety
Equitable distribution of locations, ease of access, and safety emerged as keycriteria
for determining locations.
a)Equity
Distributinglocations across Waterloo Region emerged as important from the
perspective of properly meeting the needs of those who would use the services as well
as reducingpotential community impacts and concentration of people and services by
having just one service inone location. Participants felt that at least threelocations are
needed with one in each of the downtown cores of South Cambridge (Galt), Kitchener,
and Waterloo. In addition to locations in the cores, there were some suggestions to
haveadditional smaller locations that would make the service more “normalized”and
improve access for all. Locations that encourage some movement of peoplethroughout
the community, were seen as more desirable. Many recommended not to implement
supervised injection services unless there would be more than one location.
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“How do we change the culture so that when setting up a supervised injection
site, we don’t create the feared neighbourhoods?”; “We want to be a caring,
inclusive community, but there’s the fine line of hurting businesses.”
“We have some geographical differences in our region. My feeling is that if we
went forward with SIS, and we only had one area when that’shappening, it
wouldn’t service our population fully. We would need multiple sites in order to
properly serve our population.”
b) Access
Participants shared that supervised injection services should be easy to access and
should be located in downtown cores, along the central transit corridor, and near transit
terminals or easily accessed routes and stops. It was felt that they should be located in
areas where the people are who would access services. Co-locating supervised
injection services withother services was also seen to increase access as use of the
site would be more discreet.Some participants believed that pairinginjection services
with other services that members of the public would regularly use could facilitate de-
stigmatization. There were also suggestions to think outside the box of traditional
service models to increase access; for example, having them available whenever or
wherever someone might need them such asin shopping malls, pharmacies, family
doctor offices,or existing Public Healthclinics.
Another component of access was reflected in the vast majority of those responding
indicating that supervised injection services should be a 24 hour, 7 day a week service.
Most indicated that supervised injection services should not be implemented unless it
will be 24/7. Other suggestions were provided with the caveat that “if 24/7 is not
available”:
Ensure evening, overnight, and weekend hours; offer partial services for hours when
other harm reduction services are available and then enhanced when closed
Determine the hours based on when people with lived experience indicated they
would access supervised injection services
Operate 24/7 to start and then determine use pattern and tailor service provision
accordingly
“Run 24/7 for a test period and determine when the best times are and adjust
accordingly. You have to be open to determine when the best allocation of
resources can be used. That’s the way you set it up.”
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c) Safety
Integration of Supervised Injection Services into the community in a way that prioritizes
safety was seen as vital. This includes community policing and relationship
development including establishment of a safe zone, concerns with drawing drug
trafficking and crime to the area, and paying attention to proximity to schools, parks,
residential areas, and businesses.
Other content emerging when discussing locations focused on patterns of use and
concerns regarding improperly discarded needles in the community.
“A concern I have on one large permanent site, surrounded by a safe zone, is
that in addition to drug sales and purchases, people buying drugs don’t have
money. They have to buy drugs and usually resort to crime, breaking and
entering, and prostitution. When you have a site, you create ground zero for
people without the money who do drugs. Businesses and homes in that area
will be impacted.”
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3.5Community Survey: Community Perceptions of Supervised
Injection Services
In the fall of 2017, people who lived, worked orwent toschool in Waterloo Region were
invited to complete an online survey to share their thoughts about supervised injection
services. Whilethe survey was brief, taking approximately ten minutes to complete, not
12
all participants answered every question.
Who completed the online survey?
Over 3,500 residents participated in the survey. Community members of all ageswere
representedwith the majority of responses comingfrom the 35 to 44 year age category
(See Figure 9). According to 2016 Census population estimates, the survey reached
more people from the 25to 34 and 35 to 44year age groupsthan any other age
grouping.
Figure 9. Age distribution of survey respondentsby distribution of Waterloo Region
population (n=3,458)
35%
30%
25%
20%
15%
10%
5%
0%
16-2425-3435-4445-5455+
Survey %
12.3%28.9%29.3%17.8%11.0%
2016 Population %
11.0%11.8%12.9%13.9%29.4%
Source:Population and Household Estimates for Waterloo Region(including post-secondary students);
Statistics Canada, 2016 Census.
12
The denominator for each question varies. Proportions are presented based on the number of valid
responses for each question and not the number of participants thatwere eligible to complete the survey
(n=3,819). The number of valid responses for each question can be found in Appendix G.
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Allareas of the regionresponded to the survey(See Figure 10) however Cambridge
was over represented and Kitchener, Waterloo, and the Townships were under
represented.
Figure 10.Distribution of survey respondents residence by distribution ofWaterloo
Region population(n=3,463)
50%
40%
30%
20%
10%
0%
CambridgeKitchenerWaterlooTownships
Survey (%)
38.3%33.3%18.3%5.8%
2016 population (%)
23.0%42.3%23.1%11.7%
Source: Population and Household Estimates for Waterloo Region(including post-secondary students);
Statistics Canada, 2016 Census.
The majority (78.5%) of respondents indicated they havenever used harm reduction
13
serviceshowever, 16.8 per cent reportedthat they know someone who has. A small
number of respondents (3.9%) reported current or previous use of harm reduction
services.
Respondents were asked to indicate statements that describe them. The top three
statements indicated by respondents were:
I am a community member (I live, work or go to school in Waterloo Region)
(85.5%);
I am a parent (59.7%); and
I am a student (16.1%).
Perceived Helpfulness ofSupervised Injection Services in Waterloo Region
Almost two-thirds (62.0%) of respondents reported that supervised injection services
would be very helpful or helpful in Waterloo Region(Figure 11).About one in ten (9.8%)
were undecided and 28.0 per centreported that supervised injection services would be
‘not very helpful’ or ‘not at all helpful’ in Waterloo Region.When analyzed by place of
residence, Cambridge respondents were significantly more likely to report “Not at all
13
Harm reduction services include needle syringe programming, teaching about safer drug use, naloxone
kits to prevent overdoses from opioids, and overdose prevention training.
48
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helpful” and “Not very helpful” than Waterloo Region as a whole (excluding Cambridge)
(p<0.05).
Figure 11. Extent to which supervised injection services would be helpful inWaterloo
Region(n=3,568)
50%
42.2%
40%
30%
19.8%
19.5%
20%
9.8%
8.5%
10%
0%
Not at allNot veryUndecidedHelpfulVery helpful
helpfulhelpful
Note: Percentages do not add up to 100 due to rounding.
When the data was analyzed by “I am a student”, strong support for supervised injection
services was found(61.6% of students indicated ‘very helpful’).One third (32.8% )of
parents believed that supervised injection services would be very helpful in the region,
while just over a quarter (26.6%)of parent respondents believed they would benot at all
helpful.
