residential treatment working group final...

RESIDENTIALTREATMENTWORKINGGROUP

FinalReport

July2017

ResidentialTreatmentWorkingGroup-July20173

CONTENTS

MESSAGEFROMTHECHAIR.........................................................................................................................4INTRODUCTION............................................................................................................................................6DEFININGRESIDENTIALTREATMENT...........................................................................................................7MANDATEOFTHERESIDENTIALWORKINGGROUP....................................................................................7METHODOLOGY...........................................................................................................................................7REVIEWANDDISTRIBUTIONPROECSS.......................................................................................................10

DevelopaLexiconwithCommonDefinitions(SeeAppendix4)............................................................11UnderstandingtheCurrentDemand......................................................................................................12CurrentAgency-levelCapacitytoRespondEffectively..........................................................................12

EMERGINGTRENDS....................................................................................................................................13GapsandStrengths................................................................................................................................13Waitlists..................................................................................................................................................14

VISIONOFTHEFUTURESYSTEM................................................................................................................14GuidingPrinciples...................................................................................................................................14DriversofSuccess...................................................................................................................................15

RECOMMENDEDAREASFORACTION........................................................................................................15Establishabroad-basedcross-sectoralsystemplanningtable..............................................................15YoungParents/Infants,ChildrenYouthandtheirFamiliesShouldHaveAccesstotheFullContinuumofServiceIncludingAfterCare/TransitionalSupport.................................................................................16CentralizedAccess,AssessmentandIntegratedServicePlanningforClients........................................17DataandInformationCollection............................................................................................................19SystemSustainabilityandAdvocacy......................................................................................................20

WORKINGGROUPMEMBERS.....................................................................................................................21APPENDIXES...............................................................................................................................................22


MESSAGEFROMTHECHAIR

Inearly2016,theleadagencymandatedtheResidentialTreatmentWorkingGroup(RWG)toreportonthecurrentstateofresidentialtreatmentinTorontotoinformevidencebaseddecisionmakingandplanning.Themandateincluded:developinganinventoryofexistingservices,servicedemand,systemcapacity,emergingneeds/trends,clientprofiles,occupancyrates,lengthsofstayandservicegaps.Themandatewasfurtherextendedthrough2016/2017toallowtheRWGtheopportunitytoreviewtheMinistryofChildrenandYouthServices(MCYS)PanelofExpertReportandtocompletetheworkinitiatedinPhase1.

Residentialtreatmentishistoricallyunderfunded.AgenciesacrosstheCityreportrunningdeficitsbetween$80,000-$120,000annually.Themajoritymustfundraiseorsupplementresidentialtreatmentbudgetsthroughotheravenues.TheRWGacknowledgesthecurrentsystemwithexistingfundingisnotsustainable.ThereisalsorecognitionthatdespitethestrengthsthatC.A.R.S.bringstothesystem,wearenotcurrentlyfunctioningasasystem.Decisionsare,forthemostpart,beingmadeatindividualagencylevelswithoutthebenefitofsystemdataandknowingadecision’simpactonthesystemofservices.

Overthecourseofthelastfiveyears,thesystemhaslost26transferpaymentbeds(Thisteltown,LOFT,CDIandHDCclosures)and80perdiembeds(Oolagen,EMYSx2,HDC,Delisle,LOFT,Casatta,Enterphase,KennedyandStorey).CentralizedAccesstoResidentialServices(C.A.R.S.)bedshavereducedfrom204bedsin2005to152in2016.Therewasarecognitionthatifactionwasnottakenquickly,residentialtreatmentserviceswillbefurthereroded.TheRWGfeltstronglythatweneedtomovetoaplacewhereindividualagenciesarenolongermakingdecisionsinisolationbutwherethereisasystem-wideapproachtoplanning.

TheRWGisrecommendingathoughtfuldatadrivenresponsetosystemschanges.Therearelessonstobelearnedfromlatencyagechangeswhichhaveledtoincreasedaccesstoevidenceinformedinhomeintensiveserviceswhileleavingagapinresidentialtreatmentservicesforchildrenages6-12.

WhileC.A.R.S.hascollectedrichdataonbehalfofthesystem,therearegapsininformationthatneedtobefilledbeforeconcreterecommendationscanbemadeabouthowmanybedsareneededandforwhichclientneeds.Althoughsystemsgapswereidentified,moredataisrequiredtodetermineprioritiesandhowgapsinoneareacanbefilledwithoutcreatingothers.

TherewasaconsensusamongsttheRWGthatC.A.R.S.isastrengthofthesystemandcouldbeexpandedtoprovideacentralaccesspointforallintensiveservice,therebyprovidingfamilieswithoneaccesspointtothefullcontinuumofintensiveservices.TheRWGalsostronglysupportedtherecommendationsofChildren’sMentalHealthOntario(CMHO)andKinarkthatwedevelopasysteminTorontowheretiersoftreatmentareprovidedandclientsreceiveanappropriateleveloftreatmentsupports(psychiatry,psychology,OT,etc.)basedonastructuredassessmentofneeds.TheRWGheardfromyouthandfamilieswhoinformedusthatthesystemisunwieldyanddaunting.Thereisanimperativeonthesystemthatwemoveforwardinatimelyfashiontomeettheneedsoffamiliesbeforefurtherresourcesarelost.


MembersoftheRWGrepresentedcoreserviceproviders.TheRWGfeltstronglythatthevoicesofservicerecipientsandotherstakeholdersareneededtoinformsystemschangesgoingforwardandweneedtopartnerwiththemindeterminingpriorities.TheRWGisthereforerecommendingamulti-sectoradvisorycommittee(partneringwitheducation,childwelfare,youthjusticeandhealth-possiblycaregivers).Thefirstphaseofworkwouldbetocollectandanalyzemoredatawiththegoalofrecommendingsystemschanges.

IcannotthankthemembersoftheRWGenoughfortheircommitmentandthethoughtfulclientcenteredapproachtheytooktothework.AttendanceatmeetingsamongthehighestIhaveseen.Everymembertookinitiativetoworkbetweenmeetingssowecouldkeeptheprocessmovingforward.Weareallcommittedtosystemsimprovementandchangeandwouldbehappytoprovideleadershipandpartnerwiththeleadagencyandourcommunitypartnerstoimplementourrecommendations.

