M.P. v. Youthdale Treatment Centres, 2010 CFSRB 29

CHILD AND FAMILY SERVICES REVIEW BOARD

M.P.

v.

Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: July 2, 2010

Citation: 2010 CFSRB 29

Indexed as: M.P. v. Youthdale Treatment Centres (CFSA s.124)

INTRODUCTION

1This is an application to the Child and Family Services Review Board (the “Board”) by M.P. (the “Child”), born October […], 1997 for a review of her emergency admission to the Secure treatment Program at the Youthdale Treatment Centre (“Youthdale”) on June […], 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.

4The Board finds that the Child did not meet criteria (a), (b) and (e) at the time of admission and releases her from the secure treatment program at Youthdale. Since the Board decided that criterion (a) was not met, the Board does not need to give reasons as to whether criteria (b), (c), (d) and (e) were met at the time of admission. However, the Board makes some comments on criterion (e).

BACKGROUND

5M.P. is a 12 year old, grade 7 student, who has been raised by her aunt and legal guardian, L.K. and her partner, L.A.M. since the age of 2 months. Her biological mother lives in [City A] with her half sister of about 18 months and she does not have contact with her biological father. She was enrolled in the Safe Schools Program, but she has not been attending.

6The Child’s aunt put her into the care of the [the local Children’s Aid Society “CAS”] under a Temporary Care Agreement on March […], 2010 when she was not able to manage the Child’s behaviour. The Child was placed with a foster family for a period of a month, but this placement broke down due to her behaviour. She was then placed at [“A”] residence which is a group home staffed by child and youth workers. This placement broke down again and she was moved to [“B”] residence. She went absent without leave (“AWOL”) from [“B”] and allegedly attacked another resident. She was moved to [“C”] where she continued to be defiant. On June […], 2010, the Child was taken to [Hospital1] on a Form II. She was placed on a Form I under the Mental Health Act while at [Hospital1] and transferred to Youthdale’s Acute Support Unit for admission on June […], 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, referred to the Admission Summary of Dr. C. which was filed on consent and which provided a provisional diagnosis at the time of admission of childhood onset Conduct Disorder, Attention Deficit Disorder, “by history”, Learning Disorder and Substance Use Disorder. The admitting psychiatrist wanted to rule out Mood Disorder and Post Traumatic Stress Disorder. Her summary states that there were significant concerns for the Child’s safety while she is AWOL in the community.

9Dr. T., Chief of Psychiatry, at the [Hospital2], in a letter dated October […], 2002 diagnosed the Child with Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder. Dr. T. recommended that general medical and neurological disorders be ruled out and referred the family to the clinic’s integrative psychosocial treatment, parent and family support and training program. He also recommended a dose of Dexedrine if the situation did not improve after February, 2003. It is not clear whether the family followed up on counselling recommendations. The family was hesitant about medication and no medications were tried.

10In a report dated October […], 2006 by Psychological Services of the [ ] School Board, the Child’s overall intellectual abilities were assessed using the Wechsler Intelligence Scale for Children, and her abilities fell within the low end of the Average range. The Child was found to be a visual learner and information that is verbal in nature is processed less efficiently. Tests of executive functioning abilities show difficulties. From a behaviour checklist completed by her aunt and her Grade 3 teacher, the Child was found to be more aggressive, hyperactive and inattentive than other children her age. Assessment results indicate that she has average intelligence and that deficits in short-term memory combined with her attentional difficulties indicate a learning disability. Recommendations to be discussed with the home and the school support team were that the Child should contact an agency such as the [ ] Clinic and that she be considered for an Identification, Placement and Review Committee (“IPRC”).

11L.A.M., the Child’s uncle, gave evidence of historical behaviours that were concerning. The Child has lived with him since she was about 3 months old. She has caused problems in the building where they live. He stated that the children in the building are afraid of her including his own little girl. At school, the principal called regarding the Child’s conflict with teachers, behaviour issues and alleged sexual attacks on boys.

12L.H., the Family Service Worker, took over the Child’s file on April […], 2010 when the Child was residing at [“B”] residence. Ms. L.H. testified that on May […], 2010, there was an incident in which the Child was holding her hand and attempting to cut herself. On May […], the Child locked herself in the bathroom and staff was afraid that she would harm herself. In an incident in June, 2010 the Child assaulted staff when her hair straightener was missing. During this encounter she grabbed a serrated metal spatula and when she raised her hand with the spatula, she hit a staff member on the forehead causing bleeding. She was moved to [“C”]. After 4 or 5 days at [“C”], another incident occurred when she attempted to run down the stairs. She was directed to her room where she tried to get out by breaking the window with a lamp. The window was made of plexi-glass and the lamp shattered. The Child was taken to [Hospital1] where she was put on a Form 1. She remained in the emergency department with hospital security and a [“C”] staff member present until she was transferred to Youthdale.

