R.K. v. Youthdale Treatment Centres, 2015 CFSRB 55

CHILD AND FAMILY SERVICES REVIEW BOARD

R.K.

v.

Youthdale Treatment Centres

REASONS FOR DECISION

Date: December 10, 2015

Citation: 2015 CFSRB 55

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

INTRODUCTION

1R. K. (The “Child”) made an application to the Child and Family Services Review Board (the “Board”), to review his November 27, 2015 emergency admission to the Secure Treatment Program at Y Treatment Centre. The Child took the position that the statutory criteria (a) (b) and (e) 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 at the time of his admission. The Children's Aid Society ("Society") sought his admission to the secure program, because of the Child’s alleged violent and aggressive physical behaviours towards his family and his care givers.

2The Board was satisfied that, at the time of the Child’s admission, criteria (a) (b) and (e) were met, as required in subsection 124(2) of the Act. The Child conceded criteria (c) and (d) of the Act. For that reason, the Board denied the application for the Child's release on December 3, 2015.

BACKGROUND

3The Child is twelve years old and he is currently a Ward of the Society. He maintains contacts with his family. The Child spent six months at a psychiatric facility in Hospital A, after which he was placed at Locked Facility B for an additional six months during the last year.

4The Child has five full siblings in the home. He was diagnosed with conduct disorder, and oppositional disorder. He has exhibited threatening and aggressive behaviours towards his family, nurses and staff and he requires two members of staff within sight at all times because of his anger management issues.

ANALYSIS

5Section 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).

6Section 124(2) sets out the criteria all of 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 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.

7The Board must decide whether each of the relevant criterion was met at the time of admission on the balance of probabilities.

Criterion (a): the child has a mental disorder

8The Admitting Psychiatrist was of the opinion that the Child fulfills the criteria under the Act, because the Child’s emotional, cognition and thought processes were so impaired that he did not have the capacity to make reasoned judgments. The Admitting Psychiatrist found that the Child had a history of homicidal behaviour, and aggression and that he had spent the preceding year in treatment facilities. The Psychiatrist testified that the Child had a diagnosis on the autism spectrum disorder; he also believed that the child functions with a moderate intellectual disability in the range of language and that a language assessment is necessary. Further he stated that the Child has a tic disorder which impacts his ability to control his impulses. The psychiatrist testified that there were abnormal findings on the Child's neurological examination which suggests that he has dysmorphic features. Previously the Child has been diagnosed with conduct disorder, and oppositional disorder but he refuses to take Risperidone because of the taste.

9The Psychiatrist testified that the Child was moved to Facility B, which is a locked facility, from Hospital A because of his high needs. He believed that the Child has a mental disorder, under the act because of his inability to regulate his feelings and his underlying emotional response towards his family and the community. The Child has issues with empathy, affect, anger from fear, reciprocal feelings of intrusiveness and unusual thoughts. The Child has repeatedly assaulted his brother with a knife causing serious, life threatening wounds and he had been aggressive to other members of the family as well as his caregivers.

10The Society Supervisor reported that the child was placed at Facility B on June 3, 2015, and he frequently exhibits aggressive behaviours towards staff and his family. In August, 2015 he punched a female worker in the face, because he was angry. Staff gave him time out in July 2015, and he punched that staff in September without warning, an indication that he harbours anger for lengthy periods and that his anger can erupt without notice. The Child displayed aggressive acts to his workers and to his mother in August, September and October without provocation. His Individual Educational Plan included accommodations for language, maths, science, social studies, and addressed behavioural concerns because his behaviour was volatile.

The Act states:

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.

11During the Child's placement at Facility B, he was alone in a special unit for six months. It was an artificial environment with very little peer interaction. The goal of the placement was to complete a full assessment of the Child, in order to inform future treatment and placement. He received a partial assessment from Facility B, because he needed to be placed in a facility with his peers, in order to complete the assessment. The Child's reaction to his peers is unpredictable. The Supervisor stated that when the Child is at home the girls sleep with their parents and they lock up the knives to keep safe.