DebbieSchatia,M.S.W.ExecutiveDirectorTurningPointYouthServices


INTRODUCTIONMovingonMentalHealth(MOMH)isanimportantpartofOntario’sComprehensiveMentalHealthandAddictionsStrategy.Theplanensuresinfants,children,youthandfamiliescangetmentalhealthservicesintheircommunitiesthatareaccessible,responsiveandbasedontheexperiencesofthechildrenandyouthwhoneedhelp.ThegoalofMOMHistoensureallchildren,youthandfamiliesinOntariohaveeasyaccessto:

• Mentalhealthservicesintheircommunities,and• Mentalhealthservicesandsupportsthatmeettheirneeds

Strengtheningthecommunity-basedsystemfordeliveringmentalhealthserviceswillbringpeopleandorganizationsclosertogetherlocallyandbenefiteveryone.EastMetro,LeadAgencyTorontoServiceAreaCollectiveImpactFramework–ACollaborativeApproachCollectiveImpactFrameworkisbasedonthebeliefthatnosingleorganizationcantackleorsolvetheincreasinglycomplexsocialproblemswefaceasasociety.Theframeworkbasedonthepremisethatmultipleorganizationsneedtojointoworktowardacommonagenda.JohnKaniaandMarkKramerfirstwroteaboutcollectiveimpactintheStanfordSocialInnovationReviewin2011andidentifiedfivekeyelementsforCollectiveImpacttosucceed.EMYShasadoptedtheseelementstoguideandshapeourworkinleadingthetransformationofthecommunity-basedchildandyouthmentalhealthsectorinthiscity.

1. AcommonagendaComingtogethertodefineaproblemandcreateasharevisiontosolveit

2. SharedmeasurementAgreeingtotrackprogressinthesameway,whichallowsforcontinuousimprovement

3. Mutuallyre-enforcingactivitiesCo-ordinatingcollectiveeffortstomaximizetheresult

4. ContinuouscommunicationsBuildingtrustandrelationshipsamongallparticipants

5. Backbonesupport–EastMetroYouthServicesDedicatedstafftocoordinate,supportandfacilitatekeyactivitiesandprocesses

RoleofWorkingGroupsThesheernumberoforganizationsbothinsideandoutsidethecommunity-basedchildmentalhealthsectorrequiresamoreintentionalfocusonrelationshipbuildingandcoordinatingopportunitiestosimplyengageandbuildaspiritofcollaboration.Thesetimeintensiveactivitiesarefoundationaltobuildingasustainablesystemchange.TohelplaythefoundationsforToronto’ssystemtransformation,workinggroupswereestablishedtoleveragetheexpertiseofthecoreserviceproviders.Inadditiontoprovidingtheinvaluableresearch,analysisandrecommendationswhichhelptoinformthedevelopmentandongoingadaptationoftheCoreServicesDeliveryPlanandCommunityMentalHealthPlan,nearlyallagenciesprovidingcoreservicesparticipatedasworkinggroupmembers,contributinggreatlytothespiritofCollectiveImpactandformingemergingrelationshipsacrossagencies.Theanalysis,recommendationsandresearch


resultsprovidedbytheworkinggroupswillcontinuetobeincorporatedintothelargeranalysisandplanningprocessaswemoveforward.DEFININGRESIDENTIALTREATMENTTheCMHOreportResidentialTreatment:Workingtowardsanewsystemframeworkforchildrenandyouthwithseverementalhealthneeds2016,clearlyidentifiesthedistinctionofresidentialtreatmentfromresidentialcare.Residentialcaredoesnotprovidetreatmentastheprimaryfocusoftheplacement.ThisdistinctionandtheimportanceofprovidingcontextandpurposebetweenresidentialtreatmentandresidentialcareincreasedafterthereleaseoftheResidentialServicesPanelReport.ResidentialTreatment,asdefinedbyMCYS,ispartofthecoreservicesclassified“IntensiveOut-of-HomeService”intheCommunity-BasedChildandYouthMentalHealthProgramGuidelinesandRequirements#1:CoreServicesandKeyProcesses,2015.InitsreportStrengtheningChildren’sMentalHealthResidentialTreatmentthroughEvidenceandExperience(Oct2015),KinarkChildandFamilyServicesfurtherdefinesresidentialtreatmentprogramsas“24-hourout-of-homefacilitiesthatprovidementalhealthtreatmentusinganinter-professional,multi-disciplinaryteamapproachthatmakestherapeuticuseofthedailylivingmilieu.”Asoutlinedintheanalysisandrecommendationsofthisreport,theRWGconcludesthatresidentialtreatmentisakeypartoftheIntensiveServicescontinuumoftreatmentwhichoftenlooksdifferentwitheachchildoryouthreceivingcare.MANDATEOFTHERESIDENTIALWORKINGGROUPTheRWGwasestablishedFebruary2016andendeditsmandateinFebruary2017.Theirmandatewastodevelopacomprehensivemapoftheresidentialtreatmentserviceslandscapeandproviderecommendationsformovingforward.METHODOLOGYWorkingGroupMeetings(SeeAppendix1forWorkingGroupmembershiplist)MembershipoftheRWGrepresentedaselectionofagenciesprovidingresidentialtreatmentservicesinToronto.Meetingonregularbasis,theChairledtheworkinggroupthroughdiscussionandanalysisofkeyissues,challengesandopportunitiesbroughtforwardfrommembers’professionalexperience,aswellasfromtheworkinggroup’sinvestigativeandresearchactivities.KeyInformantConsultationsandPresentationsSylAppsYouthCentre:SylAppsYouthCentreisasecureresidentialtreatmentcentreinOakville,ON.DebbieSchatia,RWGChair,spokewithSylAppsabouttheirprogramsastheyidentifiedaneedforyouthtobeabletotransitionfromSAYCtoresidentialtreatmentprogramsinToronto.PineRiver:DebbieSchatiawentouttothefacilityinlateMayforatourandinformalinformationalmeetingabouttheirprogramandtoidentifyareasrelevanttotheTorontoResidentialTreatmentsystem.


