J.P. v. Youthdale Treatment Centres, 2008 CFSRB 54

CHILD AND FAMILY SERVICES REVIEW BOARD

J.P. v. Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: June 2, 2008 Citation: 2008 CFSRB 54 Indexed as: J.P. v. Youthdale Treatment Centres (CFSA s.124)

1On May 9, 2008, the Child and Family Services Review Board (the “Board”) received the application of J.P., d.o.b. September […], 1994 (the “Child”), for a request to be released from the 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 this application on May 13, 2008, at the Youthdale Treatment Centre, Toronto (“Youthdale”).

2At the hearing on May 13, 2008, the Child was represented by Shuah Roskies, Counsel, from the Office of the Children’s Lawyer. Youthdale was represented by Meredith Wain, Barrister and Solicitor with Miller Thompson LLP.

ISSUE

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

PROCEDURAL MATTERS

4The parties did not have an issue with either the Board’s jurisdiction to hear the application or the composition of the panel.

5Ms. Wain made the motion that Dr. N.S., who was the Child’s psychiatrist, should not be allowed to give evidence as this could result in future confidentiality and trust issues between the Child and the doctor. Dr. N.S. had played a role in the pre-admission of the Child on April […], […] and […] as well as May […], 2008. The admitting Psychiatrist, Dr. B.W., was also summoned to give evidence however, he was unavailable.

6The Board ruled that it would hear Dr. N.S.’ testimony limited to the events leading up to the Child’s admission on May […], 2008, which would not impinge on the doctor, patient relationship.

7Ms. Wain also sought to submit a March 2004 psychological report of the Child.

8The Board ruled that this report could not be submitted due to the age of the report and furthermore, a current psychological report was available in the document package.

9Ms. Roskies objected to the Youthdale worker presenting all of the evidence in the document package as the package included matters that he had no direct knowledge or involvement with.

10The Board ruled that the Youthdale worker could testify to those issues that he has direct observation and knowledge of.

11The parties declined to give opening statements. Ms. Roskies indicated that the Child was contesting all five (5) of the criteria as set out in subsections 124(2)(a) to (e) of the Act.

12The evidence was a package from Youthdale, exhibit Y-1, and testimony from the following witnesses:

J.P. - the Child

E.P. - the Child’s mother

A.W. - the Child’s guardian, Children’s Aid Society of Toronto, Social Worker

J.M. - Youthdale, Crisis Support Team Member

Dr. N.S. - Youthdale Psychiatrist

FACTS

13The Child was diagnosed with Attention Deficit Disorder in 2002. He is currently taking Concerta 64 mg daily. This medication has been helpful, but it has resulted in sleep difficulties. Over the past several years there has been a pattern of increasing defiance at home and physical aggressivity towards his peers at school. He has fifteen suspensions from school.

14The Child was taken into care on January […], 2008 because his parents were having difficulties managing him. He was removed from his foster home as a result of his threatening behaviours on April […], 2008 and placed at the […] Residence, a secure home from which he ran away twice. Since grade seven, there has been escalating marijuana and alcohol use. The Child also uses tobacco and carries a knife. He had lost his school placement for verbally abusing and threatening a Child and Youth worker and carrying weapons to school.

ANALYSIS

Criterion (a) the child has a mental disorder.

15A 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.

16The Board received the Youthdale Admission Summary of Dr. B.W. dated May […], 2008. The doctor gave a provisional diagnosis of the Child as having Conduct Disorder and Alcohol, Marijuana and Tobacco abuse. In the doctor’s opinion, these disorders grossly impair the Child’s capacity to make reasoned judgments.

17The Board heard evidence about the Child’s behaviours that demonstrated grossly impaired judgement.

18The Child’s mother testified that she entered into an Interim Agreement with the Children’s Aid Society of Toronto because the Child’s behaviour had been escalating and he had been making dangerous choices. He had engaged in breaking and entering, car hopping, he did not come home after school until late, he was skipping school, using drugs and there had been numerous calls to the police. On one occasion, the Child had locked himself in the washroom at school and climbed into the ceiling in order to frighten the children using the washroom. His erratic behaviour had led her to have him admitted to the hospital last year where he stayed for one week. The hospital was unable to help the Child because he did not want to change. In June of 2007, the Child broke a fancy goblet in the sink. The next day, E.P. noticed slashes on his arm and asked him about them. He went to his room and retrieved the broken glass with his blood still on it and told her that he had cut himself with the goblet glass. The Child’s mother testified that he had no unsupervised time at home to prevent him from taking off and using drugs. When he entered into care, he had the option of not following the rules and started to drink and use drugs daily. The Child admitted to alcohol, tobacco and marijuana use and taking prescription medication which he got from a friend.

19While attending school the Child was suspended for being high. On occasion, he did not come home after school and he put himself at risk by going to the beer store and the park with a sexual predator who spoke to him about sexual matters and stalked him at school and on the bus. The child did not recognize the gravity of the situation and thought that it was “no big thing”. He stayed out on December […], 2007 until 4:30 am. He ran away from his foster parent’s home, as well as from the […] Residence. His mother testified that he did not have the ability to see the consequences of his actions and that he needed to be contained for treatment.

