Poor quality reporting impairs government's early warning system

TORONTO, Feb. 26, 2016 /CNW/ - A review of the province's Serious Occurrence Reports (SORs) raises questions about the effectiveness of these reports as a safeguard for children and youth in residential care.

The Office of the Provincial Advocate for Children and Youth released its preliminary findings today, and submitted the report to the Ministry of Children and Youth Services' Residential Services Panel, which is in the process of completing its review of children's residential services. Residential care for children and youth is provided in settings such as group and foster homes, kinship care and mental health residences. A final report with detailed analysis of the SORs related to the use of physical restraints, self-harm and missing children will be released in the coming weeks.

"Many children and youth who enter residential care are in need of protection or they require specialized services to address their mental health issue or a special need. The province is entrusted to provide a safe, respectful and healthy environment for these young people so they can thrive, heal, build supportive relationships and reach their full potential," said Provincial Advocate Irwin Elman. "Our report raises many questions about the system in place to safeguard the well-being of young people."

Under the Child and Family Services Act, residential service providers must notify the Ministry of incidents deemed to be of serious significance within 24 hours of the occurrence. There are eight types of serious occurrences: Death of a child; serious injury; injury of a resident by staff person or licensee; alleged, witnessed or suspected abuse or mistreatment of a child; physical restraint of a child; disaster on premises; a complaint of a serious nature made by or about a client; and any other serious occurrence and restraint concerning a child. This preliminary report contains a descriptive analysis of the events recorded in SORs and is not an assessment of the overall quality of care provided in a specific residence.

The Ministry reports that a total of 20,429 SORs were submitted in 2013 by operators of group homes and other children's residences providing specialized services in the areas of mental health developmental disability, special needs and palliative care.  The Advocate's Office obtained and analyzed 5,011 individual SORs covering a three-month period, from January 1 to March 31, 2014.

An analysis of the SORs revealed the following:

• Poor quality of SOR – The review found a wide variability in the quality of serious occurrence reports submitted to the Ministry. Some reports were missing critical information such as date and time of the incident; the name of the person who was writing the report; the names of individuals who were notified; and the current status or condition of the situation. The poor quality of writing and the lack of completeness make it difficult for the reader (presumably the Ministry) to determine whether there is a need for further investigation. Of note, many SORs lacked critical information about the events leading up to the use of restraint, the type of restraint used and the interventions used to attempt to de-escalate the situation. These omissions make it difficult to determine if the restraint was conducted in a manner consistent with policy.
  
  
• Medication errors: Seventy-five SORs reported medication errors, including medications that were administered to the wrong youth, and missed or wrong dosages.
  
  
• Serious injuries - During the 90-day review period, there were serious injuries (e.g. self-inflicted injury, medication error) reported at an average of 3.71 per day with accidental injuries accounting for 25.15 per cent of the reported serious injuries. Medical problems of a known or unknown nature account for 10.74% of serious injury reports. Self-inflicted injury (both explained and unexplained) account for 41.32 per cent of all of the serious injuries reported. Significant mental health crisis requiring hospitalization accounts for 10.18 per cent of the reports of serious injury.
  
  
• Allegations of Abuse - A total of 116 reports of alleged, witnessed, or suspected abuse were reported. Out of this number, 112 reports were allegations of abuse (e.g. physical or sexual assault, corporal punishment). In one-third of these cases, the allegations were about abuse by a family member, including current abuse occurring during a home visit.
  
  
• Missing person – A missing person report must be filed with the police when a child in the care of a children's aid society or a residential program has been missing for 24 hours. During this review period, there were 944 reports of missing young people. The majority of youth (604) returned to their program on their own volition. However, the review found that 258 reports (27.33 per cent) indicated that the whereabouts of the youth was still unknown (at the time that the SOR report was written), leaving it unclear how many were later found.
  
  
• Restraints – A total of 2,354 reports on physical restraints were submitted to the Ministry. Of these, a total of 737 incidents (31.3 per cent) were identified where a young person with a developmental disability had been restrained.

"Young people in care are some of the most vulnerable children in society and their dependency status requires that they be safeguarded," said Dr. Kim Snow, Associate Professor at Ryerson University who conducted the analysis and co-authored the report. "Medication errors, injuries and complaints are findings that point to the need for enhanced safeguards for children in residential care as well as the need for enhanced training of staff."

Elman adds, "As the Ministry's residential panel completes their review of the children's residential care system, I urge them to take a hard look at the current reality facing young people. We cannot continue to simply ignore what is happening in children's residential care. It is clear that we need bold, courageous leadership to create the change that young people need and deserve."

About the Office of the Provincial Advocate for Children and Youth
The Office of the Provincial Advocate reports directly to the Legislature and provides an independent voice for children and youth, including children with special needs and First Nations children. The advocates receive and respond to concerns from children, youth and families who are seeking or receiving services under the Child and Family Services Act and the Education Act (Provincial and Demonstration Schools).

The Office is guided by the principles of the UN Convention on the Rights of the Child and has a strong commitment to youth involvement. For more information, visit: www.provincialadvocate.on.ca. For updates, read the Advocate's Blog and follow us on Twitter and Facebook.

SOURCE Office of the Provincial Advocate for Children and Youth

Media Contact: Office of the Provincial Advocate for Children and Youth: Akihiko Tse, Media and Communications Coordinator, [phone], [email protected]