Respondents were asked which type of supervised injection service would be best for
Waterloo Region and were able to select multiple options. Two thirds (62.7%) of
respondents reported that an integrated service model (a site that also has other types
of services such as food, showers, counselling, and addiction treatment) would be best.
Mobile service (a vehicle with supervisedinjection booths inside that can move to
different locations to meet clients) wasindicated by 43.3per cent ofrespondents. There
were 27.2 per cent of respondents who feltthat supervised injection services should not
be available in Waterloo Region.
Perceived Benefits of Supervised Injection Services in Waterloo Region
Reduction in public drug use, decreased number of overdoses and a reduction in the
spread of blood borne infections were the most commonly mentioned benefits of
supervised injections services(Table 7).
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Table 7. Ways in which supervised injection services would be helpful in Waterloo
Region(n=3,579)
Benefit(%)
Less public drug use on streets or in parks62.5
Less risk of injury and death from drug overdose60.7
Help lower the risk of diseases like HIV, AIDS, and Hepatitis C59.7
Connect people who use drugs or their family members with 57.9
health, treatment, and social services
Safer community48.3
Less work for ambulance and police services45.5
Supervised injection services would not help Waterloo Region26.9
Questions and Concernsabout Supervised Injection Services
Less than half of all participants (41.2%) reported having questions or concerns about
supervised injection services in Waterloo Region. Respondents reported being most
concerned about the safety of their children or dependents (58.5%), effects on property
values (57.5%), and the perceived possibility that supervised injection services could
lead to more drug use (56.3%).
Table 8. Questions and concerns about supervised injection services in Waterloo
Region(n=1,441)
Question/Concern(%)
I have concernsabout the safety of my children or dependents58.5
Will supervised injection services have an effect on property 57.5
value?
Will supervised injection services lead to more drug use?56.3
Will supervised injection services lead to more drug selling or 53.4
trafficking in the community?
Will supervised injection services lead to more people who use 53.4
drugs in the community?
Will supervised injection services impact the reputation or image 49.7
ofour community?
Will supervised injection services impact community cleanliness 46.5
or quality of life?
Will supervised injection services have an impact on business or 41.7
profits?
Will supervised injection services lead to more crime?40.0
Will supervised injection services impact personal safety?39.8
Will supervised injection services lead to more used needles on 36.8
the street?
50
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Significantly more participants residing in Cambridge expressed having concernsabout
supervised injection servicescompared toKitchener, Waterloo, and thetownships
combined (p<0.05).Table 9 showsthe number of respondents for each location of
residence,the proportion of respondentswithin each municipalityreporting concerns for
supervised injection services,and the proportion of all respondents with concerns.
Table 9. Proportion of respondents indicatingquestions/concerns by location of
residence
Location of # of % of respondents within % of all
residencerespondentslocation withconcerns respondents with
with concerns
concerns(n=1,445)
Cambridge1,32753.449.0
Kitchener1,15332.726.1
Waterloo63428.112.3
Townships*19839.95.5
*The townships include North Dumfries, Wilmot, Wellesley, and Woolwich.
Note: 7.1 per cent of respondents with concerns indicated living outside Waterloo Region or did
not know which municipality or township they resided in.
Respondents were asked to selectstrategies to address questions and concerns of the
community about supervised injection services. While all strategies presented were
supported to some degree (See Table 10), “Evaluate the services to see what’s working
and what’s not, share resultswith the community and take action” was indicated by
most (73.2%).
Table 10. Strategies to address questions and concerns of the community(n=3,509)
Strategy(%)
Evaluate the services to see what's working and what's not, 73.2
share results with the community and take action
Have a website with information and contact email and phone 56.1
number for questions
Ask for ongoing feedback from the community about supervised 55.2
injection services
Give out information about the goals of supervised injection 54.2
services and how they can help the community
Have a community group involved in addressing questions and 49.0
concerns about supervised injection services
Other*9.7
*Other strategies included not having supervised injection services and community education.
Of those who indicated that supervised injection services would be ‘not very helpful’ and
‘not at all helpful’, ‘givingout information about the goals of supervised injection services
51
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and how they can help the community” was preferred the most (87.8%) as a strategy to
address questions and concerns.
52
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4.0 Discussion
“My impression is that what we’re trying to do is throw a life ring to someone
who is drowning. If someone is drowning, you don’t say that we really need to
give everyone swimming lessons. People are dying and we recognize this is
not where we want to be, but it’s a way to provide some kind of lifeline to folks
who are hopelessly trapped in this addiction cycle”
– Information and Consultation Session participant
4.1 Are supervised injection services supported in Waterloo Region?
14
The majority of respondentsare seeing the impact of injection drug use on individuals
and the broader community andsupport supervised injection services. Supervised
injection services were seen to prevent overdose related deaths, increase access to
services, and create a safer community for all, by providing a safe space for clientsto
inject their own drugs and properly dispose of injection drug use equipment.
Harm reduction service providers and participants of the information and consultation
sessions continually reinforced the importanceof creating a safe space for people who
inject drugs. This space would create a path to wellness by opening a door for the
development of relationships with peers and service providers that would facilitate
healthy behaviours and provide connections to treatment and recovery services when
clientsare ready.Further, there was general consensus thatprovision of a safe, non-
judgemental space would create an environment where people with lived experience
would be accepted and included, benefiting the community overall.
4.2What concerns does the community have regarding supervised
injection servicesand how can they be addressed?
Concerns regarding supervised injection services centred on questions of whether
supervised injection services would compromise the safety of dependants, people who
may use the services and the surrounding neighbourhood.There was the perception
that supervised injection services would negatively impact the neighbourhood in which it
is placed, leadingto more crime, decreasing property values, and higher rates of
improper needle disposal. Concerns were raised about the need for moreaddiction
treatment programs inWaterlooRegion andit was felt that if supervised injection
services were to become available, more treatment should also be available.Improving
access to treatment in a timely manner was seen as a priority if supervised injection
services were to move forward.In contrast, people who inject drugs strongly believed
14
Unless otherwise noted, the discussion reflects findings from all groups engaged using the four
methodologies for this feasibility study.
53
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that supervised injection services would decrease improper needle disposal along with
public drug use, crime, and street violence. They also believed that people accessing
services would learn more about treatmentand indicated strong support for access to
treatment as part of a supervised injection service integrated model.
Strategies to address the concerns of the community about supervised injection
services included improving communication about theprocess to consider supervised
injection services; educating the community onaddiction, mental health, andharm
reductionto build understanding and reduce stigma; and creating an advisory group to
oversee and respond to issues that may arise during implementation of supervised
injection services.
A comprehensive, multipronged communication strategy about the feasibility study was
identified as being neededand should describe supervised injection services and how
they work.A spokesperson for the projectwas requested along with support from other
community leaders who could provide information and dialogue about how these
services fit within a broader community approach.
