E.D. v. Youthdale Treatment Centres, 2008 CFSRB 70

CHILD AND FAMILY SERVICES REVIEW BOARD

E.D.

v.

Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: July 15, 2008

Citation: 2008 CFSRB 70

Indexed as: E.D. v. Youthdale Treatment Centres (CFSA s.124)

1On June 10, 2008, the Child and Family Services Review Board (the "Board") received the application of E.D., d.o.b. August [...], 1993, (the "Child") for review of emergency admission to the Secure Treatment Program of the Youthdale Treatment Centre, 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 June 13, 2008, at the Youthdale Treatment Centre, Toronto ("Youthdale").

2At the hearing on June 13, 2008, the Child was represented by Herb Stover, Counsel, from the Office of the Children's Lawyer. Youthdale was represented by Eric Sherkin, Barrister and Solicitor with Miller Thompson LLP.

ISSUE

3The Child was admitted to the Secure Treatment Program (the "Program") at Youthdale on June [...], 2008. She was seeking an order releasing her 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

4Mr. Stover objected to the inclusion in evidence of an excerpt of the Child's diary, in tab 8 of Youthdale's Book of Documents. He cited s.104 of the Act in arguing that the Child, who is 14 years old, has a reasonable expectation of privacy with respect to her personal possessions, and she did not give permission to view this document. Mr. Sherkin asked that it be kept in as it is relevant to the state of mind of the Child on admission, but did not strenuously object to its removal from the record as he considered it "non-essential". Having regard to s.104, the panel removed the document from the package.

5Mr. Stover also requested that the panel not view page 3 of tab 5, part of the Youthdale "Intake Review", until after having heard oral evidence from all witnesses. Although he agreed the document is relevant and admissible, he argued that the document may taint the panel's view of the Child before meeting her and was concerned with the timing of its consideration. Mr. Sherkin noted that the Child should have an opportunity to comment on the content of the document. The panel noted that it is able to listen to evidence at any time and weigh it in the context of all the information presented. Nonetheless, the panel agreed to removing the page from the package at this preliminary point in the proceedings, that is for the panel's initial review of the documentation, and that the document would be entered when referred to during testimony.

6The 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.

7The evidence was an Exhibit Brief from Youthdale with 7 tabs (tab 8 having been removed), exhibit Y-1, the Individual Crisis Management Plan (ICMP) Intake Review page that had been removed initially from tab 5, exhibit Y-2, and testimony from the following witnesses:

E.D. - the Child

A.M1. - the Child's Guardian, Durham Children's Aid Society ("CAS"), Social Worker

J. - Youthdale, Crisis Support Team Member

FACTS

8The Child is 14 years old and originally from Nova Scotia. In the summer of 2007 she was hospitalized in Nova Scotia for two weeks following a suicide attempt. Her parents have a history of drug abuse and alcohol problems. A hospital did a psychiatric assessment in July, 2007. Outpatient counselling was arranged in Nova Scotia in 2006-2007.

9In early October, 2007 she moved to Ontario and resided with her maternal grandmother in Oshawa. When her mother moved to the area in December, the Child resided with her for several weeks until she and her brother were apprehended by the Durham Children's Aid Society (CAS) following drug abuse and overdosing by her mother. E.D. is a Society Ward since December 2007. She has resided since March 2008 at the M.G.H.. E.D.'s 9-year-old brother resides with her great-aunt in Oshawa.

10Following an incident on June [...], 2008, E.D. was admitted to hospital where she was kept for three days. Upon release from hospital, A.M2., E.D.'s Child Social Worker at the CAS, applied for her admission to the Youthdale Secure Treatment Program.

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. N.S. dated June [...], 2008. The doctor gave a provisional diagnosis (see tab 5, notes of June [...]) of the Child as having Post-Traumatic Stress Disorder, Mood Disorder, Reactive Conduct Disorder and substance abuse. In the doctor's opinion, these disorders grossly impair the Child's capacity to make reasoned judgments.

13The Board heard and received evidence about the Child's behaviours that demonstrated grossly impaired judgement.

14Ms.A.M1., Child Services Worker with the Durham CAS, described her involvement with E.D. since March, 2008. E.D. did well in her first term of grade 9, receiving straight A's. She is failing all her subjects in the second term, however. E.D.'s step-father was recently acquitted of charges of sexually assaulting her, and the CAS believes this may have been a trigger for E.D.'s suicide attempt.

15AM1 referred to the "Residential Services Incident Report Form" at tab 7 of exhibit Y-1, completed by Group Home Staff regarding an incident on June [...], 2008. The Group Home Staff reported that E.D. attempted suicide by running out into traffic, forcing a car to swerve. The report includes quotes from E.D. at the time, that "I am going to smash my head against the ground and then jump up and laugh," and threatening staff by saying "I am going to punch you in the face." According to staff, she stated she wanted to die, and that she didn't feel in control any more. She also asked for help, saying she didn't want to end up like her family, turning to drugs. She was transported by ambulance to hospital, where she showed hospital staff self-inflicted cuts to her arm. The Report notes that, during a search following this incident, a suicide note and scissors were found under her bed at the Group Home.

16There are a series of Incident Report Forms regarding recent incidents when E.D. was absent without leave (AWOL) from the Group Home, on December [...], 2007, April [...], May [...],[...],[...], and most recently for five days from May, 26 to June 1, 2008. The Report notes that E.D. told the Group Home staff that she had used "hard-core" drugs when missing from the program in the past, and had done sexual favours to receive drugs.

