Child and Youth Mental Health:
the Realities
Dr. Simon Davidson
Chair, Child & Youth Advisory Committee,
Mental Health Commission of Canada;
Chief Strategic Planning Executive,
Centre of Excellence for Child & Youth Mental Health
at CHEO
Toronto, Ontario
November 6, 2009
The Facts About CYMH
▪
▪
▪
▪
High prevalence of psychiatric disorder (13-22%).
High demand for service, limited access, long wait lists
(only 1 in 6 of those needing help (16%) had accessed
services in the previous 6 months).
More than 70% of adults with mental illnesses onset in
childhood/adolescence.
Est $51B lost per year –workplace absenteeism due to
mental illness
* It all begins with children and youth!
Mental Health Commission of Canada
▪ The History
▪ The Structure
▪ The Priorities
www.mentalhealthcommission.ca
Key Initiatives
National Mental Health Strategy
Anti-stigma Campaign
Knowledge Exchange Centre
Homelessness/Mental Health Research Projects
Partners for Mental Health Campaign and Foundation
Child and Youth Advisory Committee
(CYAC) of MHCC
‘The orphan of the orphan’
….NO LONGER!
▪16 member Committee
▪Across the age spectrum to age 25
*family & youth centredness
*maternal & family health
MHCC – CYAC Funded Initiatives*
1.
2.
3.
National Mental Health Strategy
a) Evergreen Document
b) School-based mental health programs
-evidence
-demonstration projects
Youth Reference Group
Anti-stigma, Anti-discrimination Campaign
Youth Focus
Youth Reference Group
Family Self Stigma
Knowledge Exchange Centre
cymh component
*collaboration and engagement across Canada encouraged whenever
possible
(exploring national prevalence & surveillance study)
The Many Faces of Child Abuse & Neglect
1. Prevention
-the name of the game
2. If not, then early identification and early
intervention
The Many Faces of Child Abuse and Neglect
1. Iatrogenic abuse & neglect?
2. Does system inadequacy or failure
constitute abuse or neglect?
3. What about the Rights of the Child and
Youth?
‘Our children are a living message to a
time we will not see’
Sir Al Aynsley Green
Children’s Commissioner for England
Conclusion
Great Program
Stimulating day ahead
Thank you for your attention!
Understanding the Developmental
Determinants & Changing the Life
Scripts of Abused & Neglected Children
Deborah Goodman, MSW, RSW, PhD.
Manager of Research & Program Evaluation,
Child Welfare Institute, Children’s Aid Society of Toronto
The Many Faces of Child Abuse and Neglect
Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect
Friday, November 6, 2009 • Design Exchange, Toronto, Ontario
Canadian Child Welfare Context
Child and Welfare vs.
Child Protection Systems
Child Protection Systems (CPS)
• Canada, United States, United Kingdom, Australia
• Emphasis: individual rights & responsibilities; Mandate: “stand-alone” authority
Family Service Systems (FSS)
• France, Germany, Sweden, Netherlands
• Emphasis: consensual agreement; Mandate: child & family welfare
systems;
• Focus: support parent-child relationships & care of children
Community Caring Systems (CCS)
• Canada’s Aboriginal Peoples, New Zealand Maori
• Emphasis: consultations with parents, extended family, local
community
• Focus: keeping children within their family/community; respect
traditional values
Canadian Child Protection System
Characteristics
•
•
•
•
•
•
•
•
•
•
Provincial authority – model
Residual system
Focus is on risk & safety
Focus is on protecting children from harm in their own home
Mandatory reporting
1-point entry system
Reliance on court to convey authority
Viewed as stigmatizing
Division between services for family support & child protection
Service is to vulnerable / at risk youth via a patchwork of
services delivered by different ministries (e.g. child welfare,
youth justice, children’s mental health…)
The social construction of “child
maltreatment”… a moving target
1900-2000
2000- 2100…
1900’s Physical Neglect / Abandonment
 Deleterious effects of 2nd-hand smoke is
well established in literature and law
1960’s Physical harm / Medical Neglect
Parental right vs. child abuse?
1980’s Sexual harm
 Unintentional injury (UI) is the leading
cause of death for children age 1-11; half
UI’s are transportation accidents
Poor parenting decision vs. neglect?
1990’s Neglect / Inadequate Supervision/
Inappropriate Child Care
 Parental alienation
1990’s Emotional harm /Exposure to
adult conflict
Family dysfunction vs. emotional harm?
Child maltreatment by context…differs
Population
USA 2007 vs. Britain 2005 vs.
302M
61M
Canada 2003 vs.
32M
Toronto 2003
2.5M
Neglect
60%
44%
30%
46%
Phys. Abuse
11%
15%
24%
28%
Sexual Abuse
8%
9%
3%
5%
Emotional Abuse
4%
20%*
15%
1%
Exposure to DV
~
~
28%
20%
Mixed
Other
13%
4%
12%
~
~
~
~
~
100%
100%
100%
Over 214,000
investigations
Over 12,000
investigations
TOTAL
100%
* Britain includes DV
Over 1.8million
investigations
Canadian Incidence Study (CIS 2003)
5 categories 20+ maltreatment forms
Categories
1.