In parallel to the communication strategy, it was felt that an education strategy toreduce
stigma and reframe addiction as a health issueis important. The strategy would focus
on the complexity of addiction and mental health, and wouldhelp todispelmyths and
provide a “human face” to addiction and substance use issues.It would also prioritize
educating children, teens, and young adultson how to prevent addiction and
problematic drug use.
An advisory groupmade up of community members, people with lived experience of
drug use, and service providers was seen to be critical in building trust within the
communityabout supervised injection services and the overall success of this
interventionin Waterloo Region.
4.3 What services should a supervised injection servicelocation
offer?
In Ontario, supervisedinjectionservicesmust be integrated with other harm reduction
services as opposed to being stand-alone sites. This requirement ensuresaccess to
services that otherwise may not be available to people with lived experience.
Participantsof the study, excluding community survey participants, were asked which
services should be integrated alongside injection. Integrated services indicated by
participants included:
Mental Health and Addictions Services (e.g. counselling, referrals to treatment)
Health Services (including primary care and testing for blood-borne infections)
Social Services (e.g. housing, income support)
Basic Needs (e.g. washroom, drop in space, food)
54
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4.4 What geographic areas are most impacted by injection drug use?
While findings indicate that injection drug use occurs in anumber of areas throughout
Waterloo Region, the downtown cores ofKitchener and South Cambridge (Galt) were
identified has being impacted more than other areas. People who inject drugs indicated
a preference for a supervised injection service in these locations. Paramedic Services
call response data shows a higher numbers of overdose calls in the downtowncoresof
Kitchener and South Cambridge (Galt). Having more than one site was considered
essential as a means to preventing concentration of services in one area, and to ensure
access for people who would use the services.
4.5 Are supervised injection services needed and will they be used?
The primary datacollectedstrongly indicatesthat supervised injection services are
needed in Waterloo Region. This community responseisalsosupported by local opioid
related data that shows rising numbers of overdose deaths in the region. It is evident
that problematic substance use is affecting Waterloo Region.
Respondents of the injection drug use survey indicated that they would use the site with
one in four reporting thatthey would use it for all their injections. Almost every person
expressed a preference that the site islocated withother health and social services with
access to treatment being requested by 83 per cent. Respondents fromall sources
unequivocallyreported that drug use is unique for each individual and supported a 24
hour a day, 7 days a week operation.Having said that, thepreferred operating hours, as
identified by people with lived experience are 8am-4pm, and overnight hours were a
popular second choice(noting the limitation that 24/7 was not an option in the survey for
them to select).
55
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5.0 Appendices
Appendix A. Secondary Data Extraction Data Sources
The table below summarizes the data sources that were used in the secondary data
analysis.
Data TypeDescriptionData Source
Number of The estimated number of people Needle Syringe Program
injection drug who inject drugs in Waterloo Data
usersRegion based on unique client ID
through needle syringe
programming.
Confirmed opioid Confirmed opioid related deaths for Office of the Chief Coroner
related deathsWaterloo Region.for Ontario
Suspected Number of deaths in Waterloo Waterloo Regional Police
number of Region where overdose was Services
overdose deathssuspected (not opioid specific).
Opioid related The number of opioid related Region of Waterloo
paramedic Paramedic Service calls in Paramedic Services
services callsWaterloo Region.Electronic Patient Care
Record (ePCR)
Ambulance Dispatch
Reporting System (ADRS)
Naloxone kits The total number of naloxone kits Region of WaterlooPublic
distributeddistributed by Public Health and Health Program Data
community partners (Sanguen
Health Centre, Bridges, oneROOF,
and ACCKWA).
Opioid relatedNumber and rate of opioid-related National Ambulatory Care
emergency emergency department visits in Reporting System(NACRS)
department visitsWaterloo Region and Ontario.
Triage time of opioid related visit.
Disease rates Preliminarycountsand ratesof Integrated Public Health
(Hepatitis C, Hepatitis C and HIV/AIDS in Information System (iPHIS)
HIV/AIDS)Waterloo Region.-January-December 2017,
extracted January 15, 2018.
56
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Appendix B. Key InformantInterview Questionnaire
1.What do you know about supervised injection services?
Probe: So we have a common understanding about what a SIS is(provide
definition):
“Supervised injection sites or services are health facilities where people who
inject drugs can inject their pre-obtained illicit drugs under the supervision of
nurses or other health professionals. Users are provided with sterile equipment,
given information on safer injecting, as well as emergency response in the event
of an overdose, and are provided with referrals to external health and social
services”.
The MOHLTC has outlined that each SIS funded by the provincial government
will have the following core services onsite:
1.First aid
2.Education
3.Disposal
4.Distribution of naloxone
5.Referrals to other health and social services
2.Do you think SISs areneeded in Waterloo Region?
3.What would the benefits be of having SISs in Waterloo Region?
(Probe: for individual, organizational, and community-level benefits)
4.What do you see as some challenges with having SISs in Waterloo Region?
(Probe for: individual, organizational, and community-level challenges)
5.Do you think SISs will be accepted and used by people who inject drugs?
Please explain your answer.
Prompt: Do you think there are any barriers for people to use SISs?
6.What do you think are the concerns of the broader community regarding
SISs?
7.How might we address those concerns? Do you have any strategies for
addressing those concerns?
8.If you support the idea of having a SIS locally:
In addition to Public Health, who (individuals, organizations or service providers)
do you think should be involved in operating a SIS location in our community?
How many SISs do you think are needed?
Where do you think SISs should be located?
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What days and hours do you think SISs should operate?
9.What other programs or services should be offered alongside SIS to ensure
the effectiveness of SISs?
10.Do you have any other thoughts or concerns that you would like to share?
58
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Appendix C.Information and Consultation Questions
1.In what ways would supervised injection services be helpful in Waterloo Region?
2.What questions or concerns do you have about supervised injection services in
Waterloo Region?
3.Do you have any ideas to address questions or concerns about supervised
injection services in Waterloo Region?
4.What areas of Waterloo Region do you think are most impacted by drug use?
5.What services or organizations do you think should be involved in operating
supervised injection services or be located in the same facility?
6.What days and hours should a supervised injection site be open?
7.Is there anything else you would like to share about supervised injection
services?
59
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Appendix D. Number of valid responses for each question of the survey
conducted with people who inject drugs
Questionn
1. Have you injected drugs in the LAST 6 MONTHS?
146
146
2. Are you 16 years of age or older?
3. Do you live, work, or go to school in Waterloo Region? 146
4. Which city/township do you live in? 145
5. What year were you born?142
145
6. What sex were you assigned at birth (e.g., on your birth certificate)?
7. Some people identify with an ethnic group or cultural background. To
146
which ethnic or cultural group do you feel you belong?
