CHILD AND FAMILY SERVICES REVIEW BOARD
B.M.
v.
Youthdale Treatment Centres
REASONS FOR DECISION ON MERITS
Indexed as: B.M. v. Youthdale Treatment Centres (CFSA s.124)
1On May 26, 2008, the Child and Family Services Review Board (the "Board") received the application of B.M., d.o.b. June [...], 1998, (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 May 28, 2008, at the Youthdale Treatment Centre, Toronto ("Youthdale").
2At the hearing on May 28, 2008, the Child was represented by Herb Stover, Counsel, from the Office of the Children's Lawyer. Youthdale was represented by Meredith Wain, Barrister and Solicitor with Miller Thompson LLP.
ISSUE
3The Child was admitted to the Secure Treatment Program (the "Program") at Youthdale on May [...], 2008. He was seeking an order releasing him from the Program on the basis that the criteria for emergency admission as set out in subsections 124(2)(a) to (e) of the Act 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.
5Ms. Wain made the motion that the Child be excluded from the proceedings on the ground that the sensitive nature of the testimony to be given might have a damaging effect on the Child. Mr. Stover submitted that the Child wished to participate and had participated with no ill effects in a recent, previous hearing before the Board.
6The Board ruled that it would allow the Child to participate in the proceedings and that his counsel and the Board would be sensitive to the impact that the testimony may have on the Child and intervene as needed in his interest.
7Mr. Stover objected to two reports dated July [...], 2007 and September [...], 2007 in Tab 7 of exhibit Y-1 on the grounds that both documents were unsigned and outdated. Ms. Wain agreed to the removal of these documents.
8The parties declined to give opening statements. Mr. Stover indicated that the Child was contesting all five of the criteria as set out in subsections 124(2)(a) to (e) of the Act.
9The evidence was a package from Youthdale, exhibit Y-1, E.M. Youth Services ("EMYS") Client Record, exhibit Y-2, Youthdale Admission Summary, exhibit Y-3 and testimony from the following witnesses:
B.M. - the Child
S.W. - Youth Worker, EMYS, current residential unit
A.K. - the Child's guardian, Y.R.C.A. Society ("CAS"), Social Worker
M.O. - Director of Services for Children, York Region
Children's Aid Society (CAS)
J.M. - Youthdale, Crisis Support Team Member
FACTS
10The Child was apprehended by the York Region Children's Aid Society (CAS) in July, 2003 and became a Crown Ward in July, 2005. Since November, 2007 he has been the sole occupant of a group home with two to one staffing through a housing service. The Child was admitted to the Acute Support Unit (ASU) of Youthdale from May [...] to May [...], 2008. He was released based on the finding of the Board that the criteria for admission had not been met in the absence of a complete assessment being completed on the Child. Since his discharge on May [...], 2008, he has been living at the current residential unit, EMYS in the Toronto area and has had multiple visits and admissions to a health centre. He has been attending school for half days in the morning. The Child's mother is believed to be in prison in the [...] area and his father's whereabouts are unknown. His mother is a member of the [...] First Nation Band. He has an older sister who lives with the paternal grandparents in [south western Ontario] and a younger brother who is in foster care in [northern Ontario].
ANALYSIS
Criterion (a) the child has a mental disorder.
11A 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.
12The Board received the Youthdale Admission Summary of Dr. K.C. dated May [...], 2008. The doctor gave a provisional diagnosis of the Child as having Obsessive/Compulsive Disorder, Reactive Attachment Disorder, Oppositional Defiant Disorder, and Intermittent Explosive Disorder. In the doctor's opinion, these disorders grossly impair the Child's capacity to make reasoned judgments.
13The Board heard evidence about the Child's behaviours that demonstrated grossly impaired judgement.
14Ms. W. testified that the Child had been the only child in the current residential unit since May [...], 2008. Staffing originally had been two to one and was increased to three to one due to the Child's behaviour which she described as increasingly violent, explosive and aggressive. Ms. W. stated that she had been punched and kicked by the Child on a number of occasions, that one staff had to be off work for two or three days due to an injury suffered during efforts to restrain the Child and that extra staff needed to be called to implement physical restraints of the Child. Ms. W. reported that the Child had threatened to harm himself whenever his wishes were thwarted and had tried to cut himself with paper and threatened to gouge his eye out with a key. She reported that the Child needed to be restrained on a daily basis and sometimes several times a day since other approaches to de-escalating his behaviour were unsuccessful. In addition, the Child needed to be taken to the health centre on almost a daily basis in order to get his behaviour under control sometimes with the assistance of the police. He was admitted to the health centre on May [...], 2008 as the result of an escalating situation that required restraints and police assistance. Upon his return to the current residential unit, he hit and charged staff, ripped a phone off the wall and he was admitted again the same day to the health centre where he was administered medication and placed in mechanical restraints. He was transferred from the health centre to the ASU at Youthdale on May [...], 2008.
