CHILD AND FAMILY SERVICES REVIEW BOARD
K.D.
v.
Durham Children’s Aid Society
REASONS FOR DECISION
Indexed as: K.D. v. Durham Children’s Aid Society (CFSA s.144)
INTRODUCTION
1This is an application under section 144(1) (b) of the Child and Family Services Act (the “Act”). Ms. K.D. (“applicant”) asks for a review of the Durham Children’s Aid Society’s (“Society”) decision to remove [the child] who was placed with her for adoption. The Board is to decide which action is in [the child’s] best interests and either confirm the Society’s decision to remove [the child] or direct the Society to place [the child] for adoption with the applicant. The main issue before the Board is whether the mental health status of the applicant places [the child] at risk in an adoption placement, and whether such a placement is in [the child’s] best interests.
2[The child] is seven years old. The applicant applied to adopt [the child] who lived with her as a foster child for two years beginning in October, 2007. [The child] was then placed for adoption on adoption probation with the applicant in November 2009. She was removed from the applicant’s home on July […], 2010 because of concerns raised by the Society related to the applicant’s mental health.
3After an investigation into the applicant’s mental health the Society did not return [the child] to the applicant’s home. The applicant applied to the Child and Family Services Review Board (the “Board”) for a review of this decision and sought an order rescinding the Society’s decision to remove [the child] from her adoption placement with the applicant.
4The Society’s position is that the applicant has serious mental health issues which would place [the child] at risk if she were to be adopted by the applicant. The applicant’s position is that [the child’s] secure attachment and happiness in her home should not be disrupted, and that the adoption placement is in [the child’s] best interests.
5It is the Board’s decision that it is in [the child’s] best interests to confirm the Society’s decision to remove [the child] from the applicant’s home where she was placed for adoption. The reasons for this decision follow.
PRELIMINARY CONSIDERATIONS
Adjournment request
6The hearing of this application was scheduled to commence on January 4, 2011. By way of letter dated December […], 2010, the applicant’s counsel, S.B. advised the Board that she was no longer the applicant’s counsel of record. S.B. also advised that the applicant would be seeking an adjournment to seek representation.
7At the start of the hearing the applicant made a request for a short adjournment, possibly two weeks, to retain counsel or to prepare for the hearing. She stated that she only became aware that she would not have legal representation at around the same time that the Board received notification and given that it was the holiday season, she was unable to contact and retain other counsel. The applicant advised that she did not have the financial resources to retain her previous counsel and she did not have any funds to retain another.
8The Society objected to an adjournment submitting that there had been many delays in this case; delays which were not beneficial for [the child]. The Society had worked closely with the applicant’s previous counsel to establish the Hearing dates, and certain Society witnesses were only available within the previously agreed upon schedule. The Society further argued that even if the applicant were able to retain counsel, it would take more than two weeks to become familiar with the file and prepare witnesses.
9The Board granted a brief adjournment to the applicant for the following reasons. The effect of delay in making a final determination on [the child], is just one of the factors that the Board must consider in determining her best interests and in considering the adjournment request, was very important. The child had been removed from the applicant’s care for almost six months by that time. The applicant by her own admission does not have the financial resources to retain counsel and even if she did, counsel would require a lengthy adjournment to prepare. A significant delay in hearing this application would seriously impact on [the child’s] need for some finality with respect to her future plan.
10The applicant had in her possession names of the witnesses and the main documents which the Society intended to use to support its position, and knew the Society’s case she had to meet. Further, the Society in an application under s.144 of the Act presents its evidence first. Any prejudice to the applicant would be diminished because she has personal knowledge of the interactions she had with the witnesses and could adequately challenge and refute their evidence on cross-examination and when giving her testimony. The Board recognised that the applicant was not prepared to proceed on January 4, 2011 and granted a brief adjournment to allow the applicant to prepare for the hearing.
BACKGROUND
[The child]
11[The child] was born on October […], 2003. She has two biological siblings, a younger sister, S., age 6, who has been adopted by another family, and an older brother, N., age 10, who is living in another Society foster home. [The child] initially came into Society care in 2004 and was later returned to her biological parents. In 2007, all three children were made Crown Wards without access. [The child’s] history with her biological parents includes significant sexual abuse, physical abuse, and emotional trauma.
12After returning to the Society’s care in 2006, [the child] was placed in two successive foster placements, each of which broke down because of the difficulties the foster parents had in managing [the child’s] behaviour. In November 2007 [the child] was subsequently placed in foster care with the applicant who at the time was also a foster parent for V., age 12, B., age 11, and B.’s half-sister, C., age 7.
13[The child] was placed with the applicant because of her previous successes with children who were hard to place. [The child] was reported as being very damaged, keeping the applicant up all night, screaming and swearing. Initially [the child] was part of a program which monitored difficult children, however within a month the program was discontinued as she had stabilized.
14[The child’s] foster placement with the applicant, according to both the applicant and the Children’s` Aid Society of Toronto (CAST) which was supervising the placement, went exceedingly well. [The child’s] behaviour improved markedly, the applicant and [the child] appeared to bond closely and [the child] appeared to thrive, enjoying the other children in the home as well as the artistic and musical opportunities the applicant offered.