8. Please list all the places that you have lived or stayed overnight in
146
the last SIX MONTHS
9. Of theplaces you listed, where did you live mostof the time? (DO
134
NOT read out list. Check only ONE response from Question 8)
10. Are you living with someone who is a current injection drug user?145
142
11. What is the highest level of education that you haveCOMPLETED?
12. About how much money did you get from all sources LAST YEAR?142
13. Over the LAST 6 MONTHS, what were your sources of income? 146
14. In the PAST SIX MONTHS have you exchanged sex (including
146
oral) for any of the following things?
138
15. In the LAST SIX MONTHS, how often did you inject drugs?
16. Have you injected drugs in the LAST 30 DAYS?138
17. In the last SIX MONTHS, have you re-used a needle for more than
138
one injection?
18. On average, what percentage of injections are done with a needle
72
you have already used?
19. On a day when you do inject, how many times a day do you usually
132
inject on average?
20. In the PAST SIX MONTHS, in which neighbourhoods did you
146
inject?
21. Of the neighbourhoods which you have mentioned, in which
146
neighbourhood did you inject most often?
Kitchener respondents74
Cambridge respondents65
22. In the LAST SIX MONTHS, have you injected in (places)? 146
23. In the LAST SIX MONTHS, how often did you inject in public or
135
semi-public areas like a park, an alley or a public washroom?
24. What are some of the reasons you inject in public? 102
25. In the LAST SIX MONTHS, have you used water from a puddle,
public fountain or other outside source to prepare your drugs or rinse 139
your needles?
60
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Questionn
26. Have you ever injected alone?140
27. In the LAST SIX MONTHS, how often did you inject alone? 110
28. Howoften in the LAST SIX MONTHS did you need help when
134
injecting?
66
29. Why do you need help with injecting?
30. Would you be willing to learn how to inject yourself?66
31. In the PAST have you EVER…-
a) Exchanged or obtained needles at a local harm reduction program or
another needle syringe program (e.g., the Van, ACCKWA, Public 136
Health)?
b) Got NEW STERILE needles from a friend?
137
c) Got NEW STERILE needles from a dealer or someone on the street?
135
d) Injected with needles knowing they had already been used by or
134
were being used by someone else?
e) Injected with needles without knowing they had already been used
134
by or were being used by someone else?
f) Loaned syringes that had already been used by you or were being
136
used by someone else to inject?
g) Used other injecting equipment (e.g., cotton, filter, spoon, cooker)
that had already been used by or was being used by someone else 135
including your sexual partner?
h) Filled your syringe from another syringe that had already been used
133
or was being used by someone else (back-loading or front-loading)?
i) Had drugs and wanted to inject but didn't know where to get a clean
137
needle?
j) Reused a cooker with drugs in it for an extra wash?
136
k) Had trouble getting enough new needles from the needle exchange
133
program to meet your needs?
l) Had a needle syringe program limit the number of needles they would
132
give you?
31. In the PAST 6 months have you… -
a) Exchanged or obtained needles at a local harm reduction program or
another needle syringe program (e.g., the Van, ACCKWA, Public 108
Health)?
b) Got NEW STERILE needles from a friend?
109
c) Got NEW STERILE needles from a dealer or someone on the street?
106
d) Injected with needles knowing they had already been used by or
106
were being used by someone else?
e) Injected with needles without knowing they had alreadybeen used
106
by or were being used by someone else?
f) Loaned syringes that had already been used by you or were being
106
used by someone else to inject?
61
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Questionn
g) Used other injecting equipment (e.g., cotton, filter, spoon, cooker)
that had already been used by or was being used by someone else 107
including your sexual partner?
h) Filled your syringe from another syringe that had already been used
108
or was being used by someone else (back-loading or front-loading)?
i) Had drugs and wanted to inject but didn't know where to get a clean
108
needle?
j) Reused a cooker with drugs in it for an extra wash?
107
k) Had trouble getting enough new needles from the needle exchange
107
program to meet your needs?
l) Had a needle syringe program limit the number of needles they would
103
give you?
32. Have you injected \[drug\] in the LAST SIX MONTHS?146
33. What is your drug of choice?
146
34. In the LAST SIX MONTHS, which of these drugs did you inject the
146
MOST?
35. Have you EVER gotten a drug that you think was cut with another
141
substance?
36. The last time you think you got a drug that was cut with another
95
substance, what were you trying to use at the time?
37. What do you think it was cut with?
93
38. Have you heard of supervised injection services (SISs)?
146
39. If supervised injection services were available in Waterloo Region
138
would you consider using these services?
119
40. Why would you use supervised injection services?
41. Which ONE of these reasons is the MOST IMPORTANT reason for
103
you?
42. For what reasons would you NOT use supervised injection
46
services?
46
43. What reasons would make you change your mind?
44. There are a number of guidelinesbeing considered for SISs. For
each of the next statements, please let me knowif these guidelines
-
would be very acceptable, acceptable, neutral, unacceptable or very
unacceptable to you.
a) Injections are supervised by a trained staff member who can respond
132
to overdoses
146
b) 30 minute time limit for injection
146
c) Have toregister each time you use it
146
d) Required to show government ID
146
e) Required to show client #
146
f) Have to live in the neighbourhood where the SIS is
146
g) Video surveillance cameras onsite to protect users
62
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Questionn
146
h) Not allowed to smoke crack/crystal meth
146
i) Not allowed to have others assist in the preparation of injections
146
j) Now allowed to assist each other with injections
146
k) Not allowed to share drugs
146
l) May have to sit and wait until space is available for you to inject
m) Have to hang around for 10 to 15 minutes after injecting so that your
146
health can be monitored
45. There are various SERVICES being considered to provide with SIS.
I’m going to read out a number of services. I will ask you if they are very
-
important, important, moderately important, slightly important, or not
that important to you.
a) Nursing staff for medical care and supervised injecting teaching132
b) Washrooms135
c) Showers146
d) Social workers or counsellors146
e) Drug counsellors146
f) Aboriginal (Indigenous) counsellors146
g) Food (including take away)146
h) Peer support from other injection drug users132
i) Access to an opiate (methadone or buprenorphone) prescribed by a
146
health professional
j) Needle distribution132
k) Injection equipment distribution146
l) HIV and hepatitis C testing132
m) Withdrawal management146
n) Special times for priority groups such as women, indigenous
146
populations etc.
o) Referrals to drug treatment, rehab, and other services when you're
132
ready to use them
p) A 'chill out' room to go after injecting, before leaving the SIS132
q) Preventing or responding to overdose146
r) Access to general health services146
s) Assistance with housing, employment and basic skills133
t) Harm reduction education146
u) Drug testing (a service to check if your drug may have been cut with
146
another potentially dangerous substance)
v) Other146
46. Would you use SIS if it was located in each of the following
-
locations?
a) Communityhealth centre
146
b) Public health clinic
146
c) Walk-in or family doctor's clinic
146
63
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Questionn
d) Social service agency
146
146
47. What type of model/building would you prefer for a SIS?
48. How long would you be willing to walk to use a SIS in the
146
SUMMER/WINTER?
