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Issues

Access to Information

There are over 600 residential service providers across the province but there is currently no province-wide mechanism for potential users and placing agencies to get information about those services. The Ministry directly operates residential services (e.g., certain youth justice custody and detention centres and the Child Parent Resource Institute), while it also transfers payments to community agencies such as children’s aid societies to deliver residential and other services. Some transfer payment agencies (TPAs) responsible for placing children in residential care operate their own internal residential resources, whereas others utilize outside paid resources (OPRs) to provide residential services. Adding to the complexity of the service system, some community agencies use a mix of internal and external residential services.

Children’s aid societies are transfer payment agencies that are responsible for caring for children and youth in need of protection. The Panel heard about the challenges that children’s aid societies face in locating suitable residential services and ensuring that the services are high quality and well-suited to the specific and unique needs of individual children and youth. This was particularly difficult when the children’s aid society relied predominantly on outside paid resource residential services. In some cases, children’s aid societies have sought to develop efficiencies by sharing information about the quality of external residential services. For instance, children’s aid societies in the Greater Toronto Area have developed and implemented a shared assessment tool for OPR residential service providers. This tool allows for information sharing regarding the OPR program philosophy, client groups served, staffing levels, serious occurrences, and outcomes for children and youth following services. Other children’s aid societies share quality assurance managers, which may facilitate sharing best practices for analyzing data about children in care.

In addition to transferring payments to child welfare agencies, MCYS currently provides transfer payments to more than 400 agencies that provide services related to children and youth mental health, some of which provide residential services. Children, youth and their caregivers can access Ministry-funded mental health and complex special needs services by contacting service providers directly or receiving a referral from a school or other health or social service professional. Access to residential services for young people with mental health needs is managed through community tables where children and youth mental health service providers, local child welfare agencies, and other human service organizations are represented, including local hospitals. In the GTA, for example, this mechanism is referred to as Centralized Access to Residential Services (CARS). As with most such community tables managing a centralized access point for mental health residential services, referral to CARS can only be made through professionals and human service organizations, including schools. Outside of that process, there is no list describing mental health service providers that offer residential programs along with detailed information about the type and quality of care offered. Information about mental health service providers is expected to be more readily available through the work of lead agencies and the recently updated Health Care Options website ( https://www.ontario.ca/ locations/health/index.php?lang=en ), however these resources provide general information and do not specifically assist families in accessing residential services.

For young people with complex special needs, the Ministry funds transfer payment agencies to coordinate services and in some instances provide respite. A complex system to navigate, we heard that parents have tremendous difficulty locating residential services, and some parents have resorted to accessing protection services through children’s aid societies even when no child protection concerns were present but rather the issue was a lack of access to more appropriate residential services. This issue was the focus of a 2005 Ombudsman report and was discussed in our consultations 10 years later (Ombudsman Ontario, 2005). Like in the child welfare and children and youth mental health sectors, there is a lack of information available to children and youth with special needs and their families about residential service options.

The Ministry’s 2007 Child and Youth Residential Services Action Plan committed to improving access to information on residential services by developing a public website designed “to provide agencies, families, and ministry staff with a single, integrated database of reliable information” (MCYS, 2007, p.4). Following the 2007 Action Plan, the Ministry started to develop a province-wide public website that would provide “one-stop access to information about specific residential programs,” but unfortunately this website is not operational (MCYS, 2007, p.4). Families and service providers can access information about respite services provided by agencies funded by the Ministry of Community and Social Services and the Ministry of Children and Youth Services through a central website ( respiteservices.com ), which is a step in the right direction.

Limits to access to information about residential services are partly a result of the differences in routes for accessing these services. Access to residential services in Ontario is determined largely on the basis of how the need for out-of­home placement is identified (child welfare, youth justice, mental health, complex special needs), the region a young person lives in, and the funding mechanisms in place (direct operated facilities, transfer payment agencies, and outside paid resources). Some resources can be accessed through multiple sources. For instance, parents, child welfare agencies and even out-of-province organizations can access OPR services directly, as long as they have the capacity to cover the costs. Others, such as services run by child welfare agencies or youth justice, are typically only accessed through those systems. As such, each access point maintains its own list of resources. Differences in mandates, funding models and governance structures in many instances explain why access to some residential services is restricted; youth justice custody/detention facilities, for instance, are designed to be accessed through youth justice, which includes a court order. These restrictions, however, do not mean that access to information about the nature, type and quality of residential services in the province cannot be made more readily available to potential users of those services.

Access to services and access to information about services have been identified as important issues needing to be addressed in several previous reports. Throughout our consultations access was also identified as a critical issue, especially with respect to lack of placement resources in some jurisdictions or lack of options for young people with complex special needs. Access to information about resources supports a transparent consumer focused model that gives young people and their families more control over the difficult decisions that often need to be made in placing young people in out-of-home care. While access to information does not necessarily resolve lack of capacity and resources, easier access to information about the full provincial network of service providers can help (1) increase access to resources that service users would otherwise not be aware of, (2) identify service gaps or duplications to support more efficient resource planning, and (3) identify barriers to accessing underutilized services.

The need for information goes beyond simply knowing which residential services exist in the province. Service users would benefit immensely from having access to detailed information about the programming offered within various residential services, the target client group, the certifications of staff and management, and previous client experiences and outcomes. This would allow for service users to understand the quality and specialization of various residential service providers, and could increase the probability of locating a successful match between the child or youth and the residential service. Through our consultations, we learned of the challenges that families and community agencies face in finding residential resources that adequately match the unique needs of children and youth.

Monitoring Trends and Outcomes

Effective oversight of the over 600 residential service providers across Ontario requires both the capacity (1) to ensure that every individual service provider meets provincial standards for quality care (see Chapter 3 Quality of Care) and (2) to track service trends and monitor outcomes to determine at the aggregate level whether residential services are effectively supporting young people. While the youth justice sector and some service providers are reporting information that provides a sense of service trajectories and outcomes, it is not possible at this time to determine the extent to which the current design and delivery system is effectively meeting the needs of children and youth in residential care in Ontario.

The province has no easily accessible and reliable information to answer the most basic questions, for example: What is the age and sex distribution of young people entering residential care? Are there any trends in admissions and discharges broken down by Aboriginal status? What is the average number of placement changes young people experience while in care? Where do young people go when they leave residential care? How well do children and youth in care do on educational and other outcomes? Even where data is collected in these areas, it is not effectively managed and analyzed to provide insight into these questions.

Answering these and other questions requires a comprehensive and integrated approach to collecting data over time from the child welfare, children and youth mental health, youth justice, and complex special needs sectors. It also involves examining existing sources of data to identify how to maximize the utility of these sources by creating user-friendly databases that can be easily analyzed to provide both simple descriptive outputs as well as more complex longitudinal and multilevel analyses. This exercise of transforming existing data sources into datasets rich with information must occur in the context of collaboration across sectors, in order to move toward comparable cross-sector approaches to asking and answering critical questions about children and youth in residential care as well as the quality of care provided by residential services.

Existing reporting on service trends, service provider quality, and child and youth outcomes in Ontario is limited. Available data on children in residential care is typically presented as point-in-time snapshots, with little information on trajectories over time. Trends data, where available, only represent trends over a few years making it very difficult to assess the impact of incremental changes. Data is rarely representative of the population of children living in residential services across sectors and there is no way to track young people between sectors. Random sampling techniques, which can maximize representativeness while limiting the costs and time associated with population-based research, are not commonly employed in the child welfare, youth justice, children and youth mental health, and complex special needs sectors. Finally, issues of the reliability and validity of data are rarely discussed in reports on residential services, and findings are rarely presented with a clear explanation of the research methods and the limitations of those methods.

The province does not systematically collect important information in order to monitor the safety and well-being of young people receiving residential services. MCYS and residential service providers also do not have a method of consistently and publicly reporting on other important issues for children and youth in care, treatment, and custody/ detention, including schooling, friends, skills, significant adults and relationships, and satisfaction with services. Even basic demographic and service data that exist are not being fully accessed and analysed.

Promising Sources of Data

There are a growing number of promising sources of clinical data and potentially useful administrative data available in Ontario. A collection of these data sources is listed below with a short description and consideration of the strengths and limitations of each.

Limited Analytic Capacity

There is an enormous amount of fragmented information being collected about children and youth and their placements, but no one has either the mandate or the analytic infrastructure to synthesize the information. Each data collection initiative appears to be conducted independently without coordination with other initiatives. Further, there has been no effort to develop a systematic approach to research and analysis that reduces duplication, maximizes efficiency, and ensures that the data collected is of the highest quality possible.

Innovation and Evidence-Based Practices

While the capacity to monitor service trends and outcomes is the cornerstone of any effective service delivery system, not all questions are appropriately addressed by rolling up information collected on every service and service user. Evaluation research following selected samples of service users can produce rich and detailed qualitative and quantitative information that can guide the development of innovative approaches and support the implementation of evidence based programs. There is a lack of independent analysis of available service data. Information is usually provided by, analysed and presented by the service providers themselves.

Residential services in Ontario do not consistently utilize evidence-based practices and even when such practices are used, there seems to be limited tracking of long-term impact. There are several examples of research initiatives that use high quality approaches to data collection and longer term follow-up, such as the clinical trials of multisystemic therapy (MST) conducted as a collaborative effort of children’s services in Ottawa, Simcoe County, Mississauga, and London (Leschied & Cunningham, 1999). More collaborative high quality evaluations are needed to assess the impact of residential services on outcomes for children and youth.

Jurisdictional Review

A number of models are available from different jurisdictions, ranging from specialized within government units, to arms-length government agencies, to university based research centres. Three examples are described in detail below.