Key Themes

Governance – the imperative for systemic oversight and accountability for all residential services across all sectors through mechanisms that have at their core, the foundation and elevation of quality of care.

The residential services sector currently lacks a unifying mechanism for ensuring the oversight, accountability and quality of care required across the province. Residential care across the three siloes of child welfare, children and youth mental health, and youth justice sectors has developed organically, and is delivered by a diverse mix of more than 600 directly operated, transfer payment operated, private non-profit and for-profit per diem operators.

This decentralized approach to service delivery presents an opportunity to provide locally developed and delivered services that leverage community resources to meet the specific needs of children and youth, varying areas of specialization across providers and an ability to leverage both the stability afforded by transfer payment agencies and the nimbleness of per diem funded providers that can adapt their services to meet demand. From a governance perspective, however, it is challenging to ensure that there is appropriate oversight and accountability, that all residential services are held to a common standard of high quality care and are focused on continuous quality improvement, and that there is alignment with strategic directions across sectors so that services operate as a system.

Under the current structure, oversight for residential services is distributed across three Divisions within MCYS, cascaded to five regions, and further diffused through the 47 Children’s Aid Societies (for child welfare), and lead agencies across 33 service areas (for children and youth mental health) who contract with transfer payment or private per diem operators. The Ministry directly operates one mental health facility. In the youth justice sector, the Ministry directly operates six secure custody and detention facilities and contracts with 14 transfer payment operated secure custody and detention facilities and 41 open custody and detention facilities. The result is uncoordinated oversight, without a single Ministry governance structure having a full overview of the system or seeing themselves as having the ultimate oversight over the full continuum of residential services. Licensing is the primary mechanism to ensure accountability at the current time, however, the process is inadequate. Current license categories do not encompass all/emerging care models, unannounced inspections are rare and seen as difficult under the current legislation and the inspection process does not assess quality of care.

The current rate setting methodology, rate review process, and the use of special rate agreements for residential services are also concerns relative to the overall governance of the system. The Panel observed significant inconsistencies with respect to per diem rates across all sectors, and there is little confidence that higher per diems for “treatment” are actually delivering a value-added and necessary service, particularly in light of often superficial and not very compelling explanations of what ‘residential treatment’ means and how it is distinguished from other forms of residential care. The Panel also noted that compensation, infrastructure, and inflation are not criteria for rate review. The Panel frequently heard concerns from placing agencies about the use of Special Rate Agreements (SRAs), which involve child or youth-specific funding above the approved per diem rate to address exceptional circumstances requiring additional support and supervision of young people with high needs (most often one-to-one staffing). Often, neither the Ministry nor the placing agency have sufficient oversight of SRAs to ensure accountability for these expensive, and often therapeutically questionable, arrangements.

The Panel firmly believes that the Ministry must have direct authority and oversight of residential services to address the longstanding issues and challenges that we heard about related directly to governance. While the Ministry must retain its role as the steward of the system with a decentralized service delivery model, and continue to share responsibilities in many respects with its partners (parents, caregivers, agencies, Children’s Aid Societies, service providers, associations), a single unified, integrated governance structure must reside within the Ministry to provide systemic oversight and accountability for all residential services through mechanisms that have at their core, the foundation and elevation of quality of care.

Voice – the imperative of ensuring that the lived experience of all young people and their families and caregivers be integral to service design and delivery and system governance.

The individual and collective voices of those with lived experience in out-of-home care – young people, families, and immediate caregivers – at best have had a peripheral impact on: individual care experiences; development of programs and services for young people in out-of-home care; governance and accountability frameworks for services; service design - including the rules, procedures and physical design of programs and services; treatment, relationships and caring that unfolds in programs and services. Young people, families and service providers are not consistently, actively, and collaboratively involved in decisions and preparations regarding major transitions into care, between placements, and out of care.

Current processes to include young people and their families are often not seen by young people, their families and many front line staff as providing meaningful opportunities to be partners in their own care (e.g. Plans of Care) and current mechanisms to capture feedback often exclude those who aren’t comfortable/able to participate in surveys or group-based venues. Young people identified as having complex special needs are particularly voiceless and clearly vulnerable in Ontario’s residential services system.

