R.W. v. Youthdale Treatment Centres, 2010 CFSRB 21

CHILD AND FAMILY SERVICES REVIEW BOARD

R.W.

v.

Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: May 26, 2010

Citation: 2010 CFSRB 21

Indexed as: R.W. v. Youthdale Treatment Centres (CFSA s.124)

INTRODUCTION

1This is an application to the Child and Family Services Review Board (the “Board”) by R.W. (the “Child”), born December […], 1995, for a review of her emergency admission to the Secure treatment Program at the Youthdale Treatment Centre (“Youthdale”) on May […], 2010 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 was met at the time of admission, on the balance of probabilities, having regard to the best interests of the Child. Youthdale’s position is that all five criteria were met and that the application should therefore be denied. The Child’s position is that none of the criteria were met and that consequently, she should be released.

Pursuant 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).

3The 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.

4For the reasons that follow, the Board finds that the Child did not meet criterion (a) at the time of admission and releases her from the secure treatment program at Youthdale. As such, the Board does not need to decide and give reasons as to whether criteria (b), (c), (d) and (e) were met at the time of admission.

BACKGROUND

5R.W. is a 14 year old girl who has been a ward under the care of the Durham Children’s Aid Society (“the Society”) since September […], 2009. The Society became involved in July of 2009 when the mother asked for assistance. Initially, the Society tried to provide treatment in the home, but the mother made a request for care in September of 2009.

6Prior to her admission to Youthdale, the Child was placed with [Agency] at [the Residence] in January of 2010 and at [the House] in [City A] on May […], 2010.

ANALYSIS

Criterion (a) the child has a mental disorder.

7The Board was not satisfied that at the time of admission the child had a mental disorder within the meaning of the Act. A mental disorder is defined in the Act as a substantial disorder of emotional processes, thought or cognition which grossly impairs a person’s capacity to make reasoned judgments. The evidence demonstrated that, at the time of admission, the Child did not have a substantial emotional processes disorder which grossly impaired her capacity to make reasoned judgments.

8M.D., a member of the psychiatric crisis team at Youthdale, testified about the process involved in R.W.’s emergency admission to the secure treatment program. He referred to the Admission Summary of the admitting doctors, Dr. S1. and Dr. B.. Dr. B. signed the Admission Summary and Dr. S2. signed as supervisor to Dr. B.. In this summary, the Child was given a provisional diagnosis of Conduct Disorder with a history of Attention Deficit Hyperactivity Disorder. The summary also indicated the need to rule out Bipolar Disorder and Post Traumatic Stress Disorder.

9Mr. M.D. testified about the Child’s behaviour leading up to her emergency admission. Mr. M.D.’s information came from third party sources. Approximately three weeks prior to admission, the Child went AWOL with a 13 year old female peer for 3 days. During this time, the Child had full intercourse with males in front of everyone, ran around outside naked, and used drugs and alcohol. She had been found with crystal meth, uses marijuana and overdoses on cold and flu drugs on a consistent basis. The Child is also trying to become pregnant. She turned a negative pregnancy test into a positive and showed staff the result. On April […], 2010, after being AWOL for 24 hours, the Child was found and taken to the hospital where she refused medical attention. She jumped out of the car and was then AWOL for another 24 hours. On April […], she was AWOL again for 24 hours and was reported to be with a 29 year old male. Mr. M.D. testified that the Child exhibits impulsive behaviour and does self piercings.

10N.D., a case manager for the Society, testified about the behaviour of the Child prior to her admission to Youthdale. L.S., the Children’s Service Worker who manages the Child’s file and her placement while in the Society’s care, was unable to testify before the Board. Ms. N.D.’ information was based on information she received from Ms. L.S.. Ms. N.D. testified about the Society’s concerns that while at [the Residence] with [the Agency], the Child was frequently AWOL, engaged in random unprotected sex acts, involved herself with a 29 year old male, was suspended from school when caught with crystal meth, abused medications, self harms, and threatened suicide. Initially, the Child was compliant and followed her treatment plan when placed at [the Residence] in January of 2010. In early February, the Child went back to her previous behaviour. Ms. N.D. related the following incidents. The Child cut herself deeply enough to require stitches at the hospital, but she refused treatment. She went to her boyfriend’s house and returned with hickies on her neck. The Child used cold and flu medication in excess requiring hospital visits. She reportedly uses crystal meth, marijuana, and corsidin pills. On May […], 2010, the Child was placed at T.H. in [City A], a rural placement outside of [City B]. She was AWOL for forty-five minutes during which time she went to a gas station and contacted her grandmother.

11Ms. N.D. stated that an appointment was made and the Child was transported for an assessment with CAMH psychologists, but the Child refused the assessment.

12The Child testified that she went AWOL as many as three hundred times from September 2009 to May […], 2010 sometimes for 2 hours, sometimes for days. She usually went to stay with friends or with family, see her grandmother, have fun and talk to people. She felt that she was safe. Sometimes she would contact the group home to let them know the area she was in and that she was safe and would be back at a certain time. She explained that she ran around naked when she was playing truth or dare to win an ipod. She said that she only used alcohol twice. At the party they bought a 40 ounce bottle to split between 7 people. She has taken 16 cold and flu pills which would be effective for 3 days. She was dizzy, went to the hospital and hallucinated. She has taken marijuana though not frequently, twice when she went AWOL. She claims that the crystal meth that she had was actually tylenol and 3 sleeping pills which were crushed to form a powder. The Child denied engaging in the remaining behaviours relied upon by Youthdale. The Board accepts the direct evidence of the Child over the hearsay evidence of Mr. M.D. and Ms. N.D..

13Under section 124 of the Act, there must be extraordinary circumstances before a child is placed on an emergency basis, in a secure treatment facility. To safeguard the Child’s liberty rights, the Board is empowered to review the placement. As such, Youthdale has a duty to present strong and compelling evidence to support its position that all the criteria as set out under section 124(2) have been met at the time of admission.

14Youthdale did not present any direct evidence as to the Child’s mental illness. Though M.D. entered the Admission Summary into evidence, he did not author the summary and could not testify as to the accuracy of its content. He gave evidence about the Child’s behaviour from information he received from other sources. N.D. testified on behalf of the Society, however, most of her evidence came from L.S., the Child’s worker, who was not available to testify before the Board.

15The admitting psychiatrist at Youthdale gave a provisional clinical diagnosis of Conduct Disorder and Attention Deficit Hyperactivity Disorder (history of). However, at the time of admission, the psychiatrist found the child’s thought form was “coherent and logical” but noted that the child’s judgement and insight “seemed to be fairly poor”. However, there was no evidence that the Child had a substantial disorder of emotional processes as required by the Act. There is no doubt that the Child engaged in serious risky behaviours, but that does not warrant an admission into a secure treatment program.

16The Board was satisfied that criterion (a) has not been met. Pursuant to section 124 (13) of the CFSA, the Board, having satisfied itself that the criterion has not been met, released the Child, R.W., from the Emergency Secure Treatment Program at Youthdale on May 21, 2010.

Ruth Ann Schedlich

Presiding Member

Jennifer Scott

Panel Member

Mary Wong

Panel Member