15After [the child] was removed from her adoption placement with the applicant she was placed in a foster home, where she continues to reside today. Regular access visits have been arranged so that there continues to be contact between [the child] and the applicant.
THE APPLICANT – K.D.
16The applicant, age 54, is the single parent of a married son, S2, age 32, who currently lives in [Country A] with his wife and three children. The applicant grew up in [City A] in a single parent, mother led family. She has an older sister and two brothers with whom she has limited contact.
17The applicant is a creative and artistic person. She has worked in the past in early childhood education, design, and music. She very much enjoys working with children, and particularly enjoys introducing children to artistic and musical experiences.
18The applicant was a foster parent for the CAST for six years, having fostered approximately thirty children. According to the Society, the applicant was considered to be exceptionally talented and skilled with difficult children. She seemed able to parent very damaged children in a loving and creative manner. The applicant tendered her letter of resignation as a foster parent to CAST on July […], 2010.
APPLICATION TO ADOPT
19When [the child] became a Crown Ward without access in 2007 and therefore available for adoption, the applicant expressed an interest in adopting [the child]. The Society asked CAST to carry out an adoption homestudy on its behalf as the applicant was a foster parent for CAST. At the time of the homestudy, the foster children in the applicant’s home were B., C., B2 and [the child].
20The province requires that an investigation be conducted into several areas prior to a society approving an adoption application, including a financial statement, references, police vulnerable sector checks, child welfare checks and successful completion of Parenting Resource Information Development Education (PRIDE).
21Although the applicant’s homestudy was eventually successful and [the child] was finally placed for adoption with the applicant, A.H., CAST Adoption Worker, identified several concerns during the course of CAST’s homestudy of the applicant.
22The first concern related to finances. The applicant’s main source of income derived from her role as a foster parent. If [the child] were to be adopted there was a concern that there would be financial hardship for the applicant, as she would not be receiving the foster parent subsidy for [the child]. Further, income generated from foster parenting is normally not considered as income since it is not guaranteed. The Society addressed this concern by agreeing to provide a financial subsidy to the applicant for [the child], to age eighteen, if she were adopted.
23Another concern related to the fact that the applicant did not want the Society to interview her son, S2, although interviews with biological children are a requirement of the homestudy. The applicant, reportedly, was concerned that S2 would not be able to speak to the Society freely, and would be constrained by the applicant’s daughter-in-law, with whom she did not always agree. The Society obtained a positive reference from the applicant’s sister, M., after some delay and agreed to waive the requirement of speaking with S2.
24On this point the Board would like to comment that the fact that the applicant did not permit the Society to speak to her son S2 should have raised concerns for the Society. The Society did not obtain information from the person with the best knowledge about what it was like to be raised by the applicant over an extended period of time. The Society may have erred in accepting the reference from the applicant’s sister in lieu of this crucial piece of information. The evidence before the Board is that the applicant and her sister, who is 10 years older than she is, were not raised in the same home. Further their relationship appears to be wrought with conflict and lengthy periods of no contact.
25The Society was also concerned after Dr. H., the applicant’s family physician reported by letter “excess alcohol use in 2006”. Dr. H. later reported that he did not see that as a concern and her psychiatrist, Dr. H2 in June 2009 wrote that he had no concerns about substance abuse by the applicant.
26The applicant had a medical condition, involving ADHD and anxiety, and was on medication. Medical documentation related to this matter was provided and there were no concerns raised on the part of the Society.
27In her testimony to the Board, A.H. submitted that the applicant did not have to meet all the normal requirements of a full adoption homestudy completed as the applicant was a known and approved foster parent. The applicant completed some of the training and did an abbreviated module of the PRIDE program. It was thought by CAST that she met the qualifications related to training. Ms. A.H. indicated that this was a “matched” homestudy and the adoption was facilitated because of the existing placement of the child, the need for continuity of care, and the deep attachment of the child and foster mother.
28The homestudy, which took over one year to complete, was finalized in November 2009 and the applicant was approved as an adoptive parent for [the child]. [The child] was then “placed” with the applicant for adoption. In February 2010 [the child’s] placement with the applicant appeared to be progressing well and the Society considered waiving the normal six-month adoption probation period. However, by April 2010 that was no longer a consideration after an incident in the applicant’s home.
REASONS FOR REMOVAL OF [THE CHILD].
29In April and June, 2010, CAST carried out two separate investigations, related to concerns regarding C. and B2. The Society verified that there were protection concerns related to the risk of emotional harm to the children and limited caregiver skills. These incidents also raised concerns that there was the possibility of an untreated mental health issue on the part of the applicant.
April 2010 Investigation
30On April […], 2010 the applicant called the [Police] to report that her foster daughter had been stealing from her. Constable M.M. attended at the home and the applicant advised that the child had confessed to stealing various items from around the house all of which were of minimal value, and storing them at her birth mother’s house in [City A]. The applicant advised police that she believed the birth mother had been coaching the child to steal these things and referred to this as “betrayal of the birth mother.” The officer was surprised to learn the foster daughter in question was an eight-year-old child, C..
31Constable M.M. observed several hidden surveillance cameras around the house and when questioned about them, the applicant advised that they were to catch the child stealing her things. The officer indicated that the applicant seemed extremely paranoid and very disorganized. She had a difficult time answering questions directly. The officer further noted that the house was in disarray, felt very cold: colder inside than outside, and that a child the applicant was babysitting that day was wearing his coat inside the house. Based on the conversation with the applicant, Constable M.M. believed that the applicant was suffering from some sort of mental illness and contacted CAST.