49. Are you willing to take a bus to a SIS?146
50. How long would you be willing to travel by bus to get to a SIS in the
84
SUMMER/WINTER?
51. What other ways do you see yourself accessing SISs? 146
52. In which neighbourhood, or regionwould be your FIRST CHOICE
146
for seeing an SIS?
53. In which neighbourhood, or region would be your SECOND
101
CHOICE for seeing an SIS?
146
54. What time of the day would be your FIRST CHOICE to use SIS?
55. Now, what time of the day would be yourSECOND CHOICE to use
106
a SIS?
56. If SIS was established in a location convenient to you in Waterloo
146
Region how often would you use it to inject?
146
57. What would be the best set-up for injecting spaces for SISs?
58. Do you think people who use drugs should be involved in running
146
SISs?
83
59. HOWdo you think people who use drugs could be involved?
60. If it was possible to check the safety of your drug before injecting at
146
a SIS, how often would you do this?
61. How long would you wait to get the results of the drug safety test? 115
62. How many SISs do you think Waterloo Region needs?146
63. I am going to ask if you think the following would be very likely,
likely, neutral, unlikely, or very unlikely to occur in the communityif -
SISs were opened in Waterloo Region.
a) The number of people injecting outdoors would be reduced
146
b) The number of used syringes on the street would be reduced
146
c) Injection with used needles would be reduced
146
d) People would learn moreabout drug use
146
e) Overdoses would be reduced
146
f) Street violence would be reduced
146
g) Crime would be reduced in the area
146
h) Users would visit the area more
146
i) Users would move to the area
146
j) Drug dealers would be attracted to the area
146
64. Have you heard of Narcan/naloxone? 146
65. Have you heard about take-home Narcan/naloxone kits that you
123
can keep with you for an opiate overdose?
66. If yes, how did you hear about it? 110
64
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Questionn
67. Are you aware of the Narcan/naloxone Program in Waterloo
112
Region?
68. Do you currently have a take-home Narcan/naloxone kit?110
69. If yes, where did you get it from? 69
70. If no, why not? 41
71. Have you ever administered Narcan/naloxone to anyone?104
49
72. If yes, how many times?
73. Have you EVER overdosed by accident?146
74. Have you overdosed in the PAST SIX MONTHS?57
75. Altogether, how many times have you overdosed in your lifetime?55
76. When was the LAST TIME you overdosed?54
77. The last time you overdosed, doyou remember which drugs or
58
substances were involved?
78. The last time you overdosed, which drugs or substances were
49
involved? Did you inject them?
79. Were other people with you when you overdosed?58
80. What neighbourhood were you in when youLAST overdosed? 48
81. Could you tell me the type of place where you overdosed? 51
82. Was an ambulance called when you overdosed?55
83. After the ambulance was called, did the police show-up?33
84. Were you taken to an emergency department/hospital?32
85. Were you offered transport to the hospital but Declined?33
86. If yes, why did you refuse?7
87. Were you given Narcan/naloxone?53
28
88. If yes, who administered it?
89. Have you witnessed an overdose in the LAST 6 MONTHS?146
90. Whooverdosed? 75
91. What happened in response to the overdose you witnessed? 75
92. Have you EVER been afraid of being arrested when you or
146
someone else overdosed?
93. Have you EVER in your lifetime been in a drug treatment or detox
146
program?
94. Have you in the LAST SIX MONTHS been in a drug treatment or
66
detox program?
95. In the LAST SIX MONTHS, which treatment programs have you
25
been in?
96. During the PAST SIX MONTHS, have you ever tried but been
146
unable to get into any of the treatment programs?
65
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Appendix E. Key InformantInterview Participants by Organization
1.AIDS Committee Of Cambridge, Kitchener, Waterloo and Area(ACCKWA)
2.Grand River Hospital Withdrawal Management
3.House of Friendship
4.KW Counselling
5.oneROOFYouth Services
6. Ontario Addiction Treatment Centres
7.Region of Waterloo Public Healthand Emergency Services
8.Ray of Hope
9.SanguenHealth Centre
10.Simcoe House
11.The Working Centre
66
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Appendix F. Information and Consultation Session Group Participants
1.A Clean Cambridge
2.CambridgeOutreach Task Force
3.Canadian Mental Health Association
4.City of Cambridge
5.City of Kitchener
6.City of Waterloo
7.Downtown Kitchener BIA
8.For a Better Cambridge
9.Galt BIA
10.Hespeler BIA
11.Housing Outreach Workers
12.Housing Support Managers
13.Joint Emergency Services Operations Advisory Group
14.Kitchener SIS Advocacy Groups
15.Lutherwood
16.Municipal Councillors
17.Paramedic Services
18.Postsecondary Stakeholders
19.Preston BIA
20.Region of Waterloo Housing Staff
21.Township of North Dumfries
22.UpTown BIA
23.Waterloo Region Crime Prevention Council
24. Waterloo Region Integrated Drugs Strategy
25.Waterloo Regional Police Service
26.Waterloo Wellington Local Health Integration Network
67
8 - 74
Appendix G. Number of valid responses for each question of the community
survey
QuestionNumber
1. Are you willing to do the survey about supervised injection services
3,879
in Waterloo Region?
2. Do you live, work, or go to school in Waterloo Region?
3,829
3. Are you 16 years of age or older?
3,829
4. To what extent do you think supervised injection services would be
3,576
helpfulin Waterloo Region?
5. In what ways would supervised injection services be helpful in our
3,579
community?
6. Do you have any questions or concerns about having supervised
3,550
injection services in Waterloo Region?
7. What questions or concernsdo you have about supervised injection
1,441
services in Waterloo Region?
8. Do you have any ideas to address questions or concerns from the
3,509
community about supervised injection services?
9. What type(s) of supervised injection services do you think would be
3,491
the best for Waterloo Region?
10. Do you have any other comments or suggestions about supervised
1,339
injection services in Waterloo Region?
11. Describe your connection to harm reduction services.
3,321
12. Which of the following describes you?
3,483
13. What age group are you in?
3,458
14. Where do you live?
3,463
15. Where do you work?
3,446
16. Where do you go to school?
3,087
68
8 - 75
Works Cited
Centre for Addiction and Mental Health. (2002). CAMH and Harm Reduction: A
Background Paper on its Meaning and Application for Substance Use Issues.
Retrieved January 28, 2018, from Centre for Addiction and Mental Health:
http://www.camh.ca/en/hospital/about_camh/influencing_public_policy/public_poli
cy_submissions/harm_reduction/Pages/harmreductionbackground.aspx
Cotter, J. (2017, October 19). Health Canada approves safe injection sites in Edmonton,
Lethbridge. Toronto, Ontario, Canada.
