R.R-S. v. Syl Apps Youth Centre, 2008 CFSRB 75

CHILD AND FAMILY SERVICES REVIEW BOARD

R.R-S.

v.

Syl Apps Youth Centre

REASONS FOR DECISION ON MERITS

Date: August 6, 2008

Citation: 2008 CFSRB 75

Indexed as: R.R-S. v. Syl Apps Youth Centre (CFSA s.124)

1On June 25, 2008, the Child and Family Services Review Board (“Board”) received the application of R.R-S, born August […], 1994, (“Child”) for release from the Syl Apps Youth Centre, Secure Treatment Program (“Syl Apps”), pursuant to section 124(9) of the Child and Family Services Act R.S.O. 1990, c. C.11 (“Act”). All of the parties were informed of the Board’s intention to hear this application on June 30, 2008, at the Syl Apps Youth Centre, Oakville.

2At the hearing on June 30, 2008, the Child was present and was represented by Lynda S. Ross, Barrister and Solicitor, agent for the Children’s Lawyer. Mr. S.G., Associate Director of Syl Apps, attended on behalf of the treatment centre. L.R., the Child’s mother, and R.S., the Child’s father, were also present as observers.

ISSUE

3The Child was admitted to Syl Apps on June […], 2008. He is seeking an order releasing him from the Program on the basis that the criteria for emergency admission as set out in subparagraphs (a) to (e) of section 124(2) of the Act had not been met.

PRELIMINARY PROCEDURAL MATTERS

4At the commencement of the hearing, Syl Apps provided a document disclosure package that it sought to have introduced into evidence. Ms. Ross objected to several documents that were included in the package. The disclosure package included eight documents listed in Schedule “A” which is attached to this decision. The Board’s ruling on the admissibility of each of these documents is as follows:

a. Document S1 – Application for Emergency Admission to the Secure Treatment Program

Ms. Ross objected to the inclusion of paragraph A relating to mental disorder on the grounds that the diagnosis which the facility relied upon was dated and outside of the relevant time-line to support an emergency admission and as such should be struck from the record.

Counsel further argued that all the information in paragraph B, relating to serious bodily harm to the child or another person prior to the date of June […], 2008, should be struck because the information is well outside the timeframe of three to six weeks, which the Board has established for emergency admission evidence in previous decisions. The position advanced by Ms. Ross was that information about events commencing June […], 2008 forward is the only information which is relevant.

Ms. Ross also argued that all of paragraph C, with respect to secure treatment program effectiveness, should be struck, except the last three lines because the information contained should only relate to the programming available at Syl Apps and the content of paragraph C does not, for the most part, give that information.

Mr. S.G. took the position that all of the information in both paragraphs A and B should be included because this is the information which Syl Apps relied upon at the time of admission. He further argued that the information in paragraph B is particularly relevant since it demonstrates to the Board that less restrictive methods had been tried prior to the child’s admission to Syl Apps. He concurred with Counsel for the Child that all of paragraph C, except the last three lines, should be struck.

The panel ruled that paragraph A should be struck in its entirety because the information provided in respect of a mental disorder goes back to October [..], 2007 and is too dated to be admitted in the absence of any current psychiatric evidence. The Act is clear that a child must have a mental disorder at the time of admission and thus a historic diagnosis does not suffice.

All of the subparagraphs in paragraph B up to and including the subparagraph commencing “On April […], 2008 …” were struck because again the events between December […], 2007 and April […], 2008 are considered to be too dated to support this statutory requirement in the context of an emergency admission. The Board finds that the factual allegations from May […], 2008 forward may be relevant to the Board’s determination and will remain in evidence.

On consent, paragraph C excluding the last three lines, was struck.

Paragraph D and E of Document S1 remained in evidence on consent subject to submissions with respect to weight

b. Document S2 – Discharge Summary from Youthdale Treatment Centre

Ms. Ross argued that this Summary, which preceded December […], 2007 falls well-outside of any relevant time period and therefore should not form part of the record.

