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INTRODUCTION

The Ministry of Children and Youth Services (hereafter referred to as the Ministry or MCYS) struck the Residential Services Panel in July, 2015 to conduct a system-wide review of the child and youth residential services system across all sectors (i.e., youth justice, child welfare, and mental health). Residential services include foster and group care, secure treatment, youth justice open and secure custody and detention facilities, and mental health facilities. Some services are delivered by transfer payment agencies directly funded by the Ministry, some by private per diem operators, and some are directly operated by the Ministry.

The Ministry has made significant changes in the individual sectors that provide residential care (child welfare, children and youth mental health, youth justice) over the past few years, and residential services are now an area of specific focus for change. The network of residential services has grown organically in Ontario in primarily an opportunistic rather than strategic way, through a decentralized approach to governing operations. Locally developed, delivered, and operated services have the potential to provide access to a diverse array of services and providers to meet the changing needs of young people across a vast geography like Ontario. However, the legacy of this approach is a perpetuation of siloed operations that give rise to concerning practices and events, and a Ministry that finds itself focusing on issues management rather than quality improvement. Systemic barriers to centralized oversight, accountability, adequate information and analysis have hampered the Ministry’s intention to ensure that young people in out-of-home care have positive daily experiences and long term outcomes.

This report presents the Panel’s 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.

Our approach has been to integrate what has been learned from previous studies, reports and reviews that either directly or indirectly pertain to residential services in Ontario with insights and ideas gained from the Panel’s consultations with key stakeholders across Ontario. A detailed overview of our process is found in the Methodology section of this Introduction.

Mandate

The Panel was tasked with looking at residential care for children and youth at both the broad systems level and at the mechanisms that impact the everyday experience of young people living in out-of-home care to support effective residential care. Effective residential care was described by the Ministry as ensuring that children and youth can: Achieve permanency in a safe, stable and caring home-like setting as quickly as possible with minimal placement disruption if they are unable to return to their families; Receive timely, appropriate and evidence-based services that are matched to their care and treatment needs; Receive quality services and supports from a highly skilled and competent workforce; Receive the most appropriate, and least intrusive, placement that addresses their unique situation; Maintain connections to their families and community, and are able to form attachment relationships; Return to their families as quickly as possible; Maintain their educational attainment and life-skills development; Are prepared for, and supported through, their transition to independence or adult services; and, Receive follow-up support to ensure they maintain the positive outcomes and/or gains made in residential settings. From a system perspective, the Panel was asked to focus on issues such as quality, transparency and voice. At a more granular level, the Panel was asked to consider mechanisms such as funding, licensing, assessment, documenting, and human resources.

A key component of the mandate for this Panel was ensuring a strong voice for young people, foster parents, caregivers and front-line workers within the residential services system in addition to hearing from associations, service providers, management and executives, MCYS staff, experts in residential care and many others with experience in the residential services system in Ontario.

Methodology

The work of the Panel was informed by multiple sources:

  1. Foundational materials supplied to the Panel by MCYS, including previous reviews, background briefing documents, and other materials that describe the current state of the residential services system and its activities, and the reforms that the Ministry has already begun. For a full listing of all materials provided to the panel please refer to Appendix 6.

  2. Additional foundational material requested by the Panel from various units within MCYS as well as service providers, professional associations, and others, also contained in Appendix 6. Publicly available information about comparator systems and sectors in Ontario, across Canada, and international jurisdictions to explore models of residential care and mechanisms that support public care of vulnerable populations such as licensing, funding, and quality assurance. Within Ontario, particularly focus has been placed on the Long-Term Care and Child Care sectors as exemplars of a progressive and comprehensive approach to daily delivery of quality care to vulnerable populations, and dedication to measuring outcomes for performance evaluation and quality improvement purposes. Outside of Ontario, Alberta, BC, Saskatchewan, Manitoba, Newfoundland, Nova Scotia, Quebec, New Brunswick, California, New York, Wisconsin, Illinois, the United Kingdom, Israel, Australia and Scotland were jurisdictions reviewed.

