J.C. v. Youthdale Treatment Centres, 2009 CFSRB 37

CHILD AND FAMILY SERVICES REVIEW BOARD

J.C.

v.

Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: July 27, 2009

Citation: 2009 CFSRB 37

Indexed as: J.C v. Youthdale Treatment Centres (CFSA s.124)

1This is an application to the Child and Family Services Review Board (the "Board") by J.C. (the "Child"), born December [...], 1998, for a review of his emergency admission to the Secure Treatment Program at the Youthdale Treatment Centre ("Youthdale" or the "Respondent") on July [...], 2009 pursuant to section 124(9) of the Child and Family Services Act R.S.O. 1990, c. C.11 (the "Act"). The Board heard the application on July 17, 2009. The Board was satisfied that the Ministry granted approval for admission under the Act given that the Child is under the age of 12.

2The Board must decide whether each of the criteria set out in subsection 124 (2) of the Act was met at the time of admission, on the balance of probabilities, having regard to the best interests of the Child. The Respondent's position is that all five criteria were met and that the application should therefore be denied. The Child's position is that none of the criteria were met and that consequently, he should be released.

Pursuant 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).

3The relevant considerations in this case are captured by the criteria as set out in the legislative provisions, 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.

4For the reasons that follow, the Board finds that the Child meets all of the five criteria for admission and denies the Child's application.

BACKGROUND

5J. is a 10 year old child who has been living in [ ] with his mother, 7 year old half brother, N., and 3 year old half sister, S.. His mother, R.W., was never married to the Child's biological father and the Child has never met him. His mother married his stepfather in 2001 and they separated in September 2007. There was a history of family violence perpetrated by the stepfather who was verbally and physically abusive to the family. The family at times moved in and out of women's shelters.

6The Child suffered from separation anxiety since before kindergarten. He has a history of physical aggression. In grade 1, he was violent towards his classmates and had difficulty expressing himself. During grades 2 and 3, he had numerous suspensions, totalling 15, many for violent acts. Due to his difficulties at school, J. was home schooled for two years and returned to school in December of last year for social interaction with his peers. The Family sought community support through their church, counselling and programs at Trellis Mental Health and Developmental Services ("Trellis"), the school counsellor, Women in Crisis, Family and Children's Services of Guelph and Wellington ("FCSGW"), and Dr. C. at the [Hospital].

7The Child decompensated during the last few months leading to 8 visits to the [Hospital]. There were many times where the Child lost control, ending up in a rage and kicked and punched others. Following an admission to [Hospital] on July [...], 2009, the Child was placed in a foster home, transferred to [Home] and finally admitted to Youthdale.

ANALYSIS

Criterion (a) the child has a mental disorder.

8A 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. The Board was satisfied that the Child had a mental disorder within the meaning of the Act. The evidence demonstrated that, at the time of admission, the Child had a substantial emotional processes disorder which grossly impaired his capacity to make reasoned judgments.

9Dr. C., a pediatrician at the Guelph Wellington Paediatric Mental Health Clinic, saw the Child on several occasions when he was at [Hospital]. She wrote mental health reports on each of these occasions. On April [...], 2009, the Child was referred through the Emergency Department following a violent situation at home. Dr. C. examined the Child and diagnosed him with ADHD, Anxiety Disorder, Sensory Integration Dysfunction, Probable Learning Disability, not yet diagnosed, Central Auditory Processing Disorder, and Social Developmental Delay. She writes that, "When he becomes very angry he tells me that he has "no control" of his thoughts. He feels that he wants to kill other people, states he sometimes feels like killing himself, but when he calms down he has no homicidal or suicidal ideation." Dr. C. in her report described the Child as "always impulsive, anxious, sensitive and reactive and inflexible".

10After the Child was seen on May [...], 2009 at the Emergency Department, following a behavioural and emotional crisis, he was referred to Dr. C. again on May [...], 2009. In her report, Dr. C. thought that the Child met the criteria for complex post-traumatic stress disorder due to the domestic violence that has occurred over time. She also thought that there may be "undiagnosed learning disabilities, perhaps nonverbal which may involve some social skills issues". Dr. C. started him on Zoloft and increased his dose of Risperdal. The Child's behaviour escalated in July and Dr. C. saw the Child on July [...], 2009 following admission to the [Hospital]. She states in her report, "J.'s behaviour has become really extremely unreliable, unpredictable, aggressive and at times predatorially aggressive but generally just lots of reactive aggression. When he becomes escalated, he will lash out at others, even chase them down and put others at risk in his immediate environment." She was supportive of the Child's admission to Youthdale.

11Dr. C., a staff psychiatrist, admitted the Child to Youthdale on July [...], 2009. In her Admission Summary, she gave a provisional diagnosis of Post Traumatic Stress Disorder, Chronic and Complex, and Attention Deficit Disorder. She wanted to rule out another Anxiety Disorder including Separation Anxiety, Autism Spectrum Disorder, Intermittent Explosive Disorder and Tic Disorder. She also wanted to "query" Oppositional Defiant Disorder and Learning Disorder. Dr. C. noted that the Child's aggression has increased recently, likely in response to significant psychosocial stressors. Recent contact with the stepfather and a move into a shelter likely provoked the Child's aggressive behaviour.

12The Child testified that he gets very angry and has hurt his mother. He has threatened to kill himself. When he was at [Home] the first time, he got very angry when he wanted to go home and he crushed a radio and took the sheets and threw them around. He also testified that when he gets angry, he bangs his head until he feels numb.

13R.W., the mother of the Child, testified that the Child's behaviour rapidly escalated since March [...], 2009 after a visit with his step dad. She states that after the Child was prescribed Zoloft, he said that he didn't want to live any more. After his last admission to hospital in July, the Child said to her, "When I get home, can you kill me?"

14She testified to the following recent events leading to the Child's admission to Youthdale. On March [...], the Child had a "meltdown" in the park. She de-escalated him and they went home. On March [...], the Child became very violent. She called 911 and the Child was taken to [Hospital]. However, there were no available beds and the Child came home with a plan with FCSGW. Over the next while, the Child had many more eruptions at home. One night when he wanted to play on the computer and he was not allowed, he picked up a glass from the kitchen and threatened to throw it at her and S.. He threw the glass, but missed. The Child went into a rage and punched and kicked. He was verbally abusive. She went upstairs with S., locked themselves in the bathroom and called 911. The Child was taken to hospital but the hospital did not do an assessment or give a diagnosis. On March [...], the Child saw Dr. H. who referred him to Dr. C.. On March [...], the Child started counselling at [Service] with A.M.. The Child saw Dr. C. on April [...]. On April [...], she attended a shared services meeting with community agencies to seek support for the Child. On May [...], the family entered a [ ] women's shelter. While at the shelter, there were two hospital visits due to the Child's violent behaviour. They were unable to de-escalate the Child and had to call an ambulance. The Child was sent back home following the hospital visit with no medication. The Child saw Dr. C. on May [...] and was prescribed Zoloft. On May [...], another shared services meeting was held to provide support for the family. On June [...], the family left the shelter. The Child was placed at [Home] on June [...] for one night to give respite to the mother. The Child wanted to come home and had a "meltdown". He broke a radio and some glasses and was aggressive to staff. [Home] was specifically designed to deal with kids with behaviour problems. On June [...], another shared services meeting was held. On June [...], the Child had a severe "meltdown" which lasted an hour. He was very violent and his siblings locked themselves in the bedroom. On June [...], the Child had several "meltdowns" while at [ ] Camp with a [Service] staff member. The Child was rolling down a hill on July [...] and when asked to stop, he punched a kid in the nose. He punched several others, and had to be restrained for 15 minutes before he de-escalated. From July [...] to July [...], the Child had several "meltdowns" and physically attacked 3 children. On July [...], the Child had another "meltdown" in the neighbourhood. She went out to de-escalate the situation. The Child punched her in the face and kicked her. Neighbours tried to intervene. The Child punched her in the stomach. When she tried to hold him from behind, he knocked her down injuring her back. She asked for help and it took three people to restrain him. They tried for 15 minutes to calm him down and finally had to call 911. Police came and ambulance took the Child to hospital. The first night at the hospital when the mother left, the Child kicked a nurse in the chest and he had to be restrained and given a sedative. The next day when she left, the Child became aggressive again and had to be given a sedative. On July [...], the Child was discharged from hospital and went to a foster home for 3 days. He was then transferred to [Home] and stayed there until his admission to Youthdale on July [...], 2009.

15The Board accepted Dr. C.'s and Dr. C.'s diagnoses and that the Child has a mental disorder and requires further assessment. While Dr. C. did not testify, the Board had the benefit of Dr. C.'s information which in these particular, limited circumstances was sufficient to meet the Respondent's onus. The Board accepted the testimony of the mother and the Child and is satisfied that the mental disorder has grossly impaired his capacity to make reasoned judgments.

16The Board was 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.

17The Board was satisfied that the Child as a result of his mental illness, caused, attempted to cause by words or conduct, made a substantial threat to cause serious bodily harm to himself, or another person.

18The mother testified that the Child is very aggressive with his siblings. He would charge at them, intimidate, and push them. His siblings have locked themselves in the bedroom when he is in a rage. He has punched her in the face and the stomach and has kicked her in the back, bruising her to the extent that x-rays were necessary. She has serious concerns that the Child might harm himself during his "meltdowns" since he bangs his head and does not stop. He is a violent head thrasher. He also punches and charges very forcefully at things. As described in the incidents above, the Child has also hit and punched children in the neighbourhood and has been extremely aggressive to staff members at the shelter and whoever tries to restrain him. According to the mother and the Child, himself, he has threatened to kill himself.

19The Board was satisfied that Criterion (b) was 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.

20The Board was satisfied that the secure treatment program would be effective to prevent the Child from causing or attempting to cause serious bodily harm to another person.

21Youthdale has a secure and very strict locked unit with staff highly trained in behaviour management. There is a high level of supervision of interactions between the Child and his peers and parents. Nurses, doctors and staff are available to monitor moods and behaviour. The high level of security and supervision ensure the safety of the Child and prevent harm to him and other persons. Youthdale provides a secure and stable environment for the assessment of the Child's mental illness.

22V., a member of the crisis team, testified that there is a high staff to patient ratio to manage physically aggressive behaviours and head banging as manifested by the Child

23The Board was satisfied that criterion (c) was met.

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

24The Board was satisfied that treatment appropriate for the Child's mental disorder is available at Youthdale.

25Dr. C.'s initial plan for the Child is to admit the Child to the Acute Support Unit for stabilization and a thorough diagnostic assessment. V. testified that Youthdale has the professional staff to meet the Child's treatment needs. The facility has psychiatrists, neurologists, psychologists, medical doctors, and a sleep clinic. If there is an issue with medication, Youthdale has a medical team to monitor side effects and withdrawal symptoms. There are no outside influences to interfere with the results of trials of medication. To reduce the Child's anxiety level, his plan is reviewed daily with him. Staff members would debrief the Child after each outburst and teach anger management skills. Case conferences are held weekly with parents and outside agencies who will continue his treatment upon release.

26The 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.

27The Board is satisfied that no less restrictive method of providing treatment appropriate for the Child's mental disorder was appropriate in the circumstances of this admission.

28V. testified that there was no less restrictive method of providing treatment. The Child exhibited physically aggressive behaviour and needed a period of stabilization in order for a full assessment to take place.

29The family has accessed many resources that the community of [ ] has to offer. There were a number of shared services meetings over the time that the Child was in crisis involving [the Service], FCSGW, Dr. C., the school principal and counsellor. The Child received counselling at school. [The Service] provided counsellors for the family, an anxiety program for the Child and his mother, and the Child attended a program for the explosive child. The family had the support of workers from FCSGW and the crisis line was available. The family was provided with respite from their church and [Home] was available to the Child. Though [Home] can provide one-on-one supervision with a social worker, and staff members are trained for interventions, the home does not provide treatment. The Child was taken to [Hospital] 8 times where he was referred to Dr. C., a pediatrician. However, the Child was not provided with the services of a child psychiatrist to co-ordinate the treatment of his complex mental disorder. The Child had exhausted the less restrictive resources available in the community.

30The Board was satisfied that criterion (e) has been met.

CONCLUSION

31Pursuant to section 124 (13) of the Act, the Board, having satisfied itself that the criteria in subsections 124 (2) (a) through (e) were met at the time of admission, denied the release of the Child, J.C., on July 17, 2009.

Ruth Ann Schedlich

Presiding Member

Alina Lazor

Panel Member

Mary Wong

Panel Member