J.C. v. Youthdale Treatment Centres, 2013 ONCFSRB 13

CHILD AND FAMILY SERVICES REVIEW BOARD

J.C.

v.

Youthdale Treatment Centres

REASONS FOR DECISION

Date: March 7, 2013

Indexed as: J.C. v. Youthdale Treatment Centres (CFSA s.124)

INTRODUCTION

1J, the “Child”, is thirteen years old. He requested that the Child and Family Services Review Board (the “Board”) review his February 13, 2013 emergency admission to the Secure Treatment Program at the Youthdale Treatment Centre (“Youthdale”). The Child took the position that none of the statutory criteria for emergency admission contained in subsection 124(2) of the Child and Family Services Act, R.S.O. 1990, c.C.11, as amended (the “Act”) were met.

2The Child lived with his mother, father and an aunt on various occasions but none of those living arrangements proved to be successful. His mother placed him with the [ ] (“Society”) in August 2012. The Child is diagnosed with a learning disability, intermittent explosive disorder and post-traumatic stress disorder. Upon coming into the Society’s care the Child was briefly placed in a foster home and then moved to a treatment group home. On November [ ], 2012, in response to his increasingly aggressive and risky behaviours, the Child was admitted to Youthdale’s Acute Support Unit. He was transferred to the Youthdale Transitional Psychiatric Unit on November [ ]. On December [ ], 2012 he was moved to [a rural treatment setting].

3For the following reasons the Board is satisfied the Child met all the criteria for emergency admission to the secure treatment program at the time of admission. His request for review is therefore dismissed.

ANALYSIS

4Section 124(13) of the Act provides that;

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 clause 124(2) (a) to (e).

Section 124(2) sets out the criteria which must be met at the time of admission.

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.

Criterion (a) the child has a mental disorder.

5A 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 have a substantial emotional processes disorder which grossly impaired his capacity to make reasoned judgments.

6The admitting psychiatrist had seen the Child previously in December 2012, when she felt he was settling in well, and again in January when he began to experience difficulties in the [rural treatment setting]. She testified about her assessment of the Child when he was admitted in February 2013 as well as about the Form 14, Statement of Reasonable Grounds For Admission to Secure Treatment, and the Youthdale Admission Summary she completed at that time.

7In her opinion, the Child had a substantial disorder of the emotional process and thought resulting from his post-traumatic stress disorder and learning disorder at the time of his admission. She testified that the Child experiences emotional and behavioural dysregulation and can become very aggressive. He acts impulsively thus endangering himself and others. He had struggled to manage his behaviours and feelings in an adaptive manner but became explosive when agitated and caused extensive property damage. In her opinion the Child had become so aggressive and agitated at the time of admission that it was no longer safe for him to be in the [rural treatment setting]. The admission documents are consistent with her oral evidence.

8The Child’s worker testified that the Child had been aggressive and violent in his foster home and group home placements. He attempted suicide in September resulting in an involuntary admission to hospital following which he was placed in the Acute Support Unit. The Child was referred to the [rural treatment setting] but became increasingly “worse” and could not be managed successfully in the program.

9The [rural treatment setting] residence supervisor testified that for the first few weeks of residency the Child’s behaviour was appropriate. After his mother canceled a visit during the Christmas season the Child started to exhibit increasingly aggressive behaviours, punched a hole in a wall, threatened to kill staff and peers and made statements about wanting to die. These behaviours escalated despite receiving extra supports and assignment to a one to one worker. On February [ ], 2013 the Child had to be restrained.

10The Child testified about these events. He agreed he punched holes in walls but said he knew how to do so safely without hurting himself. He admitted to the destruction of property and to breaking a picture frame to use the glass as a weapon. He also acknowledged that he had threatened to commit suicide but he stated that these incidents were done to get attention.

11The Board has considered all the evidence and is satisfied, on a balance of probabilities that, at the time of admission, the Child had a substantial emotional processes disorder which grossly impaired his capacity to make reasoned judgments. The Child’s impulsivity, his inability to think through the consequences of his actions, which he testified was “normal” for him, his rage which made him destroy his surroundings, the minimizing of his actions and the easy triggering of his negative behaviours support this conclusion.

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 or others.

12Evidence from the Child and his caregivers confirm that the Child has, as a result of his mental disorder, attempted to cause and made substantial threats to cause serious bodily harm to himself.

13He punched holes in the walls and broke his bed frame. On another occasion he expelled the contents of a fire extinguisher in the corridor and then smashed his room door with the extinguisher. He wrapped a piece of glass on his hand to use as a weapon cutting his finger in the process.

14The [rural treatment setting] supervisor testified that on January [ ], 2013 Child climbed out of his window and jumped ten to fifteen feet to the ground after which he played in an isolated area with wild life and without appropriate clothing. When staff intervened the Child tried to get into a van.

