SUPERIOR COURT OF JUSTICE

FAMILY COURT

IN THE MATTER OF THE CHILD AND FAMILY SERVICE ACT, R.S.O. 1990, c. C.11

AND IN THE MATTER OF S.C.S. a child apparently in need of protection

HAMILTON CHILDREN’S AID SOCIETY -Applicant

• and -

S.C.S.

SECURE TREATMENT HEARING

REASONS FOR DECISION

BEFORE THE HONOURABLE JUSTICE D. CHAPPEL

On Thursday, October 11, 2012 at HAMILTON, Ontario

INFORMATION CONTAINED HEREIN IS PROHIBITED FROM PUBLICATION PURSUANT TO SECTION 45(8) OF THE CHILD AND FAMILY SERVICES ACT

APPEARANCES:

T. Watts Counsel for the Children’s Aid Society

R. Murdoch Counsel for the child S.C.S.

(i)

Table of Contents

SUPERIOR COURT OF JUSTICE

T A B L E O F C O N T E N T S

Examination. Cross- Re-

WITNESS In-Chief Examination Examination

... No witnesses.

E X H I B I T S

EXHIBIT NO. PAGE NO.

... No exhibits entered.

INFORMATION CONTAINED HEREIN IS PROHIBITED FROM PUBLICATION PURSUANT TO SECTION 45(8) OF THE CHILD AND FAMILY SERVICES ACT

Transcript Ordered: ........................ October 11, 2012

Transcript Completed: ........................ February 8, 2013

Ordering Party Notified: ...................... February 11, 2013

... Upon commencement of the Reasons for Decision:

Chappel, J. (Orally)

This is a hearing of an application brought by the Children’s Aid Society of Hamilton pursuant to section 120 of The Child and Family Services Act to extend the time period of the respondent child S.C.S.’s commitment to the secure treatment program at Kinark Child and Family Services, Syl Apps Youth Center, hereafter referred to as “Syl Apps,” for a period of 180 days.

This application was commenced on September 5^th, 2012. On that date the application was adjourned until October 9^th, 2012, with consent of the child S.C.S., hereafter referred to as “S.C.S..” S.C.S. was represented by counsel, Mr. Robert Murdoch, for the purposes of this proceeding. Mr. Murdoch was appointed as counsel for the child through the Office of the Children’s Lawyer. The child consented to the court receiving affidavit evidence of the Society Worker Ms. Lisa Keller and a duly executed consent to this effect was filed with the court on October 9^th, 2012, as required pursuant to section 115 of The Child and Family Services Act.

I reviewed the affidavits of Ms. Keller, which S.C.S. consented to having entered and marked as evidence in this proceeding. I also heard vive voce evidence from Ms. Keller and from the child’s psychiatrist, attending psychiatrist, at Syl Apps Youth Center, Dr. Catherine Krasnik.

By way of background I make the following findings based on the evidence adduced in this proceeding. S.C.S. is 15 years of age. On December 2^nd, 2005, he was made a Crown ward and placed in the care and custody of the applicant Society. He has remained a Crown ward in the Society’s care since that time. The Society initiated a secure treatment applica­tion respecting S.C.S. on June 11^th, 2012, request­ing that he be committed to secure treatment. The matter came on for a hearing on June 19^th, 2012, and on that date an order was made on a consent basis committing S.C.S. to secure treatment at Syl Apps for a period of 90 days. The Honourable Mr. Jus­tice Sloan made a determination on June 19^th, 2012, based on the evidence before him that the criteria set out in section 117 of The Child and Family Services Act for committing a child to secure treatment had been satisfied.

The Society’s position is that the test for extend­ing the secure treatment order has been satisfied in this case, and that a 180 day extension of the child’s commitment to the secure treatment program at Syl Apps is warranted on the facts of the case. It argues that this period of time is required to ensure that the child receives and benefits from the treatment which he requires before he can be safely reintegrated into the community. Its posi­tion is that any shorter period of commitment would not be sufficient to ensure that the child’s gains for treatment are maintained, with the result that S.C.S.’s situation would quickly revert to that which led to his being committed to Syl Apps in June of 2012. S.C.S. opposes the request for an extension of his commitment to secure treatment at Syl Apps.