20The Board finds that these incidents reveal that the Child has a grossly impaired capacity to make reasoned judgements.

21The Board accepts the opinion of Dr. B.W. and finds that the Child 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 bodily harm to himself, herself or another person.

23Dr. B.W. was of the opinion that as a result of a mental disorder the Child caused, attempted to cause and by conduct made a substantial threat to cause serious bodily harm to himself or others.

24On a visit home from his foster parents, the Child threatened to jump out of the window from the top floor of his parents’ home because he was upset. He was placed in a foster home with specially trained foster parents however, the placement broke down as a result of the Child’s escalating self destructive behaviour. The foster father found a cap gun and a knife in the Child’s room and additionally reported that he had made comments about killing himself. As a result, the Child was placed at the […] Residence, the society’s most secure home on April […], 2008. On May […], 2008, he ran away and slept in the park overnight. The next day, he ran away again and took another boy with him. They returned to the home with scratches from running in the bushes trying to evade the police. His Guardian also related an incident where the Child was upset and smashed his head against his window cutting himself and breaking the window.

25Dr. N.S. testified that the Child presented as angry and sad and that carrying a knife and abusing drugs and alcohol could impact on his behaviour in an unhealthy way, affecting judgement and impulsivity and leading to violence.

26The Child did not take responsibility for his actions explaining many of them as “not thinking” or over reaction on the part of the adults in his life.

27During testimony, he stated that he carried a knife for safety reasons to protect himself and that he had never used it. He admitted that he had a pop gun while he resided with his foster parents, but stated that others also had the same gun. The Child admitted to marijuana, tobacco, and alcohol use, as well as taking prescription medication which had been prescribed for his friend. He said that the cutting of his arm was a one time thing as he did not like the experience. He stated that his parents were making a big deal out of these behaviours and minimized the gravity of his choices. He also admitted to telling his teacher that “I feel like shitting on you” after an incident when she allegedly threw his bag outside the classroom door and his juice broke. On that occasion, he kicked his classroom door resulting in damage to the door. He testified that he had thrown a snowball (but not directly) at his Child and Youth worker and did not know what he was thinking when he did so.

28The Board finds that theses behaviours threatened to cause serious harm. The Board finds further that the Child, as a result of his mental disorder, caused and threatened to cause serious bodily harm to himself and others.

29The 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.

30Youthdale offers a secure program that is effective in preventing the Child from causing or attempting to cause serious bodily harm to himself or others. J.M., Youthdale worker, stated that the structure and programs reduced the risk of patients engaging in self-harm or harm to others. He testified that there was a high level of supervision and there was no access to potentially harmful objects. J.M. further stated that the locked facility would prevent the Child from running away. The Board accepts the fact that the secure setting at Youthdale eliminates the risk of harmful threats.

31The 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.

32Youthdale can provide appropriate treatment for children with mental disorders and has qualified staff to meet their needs. The Board accepts that psychiatric counselling and treatment is available in a secure environment at Youthdale and that this would be beneficial for the Child. Access to counsellors, a psychologist, a psychiatrist and other mental health professionals is available for the Child to address his mental health requirements.

33The Board finds that criterion (d) has been met and that Youthdale can provide the appropriate treatment for the Child’s mental disorder.

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

34Testimony from the Child’s parent and the Child’s guardian indicated that his risky behaviours had been escalating. Skipping school, being suspended from school 15 times leading to expulsion, running away from home multiple times, staying out all night, abusing drugs, alcohol and prescription medication, making contact with an inappropriate person in the community, breaking a window in anger, threatening to jump out of a window, carrying a knife, verbally abusing his Child and Youth worker, throwing a snowball at his Child and Youth worker were some of the activities that the Child had engaged in, yet he did not recognize that these were harmful or potentially harmful behaviours and accused his parents and his guardian of over reacting.

35All previous attempts to address the Child’s behavioural issues had failed. The Child’s mother had taken him to the hospital in the summer of 2007, and after a week he was discharged because he had refused to change his behaviours. The parents could not manage the Child and placed him in foster care on January […], 2008.

36He was placed with specially trained foster parents, but the placement broke down because of the Child’s behavioural problems. He was placed at the society’s most secure facility from which he ran away twice in one week. He was enrolled in the C.D. Programme at the school in January 2008, where he was in a class of nine children with a teacher and two Child and Youth workers. This programme was aimed at reducing self-harm, and addressing the Child’s drug abuse issues. He attended family and individual counselling at the facility and was placed in the society’s most secure home and despite these interventions, the child continued to exhibit harmful and concerning behaviours.

37The Board believes that the parents and other professionals made numerous attempts to address the Child’s behavioural issues and that none proved successful. Furthermore, the Board agrees with Dr. B.W. that the Child’s safety is at risk and that immediate stabilization and assessment, leading to the initiation of a treatment program, in a secure setting is recommended.

38The Board finds that criterion (e) was satisfied.

DECISION

39On 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 Child’s application for release from the secure treatment setting be denied.

Gail Gonda Presiding Member

Mary Wong Panel Member

Lorna King Panel Member