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Ontario Shores Letters

January 31, 2011

To Whom It May Concern:

It is always worrying to hear of valued programs that have provincial reach making significant problematic changes and especially when such changes involve alterations in the multidisciplinary mix of professionals.  This is particularly true in child and youth mental health services which already are so under-resourced and so fragmented in this province.

At the Children’s Hospital of Eastern Ontario (CHEO), we have always greatly appreciated the valuable, longer residential interventions Ontario Shores (formally Whitby) had been able to provide to our more complex young people requiring more than the crisis stabilization and brief interventions we can provide on our inpatient psychiatry unit. With the changes in skill mix to permit your capacity for 24/7 nursing, the layoffs of Child and Youth Workers (CYW) are indeed most unfortunate. If, as a result, the medical complexity and medication needs of the inpatient population is increasing, this skill mix is understandable and indeed matches what we have at CHEO.

As with our program, Child and  Youth Workers are highly valued members of the multidisciplinary team that contribute to the successful outcomes often enjoyed by young people even with complex needs. The specific expertise of CYW’s in the developmental, social, emotional and behavioral domains is vital in the day to day encounters and experiences with these young people. The CYW skill value is fundamentally different from RN’s and certainly very different also from RNA’s. When elaborating most appropriate skill mixes and multidisciplinary teams, we need to be extremely mindful of not only what our young people need but also what would best serve their best interests.

I sincerely hope that the longer term residential intervention we have become accustomed to at Ontario Shores to better serve our young people with complex needs, will at least continue if not be enhanced by the decision to substantially alter the skill mix in the program. If the decision represents yet another service cut to child and youth mental health, it will come at great cost, not only to the very people we serve, but also to Ontario tax payers as more young people will need out of province or out of country service and also to many well trained Child and Youth Workers who are losing their jobs.

Yours sincerely,
Dr. Simon Davidson
Medical Director, MHPSU, CHEO|
Professor and Chair of the Division of Child and Adolescents Psychiatry

c.c.:  Gilles Charron, Intake Worker, CHEO
         Mike Wattie, Intake Worker, CHEO

January 27, 2011

Dr. Eric Fonberg
Rouge Valley Health System
Emergency Department
2867 Ellesmere Road
Toronto ON  M1E 4B9 

Dear Dr. Fonberg:

We are writing to you in your capacity as Chair of Ontario Shores Centre for Mental Health Sciences.

In December Ontario Shores issued layoff notices to 28 of 40 Child and Youth Counsellors. The layoffs were part of changes to the adolescent program, including merger of the short stay Assessment, Stabilization, Treatment and Transition Unit with the longer stay Adolescent Residential Rehab program.

The five bed short stay program is not the only one in the region. The longer stay program is unique in Ontario — it attracts adolescents from across the province whose experience with short stay has not worked. These youth have between three and seven prior hospitalizations before coming to Ontario Shores.

Last year there were 14 youth served by the long term program. The average wait to get into the program was 44 days.

The stated intention of Ontario Shores is to replace the CYCs with a smaller number of nurses – mostly RPNs. They also intend to expand the short stay program without increasing the total number of beds, which by default means fewer long stay beds.

Given these two important changes, it is the expectation of most experts that the long stay program will be phased-out, leaving these difficult to care for youth caught in a revolving door they can’t get out of.

In the short term, there is also concern about mixing together two very different adolescent populations.

Child and Youth Counsellors have three years of intensive training in adolescent behaviour. In the long-stay program they develop unique plans for each adolescent in their care. The posting for the nursing positions make any prior experience with adolescent mental health an asset, not a requirement.

The hospital maintains that it is moving to a more team-based model, however, we can assure you that the opposite is taking place. Nursing staff have always been part of this program. In addition to the loss of the CYCs, the program also eliminated half of its social worker positions in early 2010. It is becoming less team based, not more.

The hospital maintains that these changes are evidence-based and that extensive consultation has taken place.

However, CEO Glenna Raymond writes that the consultation was about expanding the short stay program. None of the referral partners we contacted were aware of being consulted about these very fundamental changes to the long stay program.

Further, since December OPSEU has been seeking the hospital’s evidence to support this decision. We were initially told that it had to be assembled, which of itself raises suspicions. If the decision were based on evidence, why does the hospital have to go looking for it?