LynwoodCharltonCentre,Hamilton:DebbieSchatiandDarrenFisher,leadagency,ProjectManager,spoketoMaggieInrig,DirectorofSystemPlanningatLynwoodCharltonCentre,abouttheircentralizedIntakeandassessmentprocessaswellastheworktheyaredoingasacommunitytoenhanceandrealigntheirresidentialtreatmentbeds.LatencyAgeWorkingGroup(LAW)(SeeAppendix6fortheLAWFinalReport):Thismulti-sectoralworkinggroupwasestablishedinJune2015andconcludedinJune2016.SeveralmembersoftheRWG,includingtheCo-ChairfromC.A.R.S.,werealsomembersoftheLAW.TheanalysisandrecommendationsoftheLAWwerebroughtforwardfordiscussionandanalysisastheyrelatetoresidentialtreatment.Adraftofthisgroup’sfinalreportwaspresentedtotheRWG.CentralizedAccesstoResidentialServices(C.A.R.S.)–(SeeAppendix2forinformationandreportspresentedbyC.A.R.S.)-SkylarkChildrenandYouthServicesoperatesC.A.R.S.programonbehalfoftheTorontoofficeofMCYS.Providingasinglepointofentryforresidentialplacement,C.A.R.S.playedauniqueroleasamemberoftheworkinggrouppresentinginformationanddataforreviewandanalysis.ReviewofRelevantReports(SeeAppendix3foracompletelistofreportsreviewed)Therehasbeenanincreasedinterestinresidentialmentalhealthtreatmentinrecentyears.Severalreportshavebeenproducedlookingatthestrengths,gapsandchallengesofdesigning,implementingandeffectivelyintegratingresidentialprogramsintothecontinuumofcareforchildrenandyouthaswellasintegratingwithothersectorssuchashealth,socialservicesandeducation.TheworkinggroupreviewedseveralofthesereportswhichrelatetotheirmandateofresidentialtreatmentundertheMCYScoreservicesfundingenvelope.Inadditiontothereportsandinformationpresentedthroughoutthetermoftheworkinggroup,theworkinggroupreviewedanddiscussedanadditionalthreekeyreportsrecentlyreleased.CMHO:ResidentialTreatment:Workingtowardsanewsystemframeworkforchildrenandyouthwithseverementalhealthneeds2016.AccordingtoCMHO),“serviceprovidersnoteresidentialtreatmentischronicallyunderfundedandthatcurrentfundingmodelsdonotmatchthecomplexneedsofthechildren,youthandfamilieswhorequiretheseservices.Serviceproviderscannolongerkeepupwithincreasingdemandandmanyarebeingforcedtoreducetheirtreatmentbedsand/orclosetheirresidentialprogramsaltogether.”(CMHO,ResidentialTreatment:Workingtowardsanewsystemframeworkforchildrenandyouthwithseverementalhealthneeds,2016).AssessingthecurrentagencycapacitytorespondeffectivelytothechallengesinprovidingqualityresidentialcareinTorontowasbasedontwoquestions:

• Whatevidence-basedtreatmentsupportsareofferedtochildren/youthinresidentialtreatment?

• Whatothersupportsareofferedtochildren/youthinresidentialtreatment?

TheworkinggroupreviewedtheCMHOreport,anddeterminedthatmanyofthereportrecommendationsarebeyondtheresponsibilityofleadagencywiththeexceptionsofthefollowing:

• AdopttheCMHOreportrecommendationsaroundtiersystem• Supportingauniversalassessmentaspartoftheintakeprocesstohelpdefinewhatservices

children/youth/familiesaredirectedto


ProvincialAdvocateReportIn2016,TheOntario’sProvincialAdvocate’sforChildrenandYouthissuedareport:SearchingforHome,ReimaginingResidentialcare.

• OverallthegroupfelttherewereissuesofrelevancyandscopeandwhethertherecommendationspertaintoCYMHresidentialtreatment(manyapplytoothertypesofresidencesordonotreflecttherealityofresidentialtreatmentservices)

• Thegroupagreedissuesaroundlicensingandperdiems,aswellasexitinterviewsandengagement,areworthfurtherexploration

• Buildingrelationshipswithfamily(orequivalent)shouldbeembeddedintothephilosophyofcare

• Thegroupsupportstherecommendationsforprovidingfunding/capacityforrecruitmentandtraining

• ManyoftherecommendationswerenotrelevanttoTorontoagenciesorhavealreadybeingapplied

• Discussionaroundlicensingandaccreditationo i.e.licensedversusunlicensedperdiemhomeso Licensingcouldbeimprovedtofocusmoreonqualityandimprovedoutcomes

• Buildingrelationshipswithfamily(orequivalent)shouldbeembeddedintothephilosophyofcare

PanelofExpertReportMCYScommissionedapanelofexpertstoreviewallresidentialcareintheProvinceofOntario.In2016,theypublished:BecauseYoungPeopleMatter,ReportoftheResidentialServicesReviewPanel.

• ThegroupdisagreeswiththefundingrecommendationaboutperdiemfundingandrecommendscontinuationoftransferpaymentsystemwithadditionalfundingbeingprovidedthroughSTEPS-basedfundingasacentralizedmodel

• Therewasnotsupporttheremovaloftheterms“treatment”and“specialized”o Revieweddefinitionof“effectivetreatment”(changedto“residentialtreatment”)

and“contextofresidentialtreatment”• Supportfortherecommendationtocreateanadvisorycouncilofparentsandyouthinthe

buildingofthesystem(beyondresidentialbutallintensive)• SupportthecontinuationofC.A.R.S.dataandtrackingofchildrenandyouthreceiving

servicesinToronto.ItwasnotedthatagapexistswithChildWelfareclientsastheymovein/outofToronto.

• Developapubliclyaccessibledirectoryoflicensedservices,includingarangeofelementso Requiresadedicatedresourcetohelpparentsnavigateandmakeappropriate

decisionsAnalysisanddiscussionsstemmingfromthereview:

• Thereisaneedforbaselinedataandcontextualinformationaroundcontinuityofcare,lengthofplacements,therelationshipofwhereyouliveversusreceivingtreatment(betterunderstandingofsuccessfactors,pathwaysbetweenservicesetc.)

• Thesystemdoessomecaseconferencingbutthereshouldbestructurestoensurecaseconferencingformatswithalloftherelevantparticipantsoccurateverytransitionpoint(warmhandoffsandsystemnavigation)


• Section23needstobereviewedtoincreaseaccess.ItwasnotedthatattimestherecanbebarriersfromtheMinistryofEducationtoensurechildrenandyouthlivinginresidentialsettingsgetafulleducation(ratherthanlimitedcourses)

• Thereneedstobeaneedsassessmentofspecialized/underservedpopulationstobetteridentifyhowthesystemcanadapt

o Thereshouldbeaprocessformoreproactiveworkwhenservicingthesepopulations(i.e.ARAOplans)

o ItwasnotedthatFrenchservicesisamajorgap• Supportforafeedbacksystemofclientsatisfaction(couldbepartoftheroleofthe

child/youth/familyadvisorycommittee?)

