Implications for Recommendations

The Panel recognizes that no existing body or unit within either MCYS or the residential service system more generally is able to ensure that quality of care is a central component of system performance and accountability. As outlined in Chapter 1 on Governance, the Panel is therefore developing the concept of a Quality of Residential Care Branch/ Division, to be housed within MCYS, with functions that include the promotion of Quality of Care enhancement activities across sectors that specifically are focused on the one hand on the everyday experience of young people and a meaningful articulation and approach to measuring outcomes while on the other hand, on the trajectories of young people through the care system over time; the validation of any claims made by service providers about their strength and competencies, with both quantifiable and qualitative evidence to back up such claims; and a significantly more transparent approach to the public dissemination of Quality of Care activities, measures and performance pertaining to individual service providers across sectors.

The Panel believes that quality of care can only be ensured with strong oversight not only of the activities of individual residential programs, but also strong oversight of each young person’s journey through the care system, with rapid response and engagement in circumstances where placement changes occur, school changes may be necessary, or serious occurrence reporting may be indicative of quality of care problems. To this end, the Panel is developing recommendations that replace existing mechanisms such as crown ward reviews, agency-based reviews of private per diem operations where children and youth are placed, and licensing specialist checklist items vaguely related to quality of care with clearly identified functions in charge of overseeing and responding to placement or other activity in relation to young people across systems. In this context, the Panel is responding in particular to the experiences of young people who may enter out-of-home care through channels other than child welfare, such as youth justice custody or children and youth mental health, as well as young people who cross over some or all of these service sectors during their time in out-of-home care.

Young people’s voices are an important component of raising the quality of care in residential services (see Chapter 2, Voice). The expertise that comes from the lived experience of young people, either current or retrospectively, must inform the design, governance and operation of the residential service system, and with respect to the Quality of Residential Care Division, must be a fully integrated component of all levels of work undertaken by the Division.

The Panel is developing a range of universal indicators designed to provide foundational evidence of quality of care considerations, such as the staff qualifications and professional development, supervision standards, the integration of young people’s voices, their engagement and participation in all levels of organizational activity, education and learning supports, family and community engagement activities, cultural competence and measures to embrace multiple identities, and others (See Chapter 10, Indicators).

Given the differentiation of service providers across residential care sectors in Ontario, the Panel is developing a framework for validating the claims of service providers related to their strengths and competencies, with a view of limiting the exposure of young people to placements that are not well suited to meet their needs. All recommendations in this context will serve to ensure that young people receive the right service at the right time from the right service provider, based not on service provider rhetoric or marketing materials, but instead on information validated by the Quality Inspectorate, as part of the work of the Quality of Residential Care Branch/Division. To this end, service providers will be asked to produce a concept statement each year as part of their licensing renewal application (or new license application) that provides detailed information, in addition to evidence related to staff qualifications, on-going training and professional development, as well as data about client outcomes. Please refer to Appendix 2.

The Panel believes that the licensing process currently in place under the auspices of MCYS Regional Offices is an insufficient mechanism for accountability and performance enhancement with respect to quality of care. The introduction of the Quality Inspectorate serves to eliminate the licensing process as it currently exists and subsume some elements of that process into the quality inspection process instead. Some current licensing functions, such as measurable or identifiable compliance in the areas of physical infrastructure, human resources, and case file completeness, will continue to be performed as part of the Quality Inspection process. It should be noted that the position qualifications for the Quality Inspectors, and specifically the function of validating service provider claims about strengths and competencies, will be substantively different than the position qualifications for the current licensing specialist positions within regional offices. Therefore, a HR transition plan will be necessary in order to progress from current functions/qualifications to new recommended ones.

The Panel is seeking to mitigate the impact of a complex nomenclature that has developed within residential services over time without much consistency or system-wide context. To this end, recommendations related to the elimination of setting descriptors such as treatment, specialized or regular, and others are being developed in order to avoid inaccurate perceptions of service provision and to mitigate funding or per diem costing based on nomenclature rather than substantive evidence of a high quality of care with commensurate outcomes.