Mr. Murdoch most ably represented S.C.S. in this proceeding and he acknowledged that the criteria set out in section 120(5) subsections (a) to (d) for extending the secure treatment order have been met. His argument was that the criterion set out in section 120(5)(e) has not been satisfied in this case. In particular he submitted that the Society has not identified a clear and precise plan for S.C.S.’s care when he is discharged from secure treatment. Mr. Murdoch submitted that this pro­ceeding is not concerned about the best interests of S.C.S., but rather that the court must remain focussed at all times on the strict criteria set out in section 120(5) of The Child and Family Services Act. His view is that section 120(5)(e) requires the Society to provide clear and precise details regarding its plan for discharge that it would implement upon the release of the child from secure treatment. Mr. Murdoch’s position is that the Society’s plan for S.C.S. upon discharge is unclear in many aspects, and in particular he suggested that the plan is in many respects in the nature of a wing and a prayer, due to concerns regarding the availability of resources.

Although Mr. Murdoch on behalf of S.C.S. concedes that section 120(5)(a) to (d) have been satisfied, I am obliged to give reasons nonetheless for my decision in this matter, pursuant to section 119 of The Child and Family Services Act, and therefore I will address in detail each of the criteria set out in section 120(5).

As I have indicated, I heard testimony from both the child’s attending psychiatrist at Syl Apps, Dr. Catherine Krasnik, and the Society Crown wardship worker Lisa Keller. I found these witnesses to be very credible and reliable. They both had a sound recollection of events. They were organized in their presentation. They were consistent in their testimony about events. Their testimony was not, in my view, undermined in cross-examination despite the excellent job which Mr. Murdoch did in this regard.

As I have referred to, the test for extending a secure treatment order is set out in section 120(5) of The Child and Family Services Act. As counsel have indicated that provision sets out five crite­ria, all of which just be satisfied, before the court can grant an extension of a secure treatment order. I will deal with each of these criteria in turn.

Dealing with the first criteria under section 120(5)(a) stipulates that the court must be satis­fied that the child suffers from a mental disorder. The term mental disorder is defined in section 112 of The Child and Family Services Act as meaning;

“A substantial disorder of emotional pro­cesses, thought or cognition which grossly impairs a person’s capacity to make reasoned judgments.”

I find that the Society has met this branch of the test. I reach this conclusion based on the evi­dence of Dr. Krasnik, who was qualified as an expert in this proceeding in the area of forensic psychiatry, both for adults and youths.

Based on her evidence I make the following find­ings: Dr. Krasnik initially met S.C.S. on June 19^th, 2012, upon his admission to Syl Apps. Until recently she met with him on a weekly basis. More recently she has been meeting with him either weekly or biweekly. When Dr. Krasnik first met with S.C.S. she diagnosed him as suffering from acute psychosis - not otherwise specified, rule out possible schizophrenia. At that time S.C.S. presented with extremely flat affect and slowed thought process. His attention span was extremely poor and he was unable to process verbal comments being made to him in a reasonable manner.

During the initial period of his commitment to secure treatment S.C.S. was operating under a delusional system which involved a belief that there was a portal in his skull which allowed people to access his brain, and that Syl Apps staff and residents were accessing his brain in this fashion to grow and harvest his brain. He referred to this as people “sieging” his brain.

Over the course of S.C.S.’s commitment at Syl Apps his acutely psychotic state has been gradually clearing with medication and with the absence of marijuana use. His delusional thought system has not been present for approximately one month now. However, I do find based on Dr. Krasnik’s testimony that S.C.S. continues to exhibit residual symptoms of thought disorder, including incidents of disor­ganized thought, inappropriate perseverance on issue, some cognitive deficits and some residual delusional beliefs.