The Panel strongly believes that the lived experience of young people and their families and caregivers must be integral to service design and delivery and system governance, not as an end goal, but as the starting point of meaningful transformation.

Quality of Care – the imperative of ensuring that quality of care is a central component of system performance and accountability.

The everyday experience of young people in out-of-home care is impacted first and foremost by the quality of care provided in residential services. Such quality of care is a function of a wide range of factors that include the quality of human resources, the relationships among young people and between young people and care givers, the physical infrastructure of residential programs, the appropriateness of program routines, rules, and activities, and also the quality of food, the attention to identity and developmental growth, the levels of physical and emotional safety, and the on-going connections to family, kin, friends and community.

At the level of everyday experience for young people living in residential services, the Panel was particularly impacted by the many stories of young people outlining rules, routines and program structures that are compliance-focused, and bear little resemblance to the mission and vision statements of residential service providers. The general themes in these stories were often confirmed by the observations of CAS workers and licensing specialists with experience in a range of group homes.

The current service system has evolved without much oversight, accountability or incentives to consistently focus on quality of care considerations and the everyday experiences of young people living in out-of-home care. Also concerning is the incongruence between what organizations say they do and what is observable at the level of everyday experience.

In developing a framework for ensuring excellence in quality of care with the appropriate oversight, the Panel seeks to ensure that residential services are engaged in on-going quality improvement activities, while at the same time are subject to a much more transparent and accountable system of validating their claims related to quality of care. Families, young people themselves, and placing agencies and workers currently have very little meaningful information about quality of care in any given residential setting upon which to base a placement decision.

At this time, the Panel notes that there are no universal, or even common, set of indicators, standards or concepts that might lend themselves to the measurements of quality of care in residential services across sectors. Given the rich diversity of service providers, the applicability of universal indicators across sectors may be limited, although the Panel believes that some foundational indicators can be articulated.

Continuity of Care – the imperative to see residential services as a journey of care and within the context of a young person’s whole life at the individual level, and as a system of integrated services at the systemic level.

Many children and youth experience residential services at several points in time from multiple sectors, living in numerous settings with various levels of intensity and quality. Currently, residential services in Ontario are not designed as a journey of care at the systemic level and, they do not provide seamless and integrated care to a child or youth as they access the range of services they need over the course of their childhood and adolescence. The siloing of services from a sectoral perspective make the system hard to navigate for young people, their families and even placement agencies, and sometimes encourage placement decisions that are neither based on the best interests of the young person nor inclusive of the young person’s voice.

At the service delivery level this translates into each placement being seen as a discrete activity rather than a continuum of care. Young people and their families often have to re-tell their story at each intake, experience a lack of continuity from previous placements (particularly in terms of maintaining relationships and connections to community), and face a lack of integration between life outside of any given residential service and life within a care, treatment, or custody/detention setting. Transitions in care – between placements and sectors, or out of care - are not seen as part of the journey, equally deserving of support and resourcing as periods of in-care. Children and youth are often given insufficient notice and preparation of a move between placements, resulting in feeling unprepared for both the physical and emotional impacts of changing caregivers. Young people leaving care, whether to go back home or to reintegrate into the community often report feeling similarly unprepared with the life and social skills, and relational and community supports to be successful. In many ways, the experience of living in a residential setting erodes the very skills needed for healthy and successful independence.

From a system perspective, the Ministry is currently unable to track children between sectors and across placements within sectors, posing a significant barrier to understanding children and youth’s trajectories through residential care, including their point in time experiences and outcomes following services.

The Panel believes that strong oversight of each young person’s journey through the care system is critical, with rapid response and engagement in circumstances where placement changes occur, school changes may be necessary, or serious occurrence reporting may be indicative of quality of care problems. The Panel also believes that significant supports are necessary for the successful reintegration of young people leaving out-of-home care, including secure custody/detention, into their families and communities.