12The Psychiatrist testified that in his opinion the Child has mental, cognitive and emotional difficulties and he has a mental disorder within the meaning of the Act, as evidenced by his inability to regulate his feelings and his emotions towards his family and the members of his community. This is as a result of the Child's issues with empathy, affect, rage from fear, reciprocal feelings of intrusiveness and unusual thoughts

13The Board concluded that the Child had a mental disorder within the meaning of the Act. The Admitting Psychiatrist was of the opinion that the Child’s emotional, cognition and thought processes were so impaired that he could not control his behaviours or make reasoned judgments. This was reflected in the Child's history of homicidal behaviours with a weapon and his aggression in treatment settings, and the behaviours of the Child as described by the Supervisor and the Admitting Psychiatrist. The seriousness of the Child's mental disorder is also reflected in his yearlong admissions to Hospital A and Facility B. The Board accepted the evidence of the Admitting Psychiatrist that the Child had a substantial, mental disorder that grossly impairs his ability to make reasoned judgments.

14The Board is satisfied that criterion (a) has been 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 or others.

15The Admitting Psychiatrist testified that the Child had stabbed his eighteen year old brother in the chest while he was studying, in 2014, resulting in pneumothorax. The Child had previously stabbed the same brother in the leg and showed little remorse for these stabbings. The Psychiatrist testified that the Child was fascinated with physical aggression towards his peers and the nurses at Hospital A, and this had resulted in many restraints. He was released to Facility B after six months at Hospital A, which was not equipped to look after him.

16The Supervisor testified that the Child was disruptive and reactive at school and his unprovoked violence was difficult to manage. He hit and punched his family, in one incident on an outing on August 8, 2015 he choked his younger brother who is five years old, damaged property in the mall, and threw a pile of napkins in his mother's face. The visit had to be discontinued. There is no way to predict the Child's violent outbursts. He was placed alone in a unit at Facility B but the unit was unable to complete an assessment of the Child's unusual and complex needs in this isolated setting as he had very little contact with children his own age.

17During the last year the Child has lived at Hospital A and Facility B and despite the controlled settings in these institutions, he has engaged in violent, aggressive and unprovoked acts against staff and his family. The Psychiatrist at Facility B testified that there were concerns around the Child's aggression and level of risk, he was deregulated and he would get stuck and rigid and find that he could not proceed.

18The Board concluded that the Child caused serious bodily harm to his brother and that, this was as a result of his mental disorder. The Board heard that the Child had been admitted to a Hospital Mental Health unit for six months and then moved to a locked unit at Facility B for an additional six months. This unit was specially designed to assess the Child's complex needs, however, due to his age he was placed alone in a unit. The evaluation could not be completed, because the Child's response to his peers could not be evaluated because of his isolation.

19The Board noted that the Child made serious attempts to harm his brother and he inflicted a life threatening stab wound in 2014. Since then he has been in institutions, however, his fascination with knives is ongoing, as is his violent, erratic, reaction to his family and caregivers. The Board concluded that because of the Child’s persistent attempts to harm his workers and his family and his lack of control and impulsivity, he has the potential to cause serious bodily harm to others. Despite the two workers which are assigned to him, the Child is able to precipitate incidents of aggression, requiring restrains.

20The Board is 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.

21The Facility B Psychiatrist confirmed that the Child's evaluation had not been completed during the six months he spent at that facility because the peer interaction component was missing. He was referred to Facility B from Hospital A, therefore the Child had spent a year in mental health facilities without a complete assessment. The Psychiatrist from Facility B described the child as "high-risk" and testified there were concerns around his aggression. She believed that he needed an age appropriate residential setting to manage his behaviours.

22The Society Placement Supervisor testified that the Society had requested the assessment report from Facility B, to inform its decision regarding potential placements for the Child. Unfortunately, with the noted concerns around the Child's aggression and risk and with no information regarding his interaction with peers, the Society had difficulties identifying and meeting the Child's needs, based on the information provided by Facility B. The facility recommended a residential home placement but none of the residential homes were appropriate to place the Child. One home stated that it would accept the Child if the assessment was completed and he was stabilized, so they could better understand his issues, triggers and treatment plan.

23The evidence before the Board indicated that although the Child had been at Hospital A and Facility B for a year, his assessment and treatment plan were not completed. The Child's behaviors around his peers is critical to his placement in a home with other children, as is his stabilization and the identification of his issues to minimize risk. The Board concluded that, at this time, the Child requires a secure environment to keep him and his peers safe, while he is being assessed and stabilized for transition to a residential placement.

24The Board is satisfied that criterion (e) has been met.

CONCLUSION

25Pursuant to section 124(13) of the Act, the Board, having satisfied itself that criteria (a)(b) and(e) in subsections 124(2) has been met, denied the release of the Child on December 3, 2015. The Child had conceded that (c) and (d) were met.

CONFIDENTIALITY ORDER

26Pursuant 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 any 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, except with an order of the Court or the Board, as appropriate.