Physical abuse
2. Sexual abuse
3. Neglect
4. Emotional maltreatment
5. Exposure to domestic violence
Substantiated by child age: CIS 2003
CIS 2003
Age
Group
Incidence/
per 1000
%
Substantiated
<1
28.22
7%
1-3
19.93
15%
4-7
21.35
24%
8-11
23.21
29%
12-15
20.40
25%
Total
21.71
100%
Reason for service at an Ontario CAS
Ontario Eligibility Spectrum
PROTECTION SECTIONS 1-5
Section 1 – Physical/Sexual Harm by Commission
Section 2 –Harm by Omission / Neglect
Section 3 – Emotional Harm/ Exposure to Partner Conflict
Section 4 –Abandonment/ Separation
Section 5 –Parental Capacity
Top 3 Ontario Eligibility Codes –
Children 0-5 for 2008 @ 1 CAS in GTA
Children 5 & under
No Court Involvement
N=2,245
Section 1-Physical Harm
Section 3-Emot Harm/DV
Section 5- Parental Capacity
Total
29%
28.5%
27%
84-85%
Children 5 & under
Court Involvement
N=50
22%
12%
48%
82%
Eligibility Code –Top Section & Top Scale
Children 0-5: 2006-2008
Top Section/Scale:
5-3 Caregiver with
a Problem
NO –
court involvement
YES - court
involvement
2006
286
35
2007
341
19
2008
433
14
Sub total 5-3
1060
68
Total all sections
5620
187
% 5-3 accounts for
All Reasons of
Service
18.9%
36.4%
About a Canadian public health issue –
children at risk
About the areas of concern for the
Public Health Agency of Canada
AREAS
1- Poverty / low SES
APPROACH
1- Prevention
2- Child abuse and neglect
3- Prenatal
4- Children’s mental health
5- Obesity
6- Unintentional injuries
2- Promotion
3- Protection
4 -Treatment
About the development of brain growth:
newborn to 6 months
newborn
1 month
3 months
6 months
Wotherspoon
Outcome
Former youth in Canadian youth
(ages 15-25)
care
(Results from US and
Canadian research studies)
Not complete high school
27 to 75%
15%
Unemployed
46%
14%
Receive public assistance
38%
6% a
45 to 90%
-
30% b
6%
Involved in justice system
60%
2%
Emotional/mental health
problems
50%
18%
Experienced homelessness
Pregnant at an early age
These statistics are not direct comparisons as they are not based on controlled sampling within single research projects.
a
b
Total Canadian population
Of the 30% of former Crown wards who became pregnant at an early age, 60% became re-involved in the child welfare system as parents.
MCYS
Early developmental determinants of
risk and resilience
Risk and protective factors
Risk
Protective
Personal/Internal factors
Personal/ Internal factors
• Exist within the individual e.g.
genetic, disabilities
•
Environmental factors
External factors
• Exist within a social context e.g.
family, school, community,
country
•
NOTE: The #of risk factors is more
important than the type of risks
NOTE: Protective factors reduce risk of harm,
improve resistance to risk, contribute to
positive outcomes
Exist within the individual e.g.
personality, autonomy
Exist within a social context e.g.
family, school, community, country
About the effects of physical
discipline/harm on child development…
• About the effects of line on child development…
10/11 meta analyses found parental corporal punishment is
associated with the following behaviours & outcomes:
Decrease in
Increase in
-
-
Child’s moral internalization
Quality of relationship: parent to child
Child mental health
Adult mental health
Child delinquency
Child anti-social behaviour
Likelihood of being a victim phys. abuse
Adult aggression
Adult criminal/anti-social behaviour
Likelihood of abusing own child/spouse
Short-term effect
+ Immediate child compliance
*
*2 =5.9, p<.04
About the effects of domestic violence
on child development…
• The effects of domestic violence on infants and toddlers place
these children at increased risk of abuse by their mothers
and/or the abusive adult in the home.
• Child abuse occurs in 30-60% of spousal violence cases.
• 21% Canadian women are abused by their partners during
pregnancy.
◦ 40% of those women who were abused during pregnancy reported that the abuse began when
they were pregnant.
◦ 11% of the women stated the violence occurred before their current pregnancy
◦ 64% of the women indicated the abuse escalated during the pregnancy
Still Face Experiment
http://www.youtube.com/watch?v=7AGJFg6twjg&feature=related
About the effects of neglect on child’s
developing brain…
NO NEGLECT
NEGLECT
About the effects of sexual abuse on the
developing brain…
About the effects of alcohol on the
developing fetus…
Direct Effects of Alcohol on Fetus:
•
•
•
•
Neuronal cell damage/cell death
Inhibited protein and DNA synthesis in the placenta, fetal liver and brain = fewer cells,
decreased growth and differentiation = smaller organs
Effected the hippocampus, amygdala, cerebellum -all appear particularly sensitive to effects
of alcohol
Smaller skeleton, greater cartilage and less skeletal bone creation (e.g. craniofacial anomalies
due to effects of cell death & reduced neural crest cell numbers)
Indirect Effects of Alcohol on Fetus
•
•
•
•
•
•
Nutritional deprivation/malnutrition
Calcium abnormalities
Structure and function of the placenta was altered
Circulatory changes = decreased fetal blood flow
Interference with growth factors and other cell signaling mechanisms
Fetal overexposure to stress hormones (brain areas involved in a) the stress response, b)
depression, and c) addiction overlap
Prenatal alcohol exposure delays
skeletal development in fetal rats
Alcohol
Pair-fed control
Ad-lib fed control
Weinberg
About the impact of emotional trauma on
the developing brain…
• # /frequency/duration/chronicity of stress episodes is important
e.g. infant feels unsafe with caregiver (physical harm),
&/or is in an unsafe situation (DV),
&/or has unpredictable/no response from caregiver with infant’s distress cues (parent capacity re
substance use/mental health, neglect)
STRESS SITUATION
Activates infant’s stress response system
Large amounts of cortisol flood the infant’s developing brain