An OPSEU Steward was recently told that the evidence had been prepared, but was given to the communications department instead given the publicity surrounding the changes. This, of course, is absurd. I’m sure Ontario Shores is in possession of a photocopier. We still have none of the hospital’s evidence to support this decision.

A Dr. Pamela Wilansky-Traynor, manager of professional practice and leader of psychology at Ontario Shores, told the local media that the evidence came from the American Academy of Child and Adolescent Psychiatry. When we contacted the Academy, they asked us for Dr. Wilansky-Traynor’s address so they too could find out how their evidence was being used under these circumstances.

Further Dr. Wilansky-Traynor quotes the first page of the Academy’s web site about treating children in the least restrictive environment, however, she ignores the more in-depth discussion about support for youth for whom short stay programs do not work.

We would also caution about American recommendations around staffing given the training and role of CYCs is considerably different in Canada than it is in the United States.

The Adolescent Residential Rehab program has successfully treated youth at the Centre for more than 40 years. To us that is the strongest evidence in support of maintaining this program.

We have collected letters from a variety of sources, including two specialists in adolescent mental health, which we are attaching here.

We would ask that you and your board revisit this decision and do the right thing.

Should you have further questions, we would be more than pleased to facilitate a meeting with our CYCs or any of the experts we have relied upon.

Sincerely,

Warren (Smokey) Thomas

OPSEU President

cc. Ontario Shores Centre for Mental Health Sciences Board

 

January 30, 2011

Dr. Eric Fonberg
Chairman, Ontario Shores Centre for Mental Health Sciences
700 Gordon Street
Whitby, ON, L1N 5S9

Dear Dr. Fonberg:

After reading the Whitby – This Week newspaper article regarding the changes that are in the process of being implemented in the adolescent program at Ontario Shores Centre for Mental Health Sciences in Whitby, I want to express my concerns.

I was hired as a child care worker for the adolescent program in January 1972. Adolescents had recently been moved from the adult wards to a separate “cottage”. This was seen as being in the best interests of the adolescents and their families. Initially, staffing was provided by RNs and PRNs. Child and youth workers, or as they were known then, child care workers, were soon hired to provide behavioural, developmental and mental health services that were not available through RNs and RNAs. A few RNAs remained as adolescent staff and were required to further their education by obtaining a child care worker diploma through George Brown College extension courses. Social workers, school teachers and psychology staff worked with the child care workers to provide these services. Psychiatric services were provided by Dr. John Deadman, who was the Medical Director for the hospital.

In the mid 1970s, funding was moved from MOH to MCSS to co-fund the adolescent program that was to include a multi discipline approach including child and youth workers for daily programming and counseling, nurses for physical and medical issues, social workers, psychologists and psychiatrists, all who had training with adolescents. A second “cottage” was opened to provide a secure, short term, crisis program for adolescents as part of the MCSS Four Phase plan for the Eastern Region. Again, this program evolved in keeping with the best interests of the adolescents and their families. Cottage 6 continued a multi discipline approach providing longer term treatment for adolescents.

Having worked as a front line staff, a supervisor and the residential coordinator over approximately a ten year period with the adolescent program, I have experienced first hand how effective this type of multi disciplinary group of staff can provide assessment, treatment and recommendations for adolescents and their families. The adolescent programs at your facility have been held in high esteem for over thirty years by families, community agencies, general hospitals, children aid societies, school boards, ministries and community colleges. Staff members have actively participated in presenting at seminars and conferences, providing training for community agencies. The programs also provided a positive environment for student placements for community colleges for child and youth workers. General hospitals, school boards and children aid societies have added child and youth workers to their teams to better meet the needs of the children and adolescents they serve, partially as a result in the ground breaking work done in the adolescent programs at this facility.

Over thirty-some years, the adolescent services have evolved with the needs of the community while maintaining a high level of professionalism and service. It is important that programs continue to meet the needs of their community while keeping the best interests of the clients at the forefront. Does decreasing the number of beds for adolescents and essentially closing a valuable program meet the needs of our adolescents and their families?