15The Child agreed he jumped out of his window but said it was only a four feet drop to the ground. He claimed he was just going around the van and did not go in it. He said he wanted staff to leave him alone so he could jump out of his window again. He explains that his behaviour was as a result of wanting to return to the City. He testified that he took the “bad way” to get out of the camp as he never got to see his mother.

16Staff at the [rural treatment setting] believed that many of his actions were not “attention seeking” despite the Child’s claims that they were. On January [ ], 2013 the Child barricaded himself in his room and slipped a note under his door which stated “I am done living, bye bye”. Staff pushed into the room and found the Child with a garbage bag over his head. Staff took away the garbage bag and the Child threatened staff with a sharp pencil and climbed on his window threatening to jump. He also threatened to stab himself in the neck if staff did not get out of his room. The Child took down the curtain rod and threatened the staff with it. The Child continued to escalate telling staff that he will slit their throat and gouge their eyes out.

17On another occasion the Child became upset with a peer and after throwing things around his room, he broke 2 chairs and wrote that he wanted to kill a peer, he made weapons out of a corkboard with screws and he threatened to hurt staff by cracking their skull and then killing himself.

18The Child attempted suicide on three separate occasions by putting a rope, a chain and a belt around his neck in attempts to hang himself.

19The Board is satisfied there is ample evidence of serious threats of harm to the Child and others and that these are a result of the Child’s mental disorder and in particular his inability to control his moods and actions. The Child has made sharp objects into weapons and repeatedly threatened to harm himself, peers and/or staff. The Child explained his actions in the [rural treatment setting] as attempts to be returned to the City. However, the evidence is clear the Child engaged in similar aggressive and self-harming behaviours, most notably the suicide attempt which resulted in the involuntary hospital admission, while living in the foster home and the group home in the City. The Child’s threats of self-harm and harm toward others were substantial because they involved more than the Child making statements. There were actions; he made potential weapons out of household objects, he attempted to strangle and suffocate himself, he hurt himself and did not recognize that he was hurting himself. These actions increased the likelihood that the Child would carry through with his attempts at serious bodily harm.

20The Board finds criterion (b) was met at the time of admission.

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.

21The psychiatrist testified that the secure treatment program would be effective to prevent the Child from causing or attempting to cause serious bodily harm to himself or another person. The secure program ensures that objects including belts, strings and knives are not available to be used by the residents to harm themselves or others. The high level of security and structure, along with a high staff to child ratio which is maintained at all times will prevent the Child from harming himself or others.

22The Crisis Worker agreed the Child could threaten to harm himself on the unit; however, he would be monitored very closely because of his history of risk.

23Placement at Youthdale will prevent the Child from engaging in the impulsive behaviours that have put the Child at risk of attempting to cause harm to himself or others. The 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.

24The Board is satisfied that treatment appropriate for the Child’s mental disorder is available at Youthdale.

25The Crisis Worker testified concerning Youthdale’s clinical, therapeutic and counselling services which would be available to the Child. The Board is satisfied Youthdale has appropriate clinicians and supports to closely monitor the impact of medication, as well as the Child’s behaviours. The 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.

26Based on the evidence presented by the Child’s Worker and the admitting psychiatrist, the Board was satisfied that no less restrictive method of providing treatment appropriate for the Child’s mental disorder was appropriate.

27As noted above the Child’s foster home and treatment group home placements broke down because of the Child’s aggressive and self-harming behaviours. Placements in the Acute Support Unit, the Transition Unit and [rural treatment setting] were similarly unsuccessful. Despite having individual assistance at school, a one to one worker, regular phone meetings with a psychiatrist, and medication adjustments at his request while in the [rural treatment setting],, the Child’s aggressive, risky and potentially harmful behaviours continued to escalate.

28The Board finds the Child received services with various degrees of intrusiveness in the community and despite these measures the Child’s behaviors have escalated. The Board is satisfied that given the Child’s extreme behaviors, a locked setting was required. The psychiatrist’s opinion was that the Child needed to be contained on a locked unit because he was very explosive which causes safety concerns for peers, staff as well as the Child. It will also provide appropriate treatment because the Child will attempt to run from or disrupt a non-secure setting and will only be able to benefit from treatment in a locked setting.

29The Board finds that criterion (e) was met and that no less restrictive method of providing treatment appropriate for the Child’s mental disorder was appropriate in the circumstance.

CONCLUSION

30Pursuant to section 124(13) of the Act, the Board, having satisfied itself that each of the criteria in subsections 124(2) (a) through (e) have been met, dismisses the application for released of the Child on February 19, 2013.

CONFIDENTIALITY ORDER

31Parties and their representatives must not use, share or disclose any documents or information provided or used in this application with anyone including the media or on-line. Any documents or information shared by the parties must be used only for the purpose of the hearing of this application by the Board.