CO'T v. Youthdale Treatment Centres, 2019 CFSRB 8

CHILD AND FAMILY SERVICES REVIEW BOARD

BETWEEN:

CO'T Applicant

-and-

Youthdale Treatment Centres Respondent

DECISION

Adjudicators: John F. Spekkens, Brenda Bowlby and Gail Gonda Date: March 6, 2019 File: ES19-0002 Citation: 2019 CFSRB 8 Indexed as: CO'T v Youthdale Treatment Centres (CYFSA s.171)

APPEARANCES

CO'T, Applicant Herb Stover, Counsel

Youthdale Treatment Centres, Respondent Jane Hunt, Counsel

Introduction

1On February 20, 2019, the Applicant, (the “Child”), made an application to the Child and Family Services Review Board (“CFSRB”) to review her February 19, 2019 emergency admission to the Secure Treatment Program at Youthdale Treatment Centre (“Youthdale”). A hearing was held on February 22, 2019.

2At the hearing, the Child took the position that none of the statutory criteria for emergency admission to secure treatment in subsection 171(2) of the Child, Youth and Family Services Act, 2017, SO 2017, c.14, Sched. 1 (the “Act”) were met at the time of her admission.

3Following the February 22, 2019 hearing, and for the reasons that follow, we denied the application by the Child for release as we were satisfied that all criteria under subsection 171(2) had been met at the time of the Child’s admission.

Background

4The Child is fourteen years old. She lives with both parents, an older sister, and a younger brother. She has been the victim of bullying in school and at the time of her admission to Youthdale was engaged in her studies at home with check-ins by teachers. On January 10, 2019, the Child took an overdose of Tylenol and as a result was admitted to a local hospital for a week.

5The Child was previously admitted on an emergency basis to Youthdale on January 18, 2019. She was released after two weeks on February 1, 2019 as the result of an agreement to resolve an application she had made to the CFSRB to review her admission.

6After the Child's return home on February 1, 2019, things escalated quickly. On February 3, she engaged in a loud argument with her sister and shoved her sister near the top of stairs. The Child then climbed on the kitchen counter and refused to come down when the family tried to “talk her down”. She then left home without telling anyone and ended up at her boyfriend’s home. She returned home the next day.

7On February 7, the Child left her home without telling anyone, this time without coat, boots, or mittens, in cold weather. The police were alerted (as per a vulnerable person's registry protocol) and found her. When the police tried to get her into their vehicle, she became aggressive and kicked one of the officers. She was handcuffed and taken home where she was transferred, again with aggressive resistance, to police vehicle and taken to the hospital.

8Once at the hospital, the Child calmed initially, but reacted with physical aggression when a police officer tried to encourage her to remain in the triage area. As a result, she had to be restrained while yelling and screaming at the top of her lungs. She was subsequently placed in hospital restraints and given an injection to calm her down. Prior to this, the Applicant head butted a nurse.

9She remained in hospital until her placement at Youthdale on February 19, 2019.

10The Child's parents have sought and received a range of services and supports for the Child and for themselves. Most recently, the Child has been assessed for services at a local children's mental health centre.

The Law

11Section 171(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 171(2)(a) to (e).

12Section 171(2) sets out the criteria:

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 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.

13Section 157 of the Act defines “mental disorder” as follows:

a substantial disorder of emotional processes, thought or cognition, which grossly impairs a person’s capacity to make reasoned judgements

Analysis

14In deciding this application, we must determine whether each of the relevant criteria in subsection 171(2) of the Act was met at the time of admission. This determination is made on a balance of probabilities. If any one of the criteria was not met at the time of admission we must order the Child released.

15The Child argues that none of the criteria were met at the time of admission.

16We conclude that all five criteria were met at the time of admission.

Criterion (a): the Child has a mental disorder which is defined as a substantial disorder of emotional processes, thought or cognition, which grossly impairs a person’s capacity to make reasoned judgements

17The Admitting Psychiatrist testified that the Child had a mental disorder, i.e., a substantial disorder of emotional process, thought and cognition at the time of her admission to Youthdale. This was evidenced primarily by her emotional dysregulation which resulted in her conflicts with and aggression toward family members, leaving the home without permission, resistance and aggression toward police and staff at the hospital where she was taken on February 7, 2019.

18The Admitting Psychiatrist also referenced the diagnoses which had been noted by other professionals including those involved in her admission to hospital as including anxiety, depression, oppositional defiant disorder and a possible intellectual disability as revealed through a recent Wechsler Intelligence Scale for Children (“WISC”) low test results. A low score on the WISC is associated with a risk of vulnerability to exploitation.

19Of particular note was the Child's recent suicide attempt in January as well as an historical pattern of suicidal ideation. Although the suicide attempt did not immediately precede her current admission to Youthdale, the Child was perceived to be in crisis mode and at risk at the time of her admission and continuously since early January. Evidence for this was the fact that except for a brief period since that time, the Child had been institutionalized and remained unstable.

20A psychiatrist who had been involved in the Child's treatment supported the re-admission to Youthdale in the interest of helping to stabilize her.