  3. Consultation 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 encouraged candour in all its consultations, and took care not to identify young people in any way in order to protect their privacy. The Panel structured the consultation process to give voice to those with lived experience who are not always heard in other forums.

From the outset of this project, the Panel was committed to ensuring that the voices of young people in out-of­home care were to be at the core of its consultation process. To this end, we developed a comprehensive youth engagement strategy. Our goal was to ensure that we spoke to as many young people with lived experience in residential care as possible, and that we make every effort to hear the voices of young people who often are not afforded opportunities to share their experiences. Our strategy was endorsed by both the Ministry and Provincial Advocate for Children and Youth. It found strong support amongst all service providers we encountered along the way, and young people themselves expressed appreciation for the opportunity to contribute to this process.

As part of its broader engagement strategy, the Panel held consultation sessions with young people currently living in residential services (primarily foster care and group care) at six regional sites: Ottawa, Toronto, Kingston, Thunder Bay, Sudbury and London. We collaborated with the Child and Youth Care programs at the local colleges and universities in each of the regions. Six senior Child and Youth Care students were hired and trained at each location. They each facilitated a discussion table related to one specific question or theme. The Panel requested that Regional MCYS Offices work with service providers from the regions in order to identify 50 young people for each consultation session, ideally from a range of service providers within the child welfare, children and youth mental health and private per diem funded operators. The young people rotated in smaller groups for discussions of the six themes/questions at each of the tables facilitated by a student. The specific themes that were explored with young people included Voice, Family and Relationships, Education, Basic Needs and Food, Therapeutic Activities and Recreation, and Treatment.

Following the round table discussions, the facilitators at each table documented the core themes raised by the young people. At least two Panel members and one Research Assistant were in attendance at each session. In addition, the Panel ensured the presence of at least one professional child and youth care practitioner who was available to young people who may have required support during the consultation process or respite from the consultation activities.

In terms of criteria for the identification of young people, the Panel asked the following to be taken into consideration:

  1. A smaller number of young people between the ages of 10 and 13;

  2. A larger number of young people between the ages of 14 and 19;

  3. All young people currently live in either foster care or group care, with both living arrangements represented more or less equally;

  4. Social and communication capacity to comfortably participate in small group discussions for a total period of up to three hours, with breaks and food provided throughout.

The Panel recognized from the beginning that many young people may not feel comfortable in larger group discussions, and therefore engaged in one-on-one consultations with young people who otherwise may not have been heard, including many young people with developmental disabilities and those impacted by Fetal Alcohol Spectrum Disorder (FASD), Autism and intellectual disability. In addition, the Panel held several focus groups with young people living in secure custody facilities, and furthermore consulted with young people already participating in formal or semi-formal groups through the Provincial Advocate for Children and Youth (PACY - Youth Amplifiers), Ontario Association of Children’s Aid Societies (OACAS - YouthCan), Children and youth mental health Ontario (CMHO - New Mentality), MCYS and others. The Panel also joined the Provincial Advocate for Children and Youth on a site visit and youth consultation day at a large residential service provider. And finally, the Panel ensured youth engagement of young people situated in unique contexts, including LGBTQ2S youth, Black Youth, Inuit youth, First Nations youth, and Métis youth.

The Panel’s rationale for a youth engagement strategy that included large groups, small groups, individual consultations and focus groups reflects its belief in the importance of the incorporation of youth voice and lived experience in understanding residential services. A critical aspect of the Panel’s work and final report is the meaningful integration and focus on youth voice.

During our consultations with young people, they were provided with materials and encouraged to sketch on the paper covering each round table if they wished to do so. The result were many colourful drawings, which the Panel has been happy to incorporate into our report with the permission of the artists.

For a full listing of organizations, professionals and young people who were represented throughout the consultations, please refer to Appendix 5.

Organization of the Report

The report is organized into ten chapters, each one centered on a significant theme that emerged through the Panel’s review process and consultations. Each chapter describes the current situation, articulates issues based on evidence from materials, consultations and jurisdictional reviews where applicable, and concludes with the implications of these issues on the recommendations put forth in the final section of this report. The chapters are organized to flow from themes that impact all young people in residential care across all sectors, to those that particularly affect specific populations. The chapters are:

  1. Governance – a focus on the structures and mechanisms that affect the oversight of, accountability for, and service delivery of residential services.