Data and Information – the imperative to have the data and information necessary to understand individual and collective experiences and outcomes, provide oversight and assess system performance, and facilitate informed placement decisions and system planning.

MCYS currently lacks a meaningful way to use data and information to understand “the big picture” of residential services in Ontario. Data and information must actively contribute to the oversight of the system; to understanding how young people in care –individually and collectively – are doing at any point in time and over the long term; to informing choice and to facilitating access to services; and to conduct system planning. Existing mechanisms by which to track an individual young person’s journey in out-of-home care, to understand the experiences of young people, families and front-line staff with residential care as a collective, or to assess overall system performance and outcomes are inadequate, lack coordination, and do not lend themselves to data-informed analytical practices.

Effective oversight of the over 600 residential service providers caring for thousands of young people across Ontario requires both the capacity to ensure that every individual service provider meets provincial standards for quality care, and to track service trends and monitor outcomes to determine at the aggregate level whether residential services are effectively supporting young people.

At the individual level, there is no reliable information about a young person’s trajectory in care. There is no way to follow a child or youth as they move in and out of care, or between sectors, and no way of looking at this journey holistically to facilitate service coordination, flag issues or take their full experience into context when understanding needs and making decisions. At the collective level, there is no way to understand the trajectories of young people through the care system over time. It is critical that MCYS develops a method of systematically tracking the movement of children and youth in care within and across residential service sectors.

There is currently no comprehensive and easily accessible province-wide mechanism for potential users and placing agencies to get information about available services. Access to clear, credible and verified information about the expertise, strengths and experience of each operator and the quality of care in any given residential setting would give, young people and their families as well as placing agencies more input into the difficult decisions that often need to be made in placing young people in out-of-home care.

While access to information does not necessarily resolve lack of capacity and resources, easier access to information about the full provincial network of service providers can help increase access to resources that service users would otherwise not be aware of, identify service gaps or duplications to support more efficient resource planning, and identify barriers to accessing underutilized services.

The Ministry must be empowered to compel, receive, analyse and utilize the data and information necessary to ensure that children and youth in out-of-home care are receiving high quality care. The Panel has recommended the creation of an online directory of all residential services to facilitate informed decision making at the case level and system planning, and has also identified an approach to tracking service and outcome indicators.

Human Resources: the imperative to ensure that the quality of all caregivers involved in providing residential care to children and youth is commensurate with the responsibility of providing out-of-home care to some of the most vulnerable young people in the province.

There are no consistent or mandatory standards for the pre-service educational qualifications, levels of experience, compensation, training, and employment conditions of front-line staff in both group and foster care residential settings. This has resulted in the recruitment of under-qualified staff in some cases, and in poor retention and high turnover rates, directly impacting on the quality of care experienced by young people. The Panel was particularly concerned to learn that relief and casual staff as well as one-to-one staff hired under Special Rate Agreements (SRA) are often exempt from the same level of agency-specific qualification required of regular staff, and are almost always excluded from agency training programs, clinical staff meetings, and the supervision process. In addition, promotional standards are often unclear and inadequate supervision models to support staff in their relational practice with young people, were commonly reported and observed.

The Panel is concerned that ever-increasing demands related to the claim of greater complexity of child and youth profiles in residential services, the evidence-based interventions required, and the challenges associated with navigating systems both within larger organizations and between service providers embedded in different sectors are incongruent with the current lack of regulation in terms of pre-service educational qualifications for residential staff. The evolving context of residential care service provision in all sectors demands more highly qualified staff with an in-depth understanding of the fundamental models, approaches, theories, children’s rights, cultural and system contexts of residential service provision.

There is concern about the capacity to attract and retain well qualified staff, in both group care and foster care settings. In group care settings, compensation is not competitive with other care sectors or fields of employment, and limited career mobility is embedded in the sector. In the foster care context, a multitude of issues is making it challenging to recruit foster parents. Caregivers report that they are often peripheral to the decision-making about the young people they care for, and institutional processes and requirements sometimes make it impossible to care for young people in ways that reflect family contexts. Eligibility criteria for who can foster, such as the presence of a stay-at-home parent, and the capacity to provide foster children with their own bedrooms, results in challenges for some communities, particularly in large urban centres and Aboriginal communities.

