J.J. v. Youthdale Treatment Centres, 2008 CFSRB 92

Child and Family Services Review Board

J.J. v. Youthdale Treatment Centres

Reasons for Decision on Merits

Date: October 22, 2008 Citation: 2008 CFSRB 92 Indexed as: J.J. v. Youthdale Treatment Centres (CFSA s.124)

Introduction

1This is an application to the Child and Family Services Review Board (“the Board”) by J.J., d.o.b. December […], 1994 (the “Child” or the “Applicant”), for a review of her emergency admission to the Secure Treatment Program of the Youthdale Treatment Centre, (“Youthdale”, “the facility” or “the Respondent”) pursuant to section 124(9) of the Child and Family Services Act R.S.O. 1990, c. C.11 (the “Act” or the “CFSA”).

2The Board must decide, on a balance of probabilities, whether each of the criteria set out in subsections 124 (2) of the CFSA were met at the time of the admission. The Respondent’s position was that all five criteria had been met and that the Application should therefore be denied. The Child’s position was that criteria (a), (b) and (e) had not been met and that therefore, she should be released.

3Pursuant to section 124 (13) of the Act, upon review,

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

4If any one of the criteria is not met, the Board is obliged to release the child.

5The applicable considerations are set out in the legislative provisions, which provide as follows:

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.

6For the reasons that follow, the Board was not satisfied that criteria (b) and (e) were met and ordered the release of the Child.

Background

7The Child is currently 13 years of age and was admitted to Youthdale on September […], 2008. The Child is Aboriginal and has lived for the most part in M. and K., moving between the homes of her mother and father. At the time of admission, she was in the care of Native Child and Family Services in [ ] (“the Society”). There is a long history of child welfare involvement in the North with the Child’s family, including concerns over parental use of drugs and alcohol and domestic violence. There was also some involvement by the child welfare agency in the North for parent/child conflict.

8In or around September of 2007, the Child lost a 17 year old cousin to suicide. The Child was very close to her cousin. The Child says that she cut herself in January, 2008 when dealing with her cousin’s death. When she saw the body of her cousin for the first time she felt she wanted to kill herself. According to the Child, this was the only time she had cut herself or had those feelings. The Child participated in a tele-psychiatry conference in February of 2008 with Dr. C. consulting for the Hospital. An intervention in May of 2008 was, according to the Child, because the agency had seen her scars from January, 2008.

9The Child was sent to live in Toronto two months prior to her admission. She was sent to live with her maternal grandmother. While at her grandmother’s house, she was forced, by a friend of her grandmother’s under threat of death and violence, to have sex with at least twenty men. The Child went to a friend’s (N.’s) home and told the friend what was going on and they contacted a children’s aid society. The police came and took the Child’s statement and placed her in the care of Native Child and Family Services on September […], 2008. The Child was placed in a group home on [ ] in [ ]. She ran away from the group home. She did not like the group home because it was old and had mice and bugs. She went to stay with a 19 year old friend. She babysat her friend’s baby. Her grandmother contacted the Society to report that she had been seen with a 29 year old man. No one interviewed the grandmother. The Child was picked up by police and returned to the group home. On the night she was returned, the Child was talking to her friend and the staff wanted her off the phone. She refused and ultimately, when the staff insisted, hit the staff with the phone in the face and in the hand. Not long after this incident, she was taken to [M.], the assessment and receiving placement for children’s aid societies. She went there with her worker, F.C. (“the Worker”), whom she had met for the first time that afternoon. Shortly after they arrived, the Worker took her to Youthdale as a bed had become available.

Analysis

Criterion (a) the child has a mental disorder.

10The Board was satisfied that the Child had a mental disorder within the meaning of the Act. A mental disorder is defined as a substantial disorder of emotional processes, thought or cognition, which grossly impairs a person’s capacity to make reasoned judgments. The Board was satisfied that, at the time of admission, the Child had a substantial emotional processes disorder associated with mood and trauma, which grossly impaired her capacity to make reasoned judgments.

11The Board accepted the evidence of Dr. S., the Director of the [ ] Crisis Services, who testified that the background assessments relating to the Child provided an ample and credible basis for believing the Child to be suffering from problems related to mood and anxiety, primarily as the result of trauma, as well as possible post traumatic stress disorder. The information submitted, including the report of Dr. C. and the Admission Summary of Dr. W., supports the existence of an emotional processes disorder.

12The testimony of the Child satisfied the Board that her disorder had grossly impaired her capacity to make reasoned judgments, proximate to the time of admission. The Child ran from the group home instead of trying to address concerns about mice and bugs with the Society. While Absent Without Leave (“AWOL”) from the group home, the Child babysat a baby without appropriate supports. The Child’s reaction to staff at the group home regarding the phone was excessive.

13The 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 himself, herself or another person.

14The Board was not satisfied that the Child, as a result of her mental disorder, caused or attempted to cause serious bodily harm to herself or another person.