13Ms. L.H. stated that from April […] to June […], 2010, the Child went AWOL about 30 times for periods of several hours to several days usually during weekends. She always returned. The Child attended counselling which focused on sexual abuse trauma at [an agency] with G.L.. According to Ms. L.H., it was not “successful”. A psychological assessment was set for August, 2010.

14The Child testified that when she went AWOL, she went to a friend’s house which was a safe place for her, a place with no arguments and where nothing bad is happening. She usually went with someone from the home with the longest absence being 3 or 4 days. She never called the home. She was picked up by police once or twice when her aunt called the police. She went AWOL because she did not want to stay in the home. She denied smoking marijuana. She claimed that her eyes were red from lack of sleep and that she smelled of marijuana because on the way back to the home, she stopped to talk to some friends who were smoking it. She denied that she was a bully and claims that she is not like that and that she would just talk to people. When she wrote on the mirror that she wanted to die, she was just mad. She only cut herself once with her finger nails about 2 months ago and went to the hospital for 1 night. She had arguments with her teachers and did not fight with them. She admits that she has hit other children, but never younger kids. Her sister hits her as well.

15There was no evidence presented from any counsellors or therapists who had worked with the Child. As Youthdale did not present any direct psychiatric evidence as to the Child’s mental illness, the Board had to rely on the Admission Summary of Dr. C.., which was admitted on consent. Dr. C.’s provisional diagnosis of ADHD by history relied on the diagnosis of Dr. T. which was completed in 2002 when the Child was only 5 years old. A diagnosis of ADHD completed years ago is not necessarily indicative of a mental disorder. Dr. C. gave a provisional diagnosis of a learning disability which again is not indicative of a mental disorder. Dr. C. also gave a provisional diagnosis of Substance Use Disorder but there was only second hand speculation that the Child used drugs on one occasion. The Child denied drug use. The Board accepts the direct evidence of the Child.

16In describing the Child’s mental status on admission, Dr. C. states that, “her thought process was coherent. She denied any perceptual abnormalities. It was difficult to assess her insight.” The Act defines a mental illness as a substantial disorder of emotional processes, thought or cognition. At the time of admission, according to Dr. C., the Child’s thought process was not substantially impaired but was coherent. This mental disorder must also grossly impair a person’s capacity to make reasoned judgments. Dr. C. had difficulty assessing the Child’s insight or judgment. While the Child’s behaviour does show poor judgment as evidenced by incidents of AWOL and inappropriate aggressive behaviour, it does not meet the test of a gross impairment of her capacity to make reasoned judgments as required by the Act.

17The Board was satisfied that criterion (a) was not 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.

18Since the Board did not find that the Child had a mental disorder as defined by the Act, this criterion could not be applicable and was not met.

Criterion (e) no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the circumstances.

19The Board did not find that the Child had a mental disorder as defined by the Act. However, it is clear to the Board that the Child has difficulties and requires assistance. From March […], to June of this year, the Child was placed in a foster home, [“A”] Residence, [“B”] Residence, and [“C”]. Each of these placements became more restrictive due to the Child’s behaviour. However, there was no evidence that treatment was provided to her while she was placed at these homes. The Child was offered counselling at [the agency] for sexual abuse trauma but this occurred sometime in 2009. The Child indicated an interest in returning to counselling, which was known to her children’s aid worker but this was not followed up on. There was mention of a referral to the committee that helps find placements for hard to serve youth, “CARRS”, but this referral was never completed. A psychological assessment was not scheduled until August, 2010.

20This Child could benefit from an up to date assessment and therapy in a treatment foster home or similar environment. The Child is only twelve years of age and has not been offered services responsive to her experiences and behaviours.

CONCLUSION

21Pursuant to section 124 (13) of the CFSA, the Board, having satisfied itself that the criteria (a) (b) and (e) have not been met, released the Child, M.P., from the Emergency Secure Treatment Program at Youthdale on June 24, 2010.

Sheena Scott

Presiding Member

Alina Lazor

Panel Member

Mary Wong

Panel Member