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Child and Youth Mental Health: the Realities Dr. Simon Davidson Chair, Child

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Title: Child and Youth Mental Health: the Realities Dr. Simon Davidson Chair, Child


1
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
2
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!

3
Mental Health Commission of Canada
  • The History
  • The Structure
  • The Priorities
  • www.mentalhealthcommission.ca

4
Key Initiatives
  • National Mental Health Strategy
  • Anti-stigma Campaign
  • Knowledge Exchange Centre
  • Homelessness/Mental Health Research Projects
  • Partners for Mental Health Campaign and
    Foundation

5
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

6
MHCC CYAC Funded Initiatives
  • National Mental Health Strategy
  • Evergreen Document
  • 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)

7
The Many Faces of Child Abuse Neglect
  • Prevention
  • -the name of the game
  • If not, then early identification and early
    intervention

8
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?

9
  • Our children are a living message to a time we
    will not see
  • Sir Al Aynsley Green
  • Childrens Commissioner for England

10
Conclusion
  • Great Program
  • Stimulating day ahead
  • Thank you for your attention!

11
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, Childrens Aid Society of
Toronto
  • The Many Faces of Child Abuse and Neglect
  • Ontarios First Multidisciplinary Conference on
    Child Abuse and Neglect
  • Friday, November 6, 2009 Design Exchange,
    Toronto, Ontario

12
Canadian Child Welfare Context

13
Child and Welfare vs. Child Protection Systems
  • Child Protection Systems (CPS)
  • Canada, United States, United Kingdom,
    Australia
  • Emphasis individual rights responsibilities
    Mandate stand-a-lone 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)
  • Canadas Aboriginal Peoples, New Zealand
    Maori
  • Emphasis consultations with parents, extended
    family, local community
  • Focus keeping children within their
    family/community respect traditional values


14
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,
    childrens mental health)


15
The social construction of child maltreatment
a moving target
  • 1900-2000
  • 1900s Physical Neglect / Abandonment
  • 1960s Physical harm / Medical Neglect
  • 1980s Sexual harm
  • 1990s Neglect / Inadequate Supervision/
  • Inappropriate Child Care
  • 1990s Emotional harm /Exposure to adult conflict
  • 2000- 2100
  • Deleterious effects of 2nd-hand smoke is well
    established in literature and law
  • Parental right vs. child abuse?
  • Unintentional injury (UI) is the leading cause of
    death for children age 1-11 half UIs are
    transportation accidents
  • Poor parenting decision vs. neglect?
  • Parental alienation
  • Family dysfunction vs. emotional harm?


16
Child maltreatment by contextdiffers
USA 2007 vs. Britain 2005 vs.
Canada 2003 vs. Toronto 2003 Population
302M 61M 32M 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
13 12 Other
4 TOTAL 100 100 100
100 Britain includes DV
Over
1.8million Over 214,000 Over
12,000 investigations investigations
investigations

17
Canadian Incidence Study (CIS 2003) 5 categories
20 maltreatment forms
  • Categories
  • Physical abuse
  • Sexual abuse
  • Neglect
  • Emotional maltreatment
  • Exposure to domestic violence


18
Substantiated by child age CIS 2003
  • CIS 2003
  • Age Incidence/
  • Group per 1000 Substantiated
  • lt1 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


19
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


20
Top 3 Ontario Eligibility Codes Children 0-5
for 2008 _at_ 1 CAS in GTA
  • Children 5 under
  • No Court Involvement
  • N2,245
  • Section 1-Physical Harm 29
  • Section 3-Emot Harm/DV 28.5
  • Section 5- Parental Capacity 27
  • Total 84-85
  • Children 5 under
  • Court Involvement
  • N50
  • 22
  • 12
  • 48
  • 82

21
Eligibility Code Top Section Top
Scale Children 0-5 2006-2008
22
About a Canadian public health issue children
at risk

23
About the areas of concern for the Public Health
Agency of Canada
  • AREAS
  • 1- Poverty / low SES
  • 2- Child abuse and neglect
  • 3- Prenatal
  • 4- Childrens mental health
  • 5- Obesity
  • 6- Unintentional injuries
  • APPROACH
  • 1- Prevention
  • 2- Promotion
  • 3- Protection
  • 4 -Treatment


24
About the development of brain growth newborn to
6 months
Wotherspoon
newborn 1 month 3 months
6 months

25
Outcome Former youth in care (Results from US and Canadian research studies) Canadian youth (ages 15-25)
Not complete high school 27 to 75 15
Unemployed 46 14
Receive public assistance 38 6 a
Experienced homelessness 45 to 90 -
Pregnant at an early age 30 b 6
Involved in justice system 60 2
Emotional/mental health problems 50 18
These statistics are not direct comparisons as
they are not based on controlled sampling within
single research projects. a Total Canadian
population b 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
26
Early developmental determinants of risk and
resilience

