Z.M. v. Youthdale Treatment Centre, 2008 CFSRB 50

CHILD AND FAMILY SERVICES REVIEW BOARD

Z.M.

v.

Youthdale Treatment Centre

REASON FOR DECISION

Date: May 28, 2008

Citation: 2008 CFSRB 50

Indexed as: Z.M. v. Youthdale Treatment Centre (CFSA, s.124)

1On April 27, 2008, the Child and Family Services Review Board (the “Board”) received the application of the Applicant, d.o.b. January […], 1995, for a request to be released from Youthdale Treatment Centre, Secure Treatment Program, pursuant to section 124(9) of the Child and Family Services Act, R.S.O. 1990, c. C.11 (the “Act”). All of the parties were informed of the Board’s intention to hear the application on May 2, 2008 at the Youthdale Treatment Centre, Toronto (“Youthdale”).

2At the hearing on May 2, 2008, the Applicant was represented by Herb Stover, Barrister and Solicitor, agent for the Office of the Children’s Lawyer. Youthdale was represented by Eric Sherkin, Barrister and Solicitor with Miller Thompson LLP.

ISSUES

3The Applicant was admitted to the Secure Treatment Program (the “Program”) at Youthdale on April […], 2008. He was seeking an order releasing him from the Program on the basis that the criteria for emergency admission as set out in subsection 124(2)(a) to (e) had not been met.

PROCEDURAL MATTERS

4The parties did not have an issue with the Board’s jurisdiction to hear the application or the composition of the panel. The parties declined to give opening statements. Mr. Stover indicated that the Applicant was contesting all five of the admission criteria as set out in subsection 124(2)(a) to (e) of the Act.

5The evidence was a package from Youthdale, exhibit Y-1. Mr. Sherkin and Mr. Stover had both agreed to remove the contents of Tab 10 from exhibit Y-1, prior to presenting the package before the Board.

6Testimony was heard from the following witnesses:

The Applicant - the Child

Z.M. - the Mother

R.W. - the School Principal

J. - Youthdale, Crisis Support Team Member

FACTS

7The Applicant resides at home in Scarborough, ON with his mother and two older siblings; a 20 year old brother and a 16 year old sister. His mother and father separated in 1997 and divorced in 2003. His father resides in Hamilton, ON and the Applicant has no contact with him. The Applicant is presently in grade seven at school and is currently suspended due to aggressive behaviours at school. Z.M. works full time at a supermarket and while she is at work, the Applicant’s two older siblings watch over him until his mother returns. Due to their schedules, there are times when the Applicant is at home alone for up to two hours until someone arrives to supervise him.

8The Applicant has been under the care of numerous professionals who have provided recommendations for the behaviours he displays and treatment options that could assist him. A summary of that care is set out below in chronological order.

9In April of 2005, the Applicant was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) by Dr. V., M.D., at a hospital. Medication was not indicated at the time of the assessment. Referral for a psycho-educational assessment through the school system was recommended. A May […], 2005 Psycho-educational assessment report made the following findings:

Grade four increasing academic and attention difficulties, teasing at school was reported by Z.M. to the school attended from Kindergarten to Grade five, Secord School.

Z.M. reports the Applicant had been angry and disliked school since grade four. In grade five a follow up on the Occupational Therapy assessment was recommended.

10Z.M. and R.W. both agreed on the following facts. In grade six, the Applicant attended a middle school where he experienced difficulty understanding academic material across subject areas, increasing difficulties with attention, organization and work completion. He is also described as “volatile” and “explosive” as well as having “strong reactions to minor events”. He displayed frequent use of inappropriate language as well as verbal and physical aggression. Frequency and intensity of aggression increased after the December holiday. An Individual Educational Plan (Behaviour) was implemented March […], 2007. The Applicant’s physical aggression towards his peers resulted in the denial of access and placement in a Junior Intensive Behaviour Program at a learning centre in April of 2007. On May […], 2007, the Applicant was escorted to the Emergency Department at another general hospital by a Child and Youth Worker (“CYO”) due to concerns for the Applicant’s safety.

11To deal with his behaviours the Applicant had been prescribed Concerta 36mg and Fluoxetine 20mg which where both stopped in April 2008 by his mother without medical consultation or supervision due to the side effects that she had observed. Dr. N. was the Applicant’s attending physician at that time and had seen the Applicant six or seven times in the last eighteen months. Dr. N. was only to work with the Applicant on a short term basis, but the Applicant required more medical attention than initially thought.

12Z.M. indicated she was seeing Dr. K. for assistance with parenting issues to deal with the Applicant’s behaviour issues and the effects on the family dynamics.

13On April […], 2008, the Crisis Support team at Youthdale received a call from the Principal at school, R.W. Z.M. was with R.W. at the time of the call. The school had organized a Risk Review meeting as the Applicant had been withdrawn from school and would likely not be returning due to persistent concerns regarding his aggressive behaviour. On April […], 2008, an assessment was completed and the Applicant was admitted to Youthdale.

14Z.M. testified that the support of the school and specifically the principal has been helpful and that the most important thing is that her son gets help. She has tried everything and nothing is working. She would like him to get help before he hurts himself. The Applicant once told her that “mommy you are very depressed and I am troubling you, so I am just going to kill myself”. That statement was extremely troubling for Z.M. and was a catalyst to her agreeing to admit her son to Youthdale.