The Panel firmly believes that all individuals charged with the care of children and youth in residential services must hold specific and consistent pre-service educational qualifications, preferably in the field of child and youth care, and be supported through comprehensive in-service training. For those holding or aspiring to supervisory positions, separate and specific certificate-based training is necessary to ensure that individuals holding those positions are fully equipped to do so in accordance with the purpose and intent of supervision models. Furthermore, the foster care system in Ontario is in dire need of modernization, from recruitment and retention strategies to the rules and regulations involved in caring for young people in a family context.

Youth Justice – the imperative to ensure that young people in, or at risk of, conflict with the law receive a consistent quality of treatment in custody or detention, and the necessary support to successfully reintegrate into the community and reduce recidivism.

The provision of services to youth in conflict with the law is governed by both the Youth Criminal Justice Act (YCJA) and the Child and Family Services Act (CFSA). The proclamation of the Youth Criminal Justice Act in 2003 and the creation of a new Ministry of Children and Youth Services, had a significant impact on the provision of residential services, both open and secure custody and detention, in this sector.

The recognition of the greater dependency and reduced maturity levels of young people is embedded in the Youth Criminal Justice Act, informing principles of sentencing (deterrence, rehabilitation, denunciation, proportionality, incapacitation - use of custody as a last resort - and restoration), which have resulted in a decreasing reliance on incarceration for youth on the part of the courts. The Ministry has developed a broad and extensive range of community-based alternatives to open and secure custody and detention, including programs and services for prevention and diversion; alternatives to custody and community-based interventions; the provision of rehabilitative programs for youth who are under supervision and care; and services and supports targeted to specific populations and reintegration programs for youth being released from custodial sentences into the community. The collective impact of these changes is significant excess capacity in both open and secure custody and detention facilities, among both direct ministry operated and transfer payment operated systems. Further opportunities exist to re-purpose and rationalize capacity, to more effectively use resources to meet the needs of all youth justice-engaged young people.

The new legislation also brought directly operated and transfer payment facilities under the responsibility of a single Ministry, MCYS. With few exceptions, the Ministry continues to operate the two legacy systems in secure custody and detention as two quite distinct service delivery systems, with inconsistent standards for the hiring, training and compensation of staff, or practice between the two systems. There is no systemic mechanism for sharing best practices between systems or having strategic conversations about overall challenges in the sector. An integration of the two systems into one harmonized system could bring the full resources of both systems together to enhance opportunities to meet the needs of young people in secure detention and custody.

Use of a relationship custody approach is an ongoing issue within the youth justice sector. The Ministry is committed to the use of a relationship custody approach, directed at fostering respectful, caring relationships between staff and young people and enabling staff to provide effective, evidenced based interventions to benefit youth. Challenges to fully implementing and optimizing relationship custody were identified, however, with variable practice across the range of secure custody and detention facilities. This was particularly the case at the Roy McMurtry Youth Centre, the largest of Ontario’s secure custody and detention facilities, with factors including the size of the facility and the ability to work with the numbers of young people housed there; the legacy of the adult correctional system’s approach to managing youth in conflict with the law and challenges in the transition to a less authoritarian, youth-centred culture for some staff; the numbers of high risk, gang-affiliated youth; peer on peer violence; and, the need to focus on significant security controls in order to ensure the safety of youth, being cited as challenges.

In terms of secure isolation, the Panel noted significant variation in practice across secure custody and detention facilities in frequency, duration and conditions of secure isolation. It is clear that the Ministry’s efforts to address these issues will require sustained attention to address inconsistencies in practice, mitigate the impacts on youth of secure isolation, develop alternatives to the use of secure isolation, share best practices and ensure that practices are consistent with the Ministry’s policy directives and legislation.