32The report from the [Police] triggered an investigation, carried out by K.T., CAST, Intake Department. On April […], 2010, she interviewed the applicant, and the children C., B2, and [the child]. The children reported that C. was kept up at night answering questions regarding stealing, and that she was told that she would receive her birthday gifts only if she told the truth regarding stealing. C. told the investigator “I didn’t steal, but I admit to stealing so I can go to sleep and get my birthday presents and a party at Chucky Cheese.” The Society was concerned about how the applicant was handling the alleged stealing. The Society was concerned about C.’s self esteem, about her being labelled, and about the risk of emotional harm to C.. In further discussions with the applicant, the Society suggested that she put aside the concerns related to stealing and concentrate on parenting.
33This incident was of particular concern to the Society for several reasons. Firstly, the theme of stealing had previously been an issue in the applicant’s home. In the summer of 2008 when B., C., and [the child] were residing in the applicant’s home, the applicant began to say that things in the home were missing. This continued during the Halloween and Christmas seasons. B.’s name recurred as the person responsible for the missing items. The applicant suggested that B. was going through a wall vent to take things. There was a suggestion that B. was removing the applicant’s things and taking them to her birth mother’s home, which B. denied. As well, the applicant thought that B. was damaging the younger children’s clothing.
34The Society provided a child and youth worker and Mr. T2, Foster Care Resource Worker as a support person for B. and the applicant. However, by April 2009 B. indicated that she was being blamed for stealing and wanted to move. CAST moved B. because it was determined that B. remaining in the applicant’s home was causing too much stress for everyone. The Society did not consider removing any of the other children at that time as the applicant was still receiving rave reviews for parenting.
35After B. left in June 2009 B2 joined the foster family in November 2009. The children were doing well but the theme of stealing continued and C., then age 8, became identified as the person stealing. The applicant began to question C. in the evenings and she reported in April 2010 that C. had admitted that she was stealing.
36Although the evidence is unclear as to what led to this occurring, the applicant installed three video cameras in the home, which were hidden in an air freshener, a picture frame, and a birdcage.
37The Society was also concerned about this April 2010 incident because the applicant previously had expressed concerns to the Society that a black van was following her and that a woman in a preschool music class she was teaching had been planted there to disrupt the class by screaming. Also she believed that people had keys to her house and were entering the house when she was sleeping.
38These incidents reported by the applicant, on their own appear innocuous. However, when combined with the other incidents caused the Society to conclude that the applicant may have possible mental health issues and therefore decided that an assessment was needed with regard to the applicant’s mental health. The Society and CAST decided to ask the applicant to undertake a mental health assessment. A letter was drafted but had not yet been sent to the applicant when another investigation began.
June 2010 Investigation
39In June 2010 a second incident occurred. On June […], B2 disclosed to his father that the applicant had called him a liar. She had alleged that B2 had touched [the child’s] private parts while they were at a bluegrass festival. B2 said that the applicant had threatened to call the police and that he, B2, might be killed, because the punishment for child abuse was death.
40K.T. carried out another investigation, on June […], 2010. B2, [the child] and the applicant were interviewed. C. was not present at the bluegrass festival and therefore not interviewed. B2 and [the child] all denied that B2 had touched [the child] or that [the child] had touched B2. The applicant denied both B2’s allegations and the fact that an incident had occurred at the bluegrass festival. Ms. K.T. found that the applicant was also vague as to whether or not anything was said to B2 about touching [the child]. However, B2 was found by the investigator to be credible; she was of the view that B2 would not have had the skills to make up this story, and that his acute distress was real. She noted that in this investigation the children seemed much more constrained in talking with her, as if they had been coached not to speak.
41K.T. testified that the Society was again worried about the children because of the stealing and sexual abuse allegations, specifically how the applicant was dealing with these, how the children were responding, and whether there were mental health concerns related to the applicant.
42The Society moved B2 out of the house the next day and placed him with his father, as it was determined that he would otherwise be emotionally harmed. Although the applicant did not want C. to move, she subsequently agreed and the Society moved C. from the home early in July 2010.
43The Society was of the belief that there was a risk that [the child] was likely to suffer harm if she were to remain in the applicant’s care. The Society decided that until it had an understanding of the applicant’s mental health, it was necessary to remove [the child] from the home. On July […], 2010, the Society informed the applicant in writing that it was removing [the child], who had been placed with her for adoption, from her care.
44[The child] was placed with another foster family, on a temporary basis. A parenting capacity assessment of the applicant was suggested by the Society. At that time, it was the Society’s hope that if the parenting capacity assessment proved favourable, [the child] could return to the applicant’s home.
APPLICANT’S MENTAL HEALTH
45The Society needed to get an accurate picture of the applicant’s mental health and along with counsel for the applicant consented to retaining Dr. P.S., psychiatrist, to conduct a parenting capacity assessment. The parties also agreed upon the terms of reference for this assessment, which did not include an assessment of [the child] or of [the child’s] interactions with the applicant.