15R.W. testified that he and his staff have gone to extraordinary lengths to ensure that the Applicant receives an education and that he gets the assistance he requires to keep himself, other students and staff safe. The Applicant has been provided with an Educational Assistant, an individual transport plan to and from school and constant communication between the school and home. There are forty five incidents outlined in the Special Education Student Behaviour Logs dating from Thursday September […], 2007 – April […], 2008. Several incidents caused great safety concerns at the school and on April […], 2008, the Applicant’s behaviour became extremely challenging and police intervention was warranted. The incident began when the Applicant was called to the office to be questioned about events in the classroom involving “Hush ups” that he witnessed. The Applicant believed he was being accused and he lost his temper. His behaviour escalated to swearing and threatening staff and students. The Applicant left the school and picked up a beer bottle he found in a snow bank and proceeded to threaten another teacher with it until R.W. and another teacher retrieved it from him and walked with him around the school property to calm him down.

ANALYSIS

Criterion (a): the child has a mental disorder.

16A mental disorder, pursuant to the Act, is defined as a substantial disorder of emotional processes, thought or cognition, which grossly impairs a person’s capacity to make reasoned judgments.

17The Board received the Youthdale Admission Summary of Dr. D. dated April […], 2008. Dr. D.’s provisional diagnosis for the Applicant on admission noted the following conditions which would be assessed: Oppositional Defiant Disorder (ODD), Attention Deficit Hyperactivity Disorder (ADHD), Mood Disorder (Bipolar Disorder), Obsessive-Compulsive Disorder (OCD), Neuro-Developmental Syndrome, Post Traumatic Stress Disorder. Dr. D. also noted a learning disability in written expression and a current respiratory viral illness. Some possible causes for the behavioural issues may stem from an abusive father and the subsequent traumatisation of his mother. The Applicant’s present level of functioning was recorded as poor.

18Assessment and Treatment recommendations made by Dr. D.:

1. The Applicant will be admitted to the Acute Support Unit for his safety and that of his family, peers and teachers at school.

2. During this admission it will be essential to parse out what are his exact diagnoses and whether or not he requires pharmacotherapy for a specific psychiatric illness.

3. A sleep study may be indicated as there is a significant history of poor sleep in collateral information, although this is denied by the Applicant.

19The Applicant admitted that he doesn’t know why he gets so angry and that while he threatens to kill people, he doesn’t want to kill them, he just wants to hurt them really bad. He also stated that he doesn’t think he has been bullied because he sticks up for himself.

20The Board finds that all of these incidents, behaviours and comments reveal that the Applicant has a grossly impaired capacity to make reasoned judgements.

21The Board accepts the opinion of Dr. D. and finds that the Applicant has a mental disorder.

22The 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, herself or another person.

23Dr. D. was of the opinion that as a result of his mental disorder the Applicant caused, attempted to cause and by conduct made a substantial threat to cause serious bodily harm to himself and others. The single threat to commit suicide is noted above. The Applicant did not seem to understand the consequences of his actions and the risk of injury that his actions presented to either himself or others. He had threatened to kill his child and youth worker, kicked her car, threatened a Vice Principal with a beer bottle and also threatened to set fire to the school. The Applicant minimized these actions and/or testified that he did not remember. The Applicant stated that he punched walls, explodes and confronts people when he is angry.

24The Board finds that the Applicant, as a result of his mental disorder, caused and threatened to cause serious bodily harm to himself and others.

25The Board is satisfied that criterion (b) has been met.

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.

26Youthdale offers a secure program that is effective in preventing residents from causing or attempting to cause serious bodily harm to themselves or others. J., the Youthdale Worker, in his testimony spoke of the structure provided by Youthdale in its programs and routines. He indicated that the Applicant was in the Acute Support Unit, in an area separate from the other residents, where 1:1 staffing is provided 24 hours per day. J. also spoke of Youthdale’s security measures, high degree of supervision, and restricted access to objects. The Board accepts that the secure setting at Youthdale eliminates the risk of harmful threats.

27The Board finds that criterion (c) has been met.

Criterion (d): treatment appropriate for the child’s mental disorder is available at the place of secure treatment to which the application relates.

28Youthdale can provide appropriate treatment for children with mental disorders and has the qualified staff to meet any needs that arise. The Board finds psychiatric counselling and treatment is available in the secure environment at Youthdale and that this would be of benefit to the Applicant. At Youthdale, the Applicant has access to counsellors, a psychologist, a psychiatrist and other mental health staff that are able to address his mental health needs. J. gave testimony about the security that is available at Youthdale, indicating that the Applicant would be under constant supervision.

29The Board finds that criterion (d) has been met and that Youthdale can provide the appropriate treatment for the Applicant’s mental disorder.

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

30The Applicant has seen Dr. N., a psychiatrist, Dr. V. for treatment of ADHD and ODD, and has had a psychological assessment at a hospital. He also attended behavioural school programs and was taking Concerta and Fluoxetine and yet there was no improvement in his explosive aggression.

31There is no less restrictive method available to provide the Applicant with the treatment that he requires, as detailed in the evidence above. The Board also believes the evidence presented by Dr. D. on this matter.

32The Board finds that criterion (e) has been met.

DECISION

33On the basis of the evidence presented and in keeping with the principles contained in section 1 of the Act, the Board is satisfied that the relevant criteria were met at the time the Child was admitted to the Program and for that reason unanimously order that the Applicant’s application for release from the secure treatment setting be denied.

Lorna King

Presiding Member

Deborah Simon

Panel Member