S. v. Youthdale Treatment Centres, 2013 CFSRB 16

CHILD AND FAMILY SERVICES REVIEW BOARD

S.

v.

Youthdale Treatment Centres

REASONS FOR DECISION

Date: March 21, 2013

Citation: 2013 CFSRB 16

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

INTRODUCTION

1The "Child" S, asks the Child and Family Services Review Board (the "Board") to review her March [ ], 2013 emergency admission to the Secure Treatment Program at the Youthdale Treatment Centre ("Youthdale"). Her position is that none of the statutory criteria for emergency admission contained in subsection 124(2) of the Child and Family Services Act, R.S.O. 1990, c.C.11, as amended (the "Act") were met.

2For the following reasons the Board is satisfied that the Child met all the criteria for emergency admission at the time of admission. Her request for release from Youthdale is therefore dismissed.

BACKGROUND

3The Child is a fourteen year old girl who is in the care of the [ ] (the "Society"). She has three biological siblings who are 16, 11 and 8 years old. All the siblings are in care. The Society has been involved with the family on and off for a number of years because of domestic violence between parents, substance abuse by parents, and neglect of the children. In May of 2012, the children were apprehended by the Society after the mother was charged with assaulting the Child with a baseball bat. The Child was placed in 12 foster and relief foster homes including a residence which is an accredited mental health facility for adolescent girls. All of these placements broke down due to the Child's behaviour. She was then placed in an emergency foster home for three days before being involuntarily admitted to the adolescent psychiatric unit in hospital on February [ ], 2013. She was transferred to Youthdale from the hospital on March [ ], 2013.

ANALYSIS

4Section 124(13) of the Act provides that;

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

5Section 124(2) sets out the criteria which must be met at the time of admission.

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.

6[ ], Director of Crisis Services, reviewed the Admission Summary completed by the admitting psychiatrist and is of the opinion that the Child has a mental disorder as defined by the Act. The admitting psychiatrist listed the following disorders to be ruled out with more assessment—Post Traumatic Stress Disorder, Reactive Attachment Disorder, Sleep Disorder, Learning Disorder, Mood Disorder, Fetal Alcohol Spectrum Disorder and Parent-child relational problem. The admitting psychiatrist was contemplating multiple severe mental health disorders relevant to the Child's difficulties which need to be further explored. The Director of Crisis Services is of the opinion that the Child had a substantial disorder of emotional process and thought resulting from the above disorders. He testified that the Child's disorders are the result of early exposure to neglect, violence, abuse and in utero exposure to drugs. In his opinion, the Child, when exposed to external stress becomes unexpectedly and quickly "dis-inhibited" and unable to exert self control. When overwhelmed emotionally, she resorts to threatening behavior, aggressiveness and self-harm. Her disorders significantly interfere with her ability to make reasoned judgments. He is of the opinion that when the Child is emotionally stressed, she loses her grounding in reality, misinterprets the intentions of others and reacts in a self-defensive manner resulting in aggression.

7Furthermore, prior to admission to Youthdale, the Child was involuntarily admitted to the Adolescent Psychiatric unit at the local hospital. In the discharge report, she was diagnosed with Disruptive Behaviour Not Otherwise Specified.

8The Child's worker testified to the pattern of behavior since October which led to the Child's admission to Youthdale. The Child has engaged in many incidents requiring restraints. She has been agitated, verbally aggressive, defiant, throwing her puffer and shattering it. She was not willing to follow direction or programming and did not attend school. She stayed up late running around the house, screaming and waking the other residents. She slept during the day and did not go to school. She damaged property by running around throwing things, breaking objects and turning furniture over. She showed staff a pocket knife and proceeded to slide it down her arm saying she will cut herself. She ran out into the street in traffic and when agitated takes all day to settle down. She attempted to break into the medicine cabinet. Staff could not manage her behavior.

9The Board has considered all the evidence and is satisfied, on a balance of probabilities that, at the time of admission, the Child had a substantial disorder of emotional processes which grossly impaired her capacity to make reasoned judgments. The Child's impulsivity, her lack of control, the damaging of property and her threats and attempts to harm herself show that she cannot make reasoned judgments. The Child's behaviours have demonstrated grossly impaired judgment, given the escalation in the severity and frequency of her behaviours.

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 herself or others.

10The Director of Crisis Services is of the opinion that the Child is at risk to harm herself. Her "dis-control", impulsivity and unpredictability particularly stood out for him. He noted that it is difficult to determine when she will react and she has placed a cord around her neck and told the resident doctor that she wanted to kill herself.

11The Team Leader at the Residence testified to the Child's disruptive and self-harming behaviours. The Child threw her clothes on the porch, yelled, banged on doors, poured shampoo on door handles, tore things off the walls and staff has to intervene to prevent her from grabbing medications out of the medicine cabinet. She was non-compliant with medication and has punched a staff member. She has threatened to kill herself. She went out and sat on the street in the middle of the night requiring Staff to go out and stop traffic to prevent her from being hit. She has pierced a girl's ear and allowed a girl to pierce her nose with a safety pin. She carries broken glass hidden in her brassiere and has scratched her arms and legs. She has taken a sharp object and moved it up and down over a vein while threatening to kill herself.

