Recommendations

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

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

The panel recommends that:

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

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

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

   1. A Quality Inspectorate, replacing the current licencing function, which the Panel heard overwhelmingly is inadequate and does not assess quality of care. The new Quality Inspectorate would be comprised of inspectors whose responsibility it would be to licence and inspect all residential service providers in accordance with quality performance indicators recommended by the Panel and as may be developed by the Ministry. The current licencing function would be subsumed under the new Inspectorate as a set of baseline indicators that would be required but not sufficient. The position requirements of inspector would be substantively different from those of the current licencing specialist position requirements in the focus on quality, and will require an HR transition plan. It is envisioned that regionally based quality of care branches of the Inspectorate would report jointly to the corporate Quality of Care Inspectorate and to regional directors. Further information with respect to the new Quality of Care function is contained in Quality of Care.
      
      On an annual basis, each service provider would also be required to provide a Concept Statement to the Ministry, outlining their services and self-reported areas of strength or expertise. The inspector would assess the extent to which the assertions of service providers about strengths can be supported by evidence, having access to clinical expertise as necessary. The inspector would measure and assess quality through on-site inspections, paying particular attention to the voice of young people, families, caregivers and front-line staff. The Concept Statements of service providers and the reports of inspectors would be posted by the Quality Inspectorate in such a way that all placement agencies could review and access the reports when making placement decisions.
   2. A Data Analytics and Reporting Unit that would be the central repository and data analytics unit for all sources of data and information relative to residential services, including but not limited to all Serious Occurrence reports from service providers and licencing and quality of care assessments, including performance against indicators, completed by Quality of Care inspectors. The capacity to bring together all sources of data and information and to conduct high level aggregate data analysis will create a powerful tool for the Ministry in determining and reporting publicly on the performance of the system and in assessing the progress of young people. More information on this function is found in Data and Information.
   3. A Continuity of Care Unit, staffed by Reviewers whose responsibility it would be to monitor placement changes and trajectories of children and youth in residential services. Whenever a young person’s placement was changed, it would be required that the decision maker notify the Continuity of Care Unit. The Reviewer would have information about the full placement history for each young person as well as other relevant data such as Serious Occurrence Reports, assisting the decision maker to have the full context for the young person’s trajectory through care. This would benefit the decision maker in ensuring that placement changes were thoughtful and necessary, having regard to the number of placements the young person has experienced.
      
      It is envisioned that all young people in long term care (i.e. 18 months or greater) would be monitored by the Continuity of Care Unit. The Panel recommends that the current Crown Ward Review Unit be integrated into the Continuity of Care Unit. The Reviewer would also be notified when a young person was moved from child welfare or children’s mental health into a youth justice custody/detention facility in order to assess concerns about the criminalization of young people in care. The Panel envisions that the Continuity of Care Unit would be responsive to concerns that currently the Ministry is unable to track young people across sectors, seriously impacting the Ministry’s ability to understand youth’s trajectories through residential care and outcomes following these services. This unit would also respond to concerns that pathways through care are currently disjointed, unpredictable and may result in significant placement disruption. Further information is found in Continuity of Care.

       

