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EXECUTIVE SUMMARY

Introduction

The Residential Services Panel (the Panel) was brought together by the Ministry of Children and Youth Services in July 2015 to conduct a system-wide review of the Province’s child and youth residential services system, including foster and group care, children and youth mental health residential treatment, and youth justice facilities. The Panel reviewed foundational materials supplied by the Ministry, including previous reviews, background briefing documents, as well as publicly available information about comparator systems and sectors in Ontario, across Canada, and international jurisdictions. Consultations were also held with stakeholders and partners across the province representing young people, families, caregivers, front line and agency management staff, professional associations and government staff. A total of 865 people participated in the consultations, including 264 young people.

The Panel’s report presents findings and recommendations aiming to improve the experience and outcomes of young people living in residential care. Our review and recommendations are centered on improving the everyday experience of young people living in residential services and on developing a meaningful, sustainable and consistent framework for developing outcome measures based on relevant and cross-sector outcome indicators.

The provision of residential services for some of the most vulnerable children and youth in our society is fundamentally important. Collectively and collaboratively we must ensure that the experience of young people in out-of-home care and their long term outcomes are such that the opportunities for a rich and meaningful life are just as real for young people facing enormous adversities as they are for those living in the relative comfort and safety of their family homes.

Throughout its review and consultations the Panel encountered many individuals who are dedicated to the ideals of high quality residential care. Many service providers strive to provide the best care possible, and government staff are committed to designing a system that delivers positive outcomes for children and youth. We acknowledge the efforts and interests of the Ministry in improving residential services in Ontario. The Ministry has demonstrated a commitment to improvement, implementing significant changes in recent years to the non-residential settings of the child welfare, children and youth mental health and youth justice sectors. The Ministry has consulted broadly over the past ten years and has further demonstrated its commitment to seek excellence by commissioning an independent Residential Services Review Panel.

Despite the best intentions of those working in the sector, and the recommendations received over the years, the quality of young people’s everyday experiences, and their outcomes remain uncertain. The Panel learned of significant systemic and cultural barriers to fostering the quality of care required to contribute to positive everyday experiences and long term outcomes, and identified a lack of consistent mechanisms embedded in residential services across sectors that would ensure the highest possible quality of care for children and youth.

Nine key themes emerged throughout the review and consultation process that highlighted these barriers and framed the recommendations of the Panel.

Key Themes

Governance – the imperative for systemic oversight and accountability for all residential services across all sectors through mechanisms that have at their core, the foundation and elevation of quality of care.

The residential services sector currently lacks a unifying mechanism for ensuring the oversight, accountability and quality of care required across the province. Residential care across the three siloes of child welfare, children and youth mental health, and youth justice sectors has developed organically, and is delivered by a diverse mix of more than 600 directly operated, transfer payment operated, private non-profit and for-profit per diem operators.

This decentralized approach to service delivery presents an opportunity to provide locally developed and delivered services that leverage community resources to meet the specific needs of children and youth, varying areas of specialization across providers and an ability to leverage both the stability afforded by transfer payment agencies and the nimbleness of per diem funded providers that can adapt their services to meet demand. From a governance perspective, however, it is challenging to ensure that there is appropriate oversight and accountability, that all residential services are held to a common standard of high quality care and are focused on continuous quality improvement, and that there is alignment with strategic directions across sectors so that services operate as a system.

Under the current structure, oversight for residential services is distributed across three Divisions within MCYS, cascaded to five regions, and further diffused through the 47 Children’s Aid Societies (for child welfare), and lead agencies across 33 service areas (for children and youth mental health) who contract with transfer payment or private per diem operators. The Ministry directly operates one mental health facility. In the youth justice sector, the Ministry directly operates six secure custody and detention facilities and contracts with 14 transfer payment operated secure custody and detention facilities and 41 open custody and detention facilities. The result is uncoordinated oversight, without a single Ministry governance structure having a full overview of the system or seeing themselves as having the ultimate oversight over the full continuum of residential services. Licensing is the primary mechanism to ensure accountability at the current time, however, the process is inadequate. Current license categories do not encompass all/emerging care models, unannounced inspections are rare and seen as difficult under the current legislation and the inspection process does not assess quality of care.

The current rate setting methodology, rate review process, and the use of special rate agreements for residential services are also concerns relative to the overall governance of the system. The Panel observed significant inconsistencies with respect to per diem rates across all sectors, and there is little confidence that higher per diems for “treatment” are actually delivering a value-added and necessary service, particularly in light of often superficial and not very compelling explanations of what ‘residential treatment’ means and how it is distinguished from other forms of residential care. The Panel also noted that compensation, infrastructure, and inflation are not criteria for rate review. The Panel frequently heard concerns from placing agencies about the use of Special Rate Agreements (SRAs), which involve child or youth-specific funding above the approved per diem rate to address exceptional circumstances requiring additional support and supervision of young people with high needs (most often one-to-one staffing). Often, neither the Ministry nor the placing agency have sufficient oversight of SRAs to ensure accountability for these expensive, and often therapeutically questionable, arrangements.

The Panel firmly believes that the Ministry must have direct authority and oversight of residential services to address the longstanding issues and challenges that we heard about related directly to governance. While the Ministry must retain its role as the steward of the system with a decentralized service delivery model, and continue to share responsibilities in many respects with its partners (parents, caregivers, agencies, Children’s Aid Societies, service providers, associations), a single unified, integrated governance structure must reside within the Ministry to provide systemic oversight and accountability for all residential services through mechanisms that have at their core, the foundation and elevation of quality of care.

Voice – the imperative of ensuring that the lived experience of all young people and their families and caregivers be integral to service design and delivery and system governance.

The individual and collective voices of those with lived experience in out-of-home care – young people, families, and immediate caregivers – at best have had a peripheral impact on: individual care experiences; development of programs and services for young people in out-of-home care; governance and accountability frameworks for services; service design - including the rules, procedures and physical design of programs and services; treatment, relationships and caring that unfolds in programs and services. Young people, families and service providers are not consistently, actively, and collaboratively involved in decisions and preparations regarding major transitions into care, between placements, and out of care.

Current processes to include young people and their families are often not seen by young people, their families and many front line staff as providing meaningful opportunities to be partners in their own care (e.g. Plans of Care) and current mechanisms to capture feedback often exclude those who aren’t comfortable/able to participate in surveys or group-based venues. Young people identified as having complex special needs are particularly voiceless and clearly vulnerable in Ontario’s residential services system.

The Panel strongly believes that the lived experience of young people and their families and caregivers must be integral to service design and delivery and system governance, not as an end goal, but as the starting point of meaningful transformation.

Quality of Care – the imperative of ensuring that quality of care is a central component of system performance and accountability.

The everyday experience of young people in out-of-home care is impacted first and foremost by the quality of care provided in residential services. Such quality of care is a function of a wide range of factors that include the quality of human resources, the relationships among young people and between young people and care givers, the physical infrastructure of residential programs, the appropriateness of program routines, rules, and activities, and also the quality of food, the attention to identity and developmental growth, the levels of physical and emotional safety, and the on-going connections to family, kin, friends and community.

At the level of everyday experience for young people living in residential services, the Panel was particularly impacted by the many stories of young people outlining rules, routines and program structures that are compliance-focused, and bear little resemblance to the mission and vision statements of residential service providers. The general themes in these stories were often confirmed by the observations of CAS workers and licensing specialists with experience in a range of group homes.

The current service system has evolved without much oversight, accountability or incentives to consistently focus on quality of care considerations and the everyday experiences of young people living in out-of-home care. Also concerning is the incongruence between what organizations say they do and what is observable at the level of everyday experience.

In developing a framework for ensuring excellence in quality of care with the appropriate oversight, the Panel seeks to ensure that residential services are engaged in on-going quality improvement activities, while at the same time are subject to a much more transparent and accountable system of validating their claims related to quality of care. Families, young people themselves, and placing agencies and workers currently have very little meaningful information about quality of care in any given residential setting upon which to base a placement decision.

At this time, the Panel notes that there are no universal, or even common, set of indicators, standards or concepts that might lend themselves to the measurements of quality of care in residential services across sectors. Given the rich diversity of service providers, the applicability of universal indicators across sectors may be limited, although the Panel believes that some foundational indicators can be articulated.

Continuity of Care – the imperative to see residential services as a journey of care and within the context of a young person’s whole life at the individual level, and as a system of integrated services at the systemic level.

Many children and youth experience residential services at several points in time from multiple sectors, living in numerous settings with various levels of intensity and quality. Currently, residential services in Ontario are not designed as a journey of care at the systemic level and, they do not provide seamless and integrated care to a child or youth as they access the range of services they need over the course of their childhood and adolescence. The siloing of services from a sectoral perspective make the system hard to navigate for young people, their families and even placement agencies, and sometimes encourage placement decisions that are neither based on the best interests of the young person nor inclusive of the young person’s voice.

At the service delivery level this translates into each placement being seen as a discrete activity rather than a continuum of care. Young people and their families often have to re-tell their story at each intake, experience a lack of continuity from previous placements (particularly in terms of maintaining relationships and connections to community), and face a lack of integration between life outside of any given residential service and life within a care, treatment, or custody/detention setting. Transitions in care – between placements and sectors, or out of care - are not seen as part of the journey, equally deserving of support and resourcing as periods of in-care. Children and youth are often given insufficient notice and preparation of a move between placements, resulting in feeling unprepared for both the physical and emotional impacts of changing caregivers. Young people leaving care, whether to go back home or to reintegrate into the community often report feeling similarly unprepared with the life and social skills, and relational and community supports to be successful. In many ways, the experience of living in a residential setting erodes the very skills needed for healthy and successful independence.

From a system perspective, the Ministry is currently unable to track children between sectors and across placements within sectors, posing a significant barrier to understanding children and youth’s trajectories through residential care, including their point in time experiences and outcomes following services.

The Panel believes that strong oversight of each young person’s journey through the care system is critical, 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. The Panel also believes that significant supports are necessary for the successful reintegration of young people leaving out-of-home care, including secure custody/detention, into their families and communities.

Data and Information – the imperative to have the data and information necessary to understand individual and collective experiences and outcomes, provide oversight and assess system performance, and facilitate informed placement decisions and system planning.

MCYS currently lacks a meaningful way to use data and information to understand “the big picture” of residential services in Ontario. Data and information must actively contribute to the oversight of the system; to understanding how young people in care –individually and collectively – are doing at any point in time and over the long term; to informing choice and to facilitating access to services; and to conduct system planning. Existing mechanisms by which to track an individual young person’s journey in out-of-home care, to understand the experiences of young people, families and front-line staff with residential care as a collective, or to assess overall system performance and outcomes are inadequate, lack coordination, and do not lend themselves to data-informed analytical practices.

Effective oversight of the over 600 residential service providers caring for thousands of young people across Ontario requires both the capacity to ensure that every individual service provider meets provincial standards for quality care, and to track service trends and monitor outcomes to determine at the aggregate level whether residential services are effectively supporting young people.

At the individual level, there is no reliable information about a young person’s trajectory in care. There is no way to follow a child or youth as they move in and out of care, or between sectors, and no way of looking at this journey holistically to facilitate service coordination, flag issues or take their full experience into context when understanding needs and making decisions. At the collective level, there is no way to understand the trajectories of young people through the care system over time. It is critical that MCYS develops a method of systematically tracking the movement of children and youth in care within and across residential service sectors.

There is currently no comprehensive and easily accessible province-wide mechanism for potential users and placing agencies to get information about available services. Access to clear, credible and verified information about the expertise, strengths and experience of each operator and the quality of care in any given residential setting would give, young people and their families as well as placing agencies more input into 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 increase access to resources that service users would otherwise not be aware of, identify service gaps or duplications to support more efficient resource planning, and identify barriers to accessing underutilized services.

The Ministry must be empowered to compel, receive, analyse and utilize the data and information necessary to ensure that children and youth in out-of-home care are receiving high quality care. The Panel has recommended the creation of an online directory of all residential services to facilitate informed decision making at the case level and system planning, and has also identified an approach to tracking service and outcome indicators.

Human Resources: the imperative to ensure that the quality of all caregivers involved in providing residential care to children and youth is commensurate with the responsibility of providing out-of-home care to some of the most vulnerable young people in the province.

There are no consistent or mandatory standards for the pre-service educational qualifications, levels of experience, compensation, training, and employment conditions of front-line staff in both group and foster care residential settings. This has resulted in the recruitment of under-qualified staff in some cases, and in poor retention and high turnover rates, directly impacting on the quality of care experienced by young people. The Panel was particularly concerned to learn that relief and casual staff as well as one-to-one staff hired under Special Rate Agreements (SRA) are often exempt from the same level of agency-specific qualification required of regular staff, and are almost always excluded from agency training programs, clinical staff meetings, and the supervision process. In addition, promotional standards are often unclear and inadequate supervision models to support staff in their relational practice with young people, were commonly reported and observed.

The Panel is concerned that ever-increasing demands related to the claim of greater complexity of child and youth profiles in residential services, the evidence-based interventions required, and the challenges associated with navigating systems both within larger organizations and between service providers embedded in different sectors are incongruent with the current lack of regulation in terms of pre-service educational qualifications for residential staff. The evolving context of residential care service provision in all sectors demands more highly qualified staff with an in-depth understanding of the fundamental models, approaches, theories, children’s rights, cultural and system contexts of residential service provision.

There is concern about the capacity to attract and retain well qualified staff, in both group care and foster care settings. In group care settings, compensation is not competitive with other care sectors or fields of employment, and limited career mobility is embedded in the sector. In the foster care context, a multitude of issues is making it challenging to recruit foster parents. Caregivers report that they are often peripheral to the decision-making about the young people they care for, and institutional processes and requirements sometimes make it impossible to care for young people in ways that reflect family contexts. Eligibility criteria for who can foster, such as the presence of a stay-at-home parent, and the capacity to provide foster children with their own bedrooms, results in challenges for some communities, particularly in large urban centres and Aboriginal communities.

The Panel firmly believes that all individuals charged with the care of children and youth in residential services must hold specific and consistent pre-service educational qualifications, preferably in the field of child and youth care, and be supported through comprehensive in-service training. For those holding or aspiring to supervisory positions, separate and specific certificate-based training is necessary to ensure that individuals holding those positions are fully equipped to do so in accordance with the purpose and intent of supervision models. Furthermore, the foster care system in Ontario is in dire need of modernization, from recruitment and retention strategies to the rules and regulations involved in caring for young people in a family context.

Youth Justice – the imperative to ensure that young people in, or at risk of, conflict with the law receive a consistent quality of treatment in custody or detention, and the necessary support to successfully reintegrate into the community and reduce recidivism.

The provision of services to youth in conflict with the law is governed by both the Youth Criminal Justice Act (YCJA) and the Child and Family Services Act (CFSA). The proclamation of the Youth Criminal Justice Act in 2003 and the creation of a new Ministry of Children and Youth Services, had a significant impact on the provision of residential services, both open and secure custody and detention, in this sector.

The recognition of the greater dependency and reduced maturity levels of young people is embedded in the Youth Criminal Justice Act, informing principles of sentencing (deterrence, rehabilitation, denunciation, proportionality, incapacitation - use of custody as a last resort - and restoration), which have resulted in a decreasing reliance on incarceration for youth on the part of the courts. The Ministry has developed a broad and extensive range of community-based alternatives to open and secure custody and detention, including programs and services for prevention and diversion; alternatives to custody and community-based interventions; the provision of rehabilitative programs for youth who are under supervision and care; and services and supports targeted to specific populations and reintegration programs for youth being released from custodial sentences into the community. The collective impact of these changes is significant excess capacity in both open and secure custody and detention facilities, among both direct ministry operated and transfer payment operated systems. Further opportunities exist to re-purpose and rationalize capacity, to more effectively use resources to meet the needs of all youth justice-engaged young people.

The new legislation also brought directly operated and transfer payment facilities under the responsibility of a single Ministry, MCYS. With few exceptions, the Ministry continues to operate the two legacy systems in secure custody and detention as two quite distinct service delivery systems, with inconsistent standards for the hiring, training and compensation of staff, or practice between the two systems. There is no systemic mechanism for sharing best practices between systems or having strategic conversations about overall challenges in the sector. An integration of the two systems into one harmonized system could bring the full resources of both systems together to enhance opportunities to meet the needs of young people in secure detention and custody.

Use of a relationship custody approach is an ongoing issue within the youth justice sector. The Ministry is committed to the use of a relationship custody approach, directed at fostering respectful, caring relationships between staff and young people and enabling staff to provide effective, evidenced based interventions to benefit youth. Challenges to fully implementing and optimizing relationship custody were identified, however, with variable practice across the range of secure custody and detention facilities. This was particularly the case at the Roy McMurtry Youth Centre, the largest of Ontario’s secure custody and detention facilities, with factors including the size of the facility and the ability to work with the numbers of young people housed there; the legacy of the adult correctional system’s approach to managing youth in conflict with the law and challenges in the transition to a less authoritarian, youth-centred culture for some staff; the numbers of high risk, gang-affiliated youth; peer on peer violence; and, the need to focus on significant security controls in order to ensure the safety of youth, being cited as challenges.

In terms of secure isolation, the Panel noted significant variation in practice across secure custody and detention facilities in frequency, duration and conditions of secure isolation. It is clear that the Ministry’s efforts to address these issues will require sustained attention to address inconsistencies in practice, mitigate the impacts on youth of secure isolation, develop alternatives to the use of secure isolation, share best practices and ensure that practices are consistent with the Ministry’s policy directives and legislation.

Reintegration supports are critical in the context of youth justice. While efforts have been made to provide programs, services and resources to youth returning to the community after leaving a custodial setting, these resources were described to the Panel as inadequate to meet the needs of youth in an effective community reintegration process. In addition to the support needed specifically for a young person, resources are needed to engage families and provide them with the necessary skills and access to programs to support the return of the young person back home. The Panel affirms that there is a need to ensure that strong reintegration supports are in place for young people transitioning from custodial settings to optimize and sustain gains made from participation in evidence-based and evidence-informed programs while in custody and to reduce recidivism.

First Nations, Métis and Inuit Young People in Residential Care – the imperative to ensure that there is a separate and dedicated focus on addressing the needs of Aboriginal Children and Youth and communities.

Throughout our consultations we heard many service providers and community organizations express concern about the overrepresentation of First Nations, Métis and Inuit youth in residential care, especially in the child welfare and youth justice sectors. There has been ongoing advocacy by Aboriginal communities for interventions and programs that will reduce the need for out-of-home placements - both with respect to more services for young people and their families, and programs addressing the socio-economic conditions that undermine the well-being of Aboriginal families - as well as a much wider range of out-of-home care options, in particular ones that recognize traditional extended family and community care practices. Given the extent and persistence of the problem of overrepresentation, the Panel was surprised that there was limited reporting and analysis (apart from the youth justice sector) with respect to young Aboriginal people in residential care. Monitoring rates and patterns of overrepresentation through disaggregated data is very important to ensure that important differences over time and between groups are captured.

Relative to current care options available to Aboriginal youth, concerns include the lack of residential services in reasonable proximity to young people’s communities, limited access to cultural programming or spiritual guidance, minimal inclusion of traditional food on menu plans, and concerns about racist attitudes or insensitivity to the historical context of Aboriginal young people.

Due to the composition, time frames and mandate of the Panel, exploration of issues related to Aboriginal children and youth in out-of-home care was necessarily limited. A separate partnership process is recommended.

Unique Contexts and Unique Geographies – the imperative to ensure that system and service design and delivery of residential services adequately address the realities, needs and strengths of children and youth who identify with a cultural, racial, faith, or gender identity outside of the mainstream.

The current residential services system does not adequately support children and youth who identify with a cultural, racial, faith, or gender identity outside of the mainstream, such as those who identify as Black Youth, as Lesbian, Gay, Bi-Sexual, Transgender, Queer, or 2-spirited (LGBTQ2S). Concerns about the overrepresentation of certain identities in residential care – particularly Black Youth in child welfare and youth justice sectors – and the ability of available services to support these identities through appropriate and safe programs and services abound. The Panel furthermore heard very concerning perceptions in some communities that young people of particular racial, cultural or lifestyle groups are underrepresented in less intrusive non-residential service systems such as children and youth mental health services.

The Panel found few programs and services specifically targeted towards young people with unique life circumstances related to their culture, racial identity or gender context which would support identities and aspirations that often fall outside of the normative structures of residential care, and would provide opportunities to celebrate and enrich the strengths embedded in these identities. Daily household activities also fall short of including the diversity of the residents – from the food and personal care items provided, to the freedom to speak in one’s own language. The overall level of competence and activity in this context is insufficient, uncoordinated, and generally ad hoc. There is a need to enhance the cultural competence of all residential services in relation to the diverse identities and developmental contexts of young people, in partnership with young people themselves to both improve their everyday experiences in care and long term outcomes and to be consistent with Ontario’s commitment to social justice and egalitarian values.

Much of the information about the experiences of young people in residential care who identify with unique life contexts are anecdotal. There does not appear to be sufficient demographic data on the self-reported identity of young people living in residential care to meaningfully plan around the needs of particular cultural, racialized or other groups, or the emergence of new groups based on demographic changes (eg: Muslim youth). Disaggregated data by placement type is critical to identifying patterns and trends in practices and policies that would otherwise be masked. In partnership with the relevant community, consideration must be given to develop capacity for data collection and reporting in a transparent manner on the number of young people impacted within specific groups.

Recommendations

The Panel’s recommendations are designed to create a strong foundation for ensuring excellence in residential services across sectors. At the core of its recommendations is the conviction that the experience of living in out-of-home care for young people is often life-altering and has a major impact on the future life prospects for young people. Therefore, the Panel urges MCYS and all stakeholders in residential services to work towards a future in which well qualified and highly motivated child and youth care professionals, foster parents, and professional staff work in high quality settings that are accountable and transparent in partnership with young people and their families in order to ensure the highest possible quality of care, every day experience, and healthy outcomes.

Children and youth have been clear in what they seek: safety, respect, encouragement and love. The Panel stands with children and youth involved in residential services across Ontario and fully endorses these modest demands.

The Panel recommends that:

  1. The Ministry create one unified, integrated governance structure within the Ministry (a Quality of Residential Care Branch/Division) to provide systemic oversight and accountability for all residential services through mechanisms that have at their core, the foundation and elevation of quality of care. The new structure is envisioned to have four core components: Quality Inspectorate; Data Analytics Reporting Unit; Continuity of Care Unit; and, an Advisory Council.

    Subsections a-d below provide additional detail on the functions envisioned for each unit.

    1. A Quality Inspectorate, replacing the current licencing function, which the Panel heard overwhelmingly is inadequate and does not assess quality of care. The new Quality Inspectorate would be comprised of inspectors whose responsibility it would be to licence and inspect all residential service providers in accordance with quality performance indicators recommended by the Panel and as may be developed by the Ministry. The current licencing function would be subsumed under the new Inspectorate as a set of baseline indicators that would be required but not sufficient. The position requirements of inspector would be substantively different from those of the current licencing specialist position requirements in the focus on quality, and will require an HR transition plan. It is envisioned that regionally based quality of care branches of the Inspectorate would report jointly to the corporate Quality of Care Inspectorate and to regional directors. Further information with respect to the new Quality of Care function is contained in Chapter 3 on Quality of Care.

      On an annual basis, each service provider would also be required to provide a Concept Statement to the Ministry, outlining their services and self-reported areas of strength or expertise. The inspector would assess the extent to which the assertions of service providers about strengths can be supported by evidence, having access to clinical expertise as necessary. The inspector would measure and assess quality through on-site inspections, paying particular attention to the voice of young people, families, caregivers and front-line staff. The Concept Statements of service providers and the reports of inspectors would be posted by the Quality Inspectorate in such a way that all placement agencies could review and access the reports when making placement decisions.

    2. A Data Analytics and Reporting Unit that would be the central repository and data analytics unit for all sources of data and information relative to residential services, including but not limited to all Serious Occurrence reports from service providers and licencing and quality of care assessments, including performance against indicators, completed by Quality of Care inspectors. The capacity to bring together all sources of data and information and to conduct high level aggregate data analysis will create a powerful tool for the Ministry in determining and reporting publicly on the performance of the system and in assessing the progress of young people. More information on this function is found in Chapter 5 on Data and Information.

    3. A Continuity of Care Unit, staffed by Reviewers whose responsibility it would be to monitor placement changes and trajectories of children and youth in residential services. Whenever a young person’s placement was changed, it would be required that the decision maker notify the Continuity of Care Unit. The Reviewer would have information about the full placement history for each young person as well as other relevant data such as Serious Occurrence Reports, assisting the decision maker to have the full context for the young person’s trajectory through care. This would benefit the decision maker in ensuring that placement changes were thoughtful and necessary, having regard to the number of placements the young person has experienced.

      It is envisioned that all young people in long term care (i.e. 18 months or greater) would be monitored by the Continuity of Care Unit. The Panel recommends that the current Crown Ward Review Unit be integrated into the Continuity of Care Unit. The Reviewer would also be notified when a young person was moved from child welfare or children’s mental health into a youth justice custody/detention facility in order to assess concerns about the criminalization of young people in care. The Panel envisions that the Continuity of Care Unit would be responsive to concerns that currently the Ministry is unable to track young people across sectors, seriously impacting the Ministry’s ability to understand youth’s trajectories through residential care and outcomes following these services. This unit would also respond to concerns that pathways through care are currently disjointed, unpredictable and may result in significant placement disruption. Further information is found in Chapter 4 on Continuity of Care.

    4. An advisory council to provide access to clinical expertise and lived experience (children and youth, families, caregivers including foster parents and front line workers). In Chapter 2 on Voice, the Panel has expressed concerns that the voices of young people, as well as front line caregivers, are not adequately listened to or used to inform policy changes and enhancements to the quality of services provided in residential care. Accordingly, the Panel envisions that a properly comprised advisory council actively participates in the design and development of the new Quality of Residential Care Branch/Division, and then continues to add value to the ongoing functions of the Branch/Division.

    Please see Appendix 1 for a sample organizational chart for illustrative purposes.

  2. All service providers across sectors submit to the Quality of Residential Care Branch/Division a completed Concept Statement (for sample Concept Statement see Appendix 2) each year.

  3. Residential care descriptors such as “treatment” or “specialized” be eliminated in both group care and foster care.

  4. The placement of young people in a residential service be based on a match between the needs and strengths of the young person and the strengths and demonstrated capacities of the program as per the validated Concept Statement pursuant to that program.

  5. Key capacities for understanding the experiences of all those with experience in residential services at both a single point in time and over time be developed, including:

    1. A mechanism developed by the Quality Inspectorate to provide opportunities for all young people to report on their experiences in any placement, post discharge.

    2. A systematic sample based survey be administered every 2 years to gather feedback from foster parents, and front-line staff about their experiences in residential services.

    3. The capacity to track the trajectories of young people who receive residential services. This could be in the form of a unique residential service client identifier or a residential service information module common to all sectors.

    4. The capacity across residential services for data collection and reporting in a transparent manner, based on the principle of self-identification by children, youth and service providers, and in partnership with the appropriate group:

      1. residential service trends specific to First Nations, Métis and Inuit children and youth across all residential service sectors.

      2. the number of young people in out-of-home care within specific cultural, racial, faith, or gender groups (including trans).

  6. The Ministry create a third category of customizable licenses for services that fall outside of the existing two categories to ensure that children in out of home care only be placed in licensed residences, and to mitigate against young people being placed in unlicensed programs that often have untrained live-in staff supported by one to one workers under Special Rate Agreements, with limited oversight over quality of care or even safety considerations.

  7. The impact of licensing as a mechanism to ensure oversight and accountability be maximized by:

    1. Enabling a broad range of designates to conduct unannounced inspections at any time.

    2. Creating more meaningful consequences for non-compliance through progressive consequences, potentially beginning with administrative monetary penalties of graduating levels, and ending with broader criteria for the removal of a license. 14

    3. Enabling a common approach to the interpretation and application of licensing standards through centralized training and access to clearinghouse decisions.

  8. A centralized, publicly accessible, web-based directory of all licensed service providers across the province be created to maximize opportunities for system planning, placement decisions, and oversight of a decentralized approach to residential services. It is recommended that the directory include several key elements:

    1. Basic organizational information (as appropriate) such as whether there are multiple residences within or across regions owned by a single operator, contact information, and information pertaining to the capacity of the residence(s).

    2. A concept statement, updated annually by each licensee and validated by the Ministry, which articulates the strengths and abilities of the service provider.

    3. Any information related to the license status of the provider, including status, terms and conditions, inspection report.

  9. A commitment to accountability through public reporting (in addition to the publication of licensing information) be facilitated through:

    1. Annual progress report from the Quality of Residential Care Branch/Division

    2. Public reporting of Recommended Service and Outcome Indicators

    3. An independent study assessing the quality of care, continuity of care and outcomes of children and youth in out-of-home care at a defined period of time (e.g. Every 5 years) to be presented to the Legislature by the Minister of Children and Youth Services to provide an external complement to internal oversight mechanisms.

  10. A comprehensive review of current per diems across the province and the per diem rate setting and review process for both transfer payment and privately-operated service providers be undertaken by the Ministry, with particular attention paid to the variation in rates across Ontario for similar services, increases in cost of living and the necessary adjustment of staff salaries aligned with such increases, as well as the cost implications of the recommendations related to human resources.

  11. The use of Special Rate Agreements (SRAs) be subject to rules and regulations aiming at higher levels of accountability and more effective child and youth centered practice. To this end:

    1. The number of young people with SRAs, in any one residential program, be limited to two.

    2. Where SRAs involve the use of one-on-one workers, such agreements be reviewed every 30 days with a view to reducing the intrusiveness to children and youth.

    3. The hourly compensation for workers assigned to young people on a one-on-one basis be equitable in relation to other residential staff.

    4. The pre-service educational qualifications for one-on-one workers under SRAs be the same as for all other residential care workers.

    5. Training focused on quality practice be required for all one-on-one workers by service providers.

  12. Dedicated funding for research about residential services in Ontario be established and managed by the Ministry.

  13. A requirement for pre-service credentials be introduced whereby all front line staff in residential care must have completed at minimum a college level diploma in a human service discipline. The requirements for these credentials encompass any person engaged in paid employment activity focused on children and youth in residential services at any level, excluding any person employed solely for functions that do not involve interaction with residents such as kitchen and maintenance duties.

    1. Current staff members in residential settings have up to five years to meet this requirement.

    2. MCYS move towards establishing child and youth care practice as the required credential for residential work over the course of the next ten years.

    3. Pre-service credential requirements apply to full-time, part-time, and designated one-to-one staff in group care as well as to workers assigned to foster homes or family-based care.

    4. Modified requirements are to be developed for Aboriginal people taking into account local resources and contexts in partnership with First Nations, Inuit and Métis communities.

  14. Eligibility for supervisory positions in residential services be contingent on completion of a certificate. Such certificate shall be based on a curriculum specifically designed to enhance the capacity of supervisors to support staff in the provision of therapeutic care based on relational practices.

    1. The supervisory certificate should be developed through a partnership of the child and youth care academic sector and the residential services field.

    2. Such certificate must be obtainable only through community colleges or universities, and cannot be delivered by service providers themselves.

    3. Current supervisory positions in residential services must complete the certificate within two years after its establishment and availability.

  15. A two-week new worker training program be developed for all front-line residential service positions (with the exception of youth justice – see below) based on core competencies including life-space interventions, strength-based relational practice, ethical decision making and the unique context of Aboriginal, LGBTQ2S, Black youth and other groups.

    1. The New Worker training should be developed through a partnership between the child and youth care academic sector and the residential services field.

    2. The New Worker training is to subsume existing mandatory training for residential front-line staff including in particular crisis prevention and intervention training.

    3. A review of the Youth Justice training program for front-line youth services workers be conducted to ensure that relevant content from the new residential services curriculum be incorporated and that cross training in relational practice/relationship custody be incorporated for both directly operated and transfer payment based staff.

  16. A provincial strategy be developed to modernize foster care in Ontario, including a provincially driven recruitment strategy for new foster parents. The strategy must include:

    1. A strong voice for foster parents on an on-going basis.

    2. Provisions for foster parents from different organizations to come together regularly.

    3. An emphasis on clarifying rules and procedures for fostering.

    4. Measures to address barriers, including ones of resource for the recruitment of foster parents from Aboriginal and other uniquely situated communities.

  17. PRIDE training be extended as a requirement to all public and private foster parents.

  18. The two separate systems of secure custody and detention (directly and transfer payment operated) be harmonized and integrated into a single system to ensure that the placement and transfer process considers the entire array of resources to meet the needs of youth, resources are maximized, training is standardized and best practices are shared and scaled up system-wide.

  19. Consideration be given, where demand is demonstrated, to converting youth justice open custody residences with excess capacity to youth residences serving the full spectrum of youth justice-engaged youth requiring stable housing including: open custody youth; youth transitioning from open and secure custody requiring reintegration support; youth on probation; and youth for whom a stable residence is required to qualify for bail.

  20. A review of the remaining excess capacity in youth justice open custody and detention as well as secure custody and detention be conducted and excess capacity be rationalized. Any savings accrued should be reinvested in residential services for youth, to address areas in which there is inadequate investment.

  21. Standards and best practices from all operators with respect to relationship custody be documented and form the basis of training for all youth justice open and secure custody and detention staff in both transfer payment and directly operated facilities.

  22. The Ministry ensure that the frequency and duration of Secure Isolation is minimized as required by legislation and policies and that conditions in Secure Isolation are not punitive. This will require that the Ministry sustain its current efforts on an ongoing basis.

  23. The impacts of size of the facility and gang-affiliations of some of the youth at the Roy McMurtry Youth Centre be mitigated by transferring out youth with secure custody sentences of 30 days or more, as well as youth on long term detention (who would be returned for purposes of Court appearances), to the closest and most appropriate youth justice secure custody and detention facility with capacity. Such transfers should be considered using a case management model in the best interest of the youth.

  24. Supports and resources be enhanced to support positive outcomes and the successful transition into, between, and out of residential services, including after care and reintegration into the community.

  25. Recognizing the current provincial initiatives to support youth in transition from out of home care, the Panel recommends the continued exploration of extending the age to which residential services are funded.

  26. A separate process with Aboriginal peoples be conducted, consistent with principles of self-determination, to determine the best options for supporting Aboriginal children and youth requiring out-of-home services. The scope and mandate should be developed in partnership with Aboriginal service providers and communities.

  27. MCYS establish an advisory committee to enhance cultural competence of all residential services in relation to the diverse identities and developmental contexts of young people.

    1. All cultural competence initiatives must unfold in partnership with young people.

    2. Mechanisms must be developed to ensure visible progress in this area.

  28. The Ministry mandate residential service providers to clearly articulate the cultural, gender, racial, and other identity rights of young people.

  29. A strategy be developed by the Ministry to ensure that the rights, well-being, and participation of young people identified as having complex special needs are promoted.

  30. The Ministry develop a strategy for the identification of emerging issues, such as the sex trades, and the rapid response to such issues in a co-ordinated cross-sectoral and provincial manner.

  31. MCYS create a mechanism for ensuring equitable access to non-residential supports for Black youth, LGBTQ2S youth and other groups living in residential care.

  32. In collaboration with the school board, a specific plan be developed by service providers for every young person in relation to their school-based learning and where applicable transition from section 23 to community schools.

  33. Young people who experience mental health or other crises while in residential care receive services where they live. Additional services and supports should be provided to the young person in order to prevent a change of placement.

Call to Action

There is no room for complacency and mediocrity in the provision of residential care to some of the most vulnerable members of our society. There is an urgent need to address the existing and longstanding challenges in the current model of residential service delivery in Ontario. Notwithstanding the efforts of many dedicated public servants, human service professionals and child and youth serving organizations across the Province, and many years of seeking advice and commissioning reports, change has been very slow. It is time to shift gears. To improve residential services, we must act boldly; move efficiently and with purpose; and focus our energies on the core of the matter – the everyday experience of young people on the one hand, and improving their outcomes on the other hand.

We look to the Ministry of Children and Youth Services to provide strong, sustained, integrated leadership and a relentless focus on implementation commensurate with what is at stake – the lives of young people. In its role as steward of the system, the Ministry must be equipped to provide the overarching, integrated oversight for its large and complex residential services system. It must hold accountable all service providers entrusted with the care of young people to provide consistently high quality care. Residential services in Ontario will improve when caring adults engage in a meaningful partnership with young people themselves, who bring to our expert knowledge the lived experience that breathes life into real change

With energy and purpose, let us commit to change.

With young people, let us make that change happen now.

Because young people matter.

The Residential Services Review Panel, 2016

Dr. Kiaras Gharabaghi

Director, School of Child and Youth Care Ryerson University

Dr. Nico Trocmé

Director, School of Social Work McGill University

Deborah Newman

Former Deputy Minister Ontario Public Service

Logistics Coordinator for the Panel: Sherry Sim

Research Assistants: Hailey Kavanagh, Christine Shimoda, Melissa Van Wert