Perspectives about Treatment and Types of Care Settings

Based on targeted conversations with multiple service providers, the Panel found that residential services in Ontario are subject to a complex nomenclature that includes formal and informal designations such as residential treatment programs, specialized foster homes, treatment foster homes, intensive residential services, secure treatment, family-based care, family-based treatment and other terms (MCYS, 2015b). While some service providers have written statements about what they mean by treatment (Kinark, 2015), in its consultations, the Panel was unable to solicit a meaningful definition for residential treatment, and how it might be distinguished from other forms of residential care. Regardless of whether we asked executive management, front line staff, or young people themselves, descriptions of treatment rarely provided substantive comments beyond the imposition of structure and control on the one hand, and the availability of multiple disciplines on the treatment team on the other hand. No service provider we heard from distinguished between having multiple disciplines represented and offering an inter-disciplinary approach, suggesting that the concept of treatment currently remains somewhat nebulous in its meaning and application. Aforementioned references to evidence-based practices on the part of agency leaders were often not confirmed by front line staff, although there were some examples of a more thorough, and community-wide implementation of such practices in some instances, notably the Ottawa region where Collaborative Problem Solving has been introduced as a whole community framework for working with young people (Youth Services Bureau, 2015).

One element of critical importance in any therapeutic services context is the presence of excellent, consistent and meaningful supervision geared toward relational practice service settings with appropriate reflective and clinical content, including elements of supporting front line caregivers in the context of compassion fatigue, vicarious trauma, and self care. No service provider the Panel spoke with was able to identify a supervision model with any specificity; instead, the Panel heard vague references to performance management and case consultation in some service settings. The lack of emphasis service providers placed on the supervision process, and the apparent lack of supervisors with specific training in supervisory practices geared toward relational practice context is troubling.

The Panel explored in detail the residential services offered through a large children and youth mental health centre that focuses on assessment and treatment recommendations, and found that the residential services themselves appeared to be well regarded by young people, parents, as well as clinical and management staff. However, the services offered are short-term assessment services that end with clinical recommendations that parents told us can often not be implemented post-discharge. In spite of a very high level of parent satisfaction with the residential service itself, therefore, young people, parents or even the clinical and management staff could not confirm the usefulness of these services beyond the short term, and some parents suggested that the situation post-discharge became worse than pre-admission. Management and clinical staff readily acknowledged the lack of sustainability of outcomes of their residential service to be a major problem, but were unable to offer any solutions moving forward.

The various designations of other types of care settings often appeared somewhat ad hoc. We heard examples of treatment foster homes that were so called because one foster parent had earned an undergraduate degree in psychology in the 1960s; no other rationale was provided for referring to this home as a treatment foster home. Also, the Panel found a ‘family-based’ foster care that was teeming with paid shift staff, typically hired to work as one-to­one workers under Special Rate Agreements. We also met foster parents designated as Specialized Foster Homes who were themselves unable to explain in what ways their home was specialized. On the other hand, we also met foster parents designated as Regular Foster Care who were able to describe their approach to care in ways that far exceeded what we heard from treatment or specialized foster homes.