A.F. v. Youthdale Treatment Centres, 2014 CFSRB 10

CHILD AND FAMILY SERVICES REVIEW BOARD

A.F.

v.

Youthdale Treatment Centres

REASONS FOR DECISION

Date: February 28, 2014

Citation: 2014 CFSRB 10

Indexed as: A.F. v. Youthdale Treatment Centres (CFSA s.124)

INTRODUCTION

1A. F., the “Child”, asks the Child and Family Services Review Board (the “Board”) to review her February 10, 2014 emergency admission to the Secure Treatment Program at the Youthdale Treatment Centre (“Youthdale”). Her position is that criteria (a), (b) and (e) 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 not met.

2The Board is satisfied that the Child met all the criteria for emergency admission at the time of admission. Her request for release from Youthdale is therefore dismissed. Since the Child conceded criteria (c) and (d) in subsection 124(2) of the Act, the Board will only give reasons for its findings concerning criteria (a). (b) and (e).

BACKGROUND

3The Child is a 13 year old girl who was living with her mother and siblings. The family has been involved with the [society] on multiple occasions because of the mother’s inability to manage and care for the children and because of allegations against the mother’s partner. The Child and her two brothers are currently in the care of the [society].

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).

5Section 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.

6Since the nature of the admission was on an emergency basis, the Board followed its usual practice of considering only evidence immediately leading up to the date of admission, and preferably not more than six months prior. Evidence dating further back might be considered as background information.

7The Admitting Psychiatrist diagnosed the Child with Conduct Disorder, possible reactive attachment disorder and wanted to rule out major depression and posttraumatic stress disorder. He also noted developing mixed Cluster B personality disorder traits.

8The Admitting Psychiatrist was of the opinion that the Child had a substantial disorder of emotional processes which grossly impaired her judgement. Her pattern of behaviour suggested to him that she had problems with using appropriate judgment. The Child’s actions showed impulsivity, difficulties related to mood, relationships and historical trauma. The Admitting Psychiatrist considered the defiance of the Child to the mother, her running away sometimes for days at a time, the vandalising of property at home, carrying a knife, allegations of substance abuse and prostitution. The Admitting Psychiatrist also noted that the Child was struggling to control her moods. The Child had a history of temper outbursts punching walls until she broke her hand. She cut herself with sharp objects and had a number of hospital visits to emergency services. The Child was sexually assaulted by an uncle and physically abused by the mother. There was evidence of possible depression, anxiety and unresolved trauma. The home was disorganized and unstable and the family had a history of schizophrenia and bipolar disorder.

9A psychological assessment was completed for the Child in October of 2013. The Psychologist found that the Child had a high level of maladjustment for conduct problems with symptoms in the clinically significant range. Other areas such as hyperactivity, anxiety, somatization, attention problems and overall adaptive functioning were found to be in the at risk range. The Psychologist recommended that given the Child’s high risk behaviours, intensive residential treatment in a crisis unit such as Youthdale would be beneficial.

10The Society Worker testified to the behaviours of the Child that led to her admission to Youthdale. The Child was placed in numerous foster homes but kept placing herself at risk by running away. In September of 2013, the Child was returned to her mother under a supervision order. While with her mother, there was ongoing and serious conflict over the rules in the house. The Child very frequently was out in the community until four or five in the morning. The Child stole her mother’s car keys, and went joyriding with her friends until late at night – this at a time when the Child was barely 13 years old. She punched her locker at school numerous times and broke her hand, requiring medical attention. She injured her hand again resulting in a recasting of her broken hand. At home she punched holes in the wall and broke a door when in conflict with her mother. The Child ran away from her last foster placement in minus 20 degree weather without her coat and shoes.

11The Board found that there was sufficient evidence to show that the Child had a mental disorder within the meaning of the Act. The definition under the Act is:

s.112 “mental disorder” means a substantial disorder of emotional processes, thought or cognition which grossly impairs a person’s capacity to make reasoned judgments.

12The Board accepted the evidence of the Admitting Psychiatrist that the Child at the time of admission had a mental disorder within the meaning of the Act. The Psychologist was also of the opinion that the Child was in the clinically significant range for conduct problems. However, the Psychologist believed that the Child was only in the at risk range in overall adaptive functioning. Since the psychological report was completed several months prior to admission, the Board accepted the evidence of the Admitting Psychiatrist that at the time of admission the Child’s mental disorder grossly affected her judgement.

