S.D. v. Youthdale Treatment Centres, 2011 CFSRB 6

CHILD AND FAMILY SERVICES REVIEW BOARD

S.D.

v.

Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: March 4, 2011

Citation: 2011 CFSRB 6

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

1This is an application by S.D. (the “Child”), born January […], 1996 for a review of her emergency admission to the Secure Treatment Program at the Youthdale Treatment Centre (“Youthdale”), pursuant to section 124(9) of the Child and Family Services Act (the “Act”). The application was dated February […], 2011 and related to the Child’s admission to Youthdale on February […], 2011. The hearing was held on February 22, 2011.

2The Board must decide, on a balance of probabilities, whether each of the criteria set out in subsections 124(2) of the Act was met at the time of admission. The Respondent’s position was that all five criteria had been met and that the application should therefore be denied. The Child’s position was that all five criteria had not been 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).

4For the reasons that follow, the Board found that the Child meets all of the five criteria for admission and denied the Child’s application to be released.

BACKGROUND

5The Child is a 15-year-old youth who was admitted to Youthdale on February […], 2011. She came into the temporary care of the [Society] in June 2010. She was placed in a group home, [Group Home], at around the same time that she came into the care of the Society.

6The Child had been living with her mother and her brother before her admission to [Group Home]. Her parents have been divorced for three years but share custody of the Child. They had hired a child and youth worker for two or three days a week to work with the Child at home, before she was placed in the care of the Society and at [the Group Home].

7The Child’s behaviour escalated while she was at [the Group Home], despite one to one staffing. In December 2010, the Child’s parents, the Society and staff at [Group Home] met to discuss a more appropriate placement for her. A possible placement at the [Treatment Centre] was being considered and in the interim, a placement at the Transitional Psychiatric Unit (TPU) at Youthdale. However, the Child’s behaviour continued to escalate and she was placed in secure treatment on February […], 2011 due to the behaviours described in the following paragraphs.

ANALYSIS

8The criteria that the Board must apply in secure treatment reviews are set out in the following legislative provision:

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,

(b) the child has a mental disorder;

(c) 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;

(d) 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;

(e) treatment appropriate for the child’s mental disorder is available at the place of secure treatment to which the application relates; and

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

9Each of the above criteria must be met at the time of admission to confirm the Child’s placement at Youthdale. In this case, each criterion was met, as described below.

Criterion (a) the child has a mental disorder.

10The Board is satisfied that at the time of this admission, the Child had a mental disorder within the meaning of the Act. A mental disorder is defined as a substantial disorder of emotional processes, thought or cognition, which grossly impairs a person’s capacity to make reasoned judgments.

11The Child’s father testified that the Child’s behaviour escalated before the end of the 2010 school year to a point where he and the Child’s mother had to hire a child and youth worker to work in the home two or three days a week to assist them. He recounted an incident in or around early June when the Child threatened to kill her mother. At the time, he called the child and youth worker and the Society in order to seek their advice. He was advised to either take the Child to the hospital or admit her to [Group Home], a group home for youth with a range of difficult behaviours and diagnoses.

12The Child’s mother confirmed that the Child was placed in the care of the Society following an incident in which the Child threatened to kill her and had pulled a knife on her brother. The Child’s mother stated that she was so frightened as a result of the threat to herself that she slept on a couch. She also stated that the placement at [the Group Home] was an emergency placement and that it was not the ideal placement for her daughter.

13The Child’s father testified that while at [the Group Home], the Child suffered a number of head injuries. He believes that some of these were the result of the Child’s impulsive risk- taking behaviour. One recent incident was the result of being punched in the head by another resident after an altercation between them. This same girl kicked her in the face and the Child went to hospital and was diagnosed with a concussion.

14The Child’s father stated that while the Child was on a home visit during the Christmas holidays, she stole his heart medications and brought them back to [the Group Home]. She gave them to some of the other residents who took them. Staff at [the Group Home] became aware of this and the Child and two other girls were taken to hospital and treated. The Child told her father that she took them in order to get “high”. The Child’s mother also reported on the theft of the Child’s father’s heart medications. The Child’s father testified that he received information from staff at [the Group Home] that the Child would provoke other girls in the house to a point where they had to assign her a one-to-one worker. This was done in August 2010 shortly after her admission. After the incident in which the Child suffered a concussion, [the Group Home] believed that she needed two dedicated workers to keep her safe.