21The Child's father gave testimony that attested to a pattern of behavior that included suicidal ideation, repeated cutting, conflicts with family members, instances of poor judgment that placed the Child at risk particularly with regard to her recent suicide attempt and her involvement with an older youth who is alleged to have been abusive toward her. Her father further testified that the Child displayed defiance toward any type of authority figure. He described her as having been difficult to manage during the recent admission to hospital during both the admission phase and after admission to a point that both physical and chemical controls had to be used.

22We conclude that that the Child had a mental disorder at the time of admission as defined under the Act and that criterion a) has been met.

Criterion (b): the child has, as a result of the mental disorder, caused, attempted to cause or by words or conduct made a substantial threat to cause serious bodily harm to herself or others

23The Admitting Psychiatrist testified that at the time of admission the Child had a substantial disorder of emotional process, thought and cognition which grossly impairs the Child’s capacity to make reasonable judgments.

24The Admitting Psychiatrist diagnosed emotional dysregulation and noted diagnoses of anxiety, depression, oppositional defiant disorder, suicidal ideation and an intellectual disability. She referenced the Child's recent serious suicide attempt which involved ingesting a toxic amount of Tylenol, her continued state of crisis, conflicts and aggression with members of her family, police and hospital staff.

25She stated that the Child was at risk of harming herself and possibly others given her recent pattern of behaviour and also at risk of being exploited given her level of functioning and diminished capacity to exercise good judgment.

26The Child's father's testimony noted her general impulsivity when dealing with stressful situations as manifested by her suicide attempt, running, resistance to direction and conflicts with family members.

27The emotional dysregulation that leads to the Child's impulsivity has placed her at risk and continues to do so. This risk of harm is further compounded by her diminished capacity to exercise good judgment. The Child's placement on the vulnerable persons' registry at the suggestion of her treating psychiatrist further attests to her level of risk of harm as perceived by her parents, her psychiatrist and police.

28The Child acknowledged that her level of stress at the time triggered her suicide attempt in January. She also acknowledged that she was aggressive with hospital staff, kicked a police office and shoved her sister and that her boyfriend had slapped her.

29The Admitting Psychiatrist described the Child's triggers which give rise to her behaviours and as shared with her by the Child. These included communications and miscommunications with family members, bullying by school mates and academic stress, all of which remain present and salient. The Child confirmed that arguing with family members led to her overdose in January.

30We conclude that as a result of her mental disorder, the Child is at risk of causing serious bodily harm to herself directly and indirectly through exploitation by others. The Child is also at risk of causing serious bodily harm to others given her tendency to physically lash out at others during stressful situations which the Child did not deny.

31For these reasons we conclude that criterion (b) has been met.

Criterion c) the secure treatment program would be effective to prevent the child from causing or attempting to cause serious bodily harm to herself or another person

32The Admitting Psychiatrist testified that staff at Youthdale are trained to work with youth who present like the Child.

33Youthdale is a secure setting that is designed to minimize the risk of running as a means for the Child to deal with stress. Any objects that could be used to inflict harm are kept away from residents. Staff are trained in de-escalation and can assist the Child in coping with stress in the environment that would be helpful in assisting her to acquire better coping strategies.

34For these reasons we conclude that criterion (c) has been met.

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

35The Admitting Psychiatrist described the treatment available at Youthdale specifically geared to the Child's needs. It offers a range of treatments specific to the Child's presenting problems as well as intensive family therapy and other forms of therapy. Treatment is available that would assist the Child in developing and implementing coping strategies and assist the parents in de-escalation of the Child's emotional outbursts.

36There have been multiple players in the Child's life involved in managing her behaviors, crises and treating her. These include her parents, community partners such as mental health service providers, hospitals and the police. Youthdale has the professional staff and expertise to take into account the Child's complex diagnostic presentation and history and undertake safety planning with these players in order to ensure a successful return home. The Child acknowledged that she found her brief first stay at Youthdale to be helpful. However, there was not sufficient time to put a comprehensive safety plan in place before she was discharged.

37We conclude 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

38The Child's father testified about the range of services that had been sought for the Child and in which she participated. These included counselling in the community and through the school, psychiatric treatment and medications, services through his employer's employee assistance program and local hospitals. The parents had recently sought services from a local children's mental health centre which provides both residential and non-residential services.

39None of these services has resulted to date in providing the Child with an appropriate means to manage how she deals with stress in an effective manner. Her recent admission and stay in hospital were only a means to maintain her in a holding pattern through the use of physical and chemical restraints. She is not currently a good candidate for a community residential program given her tendency to run when stressed. Youthdale is an ideal setting to stabilize her condition and to develop an appropriate safety plan that may include a residential placement.

40For these reasons, we conclude that criterion (e) has been met.

Conclusion

41We find that all five criteria in subsection 171(2) of the Act were met at the time of the Child’s admission to Youthdale. Accordingly, on February 22, 2019, we denied the Child’s application for release pursuant to section 171(13) of the Act.

Confidentiality Order

42Pursuant to Rules 9.3 and 9.4 of the CFSRB’s Rules of Procedure parties and their representatives must not use, share, discuss or disclose any CFSRB documents or decisions or any other documents or information provided or used in this application with anyone including through the media or on-line. The CFSRB prohibits the use of any of this information for any purpose outside of the CFSRB’s proceedings, except with an order of the Court or the CFSRB, as appropriate.