Service Delivery

More detailed commentary is provided about the issues identified in the delivery of residential services in other sections of this report. The comments in this section are meant to identify overarching issues identified in the Panel’s work from a governance point of view.

In a large, diverse, decentralized system of service delivery it is critical that residential services be well coordinated, with a strong continuum of care, smooth transitions between providers and sectors and good information sharing and communication. Clear, evidence-based information about the expertise, strengths and experience of each operator is important to young people, their families and caregivers, Children’s Aid Societies and placing agencies to match children and youth to the service provider that can best meet their needs. At present, this is the responsibility primarily of placing agencies. Children and youth mental health is in the process of identifying lead agencies across 33 service areas (excluding secure treatment) for the planning and delivery of core services. Placements in Youth Justice custody/detention facilities are court ordered. The level of custody (ie. Open or secure) is determined by the courts. During our consultations, the Panel heard that service provision is often not well coordinated across and within sectors. There is little evidence of a strong continuum of service providers with good communication, information sharing and continuity of care for children and youth transitioning between sectors and providers. Ministry direct operated, transfer payment operated, and private services tend to operate quite separately from one another and generally not as an interconnected system.

Varying degrees of quality in service delivery were evident and a lack of tools and processes exist to assess the quality of individual service providers and the system overall. There are a lack of consistent standards for quality of service and an absence of common key indicators of quality within and across child welfare, children and youth mental health and to a lesser extent, youth justice.

There is unclear differentiation among service providers in the child welfare and children and youth mental health sectors, with many providers advising that they provide “treatment” without any clear definition of treatment. The designation of “treatment” and “specialized” foster homes and, where applicable, group homes, does not always correspond to a meaningful distinction in service provision. Assertions by service providers about their areas of strength are not assessed and validated by the Ministry.

In general, reintegration supports for children and youth leaving residential care and transitioning back to families and/ or communities were often identified as lacking or insufficient. The Panel heard from families in children and youth mental health that residential treatment services are offered with varying degrees of connectivity to non-residential clinical and community supports. While their child is in care, they often feel well supported but when their young person returns home, the withdrawal of support is distressing. Supports for youth transitioning from CAS care to independence were often identified as inadequate. In youth justice, the Panel heard that more reintegration resources are required to support youth and to sustain any gains made in custody.