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Issues

Perspectives on Decision Making

The needs and voice of children and youth must be at the centre of residential service delivery. The fragmented nature of residential services for young people in Ontario impedes the ability of policy makers and service providers to put the needs of young people squarely in focus.

The Panel heard about the significant challenges faced by young people and their families trying to navigate the disjointed child and youth service system. Children, youth and families described meeting countless professionals in different sectors, none of whom appeared to communicate with one another. At each juncture the young person and their family were required to re-tell their story and recount the presenting issues. Families reported feeling increasingly frustrated as they faced “dead ends” in accessing appropriate services to fully address the needs of young people even after “jumping through hoops”. The Panel heard that the system is characterized by rigid and inflexible rules about points of entry (for example, no self referrals for Centralized Access to Residential Services in children and youth mental health), access to services (for example, families seek CAS involvement to create access to private specialized residential services that are otherwise unavailable), and funding mechanisms (for example, inequitable funding formulas across sectors). These issues are structural in nature and have arisen because of a lack of coordinated services.

A major issue identified in our consultations was the lack of integration between a young person’s life outside of any given residential service and their life within a care, treatment, or custody/detention setting. Young people described feeling as though they were removed from everything they knew, including their siblings, friends, recreational activities, school, community supports, and for some young people, their specialized non-residential mental health, health, social, cultural and developmental services. These non-residential services were often discontinued during the young person’s time in residential care. We heard of one case where a long standing association of a young First Nations person to a Native Friendship Centre was discontinued while in care in spite of the geographic proximity of the centre to the placement. In addition to losing the therapeutic benefit of these services, children and youth also lost important relationships with non-residential service providers, contributing to the revolving door of usually well-meaning adults who are only involved in a young person’s life for a limited period of time.

The repeated loss of important relationships with adults may inflict serious long-term damage to a young person’s ability to form attachments to significant others throughout life. This point was also highlighted in My REAL Life Book: Report from the Youth Leaving Care Hearings (2012), which found that being able to maintain a stable and steady relationship with at least one person makes a tremendous difference in the lives of young people in care. The pattern observed by the Panel reflects a narrow understanding of the needs of children and youth, and the absence of a focus on working with young people to build on and maximize existing strengths, supports, and positive relationships.

In our consultations, we heard that placement decisions are driven by a multitude of considerations other than the needs and wishes of young people, and further, that children, youth, and families have almost no voice in the decision-making process. Financial considerations and the availability of beds appear to play an inordinate role in the decision to place a child or youth initially and to move a young person between placements. In some instances, placement decisions were delegated to administrators who have no contact with children and youth and no direct role in providing or monitoring care. The Panel heard that this type of decision-making sets the stage for placement breakdown and frequent changes for children and youth, and along with it changes in the people and places they had become familiar with, even if only for a brief period of time.

As an example, the Panel consulted with a family who reported that a group home closed without warning and their child, a youth with complex special needs, was reunified with them even though this was not in the plan of care. The young person was initially placed because of child protection concerns and while the family welcomed the youth home, they were unprepared for the rapid transition and were informed that the only reason their child was returning was because there were no other suitable beds available. Services were withdrawn upon the young person’s return home, and the family was left to navigate the transition in isolation, with little knowledge of the care and treatment the child had received in residential services and no reasons provided for the closure of the group home.

While some amount of movement in residential services may be necessary and may ultimately lead to a young person receiving the best possible care, the Panel is concerned that some children and youth move an unreasonable number of times from birth to adulthood. In our consultations, we met with young people who had changed placement upwards of 15 times. Frequent placement moves and disruptions endanger the well-being of children and youth and hinder their ability to form long-term relationships (Rubin et al., 2007). Instability in residential placement is associated with numerous poor outcomes including violent behaviour and incarceration, even when accounting for factors that influence instability (DeGue & Widom, 2009; Runyan & Gould, 1985; Ryan & Testa, 2005; Widom, 1991).

The Panel heard several examples of situations in which a young person could have remained in the current setting in which they were living, but because of a lack of supports, the child or youth was moved. The young person sometimes moved from their family of origin into residential care, and at other times they moved from their current placement into a different (usually more restrictive) residential setting. We heard examples of children and youth being moved from foster care to a mental health treatment centre because of a mental health crisis, even though that crisis could have been managed in the community if supports were available. The disruption added to the feelings of stress, unpredictability, and lack of control – feelings with which the young person was already struggling.