Cortisol floods can be toxic to the brain/ may change brain structure
About the effects of poverty on a child’s
development
• Low-income families are over-represented in child
welfare involved families (both in care and out of care)
• USA National Incidence Studies (NIS1,23) found a
strong inverse correlation with income and child
maltreatment cases
• Child maltreatment report rates are greatest in
communities with high poverty rates and high
unemployment rates
• Strong correlation between welfare assistance and child
protection caseloads
Changing life scripts
Reducing maltreatment is about
protective factors & prevention strategies
Five Protective Factors to Reduce Child Maltreatment
1. Nurturing & attachment between family members
2. Knowledge of parenting/ child development
3. Parental emotional resilience
4. Social connections for parents
5. Concrete supports – adequate food, clothing, housing
Prevention Strategies
Universal/Primary – “before the fact”
Targeted /Secondary– “before the fact”
Indicated / Tertiary – “after the fact”
Preventing child maltreatment –
Evidence-based to promising practices
Evidence-based interventions
• Primary prevention programs e.g. “Back to Sleep” - reduced SIDS
• A caring, committed caregiver & stable placement
• Healthy Babies/Healthy Children; Head Start
Emerging evidence-based interventions
• Triple P Parenting
• Trauma treatment e.g. CBT
• FASD training for professionals and respite services for children with FASD
• Family Group Conferencing
• Early diagnosis / meconium testing
Promising practices
•
•
•
•
Home visiting/targeted parenting programs
Quality preschool/family support
Improve and repair brain function e.g. exercise, pharmacology
Targeted education to children e.g. prevent sexual abuse, dating violence
Key practice & learning areas
Future Research Areas





Gene and brain research
Impact of substance use on fetus & child
Infant mental health
Stronger links -poverty to child maltreatment
Link affordable, high quality early learning &
child care programs to maltreatment prevention
 Impact of greater collaboration across sectors
Combating child maltreatment professionals
Common focus, consistent message
Comprehensive approach by all levels of government
Consolidate knowledge, especially Canadian
Consistent collaboration – practice & policy & research
& across-sectors & across-disciplines
Coordinate on evidence based practices
Capabilities to identify expanded
Collect data, analyze outcomes
Combating child maltreatmentCanadian society
• Stronger prevention focus
• Much earlier intervention with infants/young children
• Improve understanding of infant developmental needs
• Better education on risks of maternal alcohol use
• Provision of quality child care
• Eliminate corporal punishment of children
THANK YOU!
Child Welfare Institute, CAS-Toronto
Developing evidence-based knowledge today...so we can be more effective tomorrow
Deborah Goodman, PhD
Manager of Research & Program Evaluation,
dgoodman@torontocas.ca
416 -924-4640 x 2792
Working Towards
Winning
The Collaboration of
Children’s Aid Societies,
Parents and the Courts
Howard Hurwitz, M.S.W., R.S.W.
Director of Children’s Services
Jewish Family
and Child Service of Greater Toronto
MODERATOR
The Many Faces of Child Abuse and Neglect
Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect
Friday, November 6, 2009 • Design Exchange, Toronto, Ontario
Paramount Concern is Early
Permanency Planning for Children
• Although a large percentage of cases are settled
out of court, there are still too many legal battles
• Issues related to Family Courts are laden with
emotion rather than complex legal theory
• We need to work more effectively with other
professional groups, understand one another’s
roles, and forge multidisciplinary approaches
• The goal is early resolution of litigation and early
decisions to give children permanent homes.
Kristina Reitmeier
Children’s Aid Society (CAS)
The Many Faces of Child Abuse and Neglect
Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect
Friday, November 6, 2009 • Design Exchange, Toronto, Ontario
CAS Mandate
• Child and Family Services Act
– investigate allegations and information that a
child is in need of protection
– provide assistance to parents to prevent need
for protection and to protect where required
– when no less restrictive alternatives available,
must intervene through court
– Dual role of CAS worker
Nature of
Child Protection Proceedings
• Civil, not criminal
• Remedial in nature
• CAS is a party (usually the Applicant), but
subject to different expectations as an
institutional litigant
• CAS has “Crown like” disclosure obligations in
litigation
Role of CAS Counsel
•
•
•
•
give legal advice
act on instructions
represent CAS in court proceedings
in contrast to the Crown in criminal proceedings,
CAS counsel does not decide to initiate or
discontinue a case
Gary Gottlieb, B.A., LL.B.
Family Lawyer and Mediator
The Many Faces of Child Abuse and Neglect
Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect
Friday, November 6, 2009 • Design Exchange, Toronto, Ontario
Child Welfare Clients
•
•
•
•
•
Usually very needy individuals
Many struggle financially
Many grapple with emotional challenges
Some struggle to read and write
Many are from foreign countries and cultures
with parenting roles that conflict with
Canadian norms
Role of Child Welfare Lawyer
• Educate the client about the legal process and
current legal difficulties
• Calm highly emotional clients in order to focus
on the legal issues
• Gather evidence to present to the CAS and court
• Attempt to clarify and resolve issues with CAS
counsel
• Work with other professionals to provide
support, prove misapprehension on the part of
the CAS, and /or rehabilitate the client.