As a result of S.C.S. showing symptoms of schizo­phrenia over a period of time without being under the influence of substances, Dr. Krasnik’s diagno­sis of S.C.S. has evolved. Based on her evidence I find that S.C.S. is currently suffering from schizophrenia, cannabis abuse query dependence, and Oppositional Defiance Disorder as indicated in the report of Dr. Krasnik submitted in this proceeding. Dr. Krasnik characterized her diagnosis of schizo­phrenia as being a working diagnosis. She clari­fied that this means that she has actually made a diagnosis of his mental disorder but that the diagnosis may need to be reviewed at a later date depending on whether S.C.S.’s symptoms continue to persist over time without the impact of substance use.

As a result of S.C.S.’s psychotic presentation upon admission to Syl Apps Dr. Krasnik determined that he lacked the capacity to consent to medical treatment. As a result, the Society worker Ms. Keller was named as S.C.S.’s substitute decision maker. I find that Dr. Krasnik has continued to review this finding of incapacity throughout her involvement with S.C.S. on a regular basis and that she has recently confirmed that S.C.S., in her opinion, continues to be incapable of consent­ing to treatment.

The second criteria the Society must establish in this case is that the secure treatment program would be effective in preventing the child from causing or attempting to cause serious bodily harm to himself or another person. I am satisfied that this criterion has also been satisfied in this case. In order to address this branch of the test, it is necessary to understand S.C.S.’s treatment plan while he has been at Syl Apps and the proposed plan for the future if he remains there.

Until recently S.C.S.’s treatment plan has in­volved regular psychiatric monitoring by Dr. Krasnik and administration of medication to address his psychiatric symptoms. According to Dr. Krasnik, S.C.S.’s psychiatric status prior to late August 2012, was too unstable to allow him to participate in and benefit from any significant therapy. His delusional belief that staff and residents were removing pieces of his brain ren­dered him unable to interact in any meaningful way with any staff or residents. By mid August 2012, his psychosis had begun to stabilize and he was therefore oriented to the dialectical behaviour therapy program at Syl Apps and was integrated into the unit based and cross center recreational activ­ities. S.C.S. has only attended a few dialectical behaviour therapy sessions to date. In order for this treatment to be effective it is recommended that a patient attend at least 12 to 16 weekly sessions.

S.C.S. continues to receive his medication at Syl Apps and his intake is monitored closely by Syl Apps staff. The plan is for S.C.S. to continue receiving substance abuse counselling through Adapt while at Syl Apps if he is to remain there. This has not been implemented to date as S.C.S. was not considered well enough from a psychiatric stand­point to benefit from this counseling until now. In addition, the Syl Apps team intends to make a referral for S.C.S. to undergo a psychological assessment if he remains in secure treatment, which would further inform his overall assessment and assist in future planning for S.C.S..

I find based on the evidence before me that the treatment program which has been formulated for S.C.S. at Syl Apps would in fact be effective in preventing the child from causing or attempting to cause serious bodily harm to himself or another person. I conclude that in the absence of this treatment S.C.S. would continue to be at great risk of causing or attempting to cause harm to himself or other members of the public. I do find based on the evidence of Dr. Krasnik and Ms. Keller that at this time S.C.S. does not acknowledge his psychiatric difficulties, denies that he needs help and is therefore resistant to receiving treatment. Furthermore, he has expressed a clear intention to resume regular marijuana use once he is released from Syl Apps.

I accept Dr. Krasnik’s evidence that these consid­erations pose serious problems in terms of S.C.S.’s prognosis at this time if he were to be discharged from a secure treatment facility. I conclude, based on Dr. Krasnik’s and Ms. Keller’s testimony, that if S.C.S. were released from secure treatment at this time he would in all likelihood cease taking his medication and resort once again to regular marijuana use. I conclude on a balance of probabilities that this would result in S.C.S.’s condition rapidly deteriorating within a few weeks to the acutely psychotic state that he was in at the time of his admission to Syl Apps.

