N.K. v. Youthdale Treatment Centre, 2008 CFSRB 42

CHILD AND FAMILY SERVICES REVIEW BOARD

N.K. v. Youthdale Treatment Centre

REASONS FOR DECISION ON MERITS

Date: May 7, 2008

Citation: 2008 CFSRB 42

Indexed as: N.K. v. Youthdale Treatment Centres (CFSA s.124)

1On April 9, 2008, the Child and Family Services Review Board (the “Board”) received the application of N.K., a Crown Ward, d.o.b. June […], 1994, (the “Child”), for a request to be released from the Youthdale Treatment Centre, Secure Treatment Program, pursuant to section 124(9) of the Child and Family Services Act, R.S.O. 1990, c. C.11 (the “Act”). All of the parties were informed of the Board’s intention to hear this application on April 11, 2008, at the Youthdale Treatment Centre, Toronto (“Youthdale”).

2At the hearing on April 11, 2008, the Child was represented by Herb Stover, Barrister and Solicitor, agent for the Office of the Children’s Lawyer. Youthdale was represented by Amelia Leckey, Barrister and Solicitor with Miller Thompson LLP.

ISSUE

3The Child was admitted to the Secure Treatment Program (the “Program”) at Youthdale on April […], 2008. He is seeking an order releasing him from the Program on the basis that the criteria for emergency admission had not been met.

PROCEDURAL MATTERS

4The parties did not have an issue with either the Board’s jurisdiction to hear the application or the composition of the panel. The parties declined to give opening statements. Mr. Stover indicated that the Child was contesting all five (5) of the admission criteria as set out in subsections 124(2)(a) to (e) of the Act.

5Mr. Stover moved to exclude tabs 7 to 13 inclusive of the binder of materials prepared by Youthdale. He argued that the information in those sections was historical and not specific to the Child’s condition upon admission and that details from those sections were adequately summarized in Dr. S.’ admission summary. Ms. Leckey argued that the information was crucial as it detailed the numerous attempts to treat the Child and in particular efforts to ensure that criteria (e) of the admission requirements was satisfied. The Board ruled that it would accept the binder into evidence and would weigh the historical information accordingly.

6Testimony was heard from the following witnesses:

N.K. - the Child

M.H. - Children’s Aid Society of Toronto (“CAST”)

C.C. - Children’s Aid Society of Toronto

J.H. - Youthdale, Crisis Support Team Member

FACTS

7N.K. had been in numerous placements/institutions since May, 2007 when the serious issues, which will be described later, began. The locations will be dealt with in chronological order. From May, 2007 until August, 2007, N.K. was at a temporary residence used by CAST when a more suitable placement for a Crown Ward is not available. The temporary residence is not a secure facility and offers no treatment for children with mental disorders. From August, 2007 until December, 2007, he was at a group home. This home is a secure facility which offers specialized treatment for children with Fetal Alcohol Syndrome Disorder (“FASD”). During this 4-5 month period, N.K. was removed and placed in custody on four separate occasions, one of which was, for one month, at a youth detention centre. Psychological and psychiatric assessments were done for N.K. while he was at the youth detention centre. As his stay was only one month, no treatment was initiated.

8In January, 2008, N.K. was not permitted to return to the group home so he was temporarily placed at the temporary residence. On January […], 2008 he was taken into custody and detained at another youth detention centre. Shortly thereafter he was moved to a secure facility with no treatment programs. On February […], 2008 N.K. was moved to a non-secure treatment facility that offers treatment programs for children with conduct disorders. On March […], 2008 N.K. was again taken into custody with nine (9) separate assault charges and held at the other youth detention centre. Due to his FASD and Attention Deficit Hyperactivity Disorder (“ADHD”), the charges against him were dropped on April […], 2008 and he was returned to the non-secure treatment facility. On April […], 2008 N.K. was admitted to Youthdale under a “Form 1” of the Mental Health Act, R.S.O. 1990, c. M.7, with police escort while wearing handcuffs.