Fitzgerald, P., & Gruenwoldt, E. (2017). CAPHC Response to Joint Statement of Action
to Address Opioid Crisis.Ottawa, Canada: Canadian Association of Paediatric
Health Centres.
Folkema, A. (2017). Infectious Diseases in Waterloo Region - Surveillance Report 2016.
Waterloo: Region of Waterloo Public Health and Emergency Services.
Health Canada. (2016, November 29). Joint Statement of Action to Address the Opioid
Crisis.Retrieved April 7, 2017, from Health Canada:
https://www.canada.ca/en/health-canada/services/substance-abuse/opioid-
conference/joint-statement-action-address-opioid-
crisis.html?_ga=1.213458205.869414053.1491572721
Health Canada. (2017, November 15). Government of Canada Actions on Opioids:
2016 and 2017. Retrieved February 13, 2018, from Government of Canada:
https://www.canada.ca/en/health-canada/services/publications/healthy-
living/actions-opioids-2016-2017.html
Kudhail, R. (2018, January 25). Starting on Opioids.Retrieved January 25, 2018, from
Health Quality Ontario: http://startingonopioids.hqontario.ca/
Levy, I. (2016). Enhanced Harm Reduction Services in Ottawa - Data, Guiding Principle
and Next Steps.Ottawa: Ottawa Health Unit.
National Institute on Drug Abuse. (2016, August). Understanding drug use and
addiction. Retrieved January 25, 2018, from National Institute on Drug Abuse:
https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-
addiction
Notarandrea, R. (2018, January 19). Fighting opioid addiction requires a sea-change in
attitudes. Vancouver, British Columbia, Canada.
Potier, C., Laprevote, V., Dubois-Arber, F., Cottencin, O., & Rolland, B. (2014).
Supervised Injection Services: What has been demonstrated? A systematic
literature review. Drug and Alcohol Dependence, 1-21.
69
8 - 76
Statistics Canada. (2018, January 9). Results of the Survey on Opioid Awareness.
Retrieved January 9, 2018, from Statistics Canada: The Daily:
http://www.statcan.gc.ca/daily-quotidien/180109/dq180109a-eng.htm
Stone, K. (2016). The Global State of Harm Reduction 2016.United Kingdom: Harm
Reduction International.
Taylor, A. (2008). Baseline Study of Substance Use, Excluding Alcohol,in Waterloo
Region.Kitchener: Centre for Community Based Research.
70
8 - 77
REPORT TO: Finance and Corporate Services
DATE OF MEETING: April 9, 2018
SUBMITTED BY: Cory Bluhm, Executive Director, Economic Development,
519-741-2200 ext. 7065
PREPARED BY: Emily Robson, Coordinator, Arts/Creative Industries, Economic
Development 519-741-2200 ext. 7084
Silvia DiDonato, Manager, Arts/Creative Industries, Economic
Development 519-741-2200 ext. 7392
WARD (S) INVOLVED: All
DATE OF REPORT: March 23, 2018
REPORT NO.: CAO-18-012
SUBJECT: Collaborative Municipal Funding for Key Cultural Institutions: Year 2
Summary
__________________________________________________________________________________________
RECOMMENDATION:
None. For information.
EXECUTIVE SUMMARY:
In May 2016, staff initiated the collaborative funding and assessment process by Kitchener,
Waterloo and the Region of Waterloo for the four Key Cultural Institutions. The development
of this process was a recommendation of the Arts Sustainability Fund Review report (CAO-15-
030) approved by Council in the fall of 2015. Furthermore, funding for THEMUSEUM,
Kitchener-Waterloo Symphony, and the Kitchener Waterloo Art Gallery was moved from Tier 1
into Economic Developments grants in 2017 (CAO-17-015) to support this initiative.
The Key Cultural Institutions currently identified by Kitchener, Waterloo and the Region are
Canadian Clay and Glass Gallery, Kitchener Waterloo Art Gallery, Kitchener Waterloo
Symphony, and THEMUSEUM. Municipal staff and the four Key Cultural Institutions (KCIs)
plan to present a summary of achievements at the All Council meeting in the spring of 2018.
The actual funding amounts and any related decision-making process continue to be made by
each individual municipality.
This report summarizes the implementation of the pilot process to date, findings from the
initiatives and describes next steps in the process.
*** This information is available in accessible formats upon request. ***
Please call 519-741-2345 or TTY 1-866-969-9994 for assistance.
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BACKGROUND:
In 2015 Council approved the Arts Sustainability Fund Review report (CAO-15-030) and
together with municipal partner organizations, a collaborative funding and
assessment process be established for the four regionally identified key cultural institutions,
being: Kitchener-Waterloo Symphony, Kitchener-Waterloo Art Gallery, Canadian Clay and
Glass Gallery and THEMUSEUM, in the form of a pilot program based on the model
recommended in the report; and further, that a regular communication mechanism be
formalized between all municipal funders regarding arts and cultural investment in the Region
of Waterloo.
A working group was established with staff representing the City of Kitchener, City of Waterloo,
Region of Waterloo and the City of Cambridge. This group collaborates with the staff and
board leadership for each of the KCIs. KCIs are large organizations that contribute to the social
and economic prosperity of the KW region, creating jobs and wealth, attracting visitors and
stimulating creative thought and activity. While these institutions are each independent, with
their own boards of directors, executive directors, staff teams, and facilities, together they
represent a significant asset and exert considerable influence locally. It is widely recognized
that cultural institutions play an important role in revitalization effortsoffering residents and
visitors engaging and diverse opportunities for cultural experiences, a strong desire and track
record of improving their surroundings, and leading the way for creative expression locally and
beyond. In addition, the key cultural institutions are integral in the local creative landscape,
providing performance, exhibition, creation, production and administrative spaces.Reliable
municipal operational funding is necessary to sustain the impact of these organizations and to
leverage funding from other levels of government and private sources.
This initiative aims to consider the total funding for the KCIs and assess the equity of the fund
allocation and ensure accountability of public funds.This collaborative approach recognizes
that Cambridge, Kitchener, Waterloo and the Region are significant funders of the four
organizations, and it is important for municipal staff to have an on-going understanding of their
strengths and challenges. In addition this collaborative approach has a number of benefits:
Improved transparency for decision-making
Improved accountability for public funds
Improved communication between municipalities, KCIs and Councils
Improved efficiency for KCIs and municipalities
It is important to note that, while the information submission and discussion takes place jointly
among municipal staff and the KCI representatives, the actual funding amounts and any
related decisions will continue to be made by each individual municipality.