15The Child’s father stated that she had been diagnosed with Tourette’s, Syndrome, Attention Deficit Disorder and possible fetal alcohol syndrome (FAS). He testified that she is in the process of having a full psychological assessment completed and an assessment done at [Hospital A] in [City A], to determine if she suffers from FAS.

16The Child’s father stated that [the Group Home] did not have the training or services available for a child with the range and severity of diagnoses and behaviours that the Child exhibited and as a result, both [the Group Home] and the Child’s parents were looking to have her placed in a long term treatment setting. There was agreement that the Child needed to have the assessments completed, a medication review and treatment planning for a placement that best met her needs.

17The Child’s father stated that initially they were looking at the [Treatment Centre] as an appropriate placement for the Child, who was looking forward to being placed there. In the meantime, the Child was being considered for a shorter-term placement at Youthdale’s Transitional Psychiatric Unit (TPU) given that her placement at [the Group Home] had broken down for the reasons described above. In addition, [the Group Home] staff had informed the Child’s father that the Child had reported swallowing glass and had to be taken to hospital. She was alleged to have done this on at least two occasions resulting in hospital visits where she was reported to have suffered abrasions.

18The Child’s mother testified that she received many calls from [the Group Home] when incidents occurred. These incidents included swallowing glass, jumping out in front of cars, repeated fights with other residents, setting fire to a couch in the residence and cutting herself. She further stated that the Child had set several fires at home as well – in the family room, on the deck, in the garage.

19The Child’s mother indicated that they had the Child admitted to [the Group Home] in the hopes that she could be helped. However, the Child’s behaviour had escalated during the time that she was there and had gotten worse.

20The Child’s Worker from the Society testified and confirmed reports from [the Group Home] similar to those the Child’s parents had received, such as the Child’s self-injurious behaviour and the pattern of altercations she got into with other residents, some of which resulted in serious injury to the Child. In a recent incident, the Worker testified that another resident had beaten up the Child because she stole from her. The Worker testified that she was also informed that the Child had attacked a staff at [the Group Home] and hit her.

21The Youthdale Crisis Support Team records included entries of reports from staff at [the Group Home] regarding the Child’s ongoing behaviour. On February […], 2011 the group home reported altercations between the Child and other residents that required calling the police, the Child’s attempt at setting a fire and an incident in the community where the Child was throwing objects at community members. There is an entry on February […], 2011 describing another altercation between the Child and other residents resulting in police charges being laid against the other residents and another fire related incident.

22The Child confirmed all of the incidents testified to by the other witnesses and described in the records. She confirmed that she does taunt and tease other kids, threatened her mother, pulled a knife on her brother, has cut in the past, took her father’s medications and set fires. The Child had an explanation for all of these behaviours that minimized their seriousness or her role in them. She stated that she had told staff at [the Group Home] that she had swallowed glass in order to get their attention. The Child presented a picture of her experience at [the Group Home] in an unrealistic positive light and failed to recognize that the group home was not able to manage her behaviour.

23A mental disorder 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 heard from the Child’s parents about behaviours that reflect a substantial disorder of emotional processes, thought or cognition which grossly impairs the Child’s capacity to make reasoned judgments. There were multiple and repeated instances of behaviours exhibited by the Child while in the care of her parents and in the group home that on the balance of probability cannot be otherwise interpreted. Many of these behaviours were aggressive gestures toward the people closest to her and to herself, or repeated gestures of inappropriate and dangerous attention seeking behaviour. Although the Board did not hear direct evidence regarding a current diagnosis, the weight of the behavioural evidence provided by the witnesses was sufficient to conclude that the Child suffers from a mental disorder.

24The Board believes that the pattern of behaviour exhibited by the Child in the months before her admission to Youthdale that are outlined in the preceding paragraphs, clearly demonstrates that she has a mental disorder as defined by the Act.

25The Board was satisfied that criterion (a) was met at the time of this admission

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.

26The Board was satisfied that the Child has, as a result of the mental disorder, attempted to cause or by words or conduct, made a substantial threat to cause serious bodily harm to herself or another person.

27The Board heard direct testimony from the Child and parents to substantiate that the Child has on many occasions threatened others and engaged in self-harming behaviours. The Board heard of multiple instances of fire-setting, cutting, ingesting glass and provocative behaviours that placed the Child and others at risk of serious bodily harm. Most recently, she gave some of the other residents at [the Group Home] her father’s heart medications that resulted in their having to go to the hospital. She also became involved in a serious altercation with another resident that resulted in a concussion to herself. For the duration of her stay at [the Group Home], the Child had to be supervised by a one-to-one worker to keep her safe and the group home was considering the need to increase her level of supervision based on her behaviours and risks they posed to herself and others.