9N.K. testified that, at various times during this 19-month time period, he was aggressive, assaulted staff, confined staff in small rooms, violated rules, set fires, threatened others with implements, verbally threatened others, stole personal property from others, stole knives from facilities, bullied fellow residents, threatened to burn a building, barricaded himself in his room, viewed adult pornography, threatened to commit suicide, and was AWOL inside the residences.

10To deal with his behaviour and disorder N.K. had been prescribed two medications, namely 200 mg per day of Seroquel, and 30 mg per day of Adderall. N.K. admitted that there were occasions when he refused to take his medications.

11CAST contacted Youthdale about N.K. on three occasions. The first contact in 2007 led to an assessment by Dr. P. which indicated that there was no bed space available and, at that time, N.K. did not meet the admission criteria. The second contact, also in 2007, was not pursued by CAST. The third contact was made on March […], 2008. Due to an escalation of his inappropriate behaviour at the non-secure treatment facility N.K. was placed on “Alert” at Youthdale, a status that included the likelihood of a future request for a bed plus a daily monitoring of his behaviour at the non-secure treatment facility. When N.K. returned to the non-secure treatment facility from the other youth detention centre on April […], 2008 the situation vis-à-vis his behaviour continued to deteriorate. A bed request was made by CAST. Because N.K. would require 1:1 staffing for 24 hours per day in a separate area within Youthdale, his admission was delayed until a suitable space was available on April […], 2008.

ANALYSIS

Criterion (a) the child has a mental disorder.

12A mental disorder, pursuant to the Act, is defined as a substantial disorder of emotional processes, thought or cognition, which grossly impairs a person’s capacity to make reasoned judgments.

13The Board received the Youthdale Admission Summary of Dr. S. dated April […], 2008. Dr. S.’ admission diagnosis for N.K. noted the following conditions which would be assessed: Reactive Attachment Disorder, Conduct Disorder, Attention Deficit Hyperactivity Disorder, and Fetal Alcohol Effect. Dr. S. also noted numerous high psychosocial stressors, namely problems with primary support group, peer relationships, education, placement and the law. The doctor reported that N.K.’s insight into his difficulties appeared to be poor and his ability to use appropriate social judgment in real life situations appeared to be very limited.

14The Board heard evidence about numerous behaviours that demonstrated grossly impaired judgment. Many are noted above and all were behaviours that N.K. admitted to. Evidence was also presented that showed the following behaviours: “sexualized” behaviour in front of female staff, masturbating in front of female staff, messing a bathroom with his feces, and threatening sexual assault.

15N.K. also admitted that he can lose control when he gets mad and acts impulsively. He stated that he does not believe there are treatments strong enough for his needs, although he claimed that he did not have needs, rather they were weaknesses. N.K. also stated that he does not think of consequences when he is misbehaving.

16The Board finds that all of these incidents, behaviours and comments reveal that N.K. has a grossly impaired capacity to make reasoned judgments.

17The Board accepts the opinion of Dr. S. and finds that N.K. has a mental disorder.

18The Board is satisfied that criterion (a) has been met.

Criterion (b) the child has, as a result of the mental disorder, caused, attempted to cause or by words or conduct, made a substantial threat to cause bodily harm to himself, herself or another person.

19Dr. S. was of the opinion that as a result of his mental disorder N.K. caused, attempted to cause and by conduct made a substantial threat to cause serious bodily harm to himself and others. The single threat to commit suicide is noted above. N.K. did admit that he had injured a staff member at one of his placements. Separate from the aforementioned assault charges, evidence was provided that N.K. had used a belt, a cheese grater (on the head of a female staff member at the group home), a back-scratcher, and a chain from a bicycle lock to threaten and/or harm staff.

20The Board believes the numerous threats were not merely manipulative, nor were they simply verbalizations of N.K.’s desire to be seen as a “tough guy”. Deeds had been committed.