46The following were the questions to be addressed by Dr. P.S. in the parenting capacity assessment:
i. Does the caregiver have a psychiatric disorder and or a similar condition?
ii. Does this psychological disorder, psychiatric disorder, and/or similar condition impact on the caregiver’s ability to care for the child?
iii. What physical, emotional, psychological, and/or educational risks, if any, are posed to the child if placed in the care of this caregiver?
iv. If the caregiver has a psychological disorder, psychiatric disorder, and/or a similar condition that impacts her ability to care for the child, are there accommodations or clinical interventions that could be put in place to manage this disorder/condition?
v. Is the caregiver able to effectively advocate, obtain, and maintain appropriate services needed by or benefiting the child?
vi. Is this caregiver able to provide a long term, stable, and healthy environment for this child?
47Dr. P.S. interviewed the applicant and a long list of ‘collaterals’, who were suggested by the parties and reviewed materials provided by the Society. Based on this information Dr. P.S. concluded that there was considerable evidence that the applicant suffers from a paranoid disorder and identified “two possible conditions” which may account for the applicant’s observed and reported behaviour:
paranoid personality trait
delusional disorder, persecutory type.
48Dr. P.S. testified that his diagnosis did not arise out of the fact that the applicant was stating that things were stolen. Rather, he was concerned about the applicant’s view that people around her including an eight-year old child, C., were conspiring against her to create chaos and to make her feel that her thinking was disorganized. Dr. P.S. opined that while an eight-year old may want to hurt an adult if they are upset, “driving a person crazy or conspiring to create chaos in a person life cannot be attributed to a child”.
49Further the applicant was concerned that B. was in touch with an applicant’s former friend, D., and with her daughter-in-law, K., in [Country A], and that they were trying to create chaos in her life. She thought that D. was talking to representatives of the Society and the children’s school, behind her back.
50It was this tendency to see interpersonal difficulties as a result of malevolence against her and the contamination of ideas based on the actions of other people leading to collaboration and conspiracy theories, which led Dr. P.S. to the diagnosis of a paranoid trait.
51Dr. H2, the applicant’s psychiatrist, strongly disagrees with Dr. P.S.’s diagnosis of the applicant. Dr. H2 diagnosed her as having attention deficit disorder (ADD) for which she has responded well to medication. He understands the applicant’s anxiety as part of her ADD. He testified that he has been treating the applicant for four years and generally sees her three or four times a year. His evidence is that over the course of this time he has seen no paranoid traits. He opined that adults do not suddenly display symptoms of paranoia in their fifties. He described the applicant’s personality as creative and sensitive which is different from a “brittle” paranoid personality. He admitted that he does not do psychotherapy with the applicant and that his interventions with her were primarily psychopharmacological.
52Dr. H2 admitted that he had read portions of Dr. P.S.’s report and that he was not aware of the Society’s reasons for removing [the child] from adoption placement with the applicant, or of the issues related to the other foster children in the applicant’s care.
53The applicant submitted that Dr. P.S.’s report is criminal, a “distorted truth” and an “assassination of her character”. She described the report as something where Dr. P.S. would just “fill in the blanks” and pick out and rely on negative pieces of information. The applicant’s evidence is that the fact that [the child] was not interviewed by Dr. P.S. points to the fact that DCAS was driving the investigation to an already predetermined conclusion. CAS workers have accepted and passed on lies as truth without consulting her and these lies are the bedrock of the case against her. Because Dr. P.S.’s report was financed by the Society it is biased.
54The applicant vigorously denied several incidents which Dr. P.S. reported after he had discussions with the individuals. As an example, Dr. P.S. spoke to Mr. B2, the principal of the public school which [the child] attended in Grade One. He stated that he had pages of notes documenting issues the school had with [the child], while there were no issues with C.. Mr. B2 reported that in May 2010 when the teacher spoke to the applicant about [the child’s] misbehaviour, she somehow blamed C. for [the child’s] actions. The applicant denies ever having this conversation with the teacher. Mr. B2 also reported that he also had a similar conversation with the applicant and that the applicant also made excuses for [the child’s] behaviour. The applicant, both in her evidence and in her discussions with Dr. P.S., denies that this conversation with Mr. B2 ever occurred. She recalls that the only discussion she ever had with Mr. B2 occurred when she asked him what he would do if a child was stealing from him and that he replied that he would take something belonging to the child. From the applicant’s perspective the principal’s comments to Dr. P.S. were “all lies”.
55The applicant in her evidence attempted to explain the incidents which occurred which led to [the child] being removed. The applicant stated that she called the police because she had made numerous calls, all unreturned, to the Society’s workers, particularly D.S., on the morning after C. confessed to stealing the articles and taking them to her mother’s home. She needed some confirmation that articles were being stolen and believed that the police could get a warrant to search C.’s mother’s home. Her evidence is that she called the police, sometime in the afternoon, and was told that they would have to send an officer to the applicant’s home. When Constable M.M. arrived the applicant had just completed her laundry, which made the house look cluttered. She further explained that the child had his coat on because they were getting ready to go to an appointment, although she had no recollection of the purpose or location of this appointment. The applicant also recalled that Constable M.M. was rude when speaking with her.