Reintegration supports are critical in the context of youth justice. While efforts have been made to provide programs, services and resources to youth returning to the community after leaving a custodial setting, these resources were described to the Panel as inadequate to meet the needs of youth in an effective community reintegration process. In addition to the support needed specifically for a young person, resources are needed to engage families and provide them with the necessary skills and access to programs to support the return of the young person back home. The Panel affirms that there is a need to ensure that strong reintegration supports are in place for young people transitioning from custodial settings to optimize and sustain gains made from participation in evidence-based and evidence-informed programs while in custody and to reduce recidivism.

First Nations, Métis and Inuit Young People in Residential Care – the imperative to ensure that there is a separate and dedicated focus on addressing the needs of Aboriginal Children and Youth and communities.

Throughout our consultations we heard many service providers and community organizations express concern about the overrepresentation of First Nations, Métis and Inuit youth in residential care, especially in the child welfare and youth justice sectors. There has been ongoing advocacy by Aboriginal communities for interventions and programs that will reduce the need for out-of-home placements - both with respect to more services for young people and their families, and programs addressing the socio-economic conditions that undermine the well-being of Aboriginal families - as well as a much wider range of out-of-home care options, in particular ones that recognize traditional extended family and community care practices. Given the extent and persistence of the problem of overrepresentation, the Panel was surprised that there was limited reporting and analysis (apart from the youth justice sector) with respect to young Aboriginal people in residential care. Monitoring rates and patterns of overrepresentation through disaggregated data is very important to ensure that important differences over time and between groups are captured.

Relative to current care options available to Aboriginal youth, concerns include the lack of residential services in reasonable proximity to young people’s communities, limited access to cultural programming or spiritual guidance, minimal inclusion of traditional food on menu plans, and concerns about racist attitudes or insensitivity to the historical context of Aboriginal young people.

Due to the composition, time frames and mandate of the Panel, exploration of issues related to Aboriginal children and youth in out-of-home care was necessarily limited. A separate partnership process is recommended.

Unique Contexts and Unique Geographies – the imperative to ensure that system and service design and delivery of residential services adequately address the realities, needs and strengths of children and youth who identify with a cultural, racial, faith, or gender identity outside of the mainstream.

The current residential services system does not adequately support children and youth who identify with a cultural, racial, faith, or gender identity outside of the mainstream, such as those who identify as Black Youth, as Lesbian, Gay, Bi-Sexual, Transgender, Queer, or 2-spirited (LGBTQ2S). Concerns about the overrepresentation of certain identities in residential care – particularly Black Youth in child welfare and youth justice sectors – and the ability of available services to support these identities through appropriate and safe programs and services abound. The Panel furthermore heard very concerning perceptions in some communities that young people of particular racial, cultural or lifestyle groups are underrepresented in less intrusive non-residential service systems such as children and youth mental health services.

The Panel found few programs and services specifically targeted towards young people with unique life circumstances related to their culture, racial identity or gender context which would support identities and aspirations that often fall outside of the normative structures of residential care, and would provide opportunities to celebrate and enrich the strengths embedded in these identities. Daily household activities also fall short of including the diversity of the residents – from the food and personal care items provided, to the freedom to speak in one’s own language. The overall level of competence and activity in this context is insufficient, uncoordinated, and generally ad hoc. There is a need to enhance the cultural competence of all residential services in relation to the diverse identities and developmental contexts of young people, in partnership with young people themselves to both improve their everyday experiences in care and long term outcomes and to be consistent with Ontario’s commitment to social justice and egalitarian values.

Much of the information about the experiences of young people in residential care who identify with unique life contexts are anecdotal. There does not appear to be sufficient demographic data on the self-reported identity of young people living in residential care to meaningfully plan around the needs of particular cultural, racialized or other groups, or the emergence of new groups based on demographic changes (eg: Muslim youth). Disaggregated data by placement type is critical to identifying patterns and trends in practices and policies that would otherwise be masked. In partnership with the relevant community, consideration must be given to develop capacity for data collection and reporting in a transparent manner on the number of young people impacted within specific groups.