Perspectives on Pathways and Planning

Ten years ago, it was recommended that residential services should be positioned “as an integral part of the continuum of services from early-stage prevention through to the after-care that is required once a child or youth leaves residential care or becomes an adult” (Bay Consulting Group, 2006, p. 80). This recommendation arose from a previous review of residential services and remains relevant today. This same review found that the “current array of residential services for children and youth is characterized by silos between MCYS funded programs and between programs of different ministries aimed at the same population” (Bay Consulting Group, 2006, p. 88). The Panel heard little evidence to suggest that the siloed residential service delivery systems documented in 2006 had improved in 2016 and in some instances there were signs of deterioration.

Residential services in Ontario are delivered by a collection of diverse service providers, including services delivered by transfer payment agencies, private per diem funded operations, and Ministry directly operated youth justice and mental health facilities (see Chapter 1, Governance). The extent of decentralization creates significant challenges in promoting continuity of care for children and youth. The Panel’s consultations with service providers and MCYS staff indicated that communication across professionals within each sector (child welfare, children and youth mental health, youth justice) is limited. Communication across the siloed sectors is even more limited. Service providers often have little capacity to maintain an ongoing relationship with young people following discharge from care, or even engage in meaningful coordination and planning with the subsequent care provider, whether it is another residential service or the family of the child or youth. As noted in Open Minds Healthy Minds: Ontario’s Mental Health and Addictions Strategy (2008a), the lack of coordination across sectors and providers makes it difficult for individuals to navigate service systems and can lead to gaps, unnecessary duplication, and inappropriate use of services. Initiatives such as Moving on Mental Health, introduced in 2012 to create a responsive and integrated system for mental health and addictions concerns, are steps in the right direction but the positive effects of such initiatives have not been demonstrated or evaluated.

The Panel heard that there is often limited communication between the non-residential service providers and the residential service providers who are involved with children and youth. These service providers also have limited communication with educators and other professionals in the school system in which a young person is enrolled. In some instances, these professionals were unaware that the other professionals existed. The extent of division and separation among important adults in the life of a young person is troubling and appears to have a significant impact on children and youth. We saw few efforts to engage in collaborative child and youth focused services that wrap around a young person and their family to provide a coordinated and effective response that includes residential services as well as family support, school-based services, and various other community-based services.

The lack of communication among professionals working with children and youth implies that these professionals do not have access to detailed information about the clinical assessments and various services that have been provided to young people over their life course. Professionals – who are positioned as experts – are operating without access to the full knowledge of the context surrounding the young person’s needs. This limits the ability of placing agencies and residential service providers to provide a thoughtful and coordinated response to young people requiring care, treatment, or custody/detention.

Various reasons were provided to explain the lack of communication and coordination among the numerous service providers. In some instances, service providers described having little time to communicate and coordinate with others following the intake or discharge of a young person due to a burdensome workload and competing demands on their time. They also described privacy concerns and legislative barriers that impacted their ability to share pertinent information. In other instances, service providers had poor relationships with other providers and the animosity present hindered any communication about the young person. The competitive and openly hostile relationships between certain service providers was concerning to the Panel.

In their 2006 review of residential services, the Bay Consulting Group found significant differences across regional offices and service providers in compensation levels for front line staff within residential services. A decade later, our consultations revealed significant differences in compensation for caregivers and staff as well as wide discrepancies in per diem funding across residential service providers (see Chapter 6, Human Resources). In fact, differences in compensation and funding were sometimes the source of hostility among service providers. This was also noted in Kinark’s (2015) report, which highlighted that the children and youth mental health, health, education, youth justice, and child welfare systems are separated by “ideological, political, and philosophical differences which are historical in nature and perpetuated by inequitable funding and arbitrary regional boundaries” (p. 40).

Perspectives on Tracking Across Sectors

The Ministry is currently unable to track children between sectors, which has serious implications for the province’s capacity to understand children and youth’s trajectories through residential care and outcomes following these services. Through our consultations, we learned that many children and youth obtain residential services at several points in time from multiple sectors, living in numerous settings with various levels of intensity and quality. Children and youth might return home between episodes of residential care or may be in care on a continuous basis from first entry to discharge. Pathways through residential services are as diverse as the young people who utilize these services. There is currently no mechanism for systematically documenting the various residential services that any given young person has received in their lifetime from birth to adulthood.

The Panel found several exemplars for collecting and sharing information and tracking children and youth through multiple systems. For example, the Ministry of Education has made strides in tracking children by assigning each child an Ontario Education Number (OEN). The OEN is a unique number that identifies students in the public education system and is used to track student records along with assessments and evaluations of achievement. Although the OEN began as an initiative for elementary and high school age children, it then expanded to early education and college and university level education. This involved collaboration across the Ministry of Training, Colleges and Universities and the Ministry of Education. The collaboration yields great potential for understanding educational trajectories between early childhood and adulthood.