56It was pointed out to the applicant that the general occurrence hardcopy from the [Police] reflects that she called the police at 9:45a.m. and that Constable M.M’s report states that she attended at the home at 10:00a.m., therefore the “police incident” occurred in the morning and not in the afternoon as she had testified. The applicant later gave evidence that the “police incident” occurred in the afternoon and that she had proof of this. On a Saturday, during the course of this hearing, the applicant attended at the police station to obtain information as to the time of the call to the police. She stated that an officer, who refused to give his name or badge number, told her that the call was made at 13:24 or 1:24p.m.
57In cross-examination the applicant admitted that she did not attend the scheduled access visit with [the child] that day, citing illness, and chose to attend at the police station to confirm her belief that the call was made in the afternoon. In fact, it is clear from the General Occurrence Hardcopy, that Constable M.M. filed her narrative (not that she attended at the residence) at 13:24 on April […], 2010.
58The applicant also told the Board that she has been told that Constable M.M. has been playing hockey on the same team as D. for approximately three years and believes that D. may have in some way influenced Constable M.M. to make a negative report about her, which would cause further chaos in her life. To confirm her belief, the applicant attended at the hockey rink where the team normally plays and testified that she identified Constable M.M. playing on the same team as D.. Based on her evidence there was nothing to support this claim that the person she saw was Constable M.M.. The applicant stated that although she does not know if D. influenced Constable M.M., she believes there is a possibility that he did and that she finds it “fishy”.
59The applicant denies that there is anything wrong with her mental health. She has attempted to explain and dismiss the concerns related to her mental health and has indicated in her final submission that many people are conspiring against her, including Dr. P.S. and the Society. There is no evidence before the Board that the applicant believes that she has mental health difficulties or that she is willing to seek treatment.
ANALYSIS
60The issue before the Board is to determine if the applicant has the capacity to respond to the child’s physical, mental, and emotional needs considering her mental health situation.
61In determining what action was in the child’s best interests, under section 144 of the Act, the Board took into account the over-arching considerations set out in section 1 of the Act, as follows:
(1) The paramount purpose of this Act is to promote the best interests, protection and well being of children.
Other purposes
(2) The additional purposes of this Act, so long as they are consistent with the best interests, protection and well being of children, are:
To recognize that the least disruptive course of action that is available and is appropriate in a particular case to help a child should be considered.
To recognize that children’s services should be provided in a manner that,
respects a child’s need for continuity of care and for stable relationships within a family and cultural environment,
provides early assessment, planning and decision- making to achieve permanent plans for children in accordance with their best interests,
62The Board was required to and did consider the following relevant factors enumerated in section 136 (2) of the Act, which reads:
(2) Where a person is directed in this Part to make an order or determination in the best interests of a child, the person shall take into consideration those of the following circumstances of the case that he or she considers relevant:
The child’s physical, mental and emotional needs, and the appropriate care or treatment to meet those needs.
The child’s physical, mental and emotional level of development.
The importance for the child’s development of a positive relationship with a parent and a secure place as a member of a family.
The child’s relationships by blood or through an adoption order.
The importance of continuity in the child’s care and the possible effect on the child of disruption of that continuity.
The effects on the child of delay in the disposition of the case
Any other relevant circumstance.
MENTAL HEALTH
63The Board in coming to its decision accepted the evidence of Dr. P.S. over that of Dr. H2 for the following reasons. Dr. P.S. interviewed the applicant nine times over fifteen hours in an attempt to determine if the applicant had any mental health issues, which would impact on her ability to parent a child. He also interviewed collaterals (third parties) that were suggested by both parties and reviewed written materials from the Society. The Board found that he was fair and balanced, not only in his report, but also when giving testimony. He noted the applicant’s positive traits including that the applicant had an insight into the children and that collaterals, together with people whose children the applicant had cared for, all agreed that she was very caring in her interactions with the children. He noted that as with most paranoid ideas, there were likely kernels of truth to what the applicant was reporting. He was prepared to accept that the stealing may have actually occurred and agreed with the applicant’s assessment of D. as intrusive, possessive, and manipulative.
64The Board finds Dr. P.S.’s assessment and testimony to be credible. His thorough and comprehensive interviews with the applicant and a range of relevant collaterals, and his review of documentation, have provided a very full picture. Dr. P.S.’s qualifications as an adult and child psychiatrist and a psychotherapist provide him with a range of experience and expertise.
65On the other hand Dr. H2’s global mental health status evaluation, which he conducted during his first meeting with the applicant, was cursory. It was based only on the self-reporting of the applicant and no information was obtained from the applicant’s family physician. Although he saw the applicant more frequently than Dr. P.S., his focus, by his own testimony, was not on psychotherapy or discussing the ongoing issues the applicant was facing in the home with the children. In fact he was not aware that there were any issues. Further Dr. H2 did not completely review Dr. P.S.’s report and therefore his critique of Dr. P.S.’s diagnosis and report carries less weight. The Board finds that Dr. H2’s view is not credible because he did not have the facts regarding the Society’s concerns available to him. He was not privy to the concerns related to the children B., C. and B2 which were the basis of the Society’s concerns regarding the applicant.
66The Board therefore finds that the evidence that the applicant has a paranoid disorder and displays mental health conditions, specifically, paranoid personality trait and delusional disorder, persecutory type is more reliable.