Role with Respect to the Child
• Parents believe they are best suited to raise
their children and, until proven otherwise, the
lawyer’s role is to do whatever is possible to
keep parents and children in frequent contact
• Where it is unlikely that parents will be
reunited with their children, the lawyer’s role is
to educate his/her client about the realities and
move the case forward expeditiously in the
interests of the child’s need for permanency
planning.
Elizabeth McCarty, B.A., LL.B.
In-House Counsel
Office of the Children’s Lawyer
The Many Faces of Child Abuse and Neglect
Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect
Friday, November 6, 2009 • Design Exchange, Toronto, Ontario
Role of the Office
of the Children’s Lawyer
• OCL is a law office in the Ministry of the Attorney
General
• OCL represents children, those under the age of 18,
when the court believes a lawyer for the child is
necessary to represent his or her interests
• In addition to child protection matters, the OCL
represents children in other custody and access
disputes, litigation cases of personal injury and estate
matters.
• OCL must have a court order to get involved unless a
parent is a minor, in which case involvement is
automatic
Role with Respect to the Child
• We are not neutral –we take a position on
behalf of the child client
• We have a solicitor client relationship –we
are obligated to keep our clients up to date on
court processes
• We do not take instructions – children at law
cannot instruct.
Position Taken by a Children’s Lawyer
• We do not take a “best interest” position that
is, we do not determine what in our view is
‘best’ for the child.
• We take a position which is based on views
and preferences of the child which are
independent, consistent and strong
• Children do not necessarily decide where
they will reside but their feelings and views
need to be put before the court
Robert Spence, B.A., LL.B., LL.M.
Ontario Court of Justice
The Many Faces of Child Abuse and Neglect
Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect
Friday, November 6, 2009 • Design Exchange, Toronto, Ontario
Important Roles for Many
in Family Court
• Family Lawyer –advocates for family
• Child’s Lawyer –presents child’s perspective
• CAS Lawyer –presents Society’s perspective
• Judge – role changes significantly from
pretrial to trial
Judge’s Role is Dramatically Different
Pre-Trial vs. at Trial
Pre-Trial Role:
• Active and proactive –
• Probing, prodding, asking questions
• Creating a roadmap for the work to be done
• Offering opinions about each lawyer’s case
• Setting timetables
At Trial Role for Judge
•
•
•
•
•
First of all – it’s a different judge!
Judge assumes a passive role
Listens to the evidence
Asks the odd question
Renders a decision at conclusion of trial
Early Intervention
for Abuse and
Neglect
The Best Get Out of Jail Free
Card!
Child Abuse:
A Noxious Precursor to Subsequent
Psychiatric and
Forensic Sequelae
Hy Bloom, LL.B., M.D. F.R.C.P.(C.)
MODERATOR
The Many Faces of Child Abuse and Neglect
Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect
Friday, November 6, 2009 • Design Exchange, Toronto, Ontario
Facts About Child Abuse:
• Child abuse is pervasive in the general
population, regardless of race, culture,
gender, SES or geographical location.
• Higher rates of abuse are seen in special
populations (e.g. psychiatric patients and
offenders especially sexual and violent
offenders).
• Abuse does not invariably lead to
psychopathology or loss of enjoyment of life.
Poor Psychosocial Adjustment for
Many Abused Individuals
• Psychosexual disorders and adjustment
problems
• Delinquency, crime, deviancy and violence
• Educational and vocational
underachievement
• Problems with intimacy, trust, authority, and
control
• Attachment problems with own children
Early Abuse Can Lead to Enduring
Difficulties in Later Life
Psychiatric conditions and Psychopathology:
•
•
•
•
•
•
depression
anxiety disorders including PTSD
dissociative disorders
substance abuse
psychosomatic conditions
maladaptive personality traits (e.g.
antisocial, borderline)
• self injurious behaviour
Best Interventions
Primary prevention of abuse and neglect
Thorough assessment
Case coordination
Early multimodal, multidisciplinary
intervention
• Education and training
• Systemic flexibility and understanding
• Creative approaches which target the
individual
•
•
•
•
Police and Prevention
INSPECTOR MARK ALLEN
Crime Prevention Section
Ontario Provincial Police
Ontario Association of Chiefs of Police
Youth Committee
Role of Policing
Police Services Act Section 4(2)
• Core police services
• Adequate and effective police services must
include, at a minimum, all of the following police
services:
1.
2.
3.
4.
Crime prevention.
Assistance to victims of crime.
Public order maintenance.
Emergency response. 1997, c.8, S.3
Directing Prevention Resources
• Research indicates best value
for investing in crime
reduction occurs during the
early years, when police have
little
access/involvement/mandate
• Dr Mathews insight into the
balance of investment.
