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.