PROGNOSIS FOR APPLICANT’S MENTAL HEALTH
67Dr. P.S. in his evidence advised that paranoid disorders are difficult to treat because the individuals do not see the problem as with themselves, but with the world. Therefore it would be difficult for the person to accept help and there can be no change unless the problem is recognised. Dr. P.S. also added that delusional disorders “wax and wane” over time and do not resolve in the short term. He opined that while these disorders can be treated, it would require a lot of intervention. Therefore the individual would have to be open to the use of medication, intensive long-term external oversight, and be cooperative with the level of supervision. His evidence is that because individuals with these disorders view this intervention as intrusive and would experience it as unpleasant and humiliating, they are less likely to tolerate it.
68Based on his assessment Dr. P.S. found that the applicant was difficult and superficially compliant particularly when there are difficulties in the relationship with service providers. Although he agreed that the applicant sought help for herself and the children in her care, it was never on a consistent and enduring basis, which would be required to successfully obtain assistance for her mental health disorders.
69Dr. P.S. was of the view that the applicant did not demonstrate any insight into her tendency to paranoid and persecutory interpretations of her experience. Working with her to develop the beginning of such insight might take some time, and there would be a considerable risk that it would not be successful.
70The applicant does not accept Dr. P.S.’s diagnosis and for this reason it would be very difficult for the applicant to receive treatment. Therefore the Board finds that the prognosis for successful treatment of the applicant’s mental health disorders is poor.
[THE CHILD’S] NEEDS
71Several assessments of [the child] carried out since 2008 provided information about [the child’s] needs.
72In 2008, DCAS asked Dr. S.M., Registered Psychologist, to assess [the child] in order to have an understanding of her learning profile prior to the adoption placement. Dr. S.M. noted that [the child] was cooperative, had a somewhat short attention span, and was somewhat impulsive. She had at least average ability and was at risk for identification of an attention disorder.
73Dr. S.M.’s recommendation was for close supervision and support to her caregiver. She was of the view that [the child] would require very structured approaches. It would be important to have her at a school where she receives the assistance she required. Dr. S.M. also suggested that it would be important to see [the child] in two to three years for an updated assessment. At the hearing Dr. S.M. submitted that although she would not base any future plan for [the child] on her assessment because the evaluation was old, she believes that some of her earlier recommendations would still apply. She pointed out that she did not assess [the child] for psychosocial or attachment issues; a supplementary assessment would be of value.
74Dr. M.K., Child Psychiatrist, saw [the child] on October […], 2010 because of concerns related to Attention Deficit Hyperactivity Disorder (ADHD). He observed that [the child] was healthy, alert, active, and likeable, and had many areas of strength. He understood that her early childhood experiences were very crucial. He noted that [the child] was in a transitory position, having been placed temporarily in her current foster home and he was aware that there were some unresolved issues related to her adoptive home. [The child] reported that in her current school she had difficulty reading and writing and that the other children bothered her.
75Dr. M.K. saw significant psychological and learning issues. He saw [the child] as currently anxious, insecure, and very worried about where she would go from here. He suggested that it was difficult to determine, at the time, whether [the child’s] significant attention difficulties were indicative of ADHD. He recommended that [the child] be reassessed when she is settled in a permanent home and if at that time she continues to show significant attention difficulties, then a trial of stimulant medication might be considered. Dr. M.K.’s impression was that [the child] has demonstrated that with a stable, consistent environment and structure at home and at school she can make progress. As well, [the child] can benefit from individual therapy on an ongoing basis, to focus on past events.
76Dr. H2, psychiatrist, diagnosed and treated [the child] for ADD and found that she was doing very well on medication. He is appalled that [the child] is currently not being treated for ADD.
77The Board accepts the evidence of Dr. M.K. and finds currently [the child’s] primary need is to be settled in a permanent home with a stable, structured consistent environment. Dr. M.K. is a Child Psychiatrist who saw [the child] most recently and in arriving at his current treatment plan was aware of the various changes in [the child’s] life which would have an impact on her presentation. He therefore is most qualified and has the knowledge to reach this conclusion.
78After [the child] was placed in her current foster home, she was also referred to [Program A] due to concerns regarding potential adjustment issues following the adoption breakdown. The [Program A] uses a multidisciplinary approach to assess children, using the resources of a clinical psychologist, art therapist, clinical case consultant and information from collateral sources like the foster parent and the Society in formulating a plan for a child.
79It was noted that [the child] is resourceful, hypervigilant, and seeks attention and is very talented in the arts, singing, dancing, drama, and musical instruments. [Program A] reported that [the child] has experienced extreme loss and is still in limbo regarding her permanency plan. [Program A] reported that [the child] will require sophisticated parenting and parents with exquisite regulatory skills since [the child] depends on adults to regulate her actions. [Program A] recommended that [the child] receive trauma and attachment work but only after her permanency is established.
80The applicant in her testimony stated that when [the child] first came into her care she was very distressed and exhibiting some bizarre night time behaviour, including inserting objects into her vagina. However, the applicant was of the view that [the child] had stopped these behaviours because she was very involved in activities (dancing, swimming, playing violin), and was too tired to think about and relive her trauma at bedtime. This may not have been an accurate assessment since E.H., Art Therapist, who completed an Art Indicator Assessment with [the child] in October 2010 found that [the child’s] drawings depicted feelings of chaos and indicated that she needs to hear her story and be able to talk about her past.