MCYS has started an initiative with the Ministry of Education to move toward understanding educational outcomes for Crown and Society wards in the care of children’s aid societies using the OEN. While this initiative is ongoing and to date has not yet resulted in any reports on educational outcomes, it is critical that this kind of collaboration is supported and expanded to include children and youth in all forms of residential care, and to include information sharing across residential service sectors.

We found several examples of missed opportunities for developing the capacity to track young people across service sectors. For instance, the province developed the Child Protection Information Network (CPIN) to enable timely sharing of critical child protection information among children’s aid societies. At present, legislative restrictions to data sharing mean that CPIN will have limited capacity to track information across sectors. CPIN was developed to increase information sharing within the child welfare system, without the capacity to share information with the youth justice and mental health sectors and about young persons with complex special needs.

Perspectives on Transition and Aftercare Support

Many children and youth need support during transitions between residential care settings and after exiting residential care. Lack of support has been documented in several previous reviews of residential services. In the Blueprint for Fundamental Change (2007), MCYS acknowledged the need for cross-sector collaboration during discharge planning in order to maximize residential stability and connections with caregivers and other supports. Collaboration is required among young people, service providers, and families in order to organize the necessary formal and informal supports for children and youth as they transition between care settings or out of care altogether.

The Panel heard that young people returning to their families of origin after discharge from mental health treatment had difficulties maintaining gains from those services. In many instances, support from the residential service provider was withdrawn after discharge. This concern was also noted in CMHO’s 2015 report, which indicated that contact with services is often lost as children and youth move in and out of residential treatment, leaving them on their own with little aftercare support and treatment guidance. Likewise, Kinark’s 2015 report noted that young people who are placed in high quality treatment programs thrive in the therapeutic milieu but often struggle once removed from that environment. Kinark called for an emphasis on preparing children and youth for life beyond residential treatment.

Young people who spend time in custody/detention require support when transitioning back into the community. The Youth Criminal Justice Act mandates reintegration supports and, although MCYS is currently piloting two reintegration centres for this purpose and utilizes a Single Case Management Model in which youth have one Probation Officer assigned who has the responsibility to plan for release, there is a critical need for more support for young people transitioning into the community. Like in the children and youth mental health sector, the Panel found that families were often excluded during a young person’s time in custody or detention, which left them without the tools needed to support the young person upon their return home.

Given that families were often excluded from the plan of care and the daily life of the child or youth while they received residential services, it is unsurprising that some families felt it was impossible to provide the level of support required after discharge. With no assistance in helping the young person transition into a different living, school and community environment, families felt at a loss. The Panel also heard that for the many young people who had negative and sometimes traumatic experiences while in care, treatment, or custody/detention, the return home or to another residential setting was particularly challenging. Some parents expressed that they did not know who their child was anymore after residential services, and they felt unprepared to cope with the mental health and relational challenges that had been exacerbated while in care, treatment, or custody/detention.

Researchers and advocates have highlighted the challenges associated with “aging out” of child welfare and other forms of out-of-home care. As the Provincial Advocate for Children and Youth has stated in the report 25 is the New 21 (2011), young people in the care of the province simply do not obtain the same access to resources as their peers outside of care, and they do not have the same sense of connection to family and community. These vulnerabilities are compounded by often highly traumatic histories of abuse and neglect and mental health difficulties. Although the province has provided greater levels of support to transition-aged youth in recent years, it was clear to the Panel that young people leaving care feel unsupported and unprepared for adulthood. Consistent with an overwhelming body of research evidence, the Panel heard that youth leaving care are vulnerable to entering the shelter system or becoming homeless, struggling with chronic unemployment and dependence on social assistance, and suffering from mental illness.

The Panel heard from children and youth across multiple sectors that they do not feel that they acquire the life and social skills in residential care needed to function independently when they transition to the community or age out. In some cases, young people felt their life and social skills had deteriorated while in residential care, treatment, or custody/detention, because of the rigid rules present in the residential setting that did not come close to resembling regular life. Rules such as not being able to speak during meal times or movie nights were harmful to the development of social skills, and the use of institutional terms (e.g., “CT” or “Community Time” to refer to an outing to the mall or a walk in the park) made young people feel as though they were getting further and further away from regular life. Children and youth desperately wanted to learn the skills and abilities that other young people learn while living in home environments, and above all, they wanted trusting and long lasting relationships to help sustain them into independence.