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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).