21The Board finds that N.K., as a result of his mental disorder, caused and threatened to cause serious bodily harm to others.

22The Board is satisfied that criterion (b) has been met.

Criterion (c) the secure treatment program would be effective to prevent the child from causing or attempting to cause serious bodily harm to himself, herself or another person.

23Youthdale offers a secure program that is effective in preventing residents from causing or attempting to cause serious bodily harm to themselves or others. J.H., in her testimony, spoke of the structure provided by Youthdale in its programs and daily routines. She indicated that N.K. was in the Acute Support Unit, in an area separate from the other residents, where 1:1 staffing is provided 24 hours per day. J.H. also spoke of Youthdale’s security measures, high degree of supervision, and restricted access to objects. The Board accepts the fact that the secure setting at Youthdale eliminates the risk of harmful threats.

24The Board finds that criterion (c) has been met.

Criterion (d) treatment appropriate for the child’s mental disorder is available at the place of secure treatment to which the application relates.

25Youthdale can provide appropriate treatment for children with mental disorders and has the qualified staff to meet any needs that arise. The Board accepts that psychiatric counselling and treatment is available in the secure environment at Youthdale and that this would be of benefit to N.K. At Youthdale, N.K. will have access to counsellors, a psychologist, a psychiatrist and other mental health staff that would be able to address his mental health needs. J.H. gave testimony to the security that is available at Youthdale, indicating that N.K. would be under constant supervision.

26The Board finds that criterion (d) has been met and that Youthdale can provide the appropriate treatment for N.K.’s mental disorder.

Criterion (e) no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the circumstances.

27CAST had made numerous attempts to have N.K. assessed and properly treated. These can be summarized as follows:

1. Crisis Assessment Form, Youthdale Psychiatric Crisis Service, Dr. P., January […], 2007.

2. Neuropsychological Consultation, Youthdale Psychological Department, G.M., PhD, February […], 2007.

3. Neuropsychological Consultation, Youthdale Psychological Department, G.M., PhD, July […] and […], 2007.

4. Crisis Assessment Form, Youthdale Psychiatric Crisis Service, K.M., Mobile Crisis Team, January […], 2007.

5. Psychological and psychiatric assessments at a youth detention centre, November and December, 2007.

6. Attempts to have N.K. placed at a youth detention centre in February, 2007 and March, 2008. In 2007 the youth detention centre was not available as N.K. was facing charges. The 2008 request was denied as the youth detention centre did not have space and there could be a 6 month wait.

7. Consideration of a general hospital. Assessment was possible but residents stay for a short-term. This was not suitable for N.K.

8. Consideration of a regional hospital, March […], 2008. Specialized services were available here. However, this facility was not suitable as it only offers treatment for up to one week in a non-secure setting.

9. An Accredited Children’s Mental Health Centre: admission sought in January, 2008. The accredited children’s mental health centre has an adequate program, however, it is not secure and admission for N.K. was refused because he was a high risk.

10. J.G.: admission sought in January, 2008. N.K. would fit into their program, however, no beds were available.

11. The Non-Secure Treatment Facility: admission sought in January, 2008. The non-secure treatment facility accepted N.K. into their facility; the non-secure treatment facility will allow N.K. to return after the assessment and treatment planning is completed at Youthdale.

28The Board believes that CAST made numerous attempts to assess and treat N.K.’s mental disorders and resultant behaviour and that none were successful. Furthermore, the Board agrees with Dr. S. that the secure setting in the Acute Support Unit will enable Youthdale to clarify and initiate facilitation of a long-term treatment program for N.K.

29The Board finds that criterion (e) was satisfied.

DECISION

30On the basis of the evidence presented and in keeping with the principles contained in section 1 of the Act, the Board is satisfied that the relevant criteria were met at the time the Child was admitted to the Program and for that reason unanimously order that N.K.’s application for release from the secure treatment setting be denied.

Donald Butler

Presiding Member

Deborah Simon

Panel Member

John Gates

Panel Member