REPORT
Based on the reports of the four KCIs, combined municipal investment contributed to
numerous social and economic benefits:
304 unique cultural experiences including exhibits, performances, and public activities
(almost one per day throughout the year);
IF1 - 2
Total attendance of over 230,000 with over 78,000 of those visits being education
related; and
6.2 million dollars in earned and private sector revenues and over 1.4 million dollars in
revenue from other levels of government.
A sample of impact data provided by the KCIs is summarized below:
Selected impactsCCGGKWAGKWSTHEMUSEUM
Unique Cultural Experiences:
71024245
exhibits/performances/events
Total attendance:
19,471 45,909 87,70682,466
(subset education attendance)(5,587)(19,500)(44, 592)(8,573)
Earned Revenue +
$397,532+$110,096+$1,927,142+$871,768+
Private Sector Revenue$240,937$449,105$2,028,138$226,189
Federal Government Revenue +
$59,037 +$305,985+$449,105 +$63,645 +
Provincial Government Revenue$96,526$141,550$329,413$21,896
Key Findings
As part of the collaborative process, municipal staff meets with members of the staff and
Boards of the individual KCIs to discuss their goals, accomplishments, challenges, and to plan
for specific actions and outcomes for the upcoming year. The purpose of this discussion is to
identify opportunities for further cooperation,possible measure to mitigate challenges, and a
deeper understanding of each KCI and their work. The following themes were identified over
the course of the collaborative process:
Need for increased and stable funding:Reliable and sustainable operating funding is
needed. While additional funding from the Canada Council seemed like a possibility for
the KCIs that currently receive grants,requests for additional funds were not successful.
Overall, provincial funding is lower than average for local organizations relative to their
counterparts across the country.
An increase in community revenues: For financial years spanning 2017 and 2018, the
KCIs collectively are projecting an overall increase of almost 14% in community
revenues. This includes both earned revenue and private sector revenue. This is a trend
over the last number of years and indicates strong community support for the KCIs
individuals, foundations and corporations are more likely to be engaged in meaningful
projects and when high community impact is demonstrated.
Strong commitment to community engagement and partnerships: The KCIs continue to
expand their reach into the community by engaging with new audiences and forging
new partnerships. For example, the KWS has led the regional implementation of the
Blue Umbrella program to make arts and culture facilities more accessible to those with
dementia. The Art of Seeing program at KWAG, now entirely funded by the Department
of Family Medicine, McMaster University, uses the art experience to improve
and empathy, resulting in stronger physicians with
IF1 - 3
better patient relationships. Working with The Kitchener and Waterloo Community
Foundation and Rotary Kitchener Grand River, the CCGG expanded their programming
to offer specific hands-on workshops for newcomers to the Region. THEMUSEUM
continues to develop programming aimed at young professionals, millennials, students
and culture craving urbanites, with their Museum after Dark (MAD) memberships.
Balance financial operational scarcity with high quality exhibitions: In order to maintain
current levels of provincial and federal funding, the KCIs receiving these funds must
demonstrate a high level of performance in organizational effectiveness and artistic and
community programming. It is a strategic endeavour to balance this commitment with
financial scarcity, especially reducing accumulated deficits. While maintaining their high
professional standing with the Ontario Arts Council peer jury by offering high quality
exhibition programming, KWAG has accommodated budget restrictions to reduce its
deficit. These reductions have made it challenging to offer competitive staff
this year the CCGG achieved an operating surplus, and has steadily reduced its
accumulated deficit. This approach has meant that other budget allocations have been
greatly reduced
reach into the community.
Municipal Investment in Key Cultural Institutions
The municipal investment in our Key Cultural Institutions recognizes the intrinsic value of arts
and culture, their economic impact and their overall contribution to the vitality of the region. In
the 2015 report, Review of Per Capita/Arts Sustainability Funding and Municipal Funding
Models for Key Cultural Institutions (CAO-15-030 Arts Sustainability Review), author Angela
Bridsell finds that any reductions in municipal funding risk the de-stabilization of organizations.
Municipal funding provides:
Stability to the organizations as well as the ability to leverage other grants;
Accessibility of programs and collections to broad audiences including youth, seniors
and newcomers; and
Public accountability of the benefits they bring to the community.
The table below summarizes the municipal funding to the KCIs and facility contributions (in-
kind) in 2017.
YĻǤ /ǒƌƷǒƩğƌ CğĭźƌźƷǤ CğĭźƌźƷǤ YźƷĭŷĻƓĻƩ ğƷĻƩƌƚƚ wĻŭźƚƓ /ğƒĬƩźķŭĻ ƚƷğƌ
LƓƭƷźƷǒƷźƚƓ ΛYźƷĭŷĻƓĻƩΜ ΛğƷĻƩƌƚƚΜ
CCGG υВЏͲЍЎВ͵ЉЉ υЎЉͲЉЉЉ υЊЍЏͲЍЎВ
KWAG υВАͲЋЍЉ͵ЉЉ υЋЉБͲЌЋЎ υАЏͲЎЉЉ υЌБЋͲЉЏЎ
KWS υЋЌЏͲЋБЋ υВБͲЉЉЉ υЌАБͲЊЉЉ υАЊЋͲЌБЋ
THEMUSEUM υЊЊЎͲАЍВ͵ЉЉ υЊЋЊͲЋЉЉ υЍЎͲЉЉЉ υЌАБͲЊЉЉ υЏЏЉͲЉЍВ
TOTAL $212,989.00 $96,459.00 $565,807 $269,500 $756,200 $0 $1,900,955
IF1 - 4
The table below summarizes the proposed budgeted municipal funding to the KCIs and facility
contributions (in-kind) in 2018.
YĻǤ /ǒƌƷǒƩğƌ CğĭźƌźƷǤ CğĭźƌźƷǤ YźƷĭŷĻƓĻƩ ğƷĻƩƌƚƚ wĻŭźƚƓ /ğƒĬƩźķŭĻ ƚƷğƌ
LƓƭƷźƷǒƷźƚƓ ΛYźƷĭŷĻƓĻƩΜ ΛğƷĻƩƌƚƚΜ
CCGG υВЏͲЍЎВ υЎЉͲЉЉЉ υЊЍЏͲЍЎВ
KWAG υВВͲЊБЎ υЋЊЏͲЎАЎ υАЏͲЎЉЉ υЌВЋͲЋЏЉ
KWS υЋЍЌͲЍЊБ υВБͲЉЉЉ υЌБЎͲЏЏЋ υЍͲЎЉЉ υАЋАͲЉБЉ
THEMUSEUM υЊЊЎͲАЎВ υЊЌЌͲЋЉЉ υЍЎͲЉЉЉ υЌБЎͲЏЏЋ υЊͲЉЉЉ υЏБЉͲЏЋЊ
TOTAL $214,944 $96,459 $593,193 $269,500 $771,324 $5,500 $1,946,420
With a combined annual investment of almost $2M, the collaborative municipal funding
approach has introduced a more robust accountability framework and greater transparency of
the total municipal funding allocated to each KCI.