13The Board found that the actions of the Child demonstrated a substantial disorder of emotional processes, thought or cognition which grossly impaired her capacity to make reasoned judgements. The Board noted that the Child’s emotional processes were so impaired that she punched her locker until she broke her hand. She subsequently reinjured her hand with continuous punching. The Child demonstrated grossly impaired judgement again when she put herself, her friends, and other motorists at great risk of serious injury when she took her friends on a joyride at the age of 13. She also on many occasions ran away in extremely cold weather without shoes or a coat.

14The Board was satisfied that criterion (a) was 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 herself or others.

15The Admitting Psychiatrist was of the opinion that the Child posed a substantial threat to cause serious harm to herself and others. He noted her lengthy periods of running away, her sexual involvement with older individuals, her suicide attempts, the possession of a knife for protection and the injury when she punched the wall. The Admitting Psychiatrist was concerned that the Child saw no risk in her sexual relationships with men and that her behaviour was escalating, thus, increasing the risk to the Child.

16The Society Worker stated that In October of 2013, the Child took eight Advil and there were concerns of her using alcohol and marijuana. The Child posted naked pictures of herself on the internet and posted that she was having sex with older men. She had panic attacks at school which resulted in an ambulance being called. The Child used razor blades to cut herself on her wrist and made tattoos on her body with razors. She admitted to cutting herself to appease her pain.

17The Society Worker stated that the Child was apprehended about a month and a half ago. Since the end of January 2014, she was placed in three foster homes. In the last foster home she was only there for about an hour before she cut a hole in the window and left with no shoes or coat in minus 20 degree weather. She was “couch surfing” in the community and back and forth at her mother’s home. She ran away from Society care for a month until found by staff and taken to hospital for an assessment.

18The Society Worker testified that the Child was engaging with men and there were strong suspicions that she was performing sexual favours for money. The Child who is only 13 has admitted to having sexual relations with men who are 16 years old, but does not acknowledge relationships with older men. There are allegations of the Child having sexual relationships with an 18 year old man.

19The Child was taken to hospital four times, seen by the crisis doctor and released. The Society Worker stated that the Child is very crafty and knows what to say to the doctors. She de-escalates and tells them that she does not want to kill herself. The Society Worker stated that the Child has engaged in suicidal ideation and has in the past alluded to ending her life in a note, put a belt around her neck, grabbed a knife and scissors intending to harm herself.

20The Society Worker testified that the Child ran away approximately 95 percent of the time.

21The Board was satisfied that by her actions the Child has made substantial threats to cause serious bodily harm to herself and others and that these are a result of the Child’s mental disorder. As noted above, the Child’s joyriding put herself and others at significant risk of serious bodily harm. The Board considered that this was a substantial risk to the Child and her friends. The Child caused bodily harm to herself which was serious enough to require medical treatment when she punched her locker with sufficient force that she broke her hand. The Board was particularly concerned with the Child’s persistent running away for 95 percent of the time. While it may not be as much of a concern in the case of an older youth, the Child just turned 13 in November of 2013 and at such a young age puts herself at significant risk when her whereabouts in the community is unknown for lengthy periods of time. In the time leading up to admission, the Child ran away from her foster placements for a period of a month. The Board believes that the Child’s actions have put her at significant risk of harm.

22The Board was satisfied that criterion (b) was met.

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

23The Admitting Psychiatrist testified that admission to the secure program was appropriate because of the Child’s history of resistance to voluntary treatment and the escalating concerns for her safety. The Child was originally accepted for admission to the voluntary unit at Youthdale. The Crisis Worker testified that there were two offers of admission to the voluntary unit made in November of 2013. On November 5, 2013, when Youthdale staff went to the Child’s home to bring her for admission, the Child and the mother were not present. The admission to the voluntary unit was rescheduled for November 7, 2013. The Child and her mother were not at home again and the admission did not occur.

24The Society Worker testified that the Child has been placed in numerous foster homes and in treatment foster homes. The Child had counselling services through Youthlink but this was not effective. The Society Worker had difficulty obtaining treatment for the Child in the community because she was constantly running away.

25Because of the Child’s persistent running away and her resistance to voluntary treatment, the Board was satisfied that no less restrictive method of providing treatment appropriate for the Child’s mental disorder was appropriate.

CONCLUSION

26Pursuant 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, dismissed the application for release of the Child on February 15, 2014.

CONFIDENTIALITY ORDER

27Pursuant to Rules 30.1 and 30.2 of the Board's Rules of Procedure parties and their representatives must not use, share, discuss or disclose and Board documents or decisions or any other documents or information provided or used in this application with anyone including through the media or on-line. The Board prohibits the use of any of this information for any purpose outside of the Board's proceedings.

LORNA KING

________________ Lorna King

Presiding Member

JOHN SPEKKENS

________________ John F. Spekkens

Board Member

MARY WONG ________________ Mary Wong

Board Member