17E.D. has been on a "safety plan" at the group home since December 2007, following a disclosure that she was having a suicide ideation, to address her "high risk behaviours". Ms. AM1 testified that counselling was set up for E.D., but that she failed to attend after the first visit in March, 2008.

18The ICMP Intake Review document at exhibit Y-2 notes that E.D. is "charming and engaging – but very superficial – usually is to gain something, manipulative; lots of lies with full eye contact."

19J., a Crisis Team worker at Youthdale, testified that the "dissociative nature" of E.D.'s risk behaviour was particularly concerning. He testified that it is hard to design coping mechanisms if the Child cannot describe her thoughts.

20E.D. testified on her own behalf. She agreed that the AWOL occurrences took place, and does not dispute the dates. She testified, however, that she never said she used cocaine or crack, or that she exchanged sex for drugs. She admitted to having taken 2 ecstasy pills in February or March, 2008. E.D. admits having made one suicide attempt while in Nova Scotia, and testified that she had blackouts during the summer of 2007, but denies that it has re-occurred.

21E.D. testified that on June [...] she did not run into traffic. E.D.'s version of events that day is that she crossed the road to get her cigarettes and that there were no cars anywhere to be seen. She denies the quotation attributed to her (above). E.D. testified that she loves school, but that she missed a lot during the second term because the Group Home made her sign a contract, that if she skips one class, she cannot attend the whole next day. She testified that she did not like living in the M.G.H. but her objections were not heard. E.D. stated that her cutting behaviours are done in an effort to have the Group Home Staff understand she wants counselling. E.D. testified that the counselling offered was all to do with her past, which she prefers not to think about because it upsets her by bringing up past issues. She believes she needs counselling on how to cope with life in the present, to deal with the "200 things" in her head at once.

22When E.D. was asked to respond to the comments in exhibit Y-2, she testified that she has lied about skipping school, with eye contact. She also admitted that she has a problem accepting things. For example, she knows the consequences to AWOL, and although she likes school, she skips and is forced to miss the next day. She agrees with the notation on exhibit Y-2 that she can "calm down on her own if given space."

23Although E.D. denies it, the panel accepts the evidence that she has attempted to cause bodily harm to herself by running into traffic, and that she had scissors and a suicide note under her bed at the Group Home. The Group Home Staff who wrote the report are disinterested observers, in the sense that they have nothing to gain by lying about the incident. The report includes specific quotes, indicating a detailed recall of actual events. The evidence includes other examples where the Child has attempted to mislead others through false information, such as an allegation to her teacher that she was pregnant, in order to be sent to the school clinic in an attempt to skip school altogether. E.D. also admitted to lying "to their face" in the past about skipping school.

24The Board finds that the serious nature of the incidents described reveal that the Child has a substantial disorder of emotional processes which grossly impairs her capacity to make reasoned judgments.

25The 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.

26As noted above, the Board accepts that the Child ran into traffic, made verbal threats regarding own safety and that of Group Home staff, and had a suicide note and scissors under her bed on June [...], 2008.

27The 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.

28J., a Youthdale Crisis Team Worker, testified that he was involved with the Child as a member of the crisis team and did the admission on June [...], 2008 when the Child was transferred to Youthdale from L.H.. He described the high level of security and close supervision provided at Youthdale. He testified that to his knowledge, in his 3.5 years at Youthdale, no Child has ever been able to harm him or herself.

29The Board accepts the fact that the secure setting at Youthdale minimizes the risk of harm to the Child and others and 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.

30Youthdale 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. J. testified that Youthdale presents a low-stimulus environment, appropriate for children such as the Applicant who are trying to make sense of competing emotional and psychological pressures. Children have access to counsellors, which J. noted is helpful for children who have rejected counselling before. A psychologist, a psychiatrist and other mental health professionals are also available for the Child to address her mental health requirements, as is an education assistant, who will assist the Child to possibly make up school credits.

31The 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.

32J. testified that E.D. would be safe in hospital, but in his view she would not receive necessary and appropriate treatment there.

33Mr. Sherkin argued that, although the Child has a capacity to do well at school, the fact that she's failing all her subjects indicates "something is going on" and she was not receiving the support she needed. Her behaviour has escalated recently, having gone AWOL more regularly and for longer periods of time, culminating in a suicide attempt. She has not accepted counselling, and the psychiatrist and psychologist consulted were of the view that the Child needs treatment for her mental disorder.

34Mr. Stover argued that there is no evidence that the CAS seriously considered, or made attempts to have E.D. live with her Grandmother, although it appears she was doing well there during the first term of school. He argued that medication was not seriously tried after her departure from Nova Scotia, and that she could benefit from out-patient counselling regarding her next steps, which should have been arranged during the five months between December, 2007 and June [...]3, 2008.

35E.D. admitted to numerous incidents of being AWOL, and that she refused to accept counselling. The panel accepts the evidence before it that E.D. engaged in high-risk behaviour such as drug use, and exchanging sex for drugs, when she was AWOL from the Group Home. We put more weight on the opinion of medical professionals regarding necessary counselling for E.D.'s depression and emotional problems resulting from past sexual abuse, than E.D.'s view of appropriate counselling. We note Dr. N.S. is of the opinion that previous efforts to treat the Child's mental disorder by other means have been inadequate. We find that, absent a secure setting, the Child's mental disorder has not been appropriately treated in these less restrictive treatment settings.

36The Board finds that criterion (e) has been met.

DECISION

37On 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.

Heather Gibbs

Presiding Member

Deborah Simon

Panel Member