ConsultationwithOtherWorkingGroupsandTablesOneofthekeylearningsfromYear1wastheneedtobetterfacilitateknowledgesharingamongthegroupsestablishedtoresearch,analyzeanddeveloprecommendationsfortheleadagencytoconsiderinitssystemplanning.Toaddressthis,DebbieSchatiaasChairoftheRWGattendedregularmeetingsoftheYear2Chairswherekeyareasofanalysisanddraftrecommendationsweresharedanddiscussed.YouthandFamilyEngagementRecognizingthesize,diversity,andcomplexityoftheTorontoserviceareatheleadagencyhasfocusedtheiryouthandfamilyengagementworkontwofronts:along-termframeworkandstrategydevelopmentinvolvingbuildingcapacitywithinthesystemtoengagefamiliesandyouthandimmediateeffortstowardsembeddingengagementprocessesandcommitmentsintheoperationsoforganizationsandsystems.Toinformthisworkandprovidealenstoviewtheworkinggrouprecommendations,theleadagencydevelopedandimplemented,inpartnershipwiththeworkinggroups,peer-ledconsultations.Inthisproject,youthandfamilymembersweretrainedtoleadconsultationsandtookpartinformingquestionsandinterpretingresults.Intotal,sevenconsultationswereheldand51youthandfamilymembersparticipated.REVIEWANDDISTRIBUTIONPROECSSInreviewingthemandate,availablecapacityandterm,theRWGorganizedthepreliminaryworkplan(March–June2016)intosixcategoriestobetterfocusthediscussionandanalysis:

• Developalexiconwithcommondefinitions• Identifyexitinginformation• Lookatcurrentdemand• Lookatcurrentagencycapacitytorespondeffectively• Identifyprogramrequirementsareneededtoprovidegoodqualitycare• EmergingTrends

Althoughthecategorieswereseparatedintodiscretediscussiontopics,itrecognizedtheyareinterrelatedandintegrated.Inadditiontothesesixdiscussioncategories,theworkinggroupengagedinafulsomereviewanddiscussionaroundwaitlists.Thisworkformedthefoundationofknowledgeandanalysiswhichinformedthesecondphaseofwork(September2016–February2017)duringwhichthegroupidentifiedkeydriversofsuccessandfinalrecommendations.


DevelopaLexiconwithCommonDefinitions(SeeAppendix4)Informaldiscussionofexperiencesamongtheworkinggroupparticipantsidentifiedinconsistentuseandunderstandingofcommontermsamongreports,peers,funders,mediaandthepublic.Specifically,therewasaneedtoreinforcetheinterconnectivityoftheissues(clientprofile,effectivetreatment,capacityetc.)andtermssuchasoccupancyandwaitlists.Tobeginthisprocess,theworkinggroupdevelopedalistofcommondefinitionstoprovidecontextandconsistencytotheworkinggroupdiscussions.Notcomprehensive,thelistisastartingpoint,designedtobea“livingdocument”whichcanbeaddedtoandamendedasnecessary.IdentifytheInformationthatAlreadyExistsWithintheMCYSresidentialtreatmentsystemthereisanabundanceofinformationavailable.Thechallengeistonotonlyidentifywhatinformationexistswhere,butalsohowtoeffectivelyaccessandextractthisinformationinausefulformat.Theworkinggroupidentifiedseveraltopicareasandsources,aswellasflaggedthosewhichweredeterminedtobeuseful,butbeyondtheworkinggroupmandateordeemedtoocomplextoacquire.Theworkinggroupalsoidentifiedtheneedtobetterinterpretthedataandidentifywhatismissingandneededtomakeinformedsystemdecisions.Areasofreviewfordataandinformationincluded:

• Inventoryofbeds,clientprofile,lengthofstay,occupancyrates,waitlists(C.A.R.S.)• DatarelatedtothequickeraccessprotocolbetweenC.A.R.S.andserviceprovidersandhowlong

bedsarevacantasaresult• Gapsinthesystem(SeeAppendix2)

o Examples-language(Frenchetc.),disability,culture,gender,GLBTQ,medicallyfragilewithpsychiatricissues,newcomers/refugees,FASD,ASD,sextrafficking,eatingdisorder

• InformationaboutinfantandyoungparentresidentialprogramsanddaytreatmentProgramsforfrancophonestudents(SeeAppendix5)

TheCentralizedaccesstoresidentialservices(FormoreinformationaboutthereportsanddatapresentedbyC.A.R.S.totheworkinggroup,pleasecontactBrianO'Hara,Director,C.A.R.S.,SkylarkChildrenYouth&Families)C.A.R.S.programwasidentifiedasacentralpointfordatacollectionandreporting.SkylarkChildren,YouthandFamilyServicesoperatesC.A.R.S.onbehalfoftheTorontoofficeoftheMCYS.C.A.R.S.providesasinglepointofentryforresidentialplacement,eliminatingtheneedforparentsandcasemanagerstocallmultipleresidencestofindopenings.C.A.R.S.’databasecontainsup-to-datedataforeverymentalhealthresidentialprograminToronto,makingiteasiertomatchachild'sneedswiththeappropriatefacility.C.A.R.S.providesavarietyofimportantservicessuchas:

• ManagingreferralstoallmentalhealthresidentialbedsforchildrenandyouthinToronto• Matchingindividualrequestsforresidentialtreatmentwiththemostappropriateproviders• Monitoringresponsetimesandconfirmingadmissions• Trackingclientsinplacement• Recordingdischarges• Monitoringavailableresources• Providingaccurateoverallsystem-basedinformationforresidentialservices

EveryyearC.A.R.S.processesreferralsfor400-500clientsaged6-18,makingapproximately1,300requestsforresidentialplacement,typicallyleadingtoactualplacementforabout200clients.Othersourcesofdataandinformation


Inidentifyingexistingavailabledataandinformationsources,theworkinggroupidentifiedseveraldatasourceslistedbelow.

• Specializedassessmentandconsultation–C.A.R.S.• Children’sServicesSystemReview&Consultation(CSSRC)report–C.A.R.S.• Communitytabledata–C.A.R.S.• STEPS/UDSS-C.A.R.S.• Whateverittakes(WIT)-EMYS/Griffin(SeeAppendix5foradescriptionoftheWITprogram)

Inadditiontothesourceslisted,theworkinggroupidentifiedothersaspromising,butbeyondthescopeand/orcapacityoftheworkinggrouptogatherandanalyze,orweretoocomplexandinconsistenttobeusefulatthisstage.