Investing in the Moderate
Risk Youth and maintaining
an investment in the Low/No
Risk Youth
Progress
National Youth Officer Program
Ontario School Resource Officer Program
Committee of Youth Officers of Ontario
Developmental Asset Approach –
Understanding Youth
• Ontario Association of Chiefs of Police Youth
Committee
•
•
•
•
Best Practice
Ottawa Police Service
Community Youth Diversion Program
Youth Mental Health Court
Youth Services Bureau Mental Health Worker
Mental Health Unit work with Mental Health
professionals on the road
• On Staff Youth Intervention and Diversion
Coordinator
•
•
•
•
•
Challenges
•
•
•
•
Focus on Prevention
Access to Resources
Consistency of Police Service Delivery
Training
Youth Criminal Justice Act
and Mental Health Diversion
TANYA KRANJC, B.A., LLB
Assistant Crown Attorney
Classification of Extrajudicial
Sanctions
Criminal Code offences are divided into 3 categories:
• Class III offences are never appropriate for
extrajudicial sanctions
• Class I offences are the least serious and are
presumptively appropriate for extrajudicial
sanctions
• Class II offences are all other offences and
eligible for consideration at the discretion of
the Crown
Other Factors for the Crown to
Consider
• Reasonable prospect of conviction and public
interest
• Prior extrajudicial sanctions or alternative
measures
• Prior youth court record
• Views of the victim and victim impact
Eligibility for Mental Health Diversion
• A behavioural disorder
• A developmental disorder
• A concurrent disorder (mental illness and
another presenting issue)
• A dual diagnosis (mental illness and
developmental disability)
Youth Mental Health Court Workers
Assist Youth with Issues such as:
• Conduct Disorder (CD)
• Attention-Deficit Disorder (ADD)
• Attention-Deficit Hyperactivity Disorder
(ADHD)
• Oppositional Defiant Disorder (ODD)
• Fetal Alcohol Spectrum Disorders
• Depression
• Anxiety including PTSD
• Dual diagnoses and mental illness plus a
concurrent disorder such as addiction
Referrals to a Youth Mental Health
Worker may come from:
•
•
•
•
•
•
Duty counsel
Defence counsel
Parents or guardians
CAS
Community agencies
Toronto Bail programme
Documentation to Develop a
Treatment Plan
•
•
•
•
•
•
•
Psychiatric/psychological assessments
Information from the family doctor
Reports from a counselor or therapist
Reports from community organizations
Contact with family or caregivers
School reports
Information about start dates for programs in
which the youth is enrolled/waitlisted
Youth Criminal Justice Act:
Rehabilitative Highlights
MIRIAM BLOOMENFELD, B.A., LLB
Ontario Court of Justice
Youth Criminal Justice Act:
General Background
• YCJA replaced Young Offenders Act in April 2003
- governs all young persons aged 12 through 17
who are investigated, charged, prosecuted and/or
sentenced in relation to criminal offences.
• Federal government’s goals included reducing the
incarceration rate for young persons, (especially
for property offences), restricting and clarifying
judicial discretion in sentencing and emphasizing
accountability, rehabilitation and reintegration
rather than deterrence and punishment.
YCJA Preamble
• Members of society share a responsibility to
address the developmental challenges and the
needs of young persons and to guide them into
adulthood.
• Communities, families, parents and others
concerned with the development of young persons
should, through multi-disciplinary approaches,
take reasonable steps to prevent youth crime by
addressing its underlying causes, to respond to the
needs of young persons, and to provide guidance
and support to those at risk of committing crimes.
Principles of the YCJA
• Promote the long term protection of the public by:
◦ Preventing crime by addressing the circumstances
underlying a young person’s offending behaviour
◦ Rehabilitating young persons who commit offences
and reintegrating them into society
◦ Ensuring that a young person is subject to meaningful
consequences for his or her offence
• Youth criminal justice system separate from adults
• Use least restrictive degree of intervention, e.g.
diversion, alternatives to custody, no custody for
mental health or social welfare issues
Purpose of Sentencing S.38(1)
Hold young person accountable through
imposition of just sanctions that have:
• Meaningful consequences for the young
person AND
• Promote rehabilitation and reintegration into
society
Thereby contributing to the long-term
protection of the public.
Conferences – YCJA s.19, 41
• A youth justice court judge, the provincial director,
a police officer, a justice of the peace, a prosecutor
or a youth worker may convene a conference for
the purpose of making a decision required to be
made under the YCJA.
• The mandate of a conference may be, among other
things, to give advice on appropriate extrajudicial
measures, conditions for bail, sentences, review of
sentences and reintegration plans.
Sentence Options: Rehabilitation,
Treatment, Custodial Alternatives
• All custody sentences include a mandatory
component of community supervision to
facilitate reintegration
• Attendance program
• Intensive Support and Supervision Program
• Intensive Rehabilitative Custody and
Supervision Program
Child Welfare Assessment
• YCJA s.35:
In addition to any order that it is authorized
to make, a youth justice court may, at any
stage of proceedings against a young person,
refer the young person to a child welfare
agency for assessment to determine whether
the young person is in need of child welfare
services.
Native Children in Care
ROBERT NEILL, B.A., M.S.W.
Director of Child Welfare Services
Native Child and Family Services of Toronto
The Many Faces of Child Abuse and Neglect
Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect
Friday, November 6, 2009 • Design Exchange, Toronto, Ontario
Children in Care Fact Sheet* as of March 31st, 2008
Aboriginal Children (With or Entitled to a
Status Number) in Care, by Age Group
OACAS Report
• Of the 51 Children’s Aid Societies that responded to the survey, 40
(78%) report aboriginal children with or entitled to a status number
in their care. The total number of children is 1,960, or 11% of all
reported children in care.
No. of
Children
Percentage
0–5
559
28.5%
3.3%
6 – 12
719
36.7%
0.3%
13 – 15
376
19.2%
-2.1%
16
106
5.4%
15.2%
17
82
4.2%
-5.7%
18
61
3.1%
35.6%
19
28
1.4%
-6.7%
20
29
1.5%
61.1%
1,960
100%
2.4%
Age Group
Total
% change to
March 31st, 2007
CIC by Age Group:
6.0%
9.6%
28.5%
19.2%
36.7%
RESEARCHERS
(2005/2006)
• John Anderson, NCW (played an instrumental
role, especially in organizing the interviews for
this report.)