I find that this situation would in all likelihood result in S.C.S. placing both himself and others in the community at great risk. S.C.S. has a history prior to his admission to Syl Apps of placing himself in situations of considerable risk to his own safety. Examples of such incidents during the period just from September 2011 until June 2012 include the following: (a) many incidents of AWOL’ing from his placements; (b) two incidents of him attempting to jump out of vehicles when they were moving with him almost being struck by a car on one such incident; (c) there was an incident where he went AWOL for several days and was eventu­ally found in a disorientated state lying in a field. On that occasion he was found to be ex­tremely dishevelled with filthy feet, and clothing and underwear that was so filthy that it had to be disposed of. It appeared that he had been wander­ing throughout this period of AWOL and that he had not eaten for some time when he was found; (d) Further, there was an incident when he was at Lynwood Children’s Center when he told a resident he was planning to jump off a bridge, and he was in fact found on the edge of a bridge and had to be removed by police; (e) There was an incident when he went AWOL and roller bladed from Durham to Hamilton. S.C.S. later told Ms. Keller that he had slept under an overpass on that occasion; (f) There was an incident of him cutting himself while talking on the phone with his Society worker as a means of convincing her to change his placement; (g) S.C.S. also has a very concerning recent history of engaging in aggressive and threatening behaviour and making serious threats of causing harm to his mother, step father and half sister. He has threatened to burn down the homes where his mother, step father and half sister live, and there was an incident prior to his admission to Syl Apps when he became aggressive towards his mother and broke many items in her home, resulting in emer­gency police and Society intervention to remove him from the home; (h) There was an incident in late 2011 when he left his father’s home in the middle of the night and smashed a window of the building across the street; (i) He has made serious allega­tions against his step father, step aunt and step uncle, resulting in those family members being investigated; (j) During his admission to McMaster Hospital Adolescent Mental Health Unit in approxi­mately late 2011, he assaulted and hurt three staff and had to be put in a confined area until stabi­lized.

These are some examples. Based on this history of extremely concerning behaviours and my conclusion regarding the likelihood S.C.S.’s mental health deteriorating if he were discharged at this point, I am satisfied that S.C.S. would in fact pose a very serious risk to both himself and to the commu­nity at large if he were discharged. In reaching this conclusion I also rely on the evidence of Dr. Krasnik that people experiencing psychotic episodes such as the one which S.C.S. was exhibiting at the time of admission can be highly unpredictable, prone to misinterpreting cues, suffer disorienta­tion and delusions and are at high risk of placing themselves in dangerous situations or acting out verbally or physically towards others.

I am satisfied that the secure treatment plan which has been formulated for S.C.S. at Syl Apps would be effective in preventing S.C.S. from causing or attempting to cause harm to himself or others of the nature and preventing the types of concerns that have arisen in the past. I accept Dr. Krasnik’s evidence that this plan has been imple­mented with the goal of assisting S.C.S. to ac­knowledge that he has mental health difficulties and to accept that he needs treatment and to commit to a substance abuse relapse prevention plan. The dialectical behaviour therapy, which has just begun, focusses on establishing emotional regula­tion and stress tolerance in developing coping strategies. According to Dr. Krasnik, S.C.S. needs to develop greater strength in all of areas in order to be able to effectively manage his psychosis and schizophrenia in both the short and long term.

The evidence of Dr. Krasnik satisfies me that this treatment plan has a reasonable prospect of being successful with S.C.S.. S.C.S. has already made gains with the treatment that he has received to date. Dr. Krasnik and Ms. Keller both testified that his delusional thinking has decreased, he is more focused, he is compliant with this medications and that he has not been using illegal drugs.

Ms. Keller testified and I find that since his admission S.C.S. has presented as calmer and more content and oriented, and that he is starting to get his sense of humour back. S.C.S.’s progress is such that he has been able to start dialectical behavioural therapy and school. Dr. Krasnik’s opinion, which I accept, is that his success to date is a very good predictor for S.C.S.’s ability to continue progressing in this setting. The key to this success of this treatment program is in my view the fact that the treatment is being provided in a secure setting. I will discuss this point further in dealing with the next criteria for an extension of the secure treatment order, which I now turn to.

