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Issues

Across Ontario’s residential services system, there is a general appreciation that the voices of young people living in residential services are important. During its consultation sessions, the Panel encountered a wide range of approaches that aim to provide opportunities for young people to express their unique needs. However, except for the aforementioned youth groups facilitated and supported by major organizations such as PACY, CMHO and OACAS, these approaches are inadequate at the agency and system levels when aiming to provide youth with meaningful ways to actively participate in their service experience at all levels of that experience. For example, holding regular focus groups in order to elicit youth perspectives or ensuring that young people are involved in their Plans of Care are not in and of themselves sufficient mechanisms of engagement. The Panel heard repeatedly in its consultations with young people and also with child protection staff, foster parents and residential staff that plans of care processes vary significantly from program to program and even from worker to worker. These processes are often not seen as providing young people with meaningful opportunities to be partners in their own care.

Many young people report a high level of disengagement and disempowerment within their everyday experience of care as well as their trajectories through care. They elaborate that they feel that their inspiration for their life and future and their unique sense of self is continuously challenged by professionals and a system that they believe should embrace them. Young people cited examples such as being streamed into vocational education against their wishes, being discouraged from pursuing their professional aspirations if these appear as incongruent with their educational achievement, and in some cases being discouraged from exploring their cultural, sexual and lifestyle identities.

The voices of young people in the system of residential services are frequently minimally represented in decision-making at the individual case, program and system levels. While there is often an emphasis on individualized treatment plans and plans of care, the mechanism of individualization also serves to fragment and minimize the collective voices of young people impacted directly by these services when these processes are implemented in a mutually exclusive manner. While it is in fact important to maintain Plans of Care and related interventions as highly customized and personalized in order to engage the unique context of young people, the voices of young people, like the voices of the professionals who work with them, need to be heard as a collective and encompass all levels of service provision, including governance, accountability, system design and specific program contexts.

The Panel is concerned that we did not hear of any mechanisms, or even initiatives, to ensure that young people with complex needs, including non-verbal young people and young people with developmental challenges, also have a voice in what happens to them within the residential service system. Furthermore, the Panel notes that the most common mechanism to listen to young people involves group formats, which excludes many young people uncomfortable in such formats. It is worrisome that residential services across sectors have not developed a menu of opportunities to provide feedback and contribute to service design involving contexts suitable for the rich diversity of young people in out-of-home care. Constant efforts are required to include the voices of the full diversity of young people.

Residential services across sectors are characterized by a high commitment to professional expertise, often at the exclusion of the expertise embedded in the lived experiences of young people and their families. Historically, residential care was firmly based on a medical model of practice, with a deficit-based approach in which professional experts operated under the assumption that they would be able to “fix” the young people who received care in this system. As a result, young people living in residential services often had no agency and voice. Although today there is much rhetoric and also increasingly authentic attempts to recognize young people’s agency, voice and valuable expertise based on their lived experience, many major decisions in a young person’s life, including issues related to the use of psychotropic medication, the types of treatment they receive, and the location and types of placements they are offered, are made by professional experts without youth participation. The Panel heard from clinical staff and social workers in several consultations that decision-making about young people particularly in the context of placement decisions can involve additional pressures related to cost containment.

The voices of families of young people involved in the system of residential services, including in children and youth mental health residential treatment services, often appear to be peripheral, especially in the context of major decisions impacting the life of a young person. Although the Panel heard many instances where young people reconnected with their biological families including their siblings following their discharge from the system, these families were not effectively included in residential services while that young person was receiving programs and services. In the Panel’s consultations, a young person’s family was either rarely referred to or referred to in negative ways by residential front line staff and foster caregivers. In the Panel’s research beyond the consultations, very few examples of services and programs were found designed specifically to include and effectively engage families. In the context of residential treatment, family work is often cited as the key ingredient of the treatment, yet the Panel heard repeatedly that families who are not immediately responsive to the attempts to engage them in the treatment process by the service provider are viewed as ‘difficult’ and often seen as the cause for treatment breakdown. The Panel is concerned that a family’s social location, which includes their socioeconomic status, education and race, can have an impact on access to resources resulting from varying capacities for self-advocacy.

The Panel was surprised to learn that immediate caregivers, including front line residential staff in group care and foster parents, see themselves as peripheral in the decision-making processes about the children and youth they care for, and also in the design of the programs and services they are tasked to deliver. Their voices, based on significant accumulated experience of being with young people where they live, and of providing for the needs of young people for ‘the other 23 hours’, appear to not be fully integrated into what are often described as multi- or interdisciplinary teams. In some instances, the Panel heard about evidence-based practices in some residential treatment programs that staff we spoke to in that program were unable to confirm or even identify. When management teams and front line care givers operate in silos, it represents a lost opportunity to meet the needs and hopes of young people.