81Although the terms of reference agreed to by the parties for the parental capacity assessment did not include an assessment of [the child], Dr. P.S. was able to provide some insight into her needs based on the information which he had obtained while completing the parenting capacity assessment. His testimony confirms what the other service providers recommended.
82Dr. P.S. was of the opinion that [the child’s] capacity to trust would have been impacted by her early traumatic experiences. This sense of abandonment by the primary caregiver would likely be further exacerbated by the previous foster care placement breakdowns and now the breakdown in her placement with the applicant. [The child] is currently in her fifth foster home in five years. These multiple losses would lead [the child] to see people and the world as untrustworthy.
83Dr. P.S.’s impressions of [the child] were that she was “utilitarian” in her interactions with people, that is, she would see people for what she could get from them. He was particularly concerned that [the child] seemed to be dependant on sensual and sexual stimulation for soothing and that she had exhibited “precipitative rejection” which led to her previous placement breakdowns.
84In conclusion, the Board finds that [the child] needs stability in her life. She needs to be placed in a permanent home, which can offer a safe, structured, consistent environment. [The child] would also need intensive individual trauma therapy and attachment therapy after a permanent placement has been found for her. Any diagnosis and treatment for ADD/ADHD can also be addressed at that time. She also needs to be placed at a school which can provide similar structure and stability.
IMPACT OF APPLICANT’S MENTAL HEALTH ON RAISING [THE CHILD]
85The Board agrees with Dr. P.S.’s assessment that the applicant had some ideals which were helpful in dealing with difficult children like [the child] – she would talk to, not shout at them, she enjoyed being with them and had a child-like sensibility to engage in activities they liked.
86Dr. P.S. was of the view that the applicant’s mental health difficulties would have an impact on the applicant’s ability to care for a child and there were some emotional, psychological and educational risks to the child. He opined that direct effects include the likelihood that a child would be directly exposed to the applicant’s paranoid ideas which would:
Tend to distort her evolving judgement about interpersonal relationships and the world at large
Undermine the child’s learning how to handle conflict and complexity
Create a sense of the applicant’s fragility and lack of assertiveness in the mind of the child
Expose the child to being the object of, or witnessing others being, the object of false accusations about not only their actions but also their intentions
Expose the child to being the object of, or witnessing others being, the object of coercive interrogation by the applicant aimed at confirming the applicant’s prior convictions
Expose the child to pressure to keep secrets
87The indirect effects would include the applicant’s serious difficulty working cooperatively with agencies and individuals with whom she has some disagreement. This might impair a child’s experience at school, with neighbours and friends, and in extra-curricular activities.
88While Dr. P.S. does not believe there are any physical risks to [the child] if she was placed with the applicant, he believed that the primary risks were with respect to the psychological and social environment in which [the child] would be raised if adopted by the applicant. However he felt that these risks would have to be balanced against what he suspected were the significant psychological risks of placing Tr. in some other home.
89Dr. H2 has seen the applicant with [the child] on several occasions and has observed a very warm and loving relationship. He strongly disputes the conclusion and outcome of the assessment by Dr. P.S.. He firmly opposes the decision of the Society to remove [the child] from the applicant’s care and would strongly support [the child’s] return to the applicant. He believes that the applicant should adopt [the child] since her ADD diagnosis does not prohibit her from being an effective parent.
90The Board heard evidence from numerous witnesses called by the applicant who opined that she should be allowed to adopt [the child]. They all spoke highly of the applicant’s care of not only [the child] but also of the other foster children in her care. These witnesses, other than W.D., her current partner, however, had only limited exposure to the applicant and were not aware of any of the recent issues which she was experiencing in the home with the children.
91The Board heard an audiotape of the applicant asking C. about the stealing. The applicant’s questions were leading and imposed emotional pressure on the child. For example she said: “But I just have a few questions because I don’t understand why you do things and do you care about me or not?.....Why would you do that?......You need to understand. Because you don’t like me?...”.
92From the applicant’s perspective her actions were justified. She believed that something was going on in her home and wanted to know what it is. She saw her life as being at stake and that she was trying to put the pieces of the puzzle together.
93The psychological impact on a child, of being kept awake, denied privileges (presents and parties) and questioned until the “correct answers” are obtained, is grave. It is also concerning that the applicant would tape conversations with the children and videotape them without their knowledge and consent. Such intrusive behaviour, in an attempt to confirm the applicant’s “suspicions” is definitely not in any child’s best interests.
94The fact that the applicant, when suspicious would focus solely on confirming her suspicion, rather than consider the best interests of the child is particularly concerning. The applicant chose to miss an access visit with [the child] in order to attend at the police station to “confirm” her belief that she had called the police in the afternoon and that Constable M.M. was wrong. This indicates that she would put her interests before that of a child, which is not a desired trait of a parent to a child who has many long-term needs, like [the child].
95The applicant also tends to resort to paranoid ideation and conspiracy theories whenever she believed that people were in conflict with her. The evidence is that [the child], not only now, but particularly in her teenage years would require a stable parent, who is prepared to handle the difficult times as she deals with the impact of her turbulent childhood. The applicant, with her untreated mental health issues, cannot provide this.