• Datacollectiontools/screenerswhichcouldhelpdefinecomplexity(CAFASetc.)wasdeterminedtobebeyondthecurrentscopeoftheworkinggroup

• Policereports,hospitaletc.weredeemedtoocomplexfortheworkinggrouptocompile• Seriousoccurrencereportsarecomplexandinconsistentevenwhenrolledup,inagencyannual

reports,andnotnecessarilyrelatedtoresidentialtreatmentprograms

UnderstandingtheCurrentDemandTobetterunderstandandclarifythecurrentdemand,theworkinggroupidentifiedkeyelementswhichcouldhelpprovideabetterunderstandingofthecurrentdemandontheresidentialsystem.Asthesinglepointofentryforresidentialplacement,C.A.R.S.providedinformationtotheworkinggrouponseveraloftheseelements:

• Basedontheagreeddefinitionofwaittimes,identificationofthedemand• Numberofyouthcomingfromhospitalintoresidentialtreatment• Regionalissues/outofcatchment(meetingtheneedsofTorontochildrenand/orthoseoutsideof

Toronto,outsideoftheprovinceo Inreviewingthedata,C.A.R.S.hasdeterminedthattherearenothighnumbersofoutofthe

regionplacementshoweveranoutofcatchmentprotocolisinplace

Someelementswerebeyondthecurrentscopeoftheworkinggroupmandate:• Placementhistoryandinstability(hardtoaccess)–howmanytimesyouthmovewithinand

outsidethesystem• Transferwithinthetransferpaymentagencies• Outcomedata

CurrentAgency-levelCapacitytoRespondEffectivelyOneofthefirsttasksofRWGwastodevelopacomprehensiveinventoryofexistingresidentialprogramsinToronto.C.A.R.S.providedadetailedresidentialprogramsummaryforToronto(typeofprogram,specializations,clientprofiles,numberofbeds,staffinglevels,lengthofstay,psychiatricandmedicalservicesandsupport,typesoftherapy,assessmenttoolsetc.)Theworkinggroupreviewedandrequestedadditionaldatathatwouldassisttheminformulatingrecommendationsaswellasstrengthenfuturesystemplanning.


EMERGINGTRENDSGapsandStrengthsPartofthereviewofexistingreportswasananalysisthroughalensoncapacitytoidentifystrengthsandgapswhichcurrentlyexistinthesystem.AfullspreadsheetanalysiswasprovidedbyC.A.R.S.whichprovidedasnapshotofthecurrentstateofthesystemincluding:Inventoryofbeds,clientprofile,lengthofstay,occupancyrates,waitlists,treatmentoptionsavailableetc.TheRWGalsofeltitimportanttohighlightexistingsystemstrengthsasidentifiedbytheworkinggroupmembers.Theintentwastoensurethataswerecommendandimplementchangeweareabletobuildonthesestrengthswithoutlosingexistingcapacity.Strengthsidentifiedbytheworkinggroupinclude:

• Awidevarietyofprogramsorages0(infants)–18years• Continuumofserviceandage• Fluidityoftransitions(upuntiladult)• C.A.R.S.-systemnavigation,centralintake• AccesstoSTEPSflexfunding• Willingnessofagenciestobeadaptableandaccommodatetochild’sneedseventhoughthechild

maynotfitstrictlyintotheprogram• CommunityTableswhereabroadrangeofserviceprovidersworktogethertoresolveaclient’s

servicechallenges• Sector-wideconsensustoimprovethesystem• Asenseofcommunity,inclusionofchildandfamily• Afocusonthewelfareoftheclient• Arichnessofknowledge,expertiseandtrainingofstaff• Thesystemfocusesonhavingqualifiedpeopleinthedifferentpositions• Thesystemandagenciesoperatewellbeyondwhatthelicensingrequiresandresources

provided• AwillingnesstoworkwithChildWelfareandaddictionorganizations,CSSRC,hospitals,colleges

anduniversitiestotakestudentplacements• AccesstomultipleservicesofferedinallCYMHagencies–accesstocommunity-basedservices

wealloffer• Involvementoffamilies(broaddefinitions)inresidentialtreatmentascoreservicepartnersand

workhardtoengagethemandtoincludesystemsofsupport• Clientswithcomplexneedsandavarietyofdiagnosis/diversityareserved• AccesstotheYouthdalewaitlistmanagementprogram• AccesstoSection23programs

C.A.R.S.providedadetailedanalysisofgapsinthesystemhavingrevieweddatafrom:communitytables,WIT,STEPSandCSRC.Somegeneralthemesrelatedtosystemgapsidentifiedbytheworkinggroupinclude:

• Psychiatric/medicationmanagementrepresentsahighneedbutisnotnecessarilywidelyavailableinourprograms

• Thereneedstobebetteridentificationofdemographicdataonwho’saccessingthesystem(culture,newcomers,languageetc.)

• Thereisalackoftransitionalageresidentialoptions• Thereneedstobeadeeperlooktoidentifypriorities


• Lackofcross-ministerialcoordination• Needforadaptiveassessments• Thereisalackofcrash,admissionassessmentandrespiteoptions• Thereisaneedforfurtherreviewofthegapsandoptionstobetterquantifythe

WaitlistsTheconceptofwaitlistsisIncludedinthe“Definitions”document.Theworkinggrouphoweverengagedinfurtherdiscussiontobetterdescribethecontextualenvironmentsurroundingthisimportantissue.

• Forresidentialtreatment,waitlistsaremediatedthroughtheprocessesatC.A.R.S.• ItwasnotedthatMCYScollectsdatabydefiningwaitlistsstartingfromwhentheystartthe

serviceatanagencyandarenotnecessarilyaccurateindefiningthenecessaryservicesdeliveredorneed

o Waitlistsshouldnotbetreatedinthetheoryofhotels/hospitalswhereanemptybedcanbefilledrightawaywithoutconsiderationoftheneedsoftheclientsonthewaitlistsorexistingclientsintheresidences

o Thisisanopportunitytorecommendwhattoconsiderwhendiscussing/definingwaitlists

o Thesystemshouldlookatclientwaitingtimesv.waitinglistsandmatchingthetwotoensurepropercareandservice

VISIONOFTHEFUTURESYSTEMWiththeassistanceofPeterO’Donnell,theRWGparticipatedinavisioningexercise.Thepurposewastocreateavisionforresidentialserviceswhichwouldformthefoundationofrecommendations.Theresultwasthedevelopmentofguidingprinciplesandalistofdriversforsuccess.Thefinalrecommendationswereformulatedbyexploringthesystemchangesandthestructuresthatwouldneedtobeinplaceachievethedriversofsuccess.GuidingPrinciplesAresidentialtreatmentsystemthat:

• Prioritizestheneedsofinfants,children,youthandyoungparents• Strivestomeettheneedsofdiversepopulationsandworkstoeliminateoppressionand

promoteequity• Supportsandincludesfamilies/caregivers• Isresponsiveandaccessible• Strivesforseamlesstransitions.• Promotescontinuityofcareandreducesduplicationforclients• Buildsonexistingstrengths• Matchesintensityofresourcestotreatmentneedsandprovidesacontinuumofservice(in

homeintensive,respiteandtiersofresidentialtreatment)whichincludesaccesstoamultidisciplinaryteam