• Lucie Cossette, NCW
• Matthew Sanger, NCW
• Trica McDiarmid, Research Contractor (Port
Coquitlam, British Columbia)
Aboriginal Children in Care by
Province and Territory
Putting Children and Youth First:
A Multidisciplinary and Rights-Based
Approach to Service Delivery
Marvin M. Bernstein, B.A., J.D., LL.M. (ADR)
Saskatchewan Children’s Advocate
The Many Faces of Child Abuse and Neglect
Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect
Friday, November 6, 2009 • Design Exchange, Toronto, Ontario
Fundamental Assumptions
• Better outcomes for children and youth will be
achieved where there is:
– A commitment to respect and implement rights under
the United Nations Convention on the Rights of the
Child.
– The implementation of a Children and Youth First
Vision where children and youth are treated as the
primary clients.
– An integrated, multidisciplinary delivery model with
services delivered across systems without narrow
service mandates, privacy barriers or funding silos.
Child Maltreatment is a
Multidimensional Social Problem
• Children and families do not live in isolation
from the broader socio-political systems schools, community, and the law.
• Not something that one Ministry, or one
discipline, or the child welfare system, can
fix by itself.
• Addressing child maltreatment requires
coordination between child welfare, other
child-serving ministries and agencies, and the
community at large.
Saskatchewan’s Children’s Advocate
• Is an independent officer of the Provincial
Legislature.
• Can take referrals from any source.
• Has authority to work towards resolving
disputes through informal processes such as
negotiation and mediation.
• Has authority to conduct formal
investigations with respect to child death,
critical injury, and fairness within systems.
Saskatchewan’s Children’s Advocate
(cont’d)
• Has authority to conduct both case-specific
and broader systemic advocacy and
investigations into the provision of services to
children/youth by ministries and agencies of
the provincial government.
• Engages in public education and is informed
by youth voice.
• Can compel the production of documents and
has subpoena powers.
Majority (68%) of Our Work Intersects
with Child Welfare
• Off-reserve child welfare serves are delivered by the
Ministry of Social Services.
• On-reserve child welfare services are delivered by 18
First Nations Child and Family Services.
• Significant over-representation of Aboriginal
children in welfare care in Saskatchewan – 15% of
the total Saskatchewan population is Aboriginal.
• Approximately, 80% of children coming into care
are of Aboriginal background.
United Nations Convention on the
Rights of the Child
• A landmark human rights document serving as a
new global standard on the treatment of children.
• Most widely endorsed international treaty in history
– by 193 states. Only the United States and Somalia
have not ratified.
• Children’s rights are human rights and include the
whole range of civil, political, social, economic and
cultural rights.
• Children have the moral and legal right to have their
provision, protection, and participation needs met.
Federal and Provincial Governments
must Ensure that all Children:
• Benefit from special protection measures.
• Have full access to education and health care.
• Can develop their personalities and abilities
to their utmost potential.
• Can grow up in an environment of love,
understanding and non-violence.
• Are informed about their rights according to
their age and maturity.
• Can actively participate in exercising their
rights.
Specifically, Governments are
obligated to:
• Ascertain that professionals remain respectful of
the child’s/youth’s views, while not abdicating
their responsibility as ‘best interests’ decisionmakers.
• In child welfare, the child’s or young person’s
best interests must be the priority when working
with families – child is the primary client.
• States and child welfare agencies are obligated to
protect children and youth from all forms of
physical or mental injury or abuse, or
exploitation, including sexual abuse.
Rights-Based Child Welfare Services
• Children and youth are entitled to be with their parents
unless they would otherwise be in need of protection and
such placement would be contrary to their best interests.
• Resources should be accessed to assist families to
provide a safe and nourishing environment.
• In Ontario, once a child/youth is admitted to care, there
are codified rights that are stipulated in child welfare
legislation.
• Alternative care must be monitored by regular private
visits and the investigation of complaints. Moving is
traumatic; children and youth are entitled to resources to
make the alternative placement successful.
Rights-Based Child Welfare Services
(cont’d)
• Children are negatively affected by multiple changes
in placement, caregivers and service providers –
stability, security and continuity are important for
all children being served in the child welfare system.
• Child welfare system must provide appropriate
services for children to heal from the abuse and
neglect they have experienced.
• Services must be provided with cultural competence,
recognizing the distinctive cultures of minorities,
especially the unique circumstances of Indigenous
children.
We have Identified Cases Where…
• Jurisdictional, political, and/or financial
considerations have been given priority over the
needs and best interests of children and youth.
• Family and blood ties have taken precedence
over the safety, protection and well-being of
children and youth.
• Sometimes, family reunification and cultural
considerations are valued over the needs and
protection of the child. When the child remains
in an unchanged environment, the cycle
continues and becomes inter-generational.
Permanency Planning
• Purpose of permanency planning is to
minimize the length of time that a child will
live in a setting that lacks the promise of
being permanent. Placement choices may
include maintaining the child with the
biological parents or placing her/him with
relatives, permanent foster parents, adoptive
parents, or foster/adoptive parents.
Permanency Planning (cont’d)
• To achieve permanency planning, it is necessary to
avoid ‘litigation limbo’ – occurs when the court
machinery fails to be sensitive to the child’s time
frame, either by allowing too much time to elapse
before a decision is reached and/or by allowing legal
proceedings to be so prolonged that the child is kept
in limbo during that critical period in which a child
must either develop a secure emotional attachment
or be left with lifelong emotional and social deficits.
• Planning must be on an individualized basis and
child must be considered the primary client in any
planning process.
