… How Ontario is failing kids who are ‘too complex’ for care
Posted on October 3, 2024 in Child & Family Delivery System
Source: TheStar.com — Authors: Amy Dempsey Raven, and Megan Ogilvie, Megan Ogilvie, Senior Writer
TheStar.com – News/Canada
Sept. 28, 2024. By Amy Dempsey Raven, Senior Writer, and Megan Ogilvie, Health Reporter
A boy on a futon in an office… Teens in budget hotels. Last-resort placements are painting a picture of a situation where Ontario’s most vulnerable children are the least likely to get help.
A 10-year-old boy spent most of this year living in an office at the children’s aid society in a small town in southwestern Ontario. For eight months, he slept on a futon in a makeshift bedroom with a sink and a fridge. Paid staff watched over him and brought him meals. School was a room down the hall with a computer for virtual learning.
Child protection workers called 98 live-in treatment centres and group homes to find a placement for the boy, but they all said no: there was no space, or his needs were “too complex.” Instead, the child turned 11 while living in a public building, getting none of the mental health treatment he desperately needed.
This boy’s story is part of an alarming trend in Ontario: hundreds of children with complex needs have been living in hotels, Airbnbs, rental apartments, offices and even camping trailers because the province has no residential treatment options for them. These children typically have two or more mental health, developmental or behavioural conditions, such as autism and depression, or substance use and self-harm, and are together known as youth with “complex needs.”
The costs of these emergency placements can range upward from $200,000 annually per child and in some cases have neared $1 million. Often, the children are getting no treatment.
In Windsor, 13 kids and youth with complex needs are living in unlicensed settings, including a teen in a budget hotel and a 10-year-old child who sleeps in the local children’s aid society office; earlier this year, the region had six teenagers in hotels. In Sarnia-Lambton, near the south shore of Lake Huron, three teens are living in Airbnbs staffed around the clock by child protection workers and other caregivers. Three more are being housed in rental apartments near Cornwall. In York Region, the children’s aid society had to place two teens in hotels for the first time this summer.
Four children and youth are in unlicensed placements in Elgin County, on the north shore of Lake Erie, including two in Airbnbs. Last summer, Chatham-Kent’s children’s aid society was forced to house children in a camping trailer in its parking lot; currently, the agency has three kids under 16 in unlicensed apartments.
In Ontario, residential services for children and youth, such as group homes or organizations providing care for young people with developmental disabilities, must be licensed according to certain criteria under provincial regulations.
Increasingly, child welfare leaders say unlicensed spaces are being used as last-resort measures because there are no treatment or residential placement options for these children. What they need does not exist or is not available to them.
To investigate, the Star interviewed more than 30 leaders in child welfare and mental health, obtained records and spoke to a dozen parents of children with complex needs. Together they paint a picture of a long-neglected crisis that has reached a breaking point, one in which Ontario’s most vulnerable children are the least likely to get help.
About the series
Ontario is failing its most vulnerable children. A broken system is leaving kids with complex mental health and developmental needs unable to get medical help and supports — and pushing families to the brink. The Star’s Amy Dempsey Raven and Megan Ogilvie are investigating how the province got into this crisis and what needs to happen to stop children from falling through the cracks.
The number of children in these emergency placements has nearly tripled since 2021, according to the agency that represents most of Ontario’s child welfare agencies. Between April 2023 and March 2024, there were 339 kids and teens in the care of children’s welfare agencies living in unlicensed placements. That’s up from 124 children and youth housed in such settings two years earlier, according to the results of a survey conducted by the Ontario Association of Children’s Aid Societies (OACAS), first reported by the Star this week.
In some cases, kids and teens with complex needs are coming into the care of children’s aid societies not because there are child protection concerns but because their parents can no longer cope. In the past year, child welfare agencies across the province served 589 kids and teens in cases where concerns such as abuse or neglect were either not present or were secondary to their unmet health needs, the OACAS said. Child welfare leaders said they are getting an increasing number of calls from hospitals and treatment centres after parents refuse to take their child or teen home, citing safety concerns, burnout and a lack of community support and treatment.