• Isdatadriven,basedonevidenceinformedpracticesanddemonstrateseffectiveness.• Istransparentandaccountabletostakeholders• Supportssystemwideplanninganddecisionmakingwhereagenciesworkaspartofthesystem

andmakecollectivedecisionsratherthanthosebasedonindividualagencyneed• Infants,childrenandyouthareconsideredasharedresponsibilityofthesystem


• Isflexibleandadaptablealwaysstrivingtoidentifyandfillgaps• Utilizebestpracticeswithinavailableresources

DriversofSuccess

• Eligibilitycriteriaareclearlydefined• Centralizedaccess,assessmentandintegratedserviceplanningforclients• Commonassessmentprocessincludingtool(s)• Commondatacollection• Keyperformanceindicators• Thesystemprovidesyoungparents/infants,childrenyouthandtheirfamilies’accesstothefull

continuumofserviceincludingaftercare• Accesstocentralizedresources• Resourcesarematchedtointensityofneed(forexample:child/youthidentifiedas“tier4”has

greateraccesstoresources/multidisciplinaryteam;resourcesareprovidedtomeetdiverseneedsandincreaseaccessibility)

• Systemisintegratedwithothersectors• Crosssectoralsystemplanningtablestoaddresssystemissues• Treatmentbasedonassessment• Traininganddevelopmentforstaff• Strengthsbasedandcollaborative(youthandfamilyengagementisfundamentalandrequired)• Allprogramsareevidenceinformed,focusonqualityimprovementandcontributetothe

developmentofevidence(includinglongitudinalevaluation)whilesupportinginnovation• Properlyandadequatelyfundedandsustainable

RECOMMENDEDAREASFORACTIONEstablishabroad-basedcross-sectoralsystemplanningtableTheworkinggroupstronglyrecommendsestablishingacross-sectoralsystemplanningtableasthefoundationofmovingforward.ItisintendedthatthistablewouldreporttotheleadagencyandshouldhaverepresentationfromCoreserviceproviders(withrepresentationfromtheadolescent/latencyandyoungparentgroups)aswellasfromotherrelatedsectorssuchaschildwelfare,educationandhealthThemandateforthisgroupwouldbeto:

• Reviewdatatodeterminegapsandtrendsandcommunicatethisinformationtothesystem• Provideaforumatwhichchangestoagencyprogramsincludingprogramclosuresor

reallocationofresourcesfromresidentialtreatmenttoinhomeintensiveservice,forexample,couldbediscussedandconsideredfromtheperspectiveofthepotentialimpactonthesystem

• DiscussandmakerecommendationsreissuesthatimpactandareofconcerntotheentireintensiveservicessysteminToronto.e.g.Howcanthesystembecomemoreresponsivetochangingneeds,thecreationofcentralizedresourcese.g.psychiatry,psychology,etc.;whatisthebestuseandaccesstoSTEPSfunding;whatistheappropriatelevelofresourcesforeachprogram“tier”(levelofintensity);etc.Evaluatethesysteme.g.intheareasofeffectiveness,efficiency,accessibility,etc.

• Themandateoftheplanningtablemustalsoincludethevoiceofyouthandparents/caregivers.Thetermsofreferenceoftheplanningtableshouldincludeasectionwhichdelineateshowyouthandfamilyvoicewillbeincluded


Theworkinggroupalsorecommends,eventually,thistablewouldoverseeallintensiveservices(Ex:Thisgroupwouldbethetabletoprovidetheanalysisandrecommendationsforconsiderationssuchasconvertingaresidentialtreatmentprogramintoanin-homeintensiveserviceetc.).Giventhecomplexity,a“phased”uptakeapproachcouldbeconsidered,startedmoreeasilybyhavingthegroupaddressresidentialservicesfirst.YoungParents/Infants,ChildrenYouthandtheirFamiliesShouldHaveAccesstotheFullContinuumofServiceIncludingAfterCare/TransitionalSupportThecontinuumwould,atminimum,includeallintensiveservices:daytreatment,in-homeintensiveservices,residentialtreatment.Asystem-wideprocessshouldbedevelopedbywhichaclient’slevelofneedisappropriatelymatchedtotheneededlevelofsupportprovidedbytheprogrami.e.program“tiers”.Clientswhoseneedsrequirethemostintensivelevelofservicesshouldhaveaccesstothewidestanddeepestrangeofsupportsandthesesupportsshouldbewellcoordinatedandseamlesslyintegrated.

DeterminewhatservicescomprisethefullcontinuumofservicesandidentifywhichservicesandwhatlevelofintensityoftheseservicesisassociatedwitheachtierWerecommendthefullcontinuumincludethefollowing:• Respite• Daytreatment• In-homeintensivetreatment• Short-termassessmentandstabilizationhomes• Residentialtreatment(includingtiers2-4whichwouldalsoincludeprogramsthattreat

anywherefrom2-8clientsatonetime)• Homesfortransitionalageyouth• Psychiatry,psychology,etc.• Aftercare/transitionalsupport

Priortochanging,addingorremovinganyexistingservices,thecross-sectoralsystemplanningtablewouldneedtoknowhowmanyofwhattypesofservicesareneeded.TheworkforthishasalreadystartedthroughagapsanalysiswhichhasbeencompletedbytheRWG.Theinitialyearofplanninghowever,needstofocusonabroaderunderstandingofneed.Furtherweneedtoidentifygapsinthecontinuumandhowtobestaddressthem.Anexampleisthecurrentgapinlatencyagedresidentialtreatmentbedsforchildrenaged10-13.Adeterminationwillneedtobemadeaboutwhichagencymightbeinthebestpositiontofillthisgapwithoutinadvertentlycreatinggapsinotherareas.• Gapsinservicesintransitionalageclients-10-13and18+needstobeprioritized• Ideallydaytreatmentshouldbeaccessedaspartofthecontinuumofcentralized

intensiveservices.Todeterminehowthiscanbestbeaccomplished,implicationsandconsiderationsshouldbereferredtoandaddressedattheEducationTable

• Weneedfurtherexplorationoftherolethatcanbeplayedby:WIT,familynavigators,tele-psychiatryandhowtheycanbeconnectedtotheIntensiveServicescontinuum?Explorecloserconnection/coordinationbetweenWITandC.A.R.S.andwrap-aroundservices


