CHILD AND FAMILY SERVICES REVIEW BOARD
S.W.
v.
Youthdale Treatment Centres
REASONS FOR DECISION ON MERITS
Date: December 18, 2009
Citation: 2009 CFSRB 78
Indexed as: S.W. v. Youthdale Treatment Centres (CFSA s.124)
INTRODUCTION
1This is an application to the Child and Family Services Review Board (the “Board”) by S.W., born July […], 1994 (the “Child” or the “Applicant”), for a review of her emergency admission to the Secure Treatment Program at the Youthdale Treatment Centre, (“Youthdale” or the “Respondent”) pursuant to section 124(9) of the Child and Family Services Act R.S.O. 1990, c. C.11 (the “Act” or the “CFSA”).
2The Board must decide whether each of the criteria set out in subsection 124 (2) of the CFSA were met at the time of admission, on the balance of probabilities, having regard to the best interests of the Child. The Respondent’s position is that all five criteria were met and that the application should therefore be denied. The Child’s position is that the criteria set out in subsections 124 (2) (a) to (e) were not met and that she should be released.
3Pursuant to section 124 (13) of the Act, upon review,
The Board shall make an order releasing the child from the secure treatment program unless the Board is satisfied that the child meets the criteria for emergency admission set out in clauses 124 (2) (a) to (e).
4The relevant considerations in this case are captured by the criteria as set out in the legislative provisions as follows:
124 (2) The administrator may admit a child to the secure treatment program on an application under subsection (1) for a period not to exceed thirty days where the administrator believes on reasonable grounds that,
a. the child has a mental disorder;
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 serious bodily harm to himself, herself or another person;
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;
d. treatment appropriate for the child’s mental disorder is available at the place of secure treatment to which the application relates; and
e. no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the circumstances.
5For the reasons that follow, the Board finds that the Child meets all of the five criteria for admission and denies the Child’s application.
6The panel did not consider information regarding police involvement with the Child. Any references to police involvement in the exhibits were redacted. The Youth Criminal Justice Act (“YCJA”) prohibits the publication of, as well as access to, information that would tend to identify a young person as having been dealt with under the YCJA. In the event a party wishes to rely on information protected under the YCJA, they must first obtain an order of the Youth Court authorizing its release.
BACKGROUND
7S.W. is a 15 year old girl who has been residing at [the Residence] since September 2009. She is described as being highly intelligent. Intense conflict in the family home between S.W., her parents and siblings, resulted in her parents being unable to support and keep her safe at home. They entered into a Temporary Care Agreement with the Toronto Children’s Aid Society in September 2009, which is due for renewal on December […], 2009.
8S.W. was previously admitted to the Acute Support Unit at Youthdale in May 2009 and after discharge in June, lived with her parents until September 2009. Her behavior was good for one month, after which a marked deterioration was observed.
9S.W. has gone “absent without leave” (“AWOL”) 17 times from her group home for periods of 2 to 5 days during her 3 months in residency. When she is away from her group home, there is concern that she engages in risky behaviors and does not care if there are health consequences. She has returned to the group home after some of these absences appearing to be “high” and bragging about her exploits while under the influence of narcotics and alcohol. She has also stopped taking her prescribed medication as it may interfere with her recreational drugs.
10The Applicant has made verbal threats of harm to others and herself and made superficial cuts on her arm. She has been involved in peer conflict, is defiant and leaves the group home when angry or upset.
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. The Board was satisfied that the Child had a mental disorder within the meaning of the Act.
12Mr. T.C., the Applicant’s children’s services worker, testified that the Child struggles with anger and rapidly escalates from calm to out of control anger and verbal barrage so intense that nothing can stop her. He reported that the Applicant’s family has significant struggles and family interaction is limited to phone contact at this time and that the Child refuses to speak to her father. He also reported that on one occasion when he visited the Applicant, she was curled up in a ball in her room with a sad affect.
13Ms. M.L.J., child and youth worker at [the Residence], testified that the Child went AWOL 17 times for periods of 2 to 5 days in the last 3 months. On some occasions, she left without proper clothing. The following is a summary of testimony given from a list of the Applicant’s unauthorized absences from [the Residence] and observations by staff upon her return:
Date Remarks
[…] to […]/09/29 Weed grinder containing weed remains and a knife confiscated from Child
[…] to […]/09/09 Applicant was high, she had glazed eyes, was giddy and hungry
[…] to […]/10/09 Applicant bragged about her drug use on return
[…] to […]/10/09 The Applicant made significant peer threats re punching and hurting room
mate requiring staff intervention
[…] to […]/10/09
[…] to […]/10/09 Applicant assaulted resident, whom she has called retard. He did something
and she punched him in the head
[…]/10/09 abusive
[…] to […]/10/09
[…] to […]/10/09
[…] to […]/11/09 Refused to talk to Youthdale worker
[…] to […]/11/09
[…] to […]/11/09
[…]/11/09 [went to emergency at [the Hospital]]
[…] to […]/11/09 Superficial cuts and a burn on the Applicant’s arm were observed, she
bragged about a box cutter
[…]/11/09 The Applicant threw an alarm clock, kicked the front door, used profanities
and said “I will not do what you say”.
[…] to […]/11/09 Property destruction, the Applicant kicked door and made threats.
[…] to […]/11/09
[…] to […]/11/09 The Applicant made threats to run away
[…]/11/09 The Applicant made threats against peer
[…]/11 to […]/12/09 The Applicant keyed staff car with corkscrew, called from pay phone to say I am going to end my life.
