V.T. v. Youthdale Treatment Centres, 2009 CFSRB 8

CHILD AND FAMILY SERVICES REVIEW BOARD

V.T.

v.

Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: February 10, 2009

Citation: 2009 CFSRB 8

Indexed as: V.T. v. Youthdale Treatment Centres (CFSA s.124)

INTRODUCTION

1This is an application to the Child and Family Services Review Board (the “Board”) by V.T., born October […] 1993 (the “Child”), for a review of her emergency admission to the Secure Treatment Programme at the Youthdale Treatment Centre (“Youthdale”) 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 all of the criteria set out in subsection 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 all five criteria had not been met, and, therefore, she should be released.

3Under section 124 (2), the administrator may admit a child to the secure treatment programme on an application made 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 programme 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.

4Pursuant to section 124 (13) of the Act, upon reviewing the case, the Board shall make an order releasing the Child from the secure treatment programme unless it is satisfied that the Child meets all of the five criteria for emergency admission as set out in clauses 124 (2) (a) to (e).

5For the reasons that follow, the Board is satisfied that criteria (a) to (e) have been met. Therefore, the Board determines that it is in the Child’s best interest that she remain in the secure treatment programme.

BACKGROUND

6V.T. (the Child) T.T.’s parents, M. and T.T., made an application for emergency admission to Youthdale, a secure treatment programme, on December […] 2008. The Child is contesting the admission. The Child’s parents testified that they had lost total control over their daughter. They stated that she had become aggressive, and that she had stopped taking her medication. She had also been running away for a period of two to four days, remaining away for as long as eight days. The Child’s parents said that her behaviour at school had become so disruptive that she was suspended indefinitely after numerous efforts to tailor programmes and attendance to her particular needs. All the parents’ efforts to seek help with various organisations in their area were to no avail.

7The Child was adopted when she was four years old. She had been removed from her biological mother because of physical and sexual abuse. The biological mother, whose family has a history of mental illness, also abused alcohol. This resulted in the Child being diagnosed with Alcohol Related Neurodevelopmental Disorder. Subsequent psychological assessments indicated a range of problems such as learning disabilities, anxiety, Post Traumatic Stress and Attention Deficit Hyperactivity.

8The Child’s parents stated that she is under medication. However, she regularly refuses to take her medication and consequently behaves in a manner that is detrimental to her safety and that of others. The parents thus sought admission for their daughter to Youthdale because they feared for her safety and that of her younger brother.

ANALYSIS

(a) The child has a mental disorder.

9For the following reasons, the Board is satisfied that the Child has a mental disorder within the meaning of the Act, defined as “a substantial disorder of emotional processes, thought or cognition which grossly impairs a person’s capacity to make reasoned judgments”.

10The Child’s mother testified that her daughter had to be medicated when she had a violent eruption at age eleven. She stated that it was very difficult to get her to take her medication regularly, and that whenever she ran away, she interrupted it completely. The mother added that the Child was unable to weigh the consequences of her behaviour. The Child’s admitting physician at Youthdale, Dr. D., noted that she had “received a diagnosis of Alcohol related Neurodevelopmental Disorder, part of what is termed the Fetal Alcohol Spectrum” (Y3, p. 4). Another Youthdale psychiatrist, Dr. P., who testified over the telephone, added that the Child’s extreme mood swings point to a major depression, and are an indicator of bipolar disorders, as well as a psychotic disorder. The Child’s parents testified that whenever she was asked to do something at school, she had on more than one occasion, run through the school screaming and yelling obscenities. The Child also testified that she felt that the guests at her parent’s motel were watching her.

11The Board accepts the evaluation of Drs. D. and Dr. P., and finds that the Child has a mental disorder within the meaning of the Act.

(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.

12The Child’s parents testified that she had taken to running away, staying as long as eight days. They stated that during those days she did not have access to her medication, which is kept under lock for fear that she might sell it or overdose on it. They testified that she informed them that she had had unprotected sexual relations with eighteen-year old boys. When her parents had her tested for Sexually Transmitted Diseases, the doctor treated her for Chlamydia. Dr. P. stated that “Awoling is the most important aspect of placing herself at great risk”. Furthermore, the parents also stated that she often said calmly that she had better kill herself. The Child herself stated to the Board that it was just talk. However, the Child admitted to drug use and drinking without any concern for the effect this might have on the medication she takes.

13The Child’s parents also testified how their daughter was physically rough on her four-year-old brother to the point that they never leave her younger siblings unattended with her. Although the Child denied having deliberately given her brother a black eye, saying that he was playing rough with her, her parents both testified that she had also pushed him down the hall. The Board thus finds that the Child, as a result of her mental disorder, has by her words and conduct made a substantial threat to cause serious bodily harm to herself and to her brother.

(c) The secure treatment programme would be effective to prevent the child from causing or attempting to cause serious harm to himself, herself or another person.

14At Youthdale, which is a secure treatment facility, the Child will not be able to behave in ways that are dangerous to herself or to others because staff are there to monitor the children’s treatment programme all the time. Thus, staff supervise that medication is taken appropriately and that the children take all required dosages. Furthermore, in a secure treatment facility, the Child would not expose herself to the dangers of the street by running away. The Board thus finds that the secure treatment programme would be effective in preventing the Child from causing or attempting to cause serious harm to herself or others.

(d) Treatment appropriate for the child’s mental disorder is available at the place of secure treatment.

15In her testimony, Dr. P. described the nature of the treatment at Youthdale as “multidisciplinary”, that is, it uses counselling, behavioural techniques, family therapy, as well as pharmacological therapy. She said that constant monitoring of the Child’s condition could lead to an understanding whether she is psychotic or not, and what the exact medication for her condition should be. The Board finds that the multifaceted treatment at Youthdale is necessary to stabilize the Child. Dr. P. explained that given the Child’s level of functioning, supportive and cognitive behavioural therapy would be appropriate and available to assist many of her syndromes. The Child would also be given a structural supportive behavioural programme to address anger issues. The Board thus finds that the multifaceted treatment appropriate for the Child’s mental disorder is available at Youthdale.

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

16The Child’s parents testified that she would not stay at any institution that had an open door policy. Her history of running away from home attests to the Child’s propensity to “bolt”. She has refused to take her medication voluntarily, and has also refused to accept a one-to-one support. Dr. P. stated that the “locked door” policy of the facility was part of the treatment needed for this Child. The Board is thus satisfied that no less restrictive method of providing treatment appropriate for the Child’s mental disorder is appropriate in the circumstances.

CONCLUSION

17Pursuant to section124 (13) of the CFSA the Board is satisfied that each of the five criteria have been met. The Board does not accept the Child’s challenge of her admission and determines that she remain at Youthdale for the requisite period.

______________________ Sheena Scott Presiding Member

Aida Graff Panel Member

Alina Lazor Panel Member