27
Risk and protective factors
  • Risk
  • Personal/Internal factors
  • Exist within the individual e.g. genetic,
    disabilities
  • Environmental 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
  • Protective
  • Personal/ Internal factors
  • Exist within the individual e.g. personality,
    autonomy
  • External factors
  • Exist within a social context e.g. family,
    school, community, country
  • NOTE Protective factors reduce risk of harm,
    improve resistance to risk, contribute to
    positive outcomes


28
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
  • - Childs moral internalization - Child
    delinquency
  • - Quality of relationship parent to child -
    Child anti-social behaviour
  • - Child mental health - Likelihood of being a
    victim phys. abuse
  • - Adult mental health
    - Adult aggression
  • - Adult criminal/anti-social behaviour
  • - Likelihood of abusing own child/spouse
  • Short-term effect
  • Immediate child compliance


29

?2 5.9, plt.04
30
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


31
Still Face Experiment
http//www.youtube.com/watch?v7AGJFg6twjgfeature
related
32
About the effects of neglect on childs
developing brain
no neglect
neglect

33
About the effects of sexual abuse on the
developing brain

34
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


35
Prenatal alcohol exposure delays skeletal
development in fetal rats
Alcohol
Pair-fed control
Ad-lib fed control

Weinberg
36
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 infants distress cues (parent capacity re
    substance use/mental health, neglect)
  • STRESS SITUATION
  • Activates infants stress response system
  • Large amounts of cortisol flood the infants
    developing brain
  • Cortisol floods can be toxic to the brain/ may
    change brain structure


37
About the effects of poverty on a childs
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


38
Changing life scripts

39
Reducing maltreatment is about protective factors
prevention strategies
  • Five Protective Factors to Reduce Child
    Maltreatment
  • Nurturing attachment between family members
  • Knowledge of parenting/ child development
  • Parental emotional resilience
  • Social connections for parents
  • Concrete supports adequate food, clothing,
    housing
  • Prevention Strategies
  • Universal/Primary before the fact
  • Targeted /Secondary before the fact
  • Indicated / Tertiary after the fact


40
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


41
Key practice learning areas

42
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


43
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


44
Combating child maltreatment- Canadian 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


45

THANK YOU!
Child Welfare Institute, CAS-Toronto Developin
g evidence-based knowledge today...so we can be
more effective tomorrow Deborah Goodman,
PhD Manager of Research Program Evaluation,
dgoodman_at_torontocas.ca 416 -924-4640 x 2792
46
Working Towards Winning The Collaboration of
Childrens Aid Societies, Parents and the Courts
47
Howard Hurwitz, M.S.W., R.S.W. Director of
Childrens Services Jewish Family and Child
Service of Greater Toronto MODERATOR
  • The Many Faces of Child Abuse and Neglect
  • Ontarios First Multidisciplinary Conference on
    Child Abuse and Neglect
  • Friday, November 6, 2009 Design Exchange,
    Toronto, Ontario

48
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 anothers
    roles, and forge multidisciplinary approaches
  • The goal is early resolution of litigation and
    early decisions to give children permanent homes.


49
Kristina Reitmeier Childrens Aid Society (CAS)
  • The Many Faces of Child Abuse and Neglect
  • Ontarios First Multidisciplinary Conference on
    Child Abuse and Neglect
  • Friday, November 6, 2009 Design Exchange,
    Toronto, Ontario

50
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


51
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


52
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


53
Gary Gottlieb, B.A., LL.B. Family Lawyer and
Mediator
  • The Many Faces of Child Abuse and Neglect
  • Ontarios First Multidisciplinary Conference on
    Child Abuse and Neglect
  • Friday, November 6, 2009 Design Exchange,
    Toronto, Ontario

54
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


55
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.


56
Role with Respect to the Child
  • Parents believe they are best suited to raise
    their children and, until proven otherwise, the
    lawyers 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 lawyers role
    is to educate his/her client about the realities
    and move the case forward expeditiously in the
    interests of the childs need for permanency
    planning.


57
Elizabeth McCarty, B.A., LL.B. In-House
Counsel Office of the Childrens Lawyer
  • The Many Faces of Child Abuse and Neglect
  • Ontarios First Multidisciplinary Conference on
    Child Abuse and Neglect
  • Friday, November 6, 2009 Design Exchange,
    Toronto, Ontario

58
Role of the Office of the Childrens 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


59
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.


60
Position Taken by a Childrens 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


61
Robert Spence, B.A., LL.B., LL.M. Ontario Court
of Justice
  • The Many Faces of Child Abuse and Neglect
  • Ontarios First Multidisciplinary Conference on
    Child Abuse and Neglect
  • Friday, November 6, 2009 Design Exchange,
    Toronto, Ontario

62
Important Roles for Many in Family Court
  • Family Lawyer advocates for family
  • Childs Lawyer presents childs perspective
  • CAS Lawyer presents Societys perspective
  • Judge role changes significantly from pretrial
    to trial


63
Judges 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 lawyers case
  • Setting timetables


64
At Trial Role for Judge
  • First of all its a different judge!
  • Judge assumes a passive role
  • Listens to the evidence
  • Asks the odd question
  • Renders a decision at conclusion of trial


65
Early Intervention for Abuse and Neglect The
Best Get Out of Jail Free Card!
66
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
  • Ontarios First Multidisciplinary Conference on
    Child Abuse and Neglect
  • Friday, November 6, 2009 Design Exchange,
    Toronto, Ontario

67
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.