14The child and youth worker testified that S.W. was a gifted student who did not want to go to school at [School], which was her assigned school. Instead she wanted to attend another school with her friends. She stated that the Child did not know what she wanted to do and expressed no interest in planning for the future. She was sad and withdrawn, had difficulty expressing herself and was usually abusive, volatile and angry.
15Ms. M.L.J. stated that the Child has discontinued taking her prescribed medication, Prozac, as it interfered with her recreational drug use. She had tried numerous strategies to motivate and manage the Child but the Child would not engage and ‘buy into’ the program. The Applicant continued to have outbursts, after which she would run away from [the Residence]. During those absences, she engaged in risky sexual behaviours and refused to be taken to the doctor to be tested for sexually transmitted diseases.
16Youthdale filed the Admission Summary of Dr. S. dated December […], 2009. The following Provisional Diagnoses were identified: Oppositional Defiant Disorder and Conduct Problems; Parent/Child Relations Problems; Substance Abuse. Under AXIS IV, Dr. S. noted that Psychosocial Stressors have been high and include problems with primary support group, peer relationship and education.
17In his statement of reasonable grounds for emergency admission to secure treatment, Dr. S. states that the Child has a mental disorder, a substantial disorder of emotional processes as evidenced by the Child’s suicide ideation, substance abuse, AWOLing, inappropriate sexual activity, assaultive behaviours towards staff at the group home and her risky behavior in the community.
18The Board accepts that the Child has mood irregularities and impulse regulation difficulties and accepts that the Child’s behaviors as identified and assessed by the admitting doctors and as outlined above support the finding that the Child has a mental disorder as defined by the Act.
19The Board was 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 serious bodily harm to himself, herself or another person.
20The Board was satisfied that the Child, as a result of her mental illness, made a substantial threat to cause serious bodily harm to her father and a staff at the group home and a substantial threat to kill herself as indicated in the summary above. The Applicant has threatened to slit her father’s throat, threatened to kill a staff with a knife and told a member of staff over the phone that she was going to end her life.
21She has a pattern of extremely poor impulse control. The Child’s difficulty in controlling her impulses and processing her anger has the potential to make her threats very real and could lead her to cause serious harm to the herself as well as others.
22The Board’s finding that her threats are substantial because of her lack of impulse control is supported by other behaviours such as persistent bullying and threatening of other peers, hitting a peer in the head in anger and keying a staff member’s car. The Child has behaved in an aggressive manner towards the staff at [the Residence] where she has assaulted a member of staff, punched holes in walls, broken doors and has thrown a clock. There are reports of numerous AWOLs resulting from the Child’s inability to process her anger. When confronted, she would run away from the residence rather than problem solve. The Board accepts the evidence of the children’s services worker and the child and youth worker who testified that the Applicant was highly irritable, volatile and agitated and that she engaged in intense, profane verbal altercations and conflicts with family, peers and staff.
23In general, the Applicant’s anger level has been escalating to the point where she was placing herself and others at risk.
24The Board was 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.
25The Board was satisfied that the Youthdale treatment program would be effective to prevent the child from causing or attempting to cause serious bodily harm to herself or others.
26Youthdale Psychiatrist Dr. P. testified to the secure nature of the facility which is locked and prevents children from leaving. The high level of security and the safety measures, along with the high staff to child ratio for residents of the unit, prevent the Child from harming herself or others.
27The Board accepted Dr. P.’s evidence and heard none to the contrary.
28The Board was satisfied that criterion (c) was met.
Criterion (d) treatment appropriate for the child’s mental disorder is available at the place of secure treatment to which the application relates.
29The Board was satisfied that treatment appropriate for this Child’s mental disorder of emotional processes was available at Youthdale.
30Youthdale provides close monitoring of medication compliance, monitoring of mental status, treatment for the behaviors identified at admission, psychiatric assessment and diagnosis, a behavior management plan, psychiatric treatment, peer therapy and interventions to help the Child deal with feelings and aggressive behaviors. Dr. P. testified to the structure, routine and stability of the unit which she opined would help to stabilize the Applicant.
31The Board was satisfied that criterion (d) has been met.
Criterion (e) no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the circumstances.
32The Board is satisfied that no less restrictive method of providing treatment appropriate for the Child’s mental disorder was appropriate in the circumstances of this admission.
33The Applicant’s child and youth worker testified that the Applicant had sporadically attended counseling at the [Clinic] where she has the services of a psychiatrist and therapist. She was frequently away from home (AWOL) and therefore she was unable to keep the appointments which were made. She also discontinued taking her medication, Prozac, as it interfered with her recreational drugs.
34A referral was made for family counseling by [Clinic]. The Applicant did not wish to participate because her understanding was that her other siblings would not participate.
35The Board heard evidence that the Applicant’s behavior was too intense for a treatment foster home. Her children’s services worker believes that her chances for a successful group home placement is dependent on the assessment and the stabilization offered by Youthdale.
36“Wrap around” community services were provided for the Child but as demonstrated by her constant absence from the group home and missed appointments, she was not interested in receiving these services and was generally non-compliant. The Board heard evidence that the Child’s behavior escalated to the point where [the Residence] could not contain her and keep her safe.
37The Board is satisfied that criterion (e) has been met.
CONCLUSION
38Pursuant to section 124 (13) of the CFSA, the Board, having satisfied itself that the criteria in subsections 124 (2) (a) through (e) have been met, dismissed the application of the Child, S.W., on December 12, 2009.
Sheena Scott
Presiding Member
Alina Lazor
Panel Member
Lorna King
Panel Member
Dated at Toronto, Ontario on this 18th day of December, 2009.