The third criteria for extending the secure treat­ment commitment order is that no less restrictive method of providing treatment that is appropriate for the child’s mental disorder is appropriate in the circumstances. The evidence satisfies me that this criteria has also been met. I find, based on Dr. Krasnik’s and Ms. Keller’s evidence, that a secure and closely monitored treatment environment is critical to S.C.S. continuing and maintaining his progress. As previously stated, it is highly likely that S.C.S. would resort back to his previ­ous lifestyle, his substance abuse and AWOL behav­iour, and discontinue his medication treatment if he were discharged from the secure environment at this time, having regard to the nature of the psychiatric illness and his inability to acknowl­edge that he has psychiatric problems which require ongoing treatment.

Having regard for S.C.S.’s history of significant AWOL’ing behaviour, any attempt to provide treat­ment for him in the community or hospital setting would involve a high risk of elopement, with him returning in all likelihood to drug use and non compliance with his medications and high risk behaviours in the community. Furthermore, I find that the treatment which S.C.S. so desperately requires at this time and the services which he so desperately requires, are available through his secure treatment placement at Syl Apps in a much more timely basis than they would be in the commu­nity at this point. I accept Dr. Krasnik’s testi­mony that if S.C.S. were discharged at this point he would not be able to receive dialectical behav­ioural therapy for at least six months. This therapy is a critical element of S.C.S.’s treat­ment plan. In addition I find, based on Dr. Krasnik’s and Ms. Keller’s evidence, that the wait list for S.C.S. to be accepted for treatment with a child and adolescent psychiatrist in Hamilton would be several months.

Time is of the essence for S.C.S.. I conclude that the treatment which he would receive in the community at this time, if he were discharged from secure treatment, would fall far short from what he requires right now. The history of attempts in this case with less intrusive community alterna­tives provides the best evidence as to why less intrusive measures and secure treatment would not be appropriate.

I make the following findings respecting previous efforts which the Society and other professionals have made since September, 2011, to implement less intrusive measures in the community, and the out­comes of those attempts: attempts were made to place S.C.S. in regular family setting foster homes with his mother, with his step father and his step uncle and aunt, with support for his health issues from a family doctor and psychiatrist. These attempts were all unsuccessful. His place­ment in the foster home which he lived in, in September 2011, broke down due largely to issues with S.C.S.’s challenging behaviours. The place­ment with his mother broke down because of his aggression towards his mother and towards items in her home, and his mother’s fear for her and S S.C.S.’s safety. Attempts at placement with the step father broke down in large part due to allegations against the step father of rape, drugging and the step father’s dog poisoning S.C.S., and threats to the safety of the step father and S.C.S.’s half sister. The attempt to place S.C.S. with his step aunt and step uncle, with community supports, likewise broke down due to S.C.S.’s very serious allegations against them.

Attempts have been made to respond to S.C.S.’s mental health issues on a crisis basis by way of emergency calls to COAST for assessment and inter­vention, and admissions to hospital. S.C.S. was admitted to St. Joseph’s and then transferred to McMaster Hospital 3G Unit for Adolescents three times, from September, 2011 to June, 2012. On each occasion when he was transferred to McMaster he remained there for an extended period of time. During his first admission to McMaster he assaulted three staff and had to be put in a confined area and tried to escape. After his last admission, his attending psychiatrist, Dr. Akinton, advised Ms. Keller that McMaster could not provide S.C.S. with the resources and level of care which he required and provided a letter to the Society recommending secure treatment as the only feasible treatment plan that had a realistic prospect of success for S.C.S..