I am having difficulty grasping the major shift in the manner that the Board of Ontario Shores has decided to staff this evolving program. It appears that Ontario Shores is moving back to a modified version of the original model from the late 1960s, which was not effective, with small allowances for keeping a few token child and youth workers. It seems to me that this will not even allow for a child and youth worker on each shift.  Is this in the best interests of the adolescents and their families or is it a step backward? Is this a cost saving factor for the facility to have the majority of front line staff be RNs for flexibility of movement within the facility at large? Will this provide consistency and continuity for the adolescents and their families? Will decreasing the number of social workers impact on the adolescents and their families and the program as a whole? I believe it will.

I must agree with Dr. Gabrielle Ledger who stated in her letter date December 26, 2010, that “the recent decisions made by the administrators of this newly divested hospital suggests that they may be unaware of the history of the programs and the careful evolution that occurred before their tenure at Ontario Shores” or is it that they do not care?

Sincerely.

Doreen Sjonger

 

January 14, 2011

The Hon. Deb Matthews
Minister of Health
10th Floor, Hepburn Block
80 Grosvenor St.
Toronto, ON    M7A 2C4

The Hon. Laurel Broten
Minister of Children and Youth
14th Floor, 56 Wellesley St. W.
Toronto, ON
M5S 2S3

Mr. Foster Loucks – Chair
Central East LHIN
Harwood Plaza
314 Harwood Avenue South
Suite 204A
Ajax, ON   L1S 2J1

Dear Minister Matthew, Minister Broten and Mr. Loucks,

I am writing out of concern over recent developments at Ontario Shores Centre for Mental Health Sciences (OSCMHS), changes to take effect on April 13 that I believe represent a giant step backward for youth mental health services in Ontario.

Days after the Legislature recessed in December, 52 positions at OSCMHS were eliminated. As you will know, OSCMHS, formerly Whitby Mental Health Centre, offers our province’s only long stay adolescent residential rehabilitation program.  Twenty-eight of these workers are specially trained child and youth counsellors (CYC), whose skills, training and experience have guided many successful outcomes for young people affected by the most complex of mental health challenges.

I am aware of recent government pledges to overhaul and transform Ontario’s mental health system.   Therefore I find it most concerning that a vital component of the system is in the throes of winding down. 

The dearth of long-term residential mental health treatment services for adolescents is already a well-known problem.  

I question the wisdom of terminating 28 Child and Youth Counsellors at OSCMHS.  They are professionals who are intensively trained to work with children and youth and cannot be replaced by mostly registered practical nurses.  It appears as though the stage is being set to reduce and replace longer term residential services with short-term and outpatient programs.  For the young patients and their families, this marks a return to the ‘revolving door’ of services that experts in the field decry.

In fact, the change in direction for youth mental health services at Ontario Shores Centre for Mental Health Sciences has prompted Dr. Gabrielle Ledger, a leading psychiatrist there, to resign.  Another medical expert and former employee, Dr. Krista Lemke, Medical Director of Child and Adolescent Mental Health Services at the Toronto East General Hospital, has voiced grave concerns about the loss of these specialized workers to the program.

CYCs will be replaced by nursing staff under the Ontario Shores plan.  Given OSCMHS already has difficulty recruiting and retaining nursing staff, it is unlikely that the promise of 20 additional nurses to the program can be fulfilled. With the nurses needed to replace the CYCs, there are presently 75 nursing vacancies at the hospital. The two vital roles are not interchangeable: CYCs attend a fully accredited three-year program specific to child and adolescents, quite different from general nursing training. 

Ontario’s child and youth specialists have been an integral part of provincial mental health programs for close to four decades.  They must be included in the mix of health care professionals who work as a team within these programs.

While the administration at OSCMHS claims to have consulted broadly on these changes, I have yet to see documentation that supports this.  One would expect that a change of this magnitude – a reduction of residential treatment services for children with mental health issues – would be backed up by evidence and the achievement of consensus, neither of which appear to have been produced.

Given that funding for child and youth counsellors comes in part as a transfer payment from the Ministry of Children and Youth Services, I believe it should compel Minister Broten to work in partnership with the Minister of Health and Long-Term Care, the Central East LHIN and OSCMHS to ensure the reinstatement and continuation of child and youth counsellors and this long term residential program.

I look forward to seeing action in this regard and will be pleased to work with all parties to achieve this goal.