Currently, the Children’s Aid Society of Toronto (CAST) has 43 children and youth in its care with no child protection concerns. Instead, these families have been told by people working in the health and social services systems they need to “abandon” their kids to CAS to get access to service, CAST’s chief executive Lisa Tomlinson told the Star.
In London, that region’s child welfare agency is caring for 14 young people with complex needs — including a 10-year-old child — whose families have relinquished custody; 10 of these youth are housed in unlicensed placements. The agency is working with another 10 families in crisis to help them get more support and prevent them from entering the child welfare system. https://www.thestar.com/news/canada/a-boy-on-a-futon-in-an-office-teens-in-budget-hotels-how-ontario-is/article_d31eac84-767f-11ef-b55f-c7f3c5f98a61.htmlLeaders at the child welfare agencies placing children in unlicensed settings acknowledge the practice is causing harm but say there are no other options in a broken system unable to meet the needs of families in crisis.
“It is unacceptable that a child is being raised in an office building in Ontario,” said Teri Thomas-Vanos, executive director of Linck, the Chatham-Kent children’s aid society. When dozens of treatment centres and agencies say no, that child is effectively being “excluded” from the system, Thomas-Vanos said.
CAS leaders say the problems extend beyond the child welfare system and they’re demanding both an immediate emergency response and commitment to long-term systemic change. It’s far past time, they say, for the provincial government to confront the crisis.
“We’re yelling at the top of our lungs that we have a five-alarm fire and it feels like the intervention (from the government) is: here are some batteries for a smoke detector,” said Derrick Drouillard, executive director of Windsor-Essex Children’s Aid Society.
Solomon Owoo, CEO of the Ontario Association of Children’s Aid Societies, said the government’s failure to acknowledge the problem is part of the problem. “We cannot walk away from these children,” he said.
Ontario Ombudsman Paul Dubé in September announced an investigation into child welfare agencies housing kids and teens in unlicensed residences. Child welfare leaders worry the probe will unfairly target their agencies without exploring the systemic issues that are leading them to use those placements as a last resort.
A spokesperson for the ombudsman’s office told the Star this week that the investigation will explore factors contributing to the problem, and that “like all of our systemic investigations, it will follow the evidence.”
Child welfare agencies across the province are reporting deficits they say stem from creating emergency placements for children with complex needs. The number of children and youth needing high-cost care has doubled in the past three years, according to OACAS data. In the year ending in March 2024, there were 354 children whose care cost child welfare agencies more than $200,000 per year.
The Star has learned of at least four children and youth for whom the annual cost of housing and round-the-clock supervision is costing child welfare agencies, which are funded by the province, roughly $1 million each, money that child advocates say would be better spent on treatment to prevent families from reaching a crisis point in the first place.
Reasons for kids’ health crisis
Kids in Crisis
Driving the demand is a surge in unmet mental health needs coming out of the COVID-19 pandemic.
Tatum Wilson, chief executive of Children’s Mental Health Ontario, said while the provincial government’s recent investments in the pediatric health system will help boost capacity for mental health services, many children continue to languish on wait lists. He said it will take time for the long underfunded system to “catch up,” especially while many organizations continue to struggle with staff shortages.
Escalating pressures in the children’s mental health system are spilling over into the child welfare space, while a chronic shortage of treatment options for children with developmental disorders, such as autism, is compounding the challenges. Agencies that in the past may have served one or two high-needs children at a time are now seeing a rapid rise in the frequency and severity of such cases.
In Oxford County, east of London, about half of the 30 children in CAS care have complex needs, said Tina Diamond, the agency’s executive director. In the past, the region might have had four such children at any given time. Eight children and youth have been sent out of the community for treatment or support, up to six hours away.
The options CAS would typically use for children who come into care — foster homes, or in some cases group homes — often decline to take these children because of their extensive health needs or challenging behaviours, such as violent outbursts, substance use or self-harm, child welfare leaders said. A foster parent shortage has compounded the challenges. Child welfare agencies face the same waiting lists for treatment that parents do.
“It’s absolutely brutal right now for kids and their families trying to get access to the supports and services they need,” said Dawn Flegel, executive director at the Sarnia-Lambton children’s aid society and regional CAS chair for southwestern Ontario. “I’ve just never seen anything quite like it, the intensity of the need and the crumbling infrastructure that should have been there.”