68
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


69
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


70
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

71
Police and Prevention INSPECTOR MARK
ALLEN Crime Prevention Section Ontario
Provincial Police Ontario Association of Chiefs
of Police Youth Committee
72
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
  • Crime prevention.
  • Assistance to victims of crime.
  • Public order maintenance.
  • Emergency response. 1997, c.8, S.3


73
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


74
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


75
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


76
Challenges
  • Focus on Prevention
  • Access to Resources
  • Consistency of Police Service Delivery
  • Training


77
Youth Criminal Justice Act and Mental Health
Diversion TANYA KRANJC, B.A., LLB Assistant
Crown Attorney
78
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


79
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


80
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)


81
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


82
Referrals to a Youth Mental Health Worker may
come from
  • Duty counsel
  • Defence counsel
  • Parents or guardians
  • CAS
  • Community agencies
  • Toronto Bail programme


83
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


84
Youth Criminal Justice Act Rehabilitative
Highlights MIRIAM BLOOMENFELD, B.A., LLB Ontario
Court of Justice
85
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 governments 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.


86
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.


87
Principles of the YCJA
  • Promote the long term protection of the public
    by
  • Preventing crime by addressing the circumstances
    underlying a young persons 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


88
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.


89
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.


90
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


91
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.


92
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
  • Ontarios First Multidisciplinary Conference on
    Child Abuse and Neglect
  • Friday, November 6, 2009 Design Exchange,
    Toronto, Ontario

93
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 Childrens 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.

CIC by Age Group
Age Group Age Group No. of Children Percentage change to March 31st, 2007
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
Total Total 1,960 100 2.4
6.0
9.6
28.5
19.2
36.7
94

95
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)


96
Aboriginal Children in Care by Province and
Territory

97
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 Childrens Advocate
  • The Many Faces of Child Abuse and Neglect
  • Ontarios First Multidisciplinary Conference on
    Child Abuse and Neglect
  • Friday, November 6, 2009 Design Exchange,
    Toronto, Ontario

98
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.


99
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.


100
Saskatchewans Childrens 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.


101
Saskatchewans Childrens Advocate (contd)
  • 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.


102
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.


103
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.
  • Childrens 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.


104
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.


105
Specifically, Governments are obligated to
  • Ascertain that professionals remain respectful of
    the childs/youths views, while not abdicating
    their responsibility as best interests
    decision-makers.
  • In child welfare, the childs or young persons
    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.


106
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.


107
Rights-Based Child Welfare Services (contd)
  • 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.


108
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.


109
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.


110
Permanency Planning (contd)
  • To achieve permanency planning, it is necessary
    to avoid litigation limbo occurs when the
    court machinery fails to be sensitive to the
    childs 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.


111
Permanency Planning (contd)
  • 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.)


112
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.


113
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.


114
All Children and Youth are Entitled to (contd)
  • 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.


115
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


116
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
    co-ordinated joint child abuse investigation.
  • Priorities of members of the multi-disciplinary
    team may occasionally be in conflict with one
    another.


117
Roles and Responsibilities (contd)
  • 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.


118
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.


119
Principles for Information Sharing (contd)
  • 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.


120
Principles for Information Sharing (contd)
  • 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
    Ontarios 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.

121
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.


122
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.


123
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.


124
Tenants of Cooperative Multidisciplinary Model
(contd)
  • 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.


125
Tenants of Cooperative Multidisciplinary Model
(contd)
  • 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.


126
Tenants of Cooperative Multidisciplinary Model
(contd)
  • 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).


127
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.


128
Conclusions (contd)
  • 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 societys
    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_at_saskcao.
ca.
129
WRAP-UP Janet Morrison, M.A., C. Psych.
Assoc. President Child Psychotherapy Foundation
of Canada
The Many Faces of Child Abuse and
Neglect Ontarios First Multidisciplinary
Conference on Child Abuse and Neglect Friday,
November 6, 2009 Design Exchange, Toronto,
Ontario
130
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.


131
What Do We Know? (contd)
  • 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


132
What are We Doing which Reflects What We Know?
  • The law upholds that the child or young persons
    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
    persons offending behaviour and have mental
    health diversion


133
What are We Doing? (contd)
  • 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


134
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.


135
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 individuals
    diagnosis and treatment needs
  • Integrated services to reduce service
    fragmentation and expand treatment options


136
Recommendations (contd)
  • 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


137
Power Point Presentation online Go to the Child
Psychotherapy Foundation website tomorrow to view
todays slides kidfix.org
The Many Faces of Child Abuse and
Neglect Ontarios First Multidisciplinary
Conference on Child Abuse and Neglect Friday,
November 6, 2009 Design Exchange, Toronto,
Ontario
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