96At this point the applicant already describes [the child] as having a “bad side”, although she was the centre of attention wherever they went. The applicant said that hidden inside, [the child] is “angry, aggressive and not very nice”.
97[The child] would be particularly at risk during the troubling adolescent years when children are in conflict with their parents. Although this is a normal stage of development, the applicant may not view this as normal and may begin to view the behaviour as a conspiracy against her and view [the child] as a threat to her. The applicant admitted that she did not want to deal with adolescents. In her testimony the applicant stated that she did not want to foster older children because any childhood difficulties which they experienced would come out in their teen years and as a single parent she did not want to deal with them. Parenting a child through these years is more onerous than fostering, where supports are put in place by the Society, which has oversight over the care the child is receiving.
98If [the child] is placed with the applicant, based on the evidence, there is a great possibility that there would be an adoption breakdown when she is a teenager, thereby adding to [the child’s] sense of abandonment, loss and rejection which she already experiences. The Board believes that it would be unfair to expose [the child] to this risk.
99The Board does not believe that the applicant will ensure that the appropriate services are in place to support [the child]. [The child’s] parent would need to work collaboratively with the Society and [the child’s] treatment team such as therapists, teachers, since she would require intensive and ongoing interventions to assist her over the coming years. Dr. P.S. found that the applicant had difficulties with judgement and assertiveness and that her wariness had the unfortunate consequence of generating suspicion of service providers working with her.
100In response to the question as to whether the applicant was able to provide a long-term, stable and healthy environment for this child, Dr. P.S. answered as follows;
“There continue to be many areas in which the applicant is likely to provide good care to [the child]. There are also significant psychological risks to placing [the child] with the applicant. These have to be balanced against what I suspect are the significant psychological risks of placing [the child] in some other home.”
101He added that there would be risks no matter where [the child] was placed, and some of these result from her separation from the applicant after having begun to establish an attachment to her.
102The applicant clearly loves [the child] deeply. While [the child] was in her home, she succeeded in caring for her in such a way that [the child’s] difficult behaviour, resulting from serious and traumatic abuse within her biological family, improved significantly. [The child] was happy in her care and is attached to her although there is no evidence before the Board to describe the quality of that attachment. However, is love enough?
103The Board finds that in this particular case, love will not be enough for [the child]. Although the applicant has strengths which would be beneficial in parenting a child like [the child], the risks to [the child] associated with her untreated mental disorders far outweigh any benefits she might otherwise obtain. [The child] needs a stable home with a mentally stable parent. The Board is of the opinion that given the applicant’s mental health, she does not have the capacity to meet [the child’s] needs.
THE BOARD’S CONCLUSION
104The Board has found this decision to be a most difficult one because of its awareness of the strength of the applicant’s love for [the child], and [the child’s] need for and right to ongoing stability and happiness in her life. The Board is also aware of the applicant’s skill and success with difficult children and particularly her past success with [the child]. The Board acknowledges that it does not have a thorough assessment of [the child] and her current functioning nor is there an assessment of the relationship between the applicant and [the child].
105The Board during the course of the hearing observed, like Dr. P.S. did, that the applicant was guarded and wary and that it was difficult to obtain precise information and to organize a coherent story from the fragmented information she provided.
106In order to parent [the child], the applicant would need significant supervision and support because of her mental health status. [The child] will require highly sophisticated and regulated parenting because of her behavioural difficulties resulting from a history of abuse and multiple placements. In caring for [the child] there will also be a critical need for the applicant to work constructively with collateral agencies. There is concern regarding the applicant’s ability to do so.
107The Board is of the view that in light of the applicant’s current mental health status it is not in [the child’s] best interests for her to be adopted by the applicant. The applicant requires a degree of supervision which is not available in an adoption context. It is too great a risk for [the child] to be placed in an unregulated situation.
108Although the Board is of the view that [the child] should not be adopted by the applicant, it is also very concerned about the alternative and long-term plans for [the child]. The Board shares the applicant’s concern about [the child’s] well being, now and in the future and that [the child] may otherwise be “warehoused” by the Society.
109The Society indicated that if [the child] is not placed with the applicant for adoption then she would likely be placed in long-term foster care with treatment support. The Board can only hope that the Society will make its best efforts to ensure that this child, who has experienced a traumatic early history, five placements in five years, and has been the unfortunate victim of this adoption breakdown, is provided with long-term loving care which will provide her with the stability and structure she requires.
110The Board recommends to the Society that in making future plans for [the child] that it reflects on and take guidance from Dr. P.S.’s final conclusion –
“………. there would be significant psychological risks in placing [the child] with Ms. K.D.. These have to be balanced against what I suspect are the significant psychological risks of placing [the child] in some other home.”
DECISION
111For the above reasons, the Board, pursuant to section 144 (11) of the Child and Family Services Act makes the following order:
The Board confirms the Society’s decision to remove [the child], born October […], 2003 from the home of K.D., where she was placed for adoption.
112The Board also recommends that the Society reflect and take guidance from Dr. P.S.’s final conclusion and consider the options for [the child] in that light.
Suzanne Gilbert
Board Chair
Denyse Diaz
Board Member
Celia Denov
Board Member
Dated at Toronto, Ontario on this 18^th^ day of March, 2011.