In some cases, kids and teens with complex needs are coming into the care of children’s aid societies not because there are child protection concerns but because their parents can no longer cope.
Money alone won’t solve the problem
In response to questions from the Star, Ontario’s Ministry of Children, Community and Social Services (MCCSS) provided a statement saying the government is “redesigning the child welfare system to focus on high-quality and culturally appropriate services.” The redesign will include “a review and audit of the system,” the ministry said, but it provided no further details on the scope, goals or timeline.
If a parent or guardian approaches a children’s aid society and “no child protection concerns exist,” wrote ministry spokesperson RJ Riley, that agency “should refer the family to appropriate community or health service providers with a mandate to provide services.”
“Although the government does not direct children’s aid societies on placement decisions, we require them to ensure placements are safe, appropriate and meet the child’s needs. That’s not an option: it’s the law.”
Kids in Crisis
Ontario had a plan to solve the growing kids crisis. It sat on the shelf for more than two years
CAS leaders stressed that the government’s response ignores a key problem: a province-wide lack of treatment and support options that is not in their control.
“This isn’t a failure of child welfare, and the deficits in the province aren’t a failure of child welfare, they’re a failure of the broader system not being able to respond,” said Chris Tremeer, executive director at Children’s Aid Society of London and Middlesex.
He stressed the children’s needs in the mental health system can’t keep up with the growing demand, leaving families and children languishing on wait lists and risking their long-term health. “There’s not enough money in the bucket for what’s being presented today.”
“There are no places out there for these kids,” said Brian Flint, executive director of the St. Thomas and Elgin children’s aid society, south of London. “Seventy calls we’re making, and you can’t find a placement.”
The lack of treatment options across the province is not a child welfare problem, but a systemic problem, said Amber Crowe, executive director of Dnaagdawenmag Binnoojiiyag Child and Family Services, an Indigenous child welfare agency.
Crowe said it’s up to the ministry to create safe treatment and living spaces for kids. “It’s not in my power, or in our sector’s power, to create licensed beds within the system that have the capacity to treat these kids.”
Earlier this year, University of Toronto experts tackled this issue in a report co-authored by Crowe. It found that while the provincial government has taken some steps to improve mental health services, critical gaps remain for children and youth with complex needs, and the situation is even worse for Indigenous children, families in rural and northern communities, and other marginalized populations. Among the report’s many findings: Indigenous children and youth are more likely to experience complex needs, and their families face greater challenges accessing treatment.
In its response to the Star, the Ministry of Children, Community and Social Services pointed out that funding to children’s aid societies has increased by 8.8 per cent over the past 10 years despite a 29 per cent decline in the number of children and youth in care.
Child welfare leaders say that budgets have increased in part because they have shifted to supporting families to keep children in their homes and communities, which requires more time and resources than placing them in foster care.
‘A lack of privacy, routine, normalc
A union survey of 450 child protection workers from across the province found that most staff believe unlicensed placements, including hotels and makeshift bedrooms in office buildings, lead to fu
Staff said such placements mean children’s meals “consist of whatever is cheap and easy,” and point to a lack of privacy, routine, normalcy, safety and security. One worker said they were “certain that any minister or staff” would cause “an uproar” if their children were in these living arrangements.
Arlette Carrier, a child protection worker in southeastern Ontario and CUPE Local 2577 president, said she has never seen anything like this in her 25-year career.
“It’s horrible” for these children, said Carrier, who represents children’s aid workers in Lanark, Leeds and Grenville. “There’s no home or family life. There’s a revolving door of strangers coming in. They often aren’t attending school.”
With the crisis still escalating, child welfare leaders and advocates stress the need for an all-government response that treats the problem like the emergency it is. Until system-wide solutions are in place, they say, kids will continue to fall through the cracks.
In southwestern Ontario, the 11-year-old boy living in his local children’s aid office was finally placed in a group home in August. He remains on waiting lists for residential mental health care. He’s not in a public building anymore, but he’s still not getting the treatment he needs.
https://www.thestar.com/news/canada/a-boy-on-a-futon-in-an-office-teens-in-budget-hotels-how-ontario-is/article_d31eac84-767f-11ef-b55f-c7f3c5f98a61.html
Tags: budget, child care, mental Health, participation
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