   4. An advisory council to provide access to clinical expertise and lived experience (children and youth, families, caregivers including foster parents and front line workers). On the Voice chapter , the Panel has expressed concerns that the voices of young people, as well as front line caregivers, are not adequately listened to or used to inform policy changes and enhancements to the quality of services provided in residential care. Accordingly, the Panel envisions that a properly comprised advisory council actively participates in the design and development of the new Quality of Residential Care Branch/Division, and then continues to add value to the ongoing functions of the Branch/Division.
2. All service providers across sectors submit to the Quality of Residential Care Branch/Division a completed Concept Statement (for sample Concept Statement see Appendix 2) each year.
3. Residential care descriptors such as “treatment” or “specialized” be eliminated in both group care and foster care.
4. The placement of young people in a residential service be based on a match between the needs and strengths of the young person and the strengths and demonstrated capacities of the program as per the validated Concept Statement pursuant to that program.
5. Key capacities for understanding the experiences of all those with experience in residential services at both a single point in time and over time be developed, including:
   1. A mechanism developed by the Quality Inspectorate to provide opportunities for all young people to report on their experiences in any placement, post discharge.
   2. A systematic sample based survey be administered every 2 years to gather feedback from foster parents, and front-line staff about their experiences in residential services.
   3. The capacity to track the trajectories of young people who receive residential services. This could be in the form of a unique residential service client identifier or a residential service information module common to all sectors.
   4. The capacity across residential services for data collection and reporting in a transparent manner, based on the principle of self-identification by children, youth and service providers, and in partnership with the appropriate group:
      1. residential service trends specific to First Nations, Métis and Inuit children and youth across all residential service sectors.
      2. the number of young people in out-of-home care within specific cultural, racial, faith, or gender groups (including trans).
6. The Ministry create a third category of customizable licenses for services that fall outside of the existing two categories to ensure that children in out of home care only be placed in licensed residences, and to mitigate against young people being placed in unlicensed programs that often have untrained live-in staff supported by one to one workers under Special Rate Agreements, with limited oversight over quality of care or even safety considerations.
7. The impact of licensing as a mechanism to ensure oversight and accountability be maximized by:
   1. Enabling a broad range of designates to conduct unannounced inspections at any time.
   2. Creating more meaningful consequences for non-compliance through progressive consequences, potentially beginning with administrative monetary penalties of graduating levels, and ending with broader criteria for the removal of a license.
   3. Enabling a common approach to the interpretation and application of licensing standards through centralized training and access to clearinghouse decisions.
8. A centralized, publicly accessible, web-based directory of all licensed service providers across the province be created to maximize opportunities for system planning, placement decisions, and oversight of a decentralized approach to residential services. It is recommended that the directory include several key elements:
   1. Basic organizational information (as appropriate) such as whether there are multiple residences within or across regions owned by a single operator, contact information, and information pertaining to the capacity of the residence(s).
   2. A concept statement, updated annually by each licensee and validated by the Ministry, which articulates the strengths and abilities of the service provider.
   3. Any information related to the license status of the provider, including status, terms and conditions, inspection report.
9. A commitment to accountability through public reporting (in addition to the publication of licensing information) be facilitated through:
   1. Annual progress report from the Quality of Residential Care Branch/Division
   2. Public reporting of Recommended Service and Outcome Indicators
   3. An independent study assessing the quality of care, continuity of care and outcomes of children and youth in out-of-home care at a defined period of time (e.g. Every 5 years) to be presented to the Legislature by the Minister of Children and Youth Services to provide an external complement to internal oversight mechanisms.
10. A comprehensive review of current per diems across the province and the per diem rate setting and review process for both transfer payment and privately-operated service providers be undertaken by the Ministry, with particular attention paid to the variation in rates across Ontario for similar services, increases in cost of living and the necessary adjustment of staff salaries aligned with such increases, as well as the cost implications of the recommendations related to human resources.
11. The use of Special Rate Agreements (SRAs) be subject to rules and regulations aiming at higher levels of accountability and more effective child and youth centered practice. To this end:
    1. The number of young people with SRAs, in any one residential program, be limited to two.
    2. Where SRAs involve the use of one-on-one workers, such agreements be reviewed every 30 days with a view to reducing the intrusiveness to children and youth.
    3. The hourly compensation for workers assigned to young people on a one-on-one basis be equitable in relation to other residential staff.
    4. The pre-service educational qualifications for one-on-one workers under SRAs be the same as for all other residential care workers.
    5. Training focused on quality practice be required for all one-on-one workers by service providers.
12. Dedicated funding for research about residential services in Ontario be established and managed by the Ministry.
13. A requirement for pre-service credentials be introduced whereby all front line staff in residential care must have completed at minimum a college level diploma in a human service discipline. The requirements for these credentials encompass any person engaged in paid employment activity focused on children and youth in residential services at any level, excluding any person employed solely for functions that do not involve interaction with residents such as kitchen and maintenance duties.
    1. Current staff members in residential settings have up to five years to meet this requirement.
    2. MCYS move towards establishing child and youth care practice as the required credential for residential work over the course of the next ten years.
