PDRC – child welfare recommendations

The PDRC – Child Welfare offers recommendations to Societies arising from review of the case materials. The recommendations are aimed at the prevention of further deaths including suggestions for enhancement or change in practice and/or procedures that may inform improvement in service delivery and potentially impact child and youth safety. 

In 2016, the PDRC – Child Welfare reviewed 32 cases and issued a total of 34 recommendations. The recommendations provided by the PDRC were in addition to recommended changes identified by the involved Societies during the internal review process. Of the 32 cases, 13 reviews provided no recommendations.

Recipients of recommendations in 2016 were: 10 individual Societies, the Ministry of Children, Community and Social Services (MCCSS), formerly known as the Ministry of Children and Youth Services (MCYS), a Local Health Integration Network (LHIN), a Police Service and one Regional Supervising Coroner in the Office of the Chief Coroner. Joint recommendations were also made to the Ministry of the Attorney General (MAG), the Ministry of Health and Long-Term Care (MOHLTC) and MCCSS.

In 2017, the PDRC – Child Welfare reviewed fewer cases (13) due in part to the work being conducted in preparation for the Expert Panel which reviewed the deaths of 12 young people in residential care and to the efforts dedicated into the establishment of the Child and Youth Death Review and Analysis (CYDRA) Unit. Of the 13 cases reviewed, a total of 11 recommendations were issued and four provided no recommendations.

 Recommendations to MCCSS in 2016 & MCCSS response

The section below outlines the categories of recommendations most frequently made to Societies by the PDRC – Child Welfare in 2016. Responses from MCCSS, which has responsibility for oversight of all children’s aid societies and Indigenous child wellbeing societies, have been provided for each recommendation grouping by year. 

2016 PDRC – Child Welfare recommendations and themes to MCCSS

Recommendation 1: The Ministry of Children and Youth Services should consider how best to support a service system to support effective navigation by parents and to coordinated service pathways for high risk youth.

Case planning structures and designated case coordinators are current methods used to assist with coordinating service pathways. The emphasis is often on current challenges, with less focus on future planning and collaboration between service providers.

MCCSS Response

The Ministry of Children, Community and Social Services (MCCSS), formerly known as the Ministry of Children and Youth Services (MCYS), is committed to supporting a coordinated service system for parents to make it easier to navigate and for high risk youth (e.g. youth involved in the child welfare, mental health and youth justice systems).

As part of Ontario’s Mental Health and Addictions Strategy, Ontario is transforming the community-based child and youth mental health system through Moving on Mental Health (MOMH), which was launched in 2012. As part of MOMH, Ontario has established lead agencies in 31 of 33 service areas across the province, which will be responsible for providing a core set of child and youth mental health services in their areas. The aim of MOMH is to transform the experience of children and youth with mental health problems and their families/caregivers so that regardless of where they live in Ontario they will know:

• What mental health services are available in their communities; and
• How to access mental health services and supports that meet their needs.

Since the launch of MOMH, the ministry and the child and youth mental health sector have been working together to put in place the foundations to support a high-quality responsive system that meets the needs of children and youth. Creating pathways to care is one of five pillars of MOMH. Through local planning work, lead agencies are working to identify and build clear pathways across the health, education and broader child and youth serving sectors.

To further strengthen service collaboration, the ministry is also working with the Ministry of Health and Long-Term Care (MOHLTC), and the Ministry of Education (EDU) to identify opportunities to build on the local work done to date, and support enhanced connections and planning for children and youth experiencing mental health problems. The ministry is committed to strengthening inter-ministerial collaboration and continuing to improve the mental health and addictions service system across sectors and across the lifespan of children and youth.

In addition to MOMH, the ministry in collaboration with EDU, and MOHLTC, launched the Special Needs Strategy in February 2014 to help connect children and youth with special needs to the services they need as early as possible and to improve the service experience of families in three key areas:

• Identifying children earlier and getting them the right help sooner
  • Trained providers will have a new developmental screen for children in the preschool years. They will screen for potential risks to the child’s development as early as possible.
• Coordinated Service Planning
  • New service planning coordinators for children and youth with multiple or complex special needs will collaborate across sectors to connect families to the right services and supports and develop one, cross-sectorial coordinated service plan.
• Making supports and service delivery seamless
  • The goal of coordinated service planning is to improve service experiences and outcomes for children and youth with multiple and/or complex special needs and their families through the support of a Service Planning Coordinator who will connect them to the multiple, cross-sectorial services they need as early as possible, and monitor their needs and progress through a coordinated service plan.

Recommendation 2: The Ministry meet with the Society, with the participation of the relevant Chief and Council, in order to facilitate reflective learning on cases.

There were ongoing concerns present within the family in a particular case that placed the children at risk of harm. There is opportunity to review service standards and service provision to ensure the safety and well-being of children and youth served by the Society.

MCCSS Response

Recommendation 3: The Ministry and Society have engaged in discussions with respect to relationship building and community involvement in case planning for First Nations children and youth receiving child welfare services.

A meeting with a Society Senior Management was held on June 19, 2018 to discuss the next steps for the PDRC recommendation. 

The meeting with the community will be set-up by the Society. The meeting will discuss the process of case consultations and partnership, with a focus on where improvements can be made to ensure better outcomes for children and youth.