Sincerely,

Andrea Horwath
Leader, Ontario’s NDP

Copy:  Glenna Raymond, President and CEO, Ontario Shores


January 12, 2011

To Whom it May Concern,

My name is Jim Martin and I worked for 30 years as a Child and Youth Counsellor (CYC) in the Adolescent Units of Ontario Shores Centre for Mental Health Sciences.  For the last several years, I was the Program Facilitator in the Adolescent Residential Rehabilitation Unit (ARR). 

As many in the Children's Mental Health field know, that unique program was a place of last resort for teens with very serious, complex mental health issues.

I can remember being at intake meetings, trying to prioritize referrals for those highly valued, very scarce beds. They were very difficult decisions to make.  These weren't just names on a file. They were young people, families and agencies who had reached the end of their rope trying to find adequate resources to address urgent needs. 

Very often a general hospital had an adolescent whose behaviours they were not equipped to deal with. These hospitals were desperate to find an appropriate setting for discharge.  

Sadly, for every referral accepted there were at least two or three who could not be served due lack of beds. There needs to be more ARR beds. That is why I was dumbfounded to hear that Ontario Shores is going to, in their words, "reallocate" the beds, which I understand to mean cutting the program. 

I cannot describe the folly of this decision. I worked with a highly professional, skilled, dedicated team of CYCs. The consistency of scheduling and the stability of the staff group allowed for the development and nurturing of trusting relationships with the patients — universally acknowledged as the basis of all treatment involving teenagers.  CYCs are viewed as the cornerstone of adolescent care.

Ontario Shores’ new model involves replacing many CYCs with nurses.  I will not go in to the impact of the difference in their skill sets.  This has been thoroughly and convincingly covered by others. 

I would like to comment on the importance of building relationships with young clients.  In the Adolescent Unit at Ontario Shores the patients and often the staff don't know who will be working in the unit on any given shift. This makes building relationships difficult.  My understanding is that this is because the hospital draws on other wards and a staff "pool" to fill shifts. These staff are nursing staff who readily admit they know little about dealing with adolescents. The administrators are trying to impose an adult model of treatment on an adolescent population to the detriment of the quality of care.

I could offer comment on the reduction of the role of the Social Worker in the program, but I will leave that to others.  Suffice to say, that I thought it was accepted that family work is integral to the treatment of mentally ill children.

There are a lot of things that I believed, in this day in age, to be self evident in the treatment of troubled youth. Ontario Shores is shaking my confidence in that belief.  I anxiously wait for the release of their “evidence-based best practices” and “consultations” that have led to these confounding decisions.

I am truly disappointed and saddened that this situation arose and I feel it necessary to express my self.

Jim Martin

Former Program Facilitator, Adolescent Unit
Ontario Shores Centre for Mental Health Sciences
(Formerly Whitby Mental Health Centre)


December 19, 2010

To Whom It May Concern:

I am writing to express my concerns regarding recent changes in the Adolescent Program at the Ontario Shores Centre for Mental Health Services.  I was previously employed as the Senior Program Psychiatrist of the Adolescent and Young Adult Program at what was then known as the Whitby Mental Health Centre.  For four of my five years at Whitby, I worked in the Assessment, Stabilization, Treatment and Transition (ASTT) unit.  Upon my departure in 2005, I took on the position of Medical Director of Child and Adolescent Mental Health Services at Toronto East General Hospital (TEGH), a position I still hold.  In my role at TEGH, I have been responsible for starting up the child and adolescent mental health program, including a six-bed acute inpatient setting.  I have also worked with our TEGH team to build active links between hospital services and our community partners and have participated in the Ontario Network of Child and Adolescent Inpatient Psychiatric Services (ONCAIPS).  I have thus considered in detail both the optimal configuration of a hospital-based multidisciplinary team and the roles of various hospital-based services in the continuum of child and adolescent mental health services in Ontario.

I would like to address two areas of concern.  The first pertains to the role of child and youth counsellors in the provision of hospital-based child and adolescent mental health services.  I understand that the Ontario Shores Adolescent Program is proceeding with a shift from child and youth counsellors to nursing staff (registered nurses and registered practical nurses) as front-line staff for the inpatient program.  While nursing staff are invaluable and essential team members, I would suggest that child and youth counsellors be viewed in the same way.  In my view, the unique expertise and training of each role is necessary to optimally address the treatment needs of children and adolescents with complex mental health needs.