28As a result of her mental disorder, the child engaged in attempts to cause serious bodily harm as noted above. In terms of a substantial threat to cause bodily harm, her threat to kill her mother was substantial because the child’s impulsivity and aggressive acting out mean that there was a chance she might actually have carried through on the threat. The threat the Child made against her brother was substantial because it involved actions combined with threatening behaviour: the actual brandishing of a knife. This in turn, could cause serious bodily harm.

29Based on this evidence, which appears in more detail under criterion (a), the Board is satisfied that criterion (b) has been met in terms of the Child’s attempts to cause and substantial threats of causing serious bodily harm to herself and others.

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.

30The Board was satisfied that the secure treatment program would be effective to prevent the Child from causing or attempting to cause serious bodily harm to herself or others.

31The Crisis Worker testified that Youthdale is a secure unit. The Child’s self-destructive and potentially self-harming behaviours occur when she has been at home and when she resided in [the Group Home], despite one-to-one supervision. Youthdale’s secure program ensures these behaviours cannot occur since any objects that can be used to inflict harm are removed and youth are supervised in accordance with their level of risk. The secure unit at Youthdale is also able to gradually integrate the Child with her peers in recognition of the past difficulties she has had.

32The 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.

33The Board was satisfied that treatment appropriate for the Child’s mental disorder was available at Youthdale.

34The Crisis Worker testified that at Youthdale, they could keep the Child safe since she would be in a locked setting with continuous observation to ensure that she does not harm herself. They could provide 24 hour nursing staff and daily medical attention from a doctor. They could provide individual therapy for the Child as well as group therapy to assist her in finding ways to safely cope with her feelings and interact with her peers. They could also gradually integrate her with her peers in a way that kept the Child and her peers safe, as part of her treatment plan.

35Youthdale is an appropriate milieu for the Child while long term secure treatment services are being sought to address her needs and the ongoing assessments are being completed. The assessment results can be used for long term treatment planning, a medication review can take place while the Child is at Youthdale and a possible sleep disorder suffered by the Child can be assessed. The Crisis Support Team records included information from staff at [the Group Home] that the Child had difficulty settling in the evening such that staff spent additional time with her to help her fall asleep.

36The Board was satisfied that criterion (d) was met.

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

37The Board is satisfied that no less restrictive method of providing treatment appropriate for the Child’s mental disorder is appropriate in the circumstances.

38The Child has recently resided in a treatment group home since July 2010. Before her admission, her parents had required a child and youth worker at home two or three times a week to assist them in managing her. The behaviours which led to her admission to the group home and coming into the care of the Society escalated while she was in the group home. Shortly after her admission to [the Group Home], the Child required one-to-one staffing to keep her safe and additional resources were being considered prior to her admission at Youthdale.

39At a Plan of Care meeting in December 2010, the Worker, the Child’s parents, the Child and the Society’s family worker agreed that [the Group Home] was not the most appropriate placement for the Child and that she could no longer remain there. As a result, alternative placements were being explored, including a placement at the [Treatment Centre] and the TPU at Youthdale. The Worker confirmed that there were assessments in progress and that the results of these would be helpful in treatment planning for the Child.

40The Youthdale Crisis Support Team records included entries that reflect the efforts being made by the Child’s parents and the Society to find a more appropriate placement for the Child. A final entry on February […], 2011 described the group home’s efforts to keep the Child out of the house daily from 5 pm to 9 pm to keep her from her peers. It further indicated that the Child could only be amongst peers if very closely supervised by staff.

41The group home was unable to manage the Child’s repeated high- risk behaviours. The Child’s parents and the Society had begun exploring other treatment options for the Child that included Youthdale’s TPU and the [Treatment Centre], when the Child’s escalating behaviours led to the need for immediate placement in a secure setting such as Youthdale’s secure unit. The caregivers in the Child’s life – her parents and the Society – believe that she requires a secure setting in order to receive treatment and keep her safe. Youthdale provides such a setting on an interim basis for up to 30 days while a longer-term treatment setting can be pursued.

42The Board is satisfied that criterion (e) was met.

CONCLUSION

43Pursuant to section 124 (13) of the Act, 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.D., under section 124(9) of the Act, on June 22, 2010.

Gail Gonda

Presiding Member

Alina Lazor

Panel Member

Lorna King

Panel Member