15Ms. K., the Child's case manager and guardian, testified about the placements he has had since November, 2007 to the present time. Before being placed at the current residential unit, the Child resided at an alternate residential unit from November 2007. This program was designed specifically for the Child who was the only child in residence and he was supported with two to one staffing throughout his stay there. Ms. K. stated that during his stay at the alternate residential unit, the Child broke a staff person's nose, talked about suicidal thoughts, jumped out a window during one outburst, used a door as a battering ram to break down the staff office door, threatened to kill staff and toppled a refrigerator and aimed and threw things at staff. These escalating aggressive behaviours led to the first admission to Youthdale on May [...], 2008. The alternate residential unit was not prepared to re-admit the Child upon his discharge from Youthdale on May [...], 2008 since a complete assessment had not been completed and they felt that they could not manage him without an understanding of his behaviour and a treatment plan to guide them in working with him. Once the Child was admitted to the current residential unit, his behaviour escalated further.
16Ms. K. summarized the Child's treatments over the last few years. They have included psychiatric assessments, psychiatric services since November 2007, foster care with parents trained in Therapeutic Crisis Intervention, a behaviour modification program, counselling services, play therapy since May [...], 2008 and at least three kinds of medication to control anxiety, explosive outbursts and a sleep disorder.
17Ms. O. testified that the CAS has always intended that the Child be returned to his home community in [northern Ontario] in order to be near his people. She testified that the team that was in place at the alternate residential unit remains in place to serve the Child once an assessment is completed and he is more stable. Ms. O. indicated that the CAS is very concerned about the Child and his well-being. She testified that everything else has been tried with the Child without success and that the risks posed for him are high given his extreme behaviour and the need for restraints. Ms. O. concluded that the CAS wants to understand how it can help the Child and the placement at Youthdale will assist to that end. Ms. O. also indicated that all of the professionals who have worked with the Child recently were supportive of the placement at Youthdale with one exception. Dr. A. is a psychiatrist who has been seeing the Child since November 2007 proposed that his caregivers 'weather the storm' and lower their expectations for the Child. Ms. O. noted that Dr. A. does not make diagnostic assessments and that the other clinicians involved differed in their opinion as to what was best for the Child at this time. Ms. O. stated that in her 30 years experience as a social worker in child welfare she has seen only two children who needed to be placed alone in a created placement, such as the current residential unit, to ensure their safety.
18The Child testified that he did hit staff and that he has a hard time controlling his anger. He also said that he doesn't know why he behaves the way he does and wants help.
19The Board finds that the many incidents and the serious nature of the incidents described reveal that the Child has a substantial disorder of emotional processes, thought or cognition, which grossly impairs his capacity to make reasoned judgments.
20The 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.
21The testimony given by Ms. W. and Ms. K. portray a child who is unable to control his explosive outbursts which have resulted in injury to others or have posed the risk of causing serious harm to him or others. This pattern of behaviour has escalated since his earlier release from Youthdale on May [...], 2008 and has resulted in the need for restraints including mechanical and pharmacological restraints as well as emergency admissions to the health centre. The Board believes that the pattern of behaviour described in the testimony given indicates that the Child has caused, attempted to cause and by his words and conduct has made substantial threats to cause bodily harm to his caregivers and to himself.
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.
23J.M., Youthdale worker, testified that he was involved with the Child as a member of the crisis team and did the admission on May [...], 2008 when the Child was transferred by ambulance to Youthdale from the health centre. He stated that Youthdale's in-patient assessment will be more comprehensive and thorough and the Child can be observed continuously and kept safe. He indicated that the Child is less likely to be able to harm himself or others at Youthdale as compared with other services given the high degree of support provided by staff and the environment itself.
24The Board accepts the fact that the secure setting at Youthdale minimizes the risk of harm to the Child and others.
25The 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.
26Youthdale can provide appropriate treatment for children with mental disorders and has qualified staff to meet their needs. The Board accepts the fact that psychiatric counselling and treatment is available in a secure environment at Youthdale and that this would be beneficial for the Child. Access to counsellors, a psychologist, a psychiatrist and other mental health professionals is available for the Child to address his mental health requirements.
27The Board finds that criterion (d) has been met and that Youthdale can provide the appropriate treatment for the Child's mental disorder.
Criterion (e) no less restrictive method of providing treatment appropriate for the child's mental disorder is appropriate in the circumstances.
28Testimony from Ms. W. and Ms. A. indicated that the Child's risky behaviours had been escalating. In November 2007 he was moved from a specialized foster care arrangement to a placement that was specifically created for him in order to manage his behaviour. Upon his release from Youthdale on May [...], 2008, he was placed at the current residential unit where he was the only child in residence due to his behaviours. During the time he was at the current residential unit, staffing levels had to be increased and he exhibited a pattern of behaviour requiring daily restraints and ultimately involvement of the police and emergency admissions to hospital. It is evident that these less restrictive treatment settings have been unable to contain and manage the Child's behaviour.
29The Board finds that criterion (e) has been met.
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 the Child's application for release from the secure treatment setting be denied.
Lorna King
Presiding Member
John Gates
Panel Member
Gail Gonda
Panel Member
Dated at Toronto, Ontario on this 10th day of June, 2008