Determinewhichservicesandatwhatlevelofintensitycompriseeach“tier”(forexample:child/youthidentifiedasneeding“tier4”levelofserviceshasgreateraccesstoresources/multidisciplinaryteamthanachild/youthneeding“tier2”).• Resourcesshouldalsobeprovidedtomeetdiverseneedsandtoremovebarrierswhich

limitaccesstoservices• Formalizefunding/resourceallocationtotiers(funding/investmentshouldfollowthe

needsoftheclient–flexibilityofthesystemtomaximizeinvestmentforgreatestimpact)

• Inventoryofexistingresourcesandfundingconnectedwithspecializedserviceso Whopaysforservices?o Partnerwithhealth?o Crisisteammoreaccessibletothesystem

CentralizedAccess,AssessmentandIntegratedServicePlanningforClientsClientstellusthatourintakeprocessesareintrusiveandcumbersomeandthattheyareregularlyrequiredtorepeattheirstories.Currentlyeachagencyhasitsownassessmentprocessandoftenfamiliesareassessedbymorethanoneagencywithoutaclearunderstandingoftheeligibilitycriteriaorthetreatmentmodelthatwouldbestmeettheirneeds.Acentralizedassessmentprocessfoundedoncleareligibilitycriteriaandintegratedserviceplanning(accesstothefullcontinuumofintensiveservices)willimprovethesystemforinfants,children,youthandfamilies(similartothecurrentpilotforlatencyagedchildren).

Determineaprocessbywhichaclient’slevelofneedwillbematchedtotheappropriate“tier”(SeeAppendix7forthedefinitionsofthetiers)ThisprocesscanbefacilitatedbytheCrossSectoralSystemPlanningTable.Somekeyactivities:• EligibilitycriteriaforIntensiveServicesneedtobedeveloped,documentedandposted

onwebsites• Screeningtoolsandprocesstobedeterminedandimplemented,including

determinationoftierofservicerequiredbasedonclientneed• Processandtoolsdevelopedtodeterminewhichintensiveserviceorcombinationof

intensiveserviceswillbeofferedtomeettheneedsoftheclient.Intensiveservicesshouldbedividedintoappropriategroupingse.g.YoungParentResourceServices,latencyagedservices,adolescentservicesetc.Communitytables,triagingofclientsanddeterminationofthetypesandtiersofintensiveservicesthatwillbestmeettheclients’needsshouldbeorganizedwithserviceprovidersfromthesegrouping

• Developacommonassessmenttodetermineyouthandfamilyreadinessforintensiveservices

• DeterminecommonKPIs.TherewillalsoneedtobeprogramorclientspecificKPIs.Strengthsbasedandcollaborative(youthandfamilyengagementisfundamentalandrequired)isacriticalsuccessfactorandshouldbeevaluated

• Developaprocesstoaddressparticularlychallengingtoserveclientneedse.g.bringcommunitytablestogetherforspecificclientneeds

• Treatment-basedassessmentisacriticalsuccessfactor.ThiscanbeaddressedafterthesystemissetupandwouldberootedintheKPIs


Eligibilitycriteriaareclearlydefined• EligibilitycriteriaforIntensiveServicesneedtobedeveloped,documentedandposted

onwebsites.(Crosssectoralplanningtablerole)• Adeterminationneedstobemadethroughthescreeningprocesswhethertheclient

meetseligibilitycriteriaforIntensiveServices.AllclientswillbescreenedatanindividualagencyusingtheInterRai/Latencyagetool/YoungParentsscreener.Thistool,aswellasaseriesofquestionstobeaskedbyallIntakeWorkerswillbeusedtodetermineeligibilityforintensiveservices

• Adeterminationwillneedtobemadeaboutwhichtierofintensiveservicetheclientrequires:tier2,3,4)

Commonassessmentprocessesandtool(s)• TheInterRaiscreenerisusedinotherjurisdictionsaspartoftheassessmentprocess.

Currentlyeachagencyhasitsownassessmenttools.Ideallyforfamilies,agencieswithinstreams(latency,adolescent,youngparents)wouldusethesameassessmenttools

• Parentsprogramsalreadyhaveacommonscreeningtool.Asmallworkgroupwillneedtodeterminewhatothercommonassessmenttoolsorquestionswillbeused.Ascreeningtoolneedstoberecommendedforlatencyagechildren

Centralorientationforintensiveservices• Clientswillbeinvolvedintheentireprocessbeginningwithanorientationtointensive

servicesviae.g.video,afterwhichdiscussionwouldoccurwithC.A.R.S.astowhichservice(s)theyneed

Buildingonexistingcapacityforcentralizedaccessandcoordination–ExpansionoftheroleandcapacityofC.A.R.S.• ToaidC.A.R.S.’sinitialdecision-making,specificeligibilitycriteriawillbedeterminedfor

eachgroupingofserviceproviders• Informedconsentfromtheclienttobeobtainedattheoutsetsothatinformationcan

besharedwithinthesystem• Currentcommunitytables,facilitatedbyC.A.R.S.,tocontinueforclientswithcomplex

needsthatthesystemmayfindchallengingtomeet• C.A.R.S.tocontinuetoprovidedatatotheleadagencyandserviceprovidersregarding

clientprofilesandsystemutilization• C.A.R.S.willcontinueinitsroletocollectdataonbehalfofthesystem.(See“Dataand

InformationCollection”section)Ontopofwhatisalreadycollected,thefollowingdatashouldalsobeincluded:

o InterRai/Screenerscoreso Moredetailedinformationaboutthepresentingproblem(s)o GeographicmappingofclientsforallIntensiveserviceso Quantifygaps/needs-howmanyofwhattypesofclientswasthesystem

servingandnotabletoserveo AnalysisofwhoisNOTbeingadmittedandwhy?o Whathappenstoclientspostdischarge-someoutcomedataincluding

wheretheclientgoespostdischargeandlengthsofstay


• Considerationshouldbegiventoseekinginputfromeithertheevaluator’sgrouporaUniversityresearcherabouthowtocollectandanalyzethedatainordertomaximizetheinformationwecollectinyear1

• C.A.R.S.,inanexpandedrole,wouldcontinuetoprovidecentralizedtriagetoresidentialservicesandpotentiallyallintensiveservices(residentialtreatment,inhomeintensiveservices,respiteanddaytreatment).AllintensiveservicesshouldformpartofthecontinuumofservicesofferedtoclientsonceitisdeterminedtheymeeteligibilityforIntensiveServices.C.A.R.S.willlikelyneedanewnametoreflectitsexpandedrole

• C.A.R.S.wouldpresentappropriatereferralstotheappropriategroupingofserviceproviderswhowouldcollaborativelydecidewhichserviceproviderwillprovidetheassessmentofthechild/familyonbehalfofthesystemprovidedithasnotbeencompletedpriortothereferraltoC.A.R.S.