To the Ministry of the Attorney General (MAG), Ministry of Community Safety and Correctional Services (MCSCS) and Ministry of Children, Community and Social Services (MCCSS):

1. The Ministries of Health and Long Term Care, the Attorney General and Children, Community and Social Services work collaboratively to:
   • (1a) Clarify the legislation as it relates to definition of roles, responsibilities and procedures for professionals related to capacity and consent in the treatment of paediatric patients.

     There are different legislative frameworks that apply in the medical treatment of children, including the Health Care Consent Act and the Child and Family Services Act^{footnote 1[1]}. There appears to be a lack of clarity regarding the circumstances for which each specific legislation applies, and clearly defined roles, responsibilities and procedures for various professionals. This lack of clarity has the potential to result in challenges when approaching case management decisions and increases the vulnerability of children and youth receiving medical treatment.

   • (1b) Consider the development of standardized processes and procedures for health care professionals when intersecting with child welfare professionals related to capacity and consent in the treatment of paediatric patients with a view to reducing inconsistencies in practices across Ontario.

     The ministries may wish to engage the Chiefs of Paediatrics, the Ontario Association of Children’s Aid Societies, the Association of Native Child and Family Services Agencies of Ontario, Aboriginal Elders and/or the Office of the Provincial Advocate for Children and Youth to develop best practice guideline(s) for health care providers and children’s aid societies to follow in similar circumstances. This may include guidelines regarding the importance of documentation regarding decision making as it relates to consent and capacity in paediatric patients and their families.

     Case examples to help elucidate processes in various circumstances may be of benefit to medical and child welfare service providers in Ontario.

   • (1c) Engage with aboriginal stakeholders, in collaboration with the Ministry of Aboriginal Affairs, to define best practices for professionals related to capacity and consent in the treatment of paediatric aboriginal patients.

     Best practice guidelines that address the unique considerations specific to aboriginal children and families would encourage and support decision-making in circumstances where aboriginal children and/or their parents choose to integrate traditional healing practices with physician-recommended treatments or where aboriginal children and/or their parents choose to stop physician-recommended treatments and medical opinion suggests that the consequences for the child could be serious.

MOHLTC and MCCSS Response

• (1a) MOHLTC and MCCSS will not pursue legislative amendments to the Health Care Consent Act, 1996 (HCCA) or the Child and Family Services Act, 1990 (CFSA) at this time. The ministries have determined that there would be broader policy implications and unintended consequences associated with amendments to HCCA.

  In reviewing the report of the PDRC, the ministries determined that the issues identified in the report indicate that further clarification in understanding existing regulations can be achieved by enhancing education and awareness among health and child welfare sectors. MOHLTC has begun to take this action by requesting that the health regulatory colleges share information with their members on the CFSA's requirement that suspicions that a child may be in need of protection be promptly reported to a Children's Aid Society.

• (1b) MCCSS and MOHLTC will issue a joint memo to all hospital CEOs and Society senior management to request that hospitals examine existing policies and procedures related to capacity and consent and duty to report laws in Ontario and work with their local Society to make any necessary improvements. The memo will highlight best practices and provide guidance on what successful policies should contain, such as the requirements of the HCCA and a child's role in making health care decisions, including complex treatment decisions. Furthermore, it will list resources that are available on consent and capacity.
• (1c) Engagement with Indigenous and system partners has identified a lack of informed knowledge and best practices on cultural safety on the part of health care providers as a key factor affecting care and decision-making. MOHLTC, in collaboration with MIRR, continues to engage with Indigenous stakeholders to define and integrate best practices for health professionals related to capacity and consent in the treatment of paediatric Indigenous patients that will complement, support and reinforce the responses to recommendations 1a and 1b. For example, the ministry has invested in Indigenous Cultural Safety training for health professionals and health service providers that is designed to increase knowledge, enhance self-awareness and build on existing skills to move towards ·a culturally safe health care system for Ontario's Indigenous peoples and communities.

  As part of the joint memo with MCCSS to all hospital CEOs and Society senior management (response to Recommendation 1b), MOHLTC will request that hospitals examine existing Indigenous education, policies and procedures related to culturally appropriate and safe care for Indigenous patients accessing treatment. The ministry will also continue to invest in initiatives that support cultural safety training, relationship building and harmonizing traditional Indigenous and Western health practices.

Implementation status of 2015 and 2016 PDRC – Child Welfare recommendations to Societies

MCCSS monitors the implementation status of the PDRC – Child Welfare recommendations and the actions taken by Societies to respond to specific recommendations. MCCSS reports that Societies have implemented or were in the process of implementing 88% of the PDRC – Child Welfare’s recommendations directed to them in 5. Societies were unable to evaluate 8% of the recommendations and the remaining % of recommendations had the content or intent of the recommendation already in place. In 2016, MCCSS reported that 100% of the PDRC – Child Welfare’s recommendations directed to Societies had the content or intent of the recommendation already in place. 

PDRC – Child Welfare recommendations to other organizations in 2016

The PDRC – Child Welfare also made recommendations to other organizations, which included a Local Health Integration Network and a Police Service.  Themes of these recommendations include using a PDRC case as a learning opportunity with a view to enhance service delivery and reviewing existing processes to ensure consistency with protocols.  The committee also identified an opportunity for the Regional Supervising Coroner to work with a Hospital Chief of Pediatrics and Emergency Department for learning opportunities to potentially inform future service delivery.