The Society has also attempted to access support services in the community for S.C.S. but unfortu­nately has been confronted, as I said, with wait lists that are far too long having regard for S.C.S.’s immediate needs. The Society followed through on a referral for S.C.S. as well for services at Cleghorn First Episode Psychosis Pro­gram after S.C.S.’s second admission to McMaster Hospital. Dr. Morgan of that program advised that the program could not meet S.C.S.’s needs and recommended that secure treatment programming is the only way to keep S.C.S. safe, for him to receive treatment, and to assess him properly.

The Society placed S.C.S. at Lynwood Hall Treat­ment Center for Children. While there S.C.S. continued to AWOL and while there he had to be removed by police from the edge of the bridge, during the incident that I have already referred to. As a result, Lynwood Hall staff advised that they could not meet S.C.S.’s needs.

Just prior to S.C.S.’s admission to secure treat­ment he was placed at Haydon Youth Services. This is a supervised group setting with 24 hour staff monitoring. Despite this 24 hour monitoring he was able to escape and continued to engage in AWOL and risky behaviours in the community. He continued to be aggressive to staff, non compliant with medica­tions, and it was there that he threw and smashed a microwave. Despite all of the community interven­tions that he had previously received and the interventions at Haydon Youth Services, S.C.S.’s condition continued to deteriorate. He developed a delusional belief that staff had AIDS and was trying to give him AIDS with needles, and that he had three tails, had horns on his head that had fallen off, and that he had claws coming from his fingers.

Attempts have also been made through the criminal system to explore options for him. However, it was determined that he cannot be kept for treatment through that venue. The Crown attorneys in both Hamilton and Durham have indicated that they feel secure treatment is the best plan and that they will stay all charges against S.C.S. if this secure treatment order is extended. In short, Ms. Keller testified and I find that she and the place­ment department at the Society contacted virtually every available mental health facility and treat­ment program for S.C.S. in the province that would be less intrusive, but that those facilities were either not available or would not accept S.C.S. based on his presenting needs.

The fourth point which the Society must establish is that the child is receiving the treatment pro­posed at the time of the original order for commit­ment or other appropriate treatment. I am satis­fied that Syl Apps staff have implemented the plan proposed at the time that the original order was made and that they continue to implement an appro­priate plan of treatment for S.C.S.. At the time of his admission S.C.S. continued to receive the medication which he had been prescribed by Dr. Akinton of McMaster 3G clinic for approximately two weeks. He did not show any meaningful response to this treatment and therefore his medication regime was altered. Despite some resistance from S.C.S. to taking his medications the Syl Apps staff have been able to ensure he has complied with his medi­cation regime. The plan which Syl Apps put in place for him at the outset of his admission in­volved stabilization through medication, social work input and behavioural management and skills training, and art and recreational therapy. Staff at Syl Apps have followed through with this plan, although S.C.S. has been resistant to some therapy initiatives, and some aspects of the plan have been delayed because of the need to ensure that S.C.S. was stable enough to benefit from the aspects of the plan.

As noted previously, S.C.S. has just recently begun to receive dialectical behavioural therapy, and if he remains at Syl Apps he will be referred for a psychological assessment and will receive substance abuse treatment and relapse prevention counseling.

Finally, I must be satisfied that there is an appropriate plan for the child’s care on release from the secure treatment program. Both Ms. Keller and Dr. Krasnik explain that this issue is diffi­cult to address as it challenging to formulate full specifics of a plan until there is information about when S.C.S. will be discharged and the state of his progress and treatment, if any, at the time of discharge.

I wish to address Mr. Murdoch’s argument regarding the proper approach to section 120(5)(e) of The Child and Family Services Act. As I indicated previously, his view is that the plan required by this section is one with full and complete details regarding all aspects of the child’s care, includ­ing identification of all specific resources that are being recommended. While I agree that the test in this case is not the child’s best interests, and that the court must adopt a strict approach to the determination of the criteria to be met, in my view the approach suggested by Mr. Murdoch is too oner­ous and is unrealistic. In a situation such as this one where the request is to extend secure treatment for a period of 180 days, his approach calls for the Society and for the child’s care providers to essentially try to engage in the impossible task of predicting precisely the state of the child’s progress in six months, what place­ments will be available at that time and where those placements may be and what precise resources might be available and/or appropriate for the child, having regard for the state of his progress at that time.