• OnceC.A.R.S.determineswhichagencywillleadtheassessment,thatagencywillcompletetheassessment.Ifitisdeterminedtheirservicesarenotthemostappropriatethatagencywillmakesureallinformationistransferredtothemostappropriateserviceprovidersothefamilyrepeatsaslittleinformationaspossible.Theagencyreceivingtheassessmentwillnotre-doorrestarttheassessmentbutmayaddinformationwhichwillhelpdeterminetheirabilitytomeetthetreatmentneedsoftheclient

DataandInformationCollectionWhileC.A.R.S.hasgatheredrichdataaboutthecurrentsystem,thegroupidentifiedsomeimportantgapsininformation.Theworkinggroupisrecommendingthat,overthecourseoftheupcomingyear,thisdatabecollectedandanalyzedwithaviewtomakingrecommendationsforsystemschange(programchangestoaddressservicegaps,possibleconversionofresidentialprogramstoinhomeintensiveorextendeddaytreatmentprogramsetc.).Theworkinggroupfeltstronglythatnosystemwidedecisionsshouldbemadewithoutathoroughdataanalysisofneedandgaps.Therewasconcernthatwithoutasystemapproach,programsmaybeconvertedorclosedwithalaterrealization(aswasseeninthelatencysystem)thatanactiontorespondtoonegapmaycreateanotherunforeseengapinanotherareaofthesystem.

• Weneedaninventoryofin-homeintensiveservicescurrentlyavailableinthecity.Theworkinggrouphasdraftedasurveyandcancompilethedatafortheleadagency,C.A.R.S.andthesystem.Thissurveytobeincludedintotheleadagencydatastrategyandactivities

• Ananalysisneedstobecompletedaboutthenumberandtypeofrespitebedsrequired• Considerationshouldbegiventoreviewingexistingdata(year1servicemapping,year2

surveysetc.)• Leadagencyshouldpartnerwithauniversitytoconductalongitudinalresearchprojectonthe

outcomesofresidentialtreatmentservices.Thisisacriticalsuccessfactor,howeveritcanbeaddressedafterthesystemissetupandwouldberootedintheKPIs

• Thereneedstobeacomprehensiveenvironmentalscanofbestpractices(withinoursystemandinotherjurisdictions)


SystemSustainabilityandAdvocacyTheworkinggrouprecognizedthatsustainabilityneedstobeaprioritywhenmakingsystemchanges.Therealityhowever,isthatthesystemisstretchedandunderresourced.Asaresult,theworkinggroupisrecommendingadvocacywithgovernmentoncedataiscollectedandwehaveabetterunderstandingofneedandsystemspressures.Theeffectivenessandefficiencyofthesystemisdependentonadequateresourcing:

• Respitebedsareneededwithinthesystem–advocacywillbeneededtoremovelicensingbarriersthatcurrentlyprohibitresidentialtreatmentprogramsfromusingtheirbedsforrespite

• Flexibilityreagelimitationsonbedsisneededtorespondbettertoclients’needs–advocacyneededtoremoveanypotentiallicencingbarriers

• Isthereawaytoaccessfundingandresourcesfromothersources:MinistryofHealth,MinstoryofEducation,MCYS-YJ,MCYSFASDstrategy?Oncedataiscollectedanalyzedbytheadvisory,othersourcesoffundingcouldbeprioritized

• ThefutureroleofHDCanditsmergerwithSickKidsneedstobebetterunderstood.CanSickKidsresourcesbeleveragedforthesystem?

• Afundedsystemneedstoincludefundingfortrainingandincludefundingfortheimplementationofevidenceinformedtreatmentmodalities.Backfillcostsforstafftoattendtrainingareprohibitive.Agenciesdonothaveresourcestopayrelief/parttimestafftoattendtrainingyetreliefstaffareavitalpartofthetreatmentteam.Fundingneedstobeallocatedtosupporttraining

• Thiswillrequireadvocacyataministrylevel.Thismayalsorequireconversionofsomeresidentialtreatmentprogramstoinhomeintensiveorextendeddaytreatmentprogramsetc.basedonneedandutilizationrates

• Theworkinggroupisrecommendingthatresourcesnotbereallocatedorprogramsclosedorconverteduntilatleastoneyearofdataiscollectedandanalyzedtobetterunderstandclientneeds.Atthisstage,wedonotknowhowmuchin-homeintensive,residentialtreatmentorextendeddaytreatmentisrequireduntilgreateranalysisincompleted


WORKINGGROUPMEMBERS

Thankyoutoourdedicatedworkinggroupmemberswhomadethisreportpossible:

• DebbieSchatia,TurningPointYouthServices(WorkinggroupChair)

• PaulAllen,YouthdaleTreatmentCentres

• EkuaAsabeaBlair,MasseyCentreforWomen

• SusanChamberlain,GeorgeHullCentreforChildrenandFamilies

• CarolynClark,HinksDellcrest

• DeannaDannell,GriffinCentreMentalHealthServices

• ZelFellegi,AislingDiscoveriesChildandFamilyCentre

• DarrenFisher,EastMetroYouthServices,TorontoLeadAgency(LeadAgencyliaison)

• SteveGregory,YouthdaleTreatmentCentres

• BrianO’Hara,DelisleYouthServicesCARS

• ShirleyShedletsky,DelisleYouthServicesCARS

• KarenProsper,ArrabonHouse

• LydiaSai-Chew,SkylarkChildren,Youth&Families

• DeliaSmith,CentreFrancophonedeToronto

APPENDIXES

Appendix1 WorkingGroupMembers

Appendix2 InformationandReportsPresentedbyC.A.R.

Appendix3 ListingofReportsReviewedbytheResidentialTreatmentWorkingGroup

Appendix4 LexiconofDefinitionsProposedbytheResidentialTreatmentWorkingGroup

Appendix5 InformationaboutSpecializedPrograms

• WIT(Whateverittakes)Programs-EMYS/Griffin• InfantandYoungParentResidentialPrograms• DayTreatmentProgramsforfrancophonestudents

Appendix6 LatencyAgedWorkinggroup:FinalReport(2016)

Appendix7 DefinitionofTiersforIntensiveServices

EastMetroYouthServices|LeadAgencyforMovingonMentalHealth–TorontoHeadOffice:1200MarkhamRoad,Suite200,Scarborough,OntarioM1H3C3

LeadAgencyDowntownOffice:365BloorStreetEast,Suite1010,Toronto,OntarioM4W3L4Tel:416-438-3697|Fax:416-438-7424|Email:[email protected]

www.emys.on.ca

RegisteredCharity#130563166RR0001|AccreditedbytheCanadianCentreforAccreditationSupported by The Government of Ontario

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