12Her self-harming behaviours are escalating since she did not engage in these activities prior to coming to the Residence. During the past month she has left the Residence without permission many times at two or three o'clock in the morning. On February [ ], 2013, she sat with a cord around her neck and shards of glass from a light bulb and threatened to harm herself. She had also assaulted staff. Following this incident, the Residence asked that she be removed since it could not keep her safe.

13The Placement Officer from the Society and the Family Services Worker testified to the incident on February [ ], 2013 which resulted in the Child being admitted involuntarily to the Adolescent Psychiatric Unit at the hospital. Following a visitation with her sisters, the Child refused to leave the agency, escalated her behavior, threw furniture around, and ran out into the street into the parking lane. She had to be restrained and police were called to escort her back to the emergency foster home. At the home, the Child's behaviour escalated again and she ripped some railings out of the floor with superhuman strength. Police were called again to escort her to the hospital. The Family Services Worker testified that the Child disclosed to the doctor that she would harm herself. The Child said that if she was not placed with her mother, she wanted to die. She was admitted involuntarily to hospital.

14The Board is satisfied that there is ample evidence that the Child has made serious threats to harm herself and that these are a result of the Child's mental disorder. Medical personnel at the hospital took the Child's threat to harm herself seriously and kept her in the Adolescent Psychiatric Unit from February [ ] to March [ ], 2013 and then released her to Youthdale. The Director of Crisis Services at Youthdale is of the opinion that the Child is at risk of harming herself due to her impulsivity, unpredictability and "dis-control". The Child's self-harming behaviours are escalating. Recently she has started to leave the Residence without permission. Her disruptive behaviours have also escalated resulting in physical restraints needing to be used to keep her safe. She has put herself in harm's way by running out into the street and lying or sitting there in the middle of the night. She has put a cord around her neck, held glass and threatened to kill herself. She has attempted to take medications out of the medicine cabinet for an overdose and hidden sharp objects in her brassiere. The escalation of all these actions increased the likelihood that the Child will carry through with her attempts to harm herself. The Child's extreme impulsivity and the escalation of the Child's behaviour leads the Board to believe that at the time of admission there was a substantial threat, that is, a very real chance that she could have caused serious bodily harm to herself.

15The Board finds that criterion (b) was met at the time of admission.

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.

16The Board is satisfied that the secure treatment program would be effective to prevent the Child from causing or attempting to cause serious bodily harm to herself or others.

17The Psychiatric Crisis Worker testified to the resources available at Youthdale to prevent the Child from causing or attempting to cause serious bodily harm to herself or others. Youthdale offers a secure treatment program with a high ratio of staff to clients. The Child would be constantly monitored so that she would have no opportunity to harm herself. There are no sharp objects in the unit and eating utensils are counted and collected. Youthdale has a very strict search policy and clothing is thoroughly searched. The Child would not be able to hide sharp objects.

18Youthdale is a locked facility so that the Child would not be able to run out into the street in an attempt to harm herself. Nor would she be able to leave without permission.

19The Board is satisfied that criterion (c) has been met.

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

20The Director of Crisis Services testified to the resources that Youthdale has in order to treat the Child. Youthdale offers a multi-disciplinary program involving teachers, child and youth workers, psychiatry services, neurological services, medical staff, and a sleep clinic. Youthdale can stabilize the Child, perform the required psychiatric assessments and implement a treatment plan to treat the Child's mental disorder.

21The Board is satisfied that Youthdale has the resources to treat the Child's mental disorder and that criterion (d) has been met.

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

22The Placement Officer testified that the Child was placed in numerous foster homes but these all broke down due to the child being out of control with ongoing verbal aggression, defiance and property destruction. She was then placed at the Residence which is an accredited mental health facility for adolescent girls. This facility is community based and provides a program for girls who need support and stabilization. It is a voluntary program and provides orientation, assessment and individualized treatment. Many of the girls come with mental health challenges such as Attention Deficit Hyperactivity Disorder, anxiety, suicidal ideation, and high risk behaviours. As noted above, this placement which is not a secure facility broke down because of the Child's aggressive and self-harming behaviours. The facility had difficulty controlling her behaviour and keeping her safe despite providing one to one staffing for her. While here, the Child's behaviour escalated and she started to self-harm and during the last month was absent without permission many times.

23The Board finds that no less restrictive method of providing treatment appropriate for the Child's mental disorder was appropriate in the circumstances and that criterion (e) was met.

CONCLUSION

24Pursuant to section 124(13) of the Act, the Board, having satisfied itself that each of the criteria in subsections 124(2) (a) through (e) have been met, dismisses the application for release of the Child on March 11, 2013.