In my view, in interpreting section 120(5)(e) of The Child and Family Services Act it is necessary for the court to be realistic of the ability of the Society and care providers to engage in this type of predictive analysis and about the resources available in the community. Section 120(5)(e) in my view requires the Society to advance, as sug­gested by Ms. Watts, a course of action regarding recommended placement and services with some assur­ance that it will be able to implement that plan, but which allows room for contingencies and fluid­ity depending on the child’s actual situation and the actual available resources at the end of the period of secure treatment. I am satisfied that the Society has met this onus.

If S.C.S. were to be released at this time I am satisfied that there is a plan in place for him immediately. Specifically the plan would be for him to be placed at Haydon Youth Services, for him to receive substance abuse treatment in the Durham area through a youth substance abuse program in that region, and for him to remain on the wait list for psychiatric services through the resources available through Whitby Psychiatric Hospital.

I find that this is the best that the Society could do at this time if the child were discharged from Syl Apps, and I do feel that the Society has made and continues to make every possible effort to obtain all appropriate services for S.C.S.. Its efforts in this regard are to be commended. In particular I commend S.C.S.’s Crown ward worker, Ms. Keller, for her obvious commitment and dedica­tion to S.C.S. and for her perseverance in at­tempting to secure services to meet his needs. In terms of long term planning, if S.C.S. remains at Syl Apps for 180 days I am also satisfied that there is an appropriate plan in place for S.C.S., although the specifics and all details will have to be finalized closer to his discharge, depending on the timing of his discharge and the extent of his progress and treatment. This plan involves a number of elements. First, finding a stable place­ment with clear guidelines and rules. I am satis­fied based on Ms. Keller’s testimony that the Society is continuously exploring available and possible resources that would be appropriate. The precise nature of the placement will depend on S.C.S.’s progress and the availability of re­sources that may be available in six months, and the nature of the placement that will be appropri­ate for S.C.S. will depend very much, and will be necessary for S.C.S., will depend very much on the extent to which S.C.S. engages in treatment and benefits from the treatment which is offered at Syl Apps.

The second aspect of the plan involves securing a psychiatrist to monitor S.C.S. and his medica­tions. I accept Ms. Keller’s testimony that S.C.S. is currently on a wait list for psychiatric services in the Whitby area and that it is expected that his name will be reached within the next few months.

The third aspect of the plan involves arranging a substance abuse program for S.C.S., specifically geared for adolescents, and for arranging for S.C.S. to participate in a mental health program for adolescents so that S.C.S. can continue to address behaviour and anxiety issues. The Society has put forward a plan for substance abuse counsel­ing for S.C.S. if he were to be discharged to a placement in the Whitby area and has indicated that it would locate an appropriate program for S.C.S. if he was discharged to a placement in any other region.

The Society has also proposed two possible programs to address S.C.S.’s ongoing mental health needs, one at Child and Adolescent Services in the Hamil­ton area and another program offered through the Whitby Psychiatric Hospital. Again, it is diffi­cult to predict at this point whether those ser­vices will be available, and the availability and appropriateness of those services will very much depend on the extent of S.C.S.’s progress, but there is a plan in place.

Both Dr. Krasnik and Ms. Keller testified they are hopeful and quite confident that an extended period of treatment at Syl Apps will assist S.C.S. in gaining insight into the fact that he does have mental health difficulties and appreciating the impact of his substance abuse on his mental health. The hope is that this will result in him developing the internal controls required to make more appro­priate choices about drug use and behave more responsibly in the community. The extent to which this expectation is realized will affect very much the particular aspects of the plan that is eventu­ally implemented.