    3. Pre-service credential requirements apply to full-time, part-time, and designated one-to-one staff in group care as well as to workers assigned to foster homes or family-based care.
    4. Modified requirements are to be developed for Aboriginal people taking into account local resources and contexts in partnership with First Nations, Inuit and Métis communities.
14. Eligibility for supervisory positions in residential services be contingent on completion of a certificate. Such certificate shall be based on a curriculum specifically designed to enhance the capacity of supervisors to support staff in the provision of therapeutic care based on relational practices.
    1. The supervisory certificate should be developed through a partnership of the child and youth care academic sector and the residential services field.
    2. Such certificate must be obtainable only through community colleges or universities, and cannot be delivered by service providers themselves.
    3. Current supervisory positions in residential services must complete the certificate within two years after its establishment and availability.
15. A two-week new worker training program be developed for all front-line residential service positions (with the exception of youth justice – see below) based on core competencies including life-space interventions, strength-based relational practice, ethical decision making and the unique context of Aboriginal, LGBTQ2S, Black youth and other groups.
    1. The New Worker training should be developed through a partnership between the child and youth care academic sector and the residential services field.
    2. The New Worker training is to subsume existing mandatory training for residential front-line staff including in particular crisis prevention and intervention training.
    3. A review of the Youth Justice training program for front-line youth services workers be conducted to ensure that relevant content from the new residential services curriculum be incorporated and that cross training in relational practice/relationship custody be incorporated for both directly operated and transfer payment based staff.
16. A provincial strategy be developed to modernize foster care in Ontario, including a provincially driven recruitment strategy for new foster parents. The strategy must include:
    1. A strong voice for foster parents on an on-going basis.
    2. Provisions for foster parents from different organizations to come together regularly.
    3. An emphasis on clarifying rules and procedures for fostering.
    4. Measures to address barriers, including ones of resource for the recruitment of foster parents from Aboriginal and other uniquely situated communities.
17. PRIDE training be extended as a requirement to all public and private foster parents.
18. The two separate systems of secure custody and detention (directly and transfer payment operated) be harmonized and integrated into a single system to ensure that the placement and transfer process considers the entire array of resources to meet the needs of youth, resources are maximized, training is standardized and best practices are shared and scaled up system-wide.
19. Consideration be given, where demand is demonstrated, to converting youth justice open custody residences with excess capacity to youth residences serving the full spectrum of youth justice-engaged youth requiring stable housing including: open custody youth; youth transitioning from open and secure custody requiring reintegration support; youth on probation; and youth for whom a stable residence is required to qualify for bail.
20. A review of the remaining excess capacity in youth justice open custody and detention as well as secure custody and detention be conducted and excess capacity be rationalized. Any savings accrued should be reinvested in residential services for youth, to address areas in which there is inadequate investment.
21. Standards and best practices from all operators with respect to relationship custody be documented and form the basis of training for all youth justice open and secure custody and detention staff in both transfer payment and directly operated facilities.
22. The Ministry ensure that the frequency and duration of Secure Isolation is minimized as required by legislation and policies and that conditions in Secure Isolation are not punitive. This will require that the Ministry sustain its current efforts on an ongoing basis.
23. The impacts of size of the facility and gang-affiliations of some of the youth at the Roy McMurtry Youth Centre be mitigated by transferring out youth with secure custody sentences of 30 days or more, as well as youth on long term detention (who would be returned for purposes of Court appearances), to the closest and most appropriate youth justice secure custody and detention facility with capacity. Such transfers should be considered using a case management model in the best interest of the youth.
24. Supports and resources be enhanced to support positive outcomes and the successful transition into, between, and out of residential services, including after care and reintegration into the community.
25. Recognizing the current provincial initiatives to support youth in transition from out of home care, the Panel recommends the continued exploration of extending the age to which residential services are funded.
26. A separate process with Aboriginal peoples be conducted, consistent with principles of self-determination, to determine the best options for supporting Aboriginal children and youth requiring out-of-home services. The scope and mandate should be developed in partnership with Aboriginal service providers and communities.
27. MCYS establish an advisory committee to enhance cultural competence of all residential services in relation to the diverse identities and developmental contexts of young people.
    1. All cultural competence initiatives must unfold in partnership with young people.
    2. Mechanisms must be developed to ensure visible progress in this area.
28. The Ministry mandate residential service providers to clearly articulate the cultural, gender, racial, and other identity rights of young people.
29. A strategy be developed by the Ministry to ensure that the rights, well-being, and participation of young people identified as having complex special needs are promoted.
30. The Ministry develop a strategy for the identification of emerging issues, such as the sex trades, and the rapid response to such issues in a co-ordinated cross-sectoral and provincial manner.
31. MCYS create a mechanism for ensuring equitable access to non-residential supports for Black youth, LGBTQ2S youth and other groups living in residential care.
32. In collaboration with the school board, a specific plan be developed by service providers for every young person in relation to their school-based learning and where applicable transition from section 23 to community schools.
33. Young people who experience mental health or other crises while in residential care receive services where they live. Additional services and supports should be provided to the young person in order to prevent a change of placement.