15The evidence of self harm and suicidal ideation was too remote for the Board to consider it relevant to this admission. Dr. S., when discussing risk, confirmed that the issue of harm to others was more clearly documented than that of self harm. The best evidence regarding self harm was that of the Child. The Board accepts that she cut herself in January of 2008 in response to the death of her cousin and that the cuts were not severe.

16There was no evidence that the Child caused serious bodily harm to the staff at the group home when she hit her in the face and hand with the phone. The staff did not testify, nor were any medical reports filed. The only evidence was that of the Society’s Worker who stated that she believed the staff went to hospital but that she “was not sure of the extent of the injury”.

17The Child was sexually exploited. She feared the woman who threatened her into having sex with multiple partners. There was no evidence led to satisfy the Board that the mental disorder and not the external threat precipitated her unwilling participation.

18Criterion (b) was not 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

19The Board was satisfied that if there was an issue of risk in relation to the Child causing harm, Youthdale’s treatment program would be effective to prevent the Child from causing or attempting to cause serious bodily harm to herself.

20The Board was satisfied, based on the evidence of Dr. S. and the Youth Crisis Worker S.R., that Youthdale offered a secure setting, with a range of therapeutic interventions specific to mood disorders and possible post traumatic stress disorder that would be effective, as required by criterion (c).

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

21The Board was satisfied that treatment appropriate for this Child’s mental disorder of emotional processes was available at Youthdale. Dr. S. and S.R. testified about the range of treatments and assessments, specifically relating to mood disorders and post traumatic stress disorder, available at Youthdale for this Child. 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.

22The Board was not satisfied that no less restrictive method of providing treatment appropriate for the Child’s mental disorder was appropriate in the circumstances of this admission.

23There was an overall lack of information pertaining to placement options and treatment methods for this Child. The Worker had only met the Child on the day she admitted her to Youthdale. The Worker had not read the file of the Society’s placement team and was not aware of what had been pursued. The Worker felt that Youthdale’s Rural program was the most appropriate for the Child and would have taken her there; however, she thought she could not do so. She felt that a rural placement, more akin to what the Child was used to, was more appropriate than an urban placement which would “set her back”.

24According to Dr. S., the rural placement is highly structured, has an on-site school and is staffed by child and youth workers.

25The Child was about to be placed at [M], prior to her admission to Youthdale. Stays at [M] can be for two weeks and possibly longer. This is longer than a hospital stay on a Form 1. [M] could have made the referral to Youthdale’s Rural Program. [M] is not a locked setting, but has measures in place to prevent AWOLs. In any event, the child had only gone AWOL on one occasion. Dr. S. testified that with proper, additional supports, including in relation to safety issues, placement in a treatment foster home might be possible if available and accessible.

26S.R. testified that it was the role of the doctors at Youthdale to assess appropriateness of other treatment methods. Dr. S. was not the admitting psychiatrist and there was a lack of information in terms of any such assessment. The one line reference to this criterion in the Admission Summary is not adequate to satisfy evidentiary standards. The Crisis Worker did not consider the possibility of one to one staffing at [M] or other alternatives. The information available to Youthdale regarding the seriousness of the assault on the group home staff was not adequate to inform any proper assessment of less restrictive methods.

27The Worker testified that she wanted the Child admitted for an assessment. The Youthdale Crisis Worker spoke of the lack of information about this Child.

28The Child could have been placed at [M] for assessment and referral, possibly to Youthdale’s Rural program. While Community assessments take time, a concern of Dr. S., [M] was longer term than a hospital stay. Further, the Society, in case managing the Child’s needs, would have an obligation to seek timely assistance. The Society did not follow up with Dr. C. or other out patient options. [M] provided a less restrictive milieu for meeting and assessing the Child’s needs, in the community.

29The Child wanted to go to a treatment foster home and stated that she would attend a program. There was no evidence provided to suggest that such options were canvassed with her and that she refused. The Child accompanied the Worker willingly to [M]. The Child had only been in one foster home for a short time. The effectiveness of treatment foster care had not been tested or clinically ruled out.

30The Board is cognizant of the need for culturally appropriate services. There was no evidence about culturally appropriate services for the Child in the North, except to the extent that the Youthdale Rural program might more closely reflect the Child’s experiences in terms of environment, in contrast to an urban setting. The Child wanted out of Youthdale, in part because she missed the fresh air. A culturally based, Northern placement in a residential treatment home, the Rural Program or a treatment foster home with additional supports would have been more appropriate for the Child, in the circumstances.

31The Board was not satisfied, on the basis of the evidence submitted, that criterion (e) was met.

Conclusion

32Pursuant to section 124 (13) of the CFSA, where the Board is not satisfied that each of the five criteria have been met, it must order the release of the Child. In this case because the Board was not satisfied that criteria (b) and (e) were met, it allowed the application of the Child, under section 124(9) of the CFSA on September 29, 2008 and ordered the release of the Child.

Sheena Scott Presiding Member

Mary Wong Panel Member

Alina Lazor Panel Member