Permanency Planning (cont’d)
• Children/youth should have a direct say in the
development of their case plans – should not be left
out of the process or simply treated with tokenism.
• Government ministries and child welfare agencies
have the right to intervene in the lives of families
without fear of being sued by family members to
protect vulnerable, at risk children. It is the ‘child’
and not the ‘family’ to whom the duty of care is
owed, and whose best interests are to be served at all
times (Supreme Court of Canada – Syl Apps Secure
Treatment Centre v. B.D.)
Children and Youth First Vision
Anchored by Children and Youth First Principles
• The Children and Youth First Principles are:
– Based upon the provisions of the United Nations
Convention on the Rights of the Child.
– Intended to simplify and highlight the most critical
and relevant provisions in the Convention, based
upon our observations and experience.
– Intended for use by our Office and the provincial
government as a filter in the development and
implementation of future child-serving policies,
programs and legislation.
All Children and Youth are Entitled to:
• Those rights defined by the United Nations Convention
on the Rights of the Child.
• Participate and be heard before any decision affecting
them is made.
• Have their ‘best interests’ given paramount
consideration in any action or decision involving them.
• An equal standard of care, protection and services.
• The highest standard of health and education possible in
order to reach their fullest potential.
• Safety and protection from all forms of physical,
emotional and sexual harm, while in the care of parents,
governments, legal guardians or any person.
All Children and Youth are Entitled to:
(cont’d)
• Be treated as the primary client, and at the centre, of
all child serving systems.
• Have consideration given to the importance of their
unique life history and spiritual traditions and
practices, in accordance with their stated views and
preferences.
• Children and Youth First Principles were adopted by
the Saskatchewan Government in February 2009,
with the commitment to use them “as a guide in
examining policy and legislation and in developing
and implementing both policy and legislative
changes.
Professionals involved in
Multidisciplinary Teams
• Physicians, including pathologists and coroners,
and nurses
• Mental health and social work professionals
• Child protection workers
• Police, crown prosecutors and judges
• Experiential youth
• Aboriginal representatives
• Participants from both urban and rural centres
Roles and Responsibilities
• Largely mandated by provincial, territorial and
federal legislation, policies, procedures and
protocols.
• Important to carefully define in writing various roles
and responsibilities in order to avoid confusion,
duplication and vacuum in service delivery.
• Collaboration between child protection and police is
essential for the purpose of conducting a well coordinated joint child abuse investigation.
• Priorities of members of the multi-disciplinary team
may occasionally be in conflict with one another.
Roles and Responsibilities (cont’d)
• Resolution of conflicts between service providers
must be guided by open and respectful
communication and the best interests of the
child.
• Team members’ statements and actions can
affect the outcome of an investigation - avoid
contaminating the evidence and interfering with
the investigation by the police and/or child
welfare authorities.
• Specialized and ongoing training is necessary.
Principles for Information Sharing
• Knowledge of applicable legislation, policy,
protocols and professional codes of ethics – this
foundational knowledge is essential.
• Policy and protocols do not create independent
authority and must be consistent with relevant
legislation.
• Consultation with legal counsel in case of
uncertainty – the law of access to and confidentiality
of records has become more complex with the
development of both provincial and federal freedom
of information and protection of privacy legislation.
Principles for Information Sharing
(cont’d)
• Sharing of information on a need-to-know basis – to
ensure that all service providers are functioning with
the same baseline knowledge and that there are
service plans, which meet the best interests of the
child and the needs of the family.
• Fully-Informed Client consent – wherever possible,
written consents should be informed and voluntarily
obtained from parents and children with
authorization to have their personal information
shared.
Principles for Information Sharing
(cont’d)
• Confidentiality and personal privacy rights should be safeguarded
where possible; however, in the absence of a comprehensive
legislative scheme and the updating and proclamation of Part VIII
(Confidentiality of and Access to Records) of Ontario’s child welfare
legislation, child protection agencies should consider the paramount
purpose of The Child and Family Services Act, as stipulated in the
Declaration of Principles, which “is to promote the best interests,
protection and well being of children.”
• There have been many documented child deaths and critical injuries
suffered by children where privacy barriers have impeded child
protection workers from accessing key information.
• A liberal interpretation of privacy legislation should be applied,
whenever it is reasonably arguable to do so, in order to ensure the
safety, protection and wellbeing of children.
Multidisciplinary Advisory Teams Assist in
Child Death and Critical Injury Investigations
Identify and describe systemic and cross-jurisdictional issues.
Propose strategies for prevention.
Propose new/amended findings or recommendations.
Provide guidance with respect to best practice in child service issues
Inform the investigative process through discussion, reflecting
several multi-disciplinary perspectives (e.g. medical, legal, law
enforcement, educational, mental health, child welfare, Chief
Coroner, Chief Forensic Pathologist, experiential youth, Aboriginal
representative).
• Provide external quality control and additional accountability to the
community.
• Support investigators during distressing investigations of child
death and critical injuries.
•
•
•
•
•
Current Selected Themes
• Lack of integrated and co-ordinated case
management, role clarification, and
communication among service providers.
• Different systems do not speak to one
another and operate ‘in silos’.
• The child welfare sector is perceived as
having the singular responsibility for
ensuring the protection and safety of children
- rather than this being seen as a collective
responsibility.
Tenants of Cooperative
Multidisciplinary Model
• Shared responsibility and mutual respect –
services should reflect a shared leadership,
planning, decision-making, resources,
evaluation and mutual respect for the unique
expertise and contribution of each
participant.