For all of these reasons I find that the Society has met all of the five criteria for an extension of S.C.S.’s secure treatment. I turn then to the question of the length of his treatment. I agree with the Society and Dr. Krasnik’s assessment that an extension of 180 days is warranted and necessary in this case. S.C.S.’s mental health difficulties are extremely serious and the treatment which he requires is in my view intensive. I find, based on the evidence which I have heard, that unfortunately there is no quick fix for his problems. Having said that, I find that there is a very good chance of success if the proper resources are put in place and adequate time is allowed for those resources to have a meaningful effect, and if S.C.S. engages fully in the treatment plan.

The initial period of secure treatment was devoted primarily to stabilizing S.C.S., and this took two and a half months. He has just begun to receive dialectical behavioural therapy, which is consid­ered so critical for his success. It will take S.C.S. several months to complete this therapy and learn how to apply it in his daily living, and he will require supports and guidance in doing so.

As I have pointed out a number of times, a very significant issue in this case is S.C.S.’s history of substance abuse and his current lack of insight into how this affects his mental health. Several months will be required to implement substance abuse counseling and for S.C.S. to receive the treatment which he requires in order to gain the insight which he needs, and also for S.C.S. to then apply the knowledge which he acquires through this counseling in his daily living. I conclude that any period of secure treatment shorter than 180 days would not provide sufficient time to achieve all of these critical objectives.

I am required by section 119(1)(b) to provide a statement of the plan, if any, for the child’s care upon release from secure treatment. The plan is the one which the Society has advanced and which I have already referred to in detail in these rea­sons.

I am also required, pursuant to section 119(1)(c), to provide a statement of less restrictive alterna­tives which I have considered and the reasons for rejecting those alternatives. Mr. Murdoch did not present any specific plan as to alternatives to secure treatment. However, I have considered all of the alternative plans which the Society previ­ously attempted to implement and the plan of plac­ing, the backup plan, of placing S.C.S. at Haydon Youth Services once again. I have already ex­plained when addressing criteria 120(5)(c) set out in The Child and Family Services Act why I do not consider these alternatives acceptable, and I repeat I am satisfied that further attempts to implement those less restrictive alternatives would in all likelihood result in an extremely quick return to AWOL behaviour and substance abuse by S.C.S. and a quick decomposition of his mental health, as well as very significant risk to S.C.S.’s mental health and the safety of both himself and other members of the community.

I conclude therefore that an order shall issue that the commitment of S.C.S., born […], 1997, to the secure treatment program at Kinark Child and Family Services, Syl Apps Youth Center, 475 Iroquois Shore Road, Oakville, Ontario, L6H 1M3, be extended for a period of 180 days commencing October 11^th, 2012. Ms. Watts, do you have a draft order?

MS. WATTS: I do, Your Honour. Your Honour, I had previously provided this to Mr. Murdoch. The only change was the date.

THE COURT: Thank you. Mr. Murdoch, have you approved this order?

MR. MURDOCH: Yes. I have looked through it and I - given that the only change is the date I think it reflects your order.

THE COURT: I have signed the draft order and I want to commend counsel for their very helpful submissions in this matter, and I want to address S.C.S.. I wish you the best of luck in the next six months. I strongly encourage you to engage fully and accept the services that are being of­fered to you. I know this is a difficult decision for you, but I trust that - I hope with time you will begin to see that the people at Syl Apps and at the Society are looking out for your interests, and I hope that you will be able to agree with them in the long term that the treatment that is being put in place does give you the best chance at success, both in the short term and the rest of your future, so I wish you the best. All right? Thank you again, counsel.

MR. MURDOCH: Thank you.

MS. WATTS: Thank you, Your Honour.

THE COURT: Thank you, Ms. Keller.

... Whereupon the reasons for decision are con­cluded.

Form 2

Certificate of Transcript

Evidence Act, Subsection 5(2)

I, Alan Zuidema, certify that this document is a true and accurate transcription of the recording of Children’s Aid Society vs. S.C.S. in the Superior Court of Justice held at 55 Main Street West, Hamilton, Ontario, taken from Recording No. 4721-1-20121011-094626 which has been certified in Form 1.

Date Signature of Authorized Person