Child and youth counsellors are specifically trained to understand and address the behavioural, developmental and mental health needs of children.  They are experts in the areas of behavioural programming, therapeutic intervention and activation.  Our child and youth counsellors at TEGH deliver crucial elements of the treatment program and hold leadership roles in the inpatient day program, the day treatment program, and the urgent care and crisis services.  Without the particular expertise of the child and youth counsellors, we would not be able to provide the quality of care that our patients and families have come to expect.  I do not say this lightly.  I would not feel comfortable overseeing the clinical care of child and adolescent mental health inpatients on a team that did not include child and youth counsellors as key members. 

During my time at the then Whitby Mental Health Centre, I was particularly impressed with the collaboration between child and youth counsellors and nurses in the inpatient programs and the overall quality of care delivered by the team.  I felt that the child and youth counsellors were a uniquely qualified group.  Staff turnover within this group was low.  Many of the child and youth counsellors had worked at Whitby for over ten years.  As a result, the team had developed an impressive level of cohesiveness and expertise in working with adolescents with complex mental health needs and those recovering from episodes of serious mental illness.  In my experience, their level of expertise in this specialized area was unsurpassed.  New team members were welcomed into the group and mentored by senior staff, while adding their own fresh perspectives, creativity and energy.  From a human resources perspective, this was a well-functioning team, capable of providing high quality care to a particularly vulnerable population of adolescents.  It saddens me greatly to hear that this unique team no longer seems to be valued and may be largely disbanded.

Although nursing staff are equally essential team members and contribute their own unique set of skills, they often require considerable additional training in child and adolescent mental health to address gaps in this area.  As we started hiring our multidisciplinary team members at TEGH, I was struck by the challenges in finding registered nurses with experience in child and adolescent mental health.  This is, in large part, due to the absence of formal child and adolescent mental health training in the nursing program.  Many of our registered nurses came from positions in adult mental health and gained the bulk of their child-specific skills through working with our child and youth counsellors.  The provision of mental health care to children and adolescents is sufficiently different from that provided to adults that a different multidisciplinary mix is needed.  In a similar vein, since work with children requires work with their families, the role of social workers is also much more prominent than it may be on an adult mental health team.  In short, child and adolescent mental health inpatient care is its own subspecialty and, for many reasons, it cannot be delivered using guidelines developed for the care of adult inpatients.

The second area of concern relates to the amalgamation of the Adolescent Residential Rehabilitation (ARR) and ASTT programs into a single, shorter stay inpatient program.  My concern here relates to the unique role of the ARR program within the continuum of child and adolescent mental health services in Ontario.  This program was developed to address the particular needs of adolescents requiring rehabilitation following an episode of serious mental illness, primarily bipolar disorder, schizophrenia and schizoaffective disorder.  Early intervention and return to optimal functioning is crucial in the outcome of these serious and persistent illnesses.  While many youth with first episode psychosis recover fully following an acute inpatient stay, some do not.  For this latter group, a targeted residential rehabilitation program allows a return to the trajectory of adolescent development that was stalled by illness, and without which the prognosis for a successful transition to young adult life is guarded at best.  I have referred numerous youth to the ARR program, to have them return to my outpatient care many months later having been given a ‘new lease on life,’ so to speak. 

An acute inpatient setting is not a suitable substitute for a well-designed residential rehabilitation program, such as the ARR program.  In fact, lengthy stays on an acute unit can lead to the iatrogenic effects of institutionalization, which can impact negatively on the desired return to optimal functioning.  Furthermore, existing community-based residential treatment programs cannot readily address the unique mental health needs of these youth, without the intensive psychiatric supports and specialized programs needed in their care.  In my view, an adolescent program within a specialized mental health centre is the ideal setting for such a program. 

I believe that the loss of the ARR program will be keenly felt by families and service providers working with this group of adolescents.  There is no other similar program serving youth in the Greater Toronto and Durham regions and very few similar programs in the province of Ontario.  I am gravely concerned that a decision with such broad-ranging impact was apparently made without larger consultation with stakeholders, including the child and adolescent inpatient