• Holistic, Child-Centred Focus – services
should be child-centred and customized, with
the interdependent nature of all systems and
programs being recognized.
Tenants of Cooperative
Multidisciplinary Model (cont’d)
• Community empowerment –communities
should be seen as diverse and unique, each with
its own strengths, history, needs and vision, and
capable of designing its own solutions.
• Cultural affirmation and sensitivity – a
respectful, barrier-free environment should be
fostered where individuals have their cultural
and spiritual values acknowledged and have
opportunities for equal access and equal benefit.
Tenants of Cooperative
Multidisciplinary Model (cont’d)
• Preventive Services – the goal is a
comprehensive range of services – including a
proper balance of prevention, early intervention
and support services – which contributes to
quality of life, enhances well-being and provides
care for the most vulnerable.
• Integrated Services – services should be
integrated to reduce service fragmentation and
improve effectiveness, with fewer children falling
between the cracks.
Tenants of Cooperative
Multidisciplinary Model (cont’d)
• Concurrent case-specific and systemic services – while a
co-operative approach should be taken in addressing the
immediate risks to individual children and families, a
larger systemic focus should be applied in identifying the
chronic underlying problems that contribute to ongoing
family dysfunction and child protection intervention (e.g.
child poverty; lack of adequate housing, childcare and
employment; lack of early childhood education and
adequate parent support; inadequate facilities to address
alcohol and drug addictions, mental health concerns, and
family violence; and disparity of services in remote rural
communities).
Conclusions
• It is important to make the effort to respect the rights of
children and youth and to break down rigid silos and artificial
bureaucratic barriers that impede effective multi-disciplinary
and integrated service delivery to children, youth and families.
• On November 20, 2009, we have the celebration of the 20th
anniversary of the adoption of the United Nations Convention
on the Rights of the Child – while Canada and our Provinces
have made some measurable progress, these entitlements
have not been sufficiently implemented and have been largely
relegated to mere ‘paper rights’.
• On this special anniversary, we all need to:
– Transform these ‘paper rights’ into lived rights’.
– Continue to speak with and speak up for children and youth.
Conclusions (cont’d)
• Develop the attributes of an effective
advocate – be assertive, collaborative,
courageous, creative, persistent, principled,
proactive, resilient and strategic.
“There can be no keener revelation of a society’s
soul than the way it treats its children.”
(Nelson Mandela)
For More Information:
Contact our website at www.saskacao.ca or email me at mbernstein@saskcao.ca.
WRAP-UP
Janet Morrison, M.A., C. Psych. Assoc.
President
Child Psychotherapy Foundation of Canada
The Many Faces of Child Abuse and Neglect
Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect
Friday, November 6, 2009 • Design Exchange, Toronto, Ontario
What Do We Know?
• We know that the costs of child maltreatment are
staggering for the child and the larger community.
• 60% of children in care will come into contact
with the criminal justice system
• 50% will experience a mental health problem
• According to the last Child Welfare Review (2007),
82% of Crown wards have ‘special needs’ including
psychiatric diagnoses, developmental disability
and learning disability.
What Do We Know? (cont’d)
• Child maltreatment report rates and poverty are closely
linked
• There is a very significant over-representation of aboriginal
children in welfare care and of those who are, few are being
raised by aboriginal families
• There is catastrophic impact of substance abuse on brain
development
• Children need early permanency planning and a permanent
home to develop a secure emotional attachment or are left
with lifelong emotional and social deficits.
• Children need appropriate often multimodal services to
heal from abuse and neglect
What are We Doing which Reflects
What We Know?
• The law upholds that the child or young person’s
best interests must be the priority when working
with families – the child is the primary client.
• The law recognizes the importance of early
permanency planning and requires decisions be
made about children in care expeditiously – one
year for children 0-6 and two years for older
children.
• The YCJA recognizes the need to:
– address the circumstances underlying a young person’s
offending behaviour and have mental health diversion
What are We Doing? (cont’d)
Best Police Practice now includes:
• Community Youth Diversion Program
• Youth Mental Health Court
• Mental Health Worker for assessment and
assistance on the road
• Youth Intervention and Diversion Coordinator
Despite this…
• Children continue to be in limbo for long periods of time
and move back and forth between home and foster care
and between foster homes.
• Children and youth frequently do not get a proper
assessment to determine whether they qualify for
Mental Health Diversion. Often a child or youth can only
get services if they have been charged with a criminal
offence.
• Many communities are not yet able to provide ‘best
practice’ services.
• Children and youth receive inadequate and piecemeal
treatment and support services.
Recommendations
A Holistic, Child-Centred Focus which includes:
• Thorough assessment including assessment of the
family as well as the child at the outset of child
welfare involvement - therapeutic access
• Assessment of child or youth when first coming
into contact with the criminal justice system
• Case coordination specific to the individual’s
diagnosis and treatment needs
• Integrated services to reduce service
fragmentation and expand treatment options
Recommendations (cont’d)
• Education and training for professionals to work in a
multidisciplinary way
• Services provided with cultural competence, especially
with an understanding of the unique circumstances of
indigenous children.
• A liberal interpretation of privacy legislation to ensure
the safety, protection and wellbeing of children.
• More research and greater practice attention to linking
poverty and child maltreatment
• Increased and earlier FASD diagnosis and intervention
The Many Faces of Child Abuse and Neglect
Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect
Friday, November 6, 2009 • Design Exchange, Toronto, Ontario
Power Point Presentation online
Go to the Child Psychotherapy
Foundation website tomorrow to
view today’s slides:
kidfix.org