Data indicates that major cultural organizations receive 16%-50% in public funding, depending
on the type of organization, with municipal norms between 7% and 24%. Funding norms differ
by sector with performing arts organizations generally receiving around 30% and public
galleries closer to 50%. This is a reflection of higher overhead costs of building and collections
maintenance and lower (or nil) admission rates. Table 4 illustrates total municipal grants as a
per cent of total operating grant for each KCI. This table also indicates the operating budget of
each organization and offers a comparison between the KCIs. While municipal funding may be
slighting above industry norms, overall public funding levels are on par with comparative
organizations. This indicates that municipal funding is plugging a gap in provincial and in some
cases, federal funding. For this reason, part of the collaborative funding conversations includes
reporting on new funding sources, increased funding from other levels of government, and
earned revenue. Since the Review of Per Capita/Arts Sustainability Funding and Municipal
Funding Models for Key Cultural Institutions
revenues.
IF1 - 5
υБͲЉЉЉͲЉЉЉ͵ЉЉ
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υЏͲЉЉЉͲЉЉЉ͵ЉЉ
υЍͲЉЉЉͲЉЉЉ͵ЉЉ
ЊВі
БАі
ƚƷğƌ aǒƓźĭźƦğƌ DƩğƓƷƭ
υЋͲЉЉЉͲЉЉЉ͵ЉЉ
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ЊЎі
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ƚƷğƌ hƦĻƩğƷźƓŭ
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Next Steps
In addition to following the established cycle of the collaborative funding and assessment
process, the Municipal Cultural Initiatives Working Group will review and refine the process
with a view to rationalizing the municipal funding allocations, building equity, and increasing
transparency.
The planned cycle of the collaborative funding and assessment process is outlined in the table
below, including at least three annual opportunities for council update or discussion.
Annual CyclePlanned activities
Q1Municipal staff process KCI grants within each independent budget process
Q2Municipal staff submit joint summary report to the individual councils (this report)
Municipal and KCI staff meet to assess process and results
KCIs present annual overview toAll Council Meeting
Q3KCIs submit individual reports onprevious fiscal year
KCIs request for funding for upcoming year through Municipal Working Group
Municipal staff meet with each KCIto review reports and discuss needs
Q4Municipal staff summarize discussion in form of strengths, challenges and planned
actions for each KCI
Municipal staff collaboratively identify potential budget issues
Municipal staff recommend KCI funding allocation to council as part of each municipal
budget process (issue paper if needed)
IF1 - 6
To further develop and refine the process, the Municipal Cultural Initiatives Working Group has
identified the following actions:
Process ImprovementActivitiesStatusDate
Develop criteria for KCIsCompleteQ22017
Establish annual cycle with key dates & milestonesCompleteQ3 2017
Finalize submission guidelinesCompleteQ3 2017
Facilitate funding allocation discussionCompleteQ4 2017
Funding Agreements Prepared & ExecutedCompleteQ4 2017
Reportto CouncilIn ProgressQ1/2 2018
Conduct operational funding analysisIncompleteQ2 2018
Prepare decision-making frameworkIncompleteQ22018
Pilot decision-making framework for 2018 assessmentIncompleteQ3 2018
CONCLUSION:
Feedback on the collaborative municipal funding and assessment process has been positive.
Standardization of reporting and the implementation of collaborative meetings have created
more effective mechanisms for information-sharing and present opportunities for enhanced
efficiency, transparency, accountability and equity. To date, adoption of this funding model has
achieved many of the anticipated outcomes. In particular, this coordinated approach has given
staff and Council a clearer picture of the complete funding profile of each KCI, provided staff
with more insight into the opportunities and challenges unique to large cultural institutions,
leveraged other funding processes to streamline submission requirements and provide
municipal funders with more performance data, coordinated advocacy for the greater benefit of
the sector, and strengthened relationships between cultural organization and municipalities. It
is imperative to this initiative and its goals: efficiency, transparency, accountability and equity,
that all funding discussions related to the KCIs be part of the Collaborative Municipal Funding
and Assessment Process.
ALIGNMENT WITH CITY OF KITCHENER STRATEGIC PLAN:
through the delivery of core service.
FINANCIAL IMPLICATIONS:
None. The actual funding amounts and any related decisions continue to be made by the City
of Kitchener as part of the annual budget process.
COMMUNITY ENGAGEMENT:
INFORM This report has been post
council / committee meeting.
COLLABORATE Collaboration with regional partners has been extensive through the
Municipal Cultural Initiatives Working Group, community partners at the Key Cultural
Institutions and various stakeholders through previous meetings with partners and the Arts and
Culture Advisory Committee meetings.
IF1 - 7
ACKNOWLEDGED BY: Dan Chapman, CAO
IF1 - 8
Appendix 1
KCI Characteristics & Shared Goals
IF1 - 9
Appendix 1
KCI Characteristics & Shared Goals
Key Cultural Institutions hold joint responsibility for public buildings, and/or have programming
intrinsically linked to those facilities. Their multi-layered programming cements and celebrates
arts, culture and ideas regionally, nationally and internationally.
The characteristics of organizations designated as KCIs were defined in the 2015 Review of
Per Capita/Arts Sustainability Funding. These core characteristics are:
Key cultural institutions uphold consistent professional standards and are recognized for
achievements in cultural production and programming at regional, national and
international levels.
They demonstrate leadership by encouraging greater community participation through
education and outreach, volunteerism, audience development, and collaborations with
other organizations and businesses.
They have large budgets with operating revenues greater than 1 million dollars, and
contribute to the social and economic prosperity of the region by creating jobs, attracting
visitors and stimulating creative thought and activity.
Key cultural institutions also usually have responsibility for public buildings, have
programming intrinsically linked to those facilities, and/or have responsibility for
conserving a permanent collection.
Paying professional fees
Bringing the outside in through programming/exhibitions etc.
As part of the collaborative process, municipal and KCI staff has identified goals that are
shared by both the municipalities and KCIs. These include:
Financial & Organizational Stability - Manages debt; engages strong leadership (stable,
representative, innovative); utilizes innovative marketing/audience development tools;
maintains diverse funding streams
Core Area Support - Actively participates in activities that draw people into the
community core areas
Community Education - Develops and presents high quality programs; provides initial
Community Diversity - Offers targeted programming to key audiences (children,
youth/teens, seniors, newcomers, Indigenous peoples, people of colour, young
professionals, etc.); increases access (by removing barriers to participation)
Economic Impact - Demonstrates excellence; nurtures and develops talent; attracts
audiences (from within and beyond the Region)
Collaborative/Partnership Opportunities (Sectoral Leadership) - Supports and develops
connections and collaborations; uses technology effectively; nurtures and grows
community capacity
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