Mr. S.G. took the position that Dr. R.M., a [Program] psychiatrist, considered this information as relevant when he was consulted prior to making a determination to admit the child for secure treatment and therefore should be permitted to remain in evidence.

The Board ruled that the document should be excluded because it was outside of the relevant time period and too dated, in the absence of any current information, to be relevant to the issue of an emergency admission.

c. Document S5 – [ ] Hospital Records

Document S5 was a report from the [ ] from 2007 and was excluded on the basis that the information was too dated to be relevant to this emergency admission.

d. Document S6 – Serious Occurrence Report

Ms. Ross argued that this report, dated March […], 2008, was also outside the relevant time period and should be excluded while Mr. S.G. asked the Board to admit this document in evidence.

e. Document S7 - Serious Occurrence Reports

(a) Serious Occurrence Report dated April […], 2008;

(b) Serious Occurrence Report dated May […], 2008;

(c) Incident Report dated May […], 2008.

Ms. Ross took the position that all three be excluded for lack of timeliness or in the alternative, suggested lack of weight. Mr. S.G. submitted that all three reports be admitted.

The Board ruled, with respect to c. and d. above, that Documents S6 and S7(a) not be admitted in evidence due to the lack of relevance and timeliness in the context of an emergency secure treatment application.

Schedule B is a summary of the documents admitted in evidence by the Board.

5The parties declined to give opening statements. Ms. Ross indicated that the Child was contesting all five of the criteria as set out in section 124(2) of the Act.

EVIDENCE

6The evidence consisted of the Syl Apps package of exhibits admitted in evidence and oral testimony from the following witnesses:

M.F. - Supervisor, The Children’s Aid Society of the County of Simcoe (“Society”)

K.S. - Area Program Director, [Program]

S.G. - Associate Director, Syl Apps

R.R-S - the Child

7The Child is thirteen years old and his family moved to Ontario from Alberta. By the fall of 2007 R.R-S was exhibiting behavioural problems both at home and at school and was placed in the care of the Society under a Temporary Care Agreement on December […], 2007. Although he returned to his parents’ care a few days later, due to a physical altercation between R.R-S and his stepfather he was made a temporary Ward of the Society on January […], 2008.

8After R.R-S was brought into the care of the Society he was placed in two [ ] foster homes where the placement broke down, and he was then moved to a N.A group home in O.. This placement was thought to be a suitable one for R.R-S and he was able to continue his education in a section 23 classroom. It subsequently became evident that R.R-S required residential treatment, which could not be provided at the N.A. group home, so the Society began to look for a suitable placement.

9Mr. M.F., who supervises R.R-S’s CAS caseworker, G.B., gave evidence that the placement of children who require residential treatment in the Simcoe County is managed by Central Intake and it was determined that [the Program] was a suitable placement for R.R-S. The Society anticipated that R.R-S would be placed within a short time period. However, his placement at the N.A group home broke down and he was transferred to another group home in W..

10K.S., [Program] Area Program Director, testified that R.R-S was admitted to the [Program] residential treatment program on May […], 2008. This placement was to a five-bed residence, for children 7-18 years old, with two staff during the day and three in the evening if there are three or more residents. The residents tend to have significant behavioural problems presenting as either depressed or aggressive and are usually those who have not been able to be successful in less intrusive placements.

11Ms. K.S. attested that staff at this program all have at least a Child and Youth Worker Diploma and four years experience working with this client population. The program also has a support team of professionals including a psychologist, nurse and social worker.

12[The Program] was concerned that R.R-S was not listening to staff, so arrangements were made to have another agency, B.I.., provide two additional “police-like” staff for the residence from June […], 2008. This arrangement continued until June […], 2008. Ms. K.S. gave evidence that the additional B.I.. staff was not there to provide one–on-one supervision for R.R-S.

13On June […], 2008 R.R-S was admitted to hospital after he threatened to jump from his window and the roof. R.R-S. eventually cooperated with the police and staff and was taken to hospital. R.R-S. testified that he was upset because on that day he was told that he would not be able to ever visit with his father again. Ms. K.S. indicated that a [Program] employee remained with R.R-S. during his stay in hospital to support R.R-S. and to reassure R.R-S. that [ the Program] had not given up on him.

14R.R-S. was discharged from hospital on June […], 2008 and R.R-S. indicated that he wanted to return to [the Program]. Ms. K.S. stated that she told him that he could only return on the condition that he not make threats of harm to himself or others. R.R-S. agreed to this condition for his return and appeared to settle into the program. On that date [the Program] made an appointment for R.R-S. to see Dr. R.M., [the Program]’s psychiatrist, on June […], 2008. One additional staff member was also brought in, however, as Ms. K.S. testified the additional staff was not there to provide one-on-one supervision for R.R-S..

15By June […], 2008, as R.R-S. appeared to become more concerned about the child protection application which was before the Courts, he became agitated and defiant. On that date R.R-S. left the residence without permission, after the police were called due to his threatening behaviour, but he eventually returned. Later that evening, he wrapped a cord around his neck in what Ms. K.S. characterized as another suicide attempt. The police were again called and he gave the cord to the police. On July […], 2008, R.R-S. continued to display threatening behaviour towards staff and peers, which resulted in the police being called. Eventually, R.R-S. was taken to the [hospital] in [ ] by the police.

16R.R-S. remained in hospital until he was discharged on June […], 2008. In the Discharge Summary, Exhibit S3, Dr. L.A., a psychiatrist at the hospital noted that R.R-S.’s medication was adjusted upon admission. Dr. L.A. noted that R.R-S. had settled on the paediatric ward and was “no problem whatsoever” during his stay there. It was Dr. L.A.’s opinion that, on the date of discharge, June […], 2008, R.R-S. was in “stable condition”. The evidence from both Mr. M.F. and Ms. K.S. is that neither the Society nor [the Program] had spoken to Dr. L.A. or had received this summary prior to R.R-S. being placed at Syl Apps. Ms. K.S. testified that [the Program]’s workers, who remained with R.R-S. during his hospitalization, made reports that were consistent with Dr. L.A.’s summary.

17Ms. K.S. testified that [the Program] had made a determination prior to R.R-S.’s discharge from hospital, and had so advised the Society that R.R-S. would not be permitted to return to the residential program unless he was charged or brought to a secure treatment facility. Ms. K.S. gave evidence that since R.R-S.’s admission to [the Program] on May […], 2008, he was not seen by their psychiatrist for a review of his medication or an assessment, although [the Program] had serious concerns about his mental health. Ms. K.S. and Mr. S.G. both gave evidence that R.R-S. was not seen by Dr. R.M. prior to being admitted to Syl Apps, although Ms. K.S. stated that she had telephone conversations with Dr. R.M. prior to R.R-S.’s admission to Syl Apps on June […] and June […], 2008 and agreed that an assessment by Dr. R.M. would have been helpful to assess “level of risk” and other considerations.

18Mr. M.F. confirmed that the possibility to having one-on-one supervision for R.R-S. was not explored at [the Program]. The Society concurred with the opinion of [the Program] that R.R-S. needed to be stabilized before he could receive appropriate treatment. Mr. M.F. gave evidence that the Society felt that R.R-S. had a mental health problem that would not be properly addressed by the youth justice system. As such the Society, in consultation with [the Program], explored mental health placement options. The Society had completed, but not filed, an application to the Court for R.R-S. to be admitted to a mental health facility for a six-month period. [ ] Centre, the facility of choice, did not have a bed available.

19G.B., Society Worker, took R.R-S. to Syl Apps, upon his hospital discharge on June […], 2008. Mr. M.F. reported being advised that R.R-S. was cooperative but nervous and anxious about being taken there. R.R-S. gave evidence that he was told that he was going shopping but that en route the workers told him that they had to pick something up at Syl Apps. R.R-S. is of the belief that the Society lied to him to get him to Syl Apps.

ANALYSIS

Criterion (a) the child has a mental disorder.

20The Board is of the view that the evidence did not establish that the Youth had a “substantial” disorder of emotional processes, which “grossly” impaired his capacity to make reasoned judgements at the time of his admission on June […], 2008, and during the six week period leading up to that admission.

21A mental disorder, pursuant to section 112 of 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.

22There was no diagnosis that R.R-S. suffered from a mental disorder, as so defined, on the date of his admission to Syl Apps. No psychiatrist at Syl Apps met with R.R-S. at the time of admission and Syl Apps relied upon a diagnosis made by Youthdale Secure Treatment Program in October 2007 to support its decision to admit R.R-S.. This dated diagnosis cannot be used to support an emergency admission to a secure treatment program. Dr. L.A., who had the opportunity to observe and assess R.R-S. in hospital over the six-day period in June immediately prior to his admission to Syl Apps, reported that R.R-S. presented no problems while on the ward and was stable on the date of his discharge.

23A person, who is assessed as stable by a psychiatrist on the date of admission to Syl Apps, does not meet the test for admission under this criterion. There was no evidence to indicate that R.R-S., as a result of a substantial disorder of emotional processes, was unable to make reasoned judgements at the time of admission to Syl Apps. In fact, the evidence suggests that the emergency in this case was the unwillingness of [the Program] to accept R.R-S. back into a [Program] program after his hospitalization and the lack of other suitable placement options available to the Society at that time.

24Upon admission to the hospital, R.R-S.’s medication was adjusted and this appears to have resulted in an improvement in his mood and behaviour. It is possible that R.R-S.’s behaviour would not have escalated had a review of his medication been undertaken by a psychiatrist when [the Program] became concerned that his behaviour was deteriorating.

25The Board finds that the evidence does not establish that the child suffered from a substantial disorder of emotional processes, thought or cognition, which grossly impaired his capacity to make reasoned judgments, at the time of his admission to Syl Apps.

26The Board is satisfied that criterion (a) has not been met and it is not then necessary to address the criteria in subparagraphs (b) – (e) and the evidence adduced and submissions made in relation to these other statutory requirements.

27As a result, the Board orders that R.R-S be released from the Secure Treatment Facility at Syl Apps.

Denyse Diaz

Presiding Member

Alina Lazor

Panel Member

Gregory Price

Panel Member

Dated at Toronto, Ontario on this 6th day of August, 2008.

SCHEDULE “A”

Syl Apps Documents

1. Document S1 – Application for Emergency Admission to the Secure Treatment Program, Syl Apps Youth Centre

2. Document S2 – Discharge Summary from Youthdale Secure Treatment Program, Youthdale Treatment Centre

3. Documents S3, S4, S5 – R.V.H. Records

4. Document S6 – Serious Occurrence Report of March […], 2008

5. Document S7 – Serious Occurrence Reports

(a) April […], 2008;

(b) May […], 2008;

(c) May […], 2008.

6. Document S8 – List of Critical Incidents from May […], 2008

SCHEDULE “B”

Documents Admitted in Evidence

1. Document S1 - Exhibit S1 – Application for Emergency Admission to the Secure Treatment Program

Paragraph B – from May […], 2008 onwards

Paragraph C – last three lines

Paragraph D

Paragraph E

2. Documents S3, S4, S5 – Exhibits S3, S4, - [hospital] Records

3. Document S7 - Exhibit S7 – Serious Occurrence Reports

(b) May […], 2008;

(c) May […], 2008.

4. Document S8- Exhibit S8 – List of Critical Incidents from May […], 2008