  2. Voice – a focus on the fundamental importance of youth voice, engagement and participation in all aspects of residential service provision.

  3. Quality of Care – a focus on the need for quality to be the foundation of service delivery and experience, and governance of residential care.

  4. Continuity of Care - a focus on the need to look at residential care as a journey that requires continuity of care, a focus on transitions, and an overall perspective of the trajectory of care over time, both at the individual and system levels.

  5. Data and Information – a focus on the data needs and analytical capacity required to evaluate how young people are doing in residential care.

  6. Human Resources – a focus on the need to ensure that those tasked with caring for vulnerable young people are best equipped to do so.

  7. Youth Justice – a focus on issues and opportunities in the secure and open custody and detention sector specifically.

  8. First Nations, Métis and Inuit Young People In Residential Care – a discussion about the importance of ensuring that a specific partnership strategy be considered regarding residential care in an Aboriginal context.

  9. Unique Contexts and Geographies - a focus on how residential care intersects with young people who identify their life context in unique ways, such as young people who identify as Black Youth, as Lesbian, Gay, Bi-Sexual, Transgender, Queer, or 2-spirited (LGBTQ2S), and those who have been identified by the system as having complex special needs. The issue of young people recruited into the Sex Trades is a component of this chapter, as is the impact of unique geographies on residential services and care.

  10. Service and Outcome Indicators – an identification of key indicators related to the evaluation of service providers, everyday experiences, and long term outcomes of young people living in out-of-home care.

The final section of the report is a Recommendations Package which includes recommendations that flow from the themes identified across all chapters, a perspective on the way in which implementation of recommendations can be phased, and the financial considerations associated with the recommendations collectively. The report concludes with the Panel’s Call to Action.

Vision

In working through the development and phasing of our recommendations, the Panel articulated a vision for an optimal residential services system. All recommendations are in alignment with this vision.

We envision residential services across all sectors in Ontario that are characterized, first and foremost, by an abundance of empathy, so that every young person living in out-of-home care feels loved, cared for, and respected. We furthermore envision services in which the voice of young people is the central component of care and treatment, so that every young person feels a strong sense of agency and control in how their lives unfold. Residential care for children and youth in Ontario must provide living arrangements that are experienced as safe and foster relationships with adults and peers that are based on mutual trust, a level of intimacy reflective of family life, and are reliable beyond the date of discharge.

The unique contexts and social locations of Black Youth, LGBTQ2S youth and others are engaged in all residential care, including through the design of physical sites and the everyday living experience as reflected in food, rules, basic needs provisions, and culturally appropriate assessment and intervention approaches. We furthermore envision residential care to reflect a nation-to-nation partnership with First Nations, Métis and Inuit peoples in such a way that all residential care in Ontario is responsive to the needs of aboriginal youth. We envision residential care that names and eliminates racism in all of its manifestations. Care should be inspired by the unique strengths and resilience of young people in out-of-home living arrangements, and aim to inspire these young people to follow their dreams and to prepare them with the skills, emotional strength and social connections to achieve those dreams, while supporting families to remain actively involved in care and planning.

Services place primary emphasis on quality of care. Well-defined standards of care which are common across all services, access to caring, qualified, well trained and appropriately compensated staff and caregivers with a significant voice in service design and planning, and communication and joined planning across all components of each young person’s life-space, contribute to a high quality of care.

All forms of residential care operate as an interconnected continuum of services that are equipped to match services to the needs of each young person. All services and service providers wrap around the youth in care to avoid further disruption. Transitions within and out of care are smooth and effective, and youth feel well supported into adulthood and beyond.

Residential services across Ontario, regardless of mandate or specific sector, are subject to significant, provincially consistent, integrated and quality-oriented oversight by government, that includes engagement on issues of empathy and safety, the everyday experience of young people, and the achievement of outcomes that celebrate the individual strengths and capacities of young people. The system practices a strong and sustainable commitment to producing data that can inform improvements in residential care contexts over time. A culture of continuous quality improvement is fostered.