CHILD AND FAMILY SERVICES REVIEW BOARD
K.F.
v.
Youthdale Treatment Centres
REASONS FOR DECISION
Indexed as: K.F. v. Youthdale Treatment Centres (CFSA s.124)
INTRODUCTION
1K.F. (the “Child”) was admitted to Youthdale Treatment Centre (“Youthdale”) on September […], 2011. She applied to the Child and Family Services Review Board (the “Board”) on September 21, 2011, under section 124(9) of the Child and Family Services Act (the “Act” or “CFSA”) for an order releasing her from Youthdale. The hearing was held on September 26, 2011.
2The Board must decide on a balance of probabilities whether all the criteria set out under subsection 124(2) of the Act were met at the time of admission. Youthdale’s position is that all five criteria have been met and that the application should be denied. The Child’s position is that none of the criteria have been met and that she should be released.
3The Board found that the Child does not meet all five of the criteria for admission and granted the Child’s application. The reasons are set out below.
BACKGROUND
4The Child was born on December […], 1997. She has been in care with the [ ] Children’s Aid Society (the “Society”) since April […], 2011 and became a crown ward on September […], 2011. Since she was in the care of the Society, she has been placed at [assessment home] two times and two foster homes before going to [ ] (“group home”) in [City] on June […], 2011.
5Since July of 2011, the Child has been AWOL (absent without leave) from her group home for short periods of time on a number of occasions, during the day. She has rubbed erasers on her body to create burn marks and cut herself with blades from pencil sharpeners and exacto knives. She was taken to hospital on two occasions for treatment of cuts to her arm. She “trashed” her room, breaking the door, destroying furniture and putting holes in the wall straight through to the next room using her body. She was taken to Youthdale and admitted on September […], 2011.
ANALYSIS
6The Board found that the Child did not meet all of the requisite criteria under the Act because she did not have a mental disorder.
7Pursuant 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).
8The legal tests in this case are reflected in the criteria as set out in the following legislative provisions:
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.
Criterion (a) “the child has a mental disorder”
9A mental disorder is defined at section 124 (13) of the Act as a substantial disorder of emotional processes, thought or cognition, which grossly impairs a person’s capacity to make reasoned judgments. The Board finds that there was insufficient evidence before it to determine that the Child had a mental illness as defined by the Act. Youthdale did not present any clinical evidence to support their position and the evidence of the Child’s behaviours presented by J.J., Program Manager at [group home], and C.C., the Children’s Services Worker, did not demonstrate behaviours which would lead to a conclusion of a “substantial” disorder which “grossly” impairs the Child’s judgement requiring treatment in a secure facility.
10The Program Manager described the Child as “quite happy” to be watching television, going to the [gym], and spending time with friends and staff. She goes to school regularly without any problems. However, the Child has difficulties settling down at night. She would be disruptive and encourage others to be disruptive.
11The Program Manager testified about the Child’s behaviours which were concerning. This involved brief AWOLs from the home, the use of erasers to burn the skin, cutting with razors, trashing her room and being aggressive to staff. Since the Child was not allowed community time due to her cutting herself, she would be considered to be AWOL if she left the house without permission. The Program Manager testified to a number of AWOLs, but could not recollect the dates without her notes. She stated that the Child would harm herself by using pink erasers to rub her skin causing burns and used razors from pencil sharpeners and shavers to cut. Several times a week she would see 2 and 3 inch burn marks on the tops of her hands. After July, the burns became less frequent and the cutting increased. She was cutting several times a week and the severity of these cuts increased in August of 2011 when she cut herself on or around August 25, 2011 and was taken to hospital the following morning. No stitches were required. The Child notified staff of her cuts.
12Another incident of cutting occurred on September […], 2011 when she went AWOL. Staff followed her and she came back to the residence asking for bandages. She was taken to hospital and required five stitches.
13On unspecified dates, sharp objects were found in a container in the Child’s room which was left out to make it easy for staff to find. She once had 23 blades in a small envelope which she gave to staff.
14On September […], 2011, the Child trashed her bedroom by knocking out five or six feet of dry wall from one room to the next with her body, breaking furniture, and taking off the door. In August 2011, the Child was kicking and punching staff, requiring a full floor restraint.
15Around August […] or […] of 2011, an appointment with a psychiatrist or a therapist (the evidence was inconsistent) was set up for an assessment, however, the Child refused to attend. Another appointment was not booked since the clinician advised the Manager to leave it until the Child was ready. The Program Manager put in a referral for the Child to see a pediatrician, but that has not happened.
16C.C., the Children’s Services Worker, testified that she was concerned for the Child’s safety due to the digression in her behaviours and her self-harming, explosive behaviour. She was at the residence on September […], 2011 to attend the 90 day plan of care meeting for the Child and witnessed the damage to her room. Initially she was told that the cutting was superficial, but she was told on September […], 2011 that the Child had cut herself requiring 5 stitches. The Child was leaving the program without permission and the Children’s Services Worker did not know what her plan was. The Child was seen with books on suicide pacts borrowed from the library by another child at the residence.
17The Children’s Services Worker contacted Youthdale from the group home on September […], 2011. When questioned by Counsel for the Child, the Children’s Services Worker admitted that the Society had made contact earlier with Youthdale on September […], 2011 requesting a bed for the Child. Dr. D. recommended on September […], 2011 that the Society utilize less intrusive measures such as an outpatient assessment at [health centre] and counselling through [centre 1] or [centre 2]. However, the Child was admitted three days later on September […], 2011. The Admitting Psychiatrist did not testify before the Board as to what had changed in those three days to warrant an admission.
18Youthdale did not introduce any clinical evidence to support their position that the Child had a mental illness within the meaning of the Act. On admission, the Child was assessed by one of Youthdale’s psychiatrists, however, the evidence was not before the Board. There were no other assessments by any medical professional before the Board. The Child was taken to hospital on two occasions for cuts to the arm, treated and released. There were no referrals to the crisis unit and the Child was not held in hospital for observation.
19The Child herself asked to see a doctor because of her problems sleeping. She was prescribed medication which did not agree with her and she got new medication which she continued to take up to the time of admission. The group home took her to a walk-in clinic and the Children’s Services Worker could not identify the medication and had not ensured that a doctor was monitoring the medication. No doctor was in fact monitoring the medication. Instead, it was the Child who identified the desire for and problems with the medication, demonstrating good judgment in this regard.
20While the Board recognizes that the Child’s behaviour (AWOLs, trashing room, cutting) demonstrates poor judgement, the evidence does not support the severity required under the Act for a determination that the Child has a mental disorder. The Program Manager testified to the concerning behaviour of the Child, however it was not severe enough for her to request any additional resources such as a one-on-one worker for the Child, nor did she refuse placement for her. At the time of admission, she testified that there was a placement for the Child at the group home. Despite the Children’s Services Worker’s concern for the Child’s safety, she did not initiate any new measures to keep her safe. She stated that there was already a safety plan in place and staff was to follow the Child if she left the house. On September […], 2011, when she contacted Youthdale, the Children’s Service Worker stated that the Child was at school, she was not unsafe at that time and there was no reason to take her to emergency at the hospital. At the time of admission, the Child’s behaviour did not demonstrate the urgency required for an emergency admission.
21The Board finds that criterion (a) has not been met.
Remaining Criteria
22In line with the Board’s finding on criterion (a) the remaining criteria have become moot, and no findings have been made on them. However, the Board will address criterion (e).
Criterion (e) no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the circumstances.
23The Board heard evidence that the Child has been placed at several placements prior to arriving at [group home]. These included placements at [assessment home] two times and two placements at a foster home, one which broke down because the Child was cutting herself and the foster parents did not want her. The Child was not receiving any treatment for her issues at [group home]. Only one clinical appointment was set up, which the Child declined. The group home has no clinical social workers on staff and no clinical interventions occurred for this young person who needed help. When Youthdale initially declined to take the Child, the recommendations for outpatient treatment were not followed up on. The Children’s Services Worker seemed to delegate clinical issues to the group home which was not proactive. For example, once the clinical appointment was declined, the group home did not follow up to see if a clinician would come to the Child on site because the residence was “too chaotic”. Consequently, no professional attempted to engage the Child in therapy. Although the group home was a “receiving and assessment” home, it does not do clinical assessments. Rather, it provides observations based on daily behaviours which were not provided to the Board. There has been no attempt, let alone a progressive attempt, at providing the Child with clinical interventions.
24Based on the Child’s behaviours and placement history, a non-secure residential treatment setting represents an appropriate less restrictive placement for the Child. Such a setting would have professional clinicians on staff to engage the Child in addressing her cutting and other behaviours. Because the Child does not AWOL at night, attends and excels at school, is functioning in the school community and has sought out medical help for sleep problems, a locked setting is not required.
CONCLUSION
25Pursuant to section 124 (13) of the Act, the Board, having satisfied itself that the criteria in subsection 124(2) have not all been met, allowed the application of the Child, and ordered her release on September 26, 2011.
Sheena Scott
Presiding Member
John F. Spekkens Panel Member
Mary Wong Panel Member
Dated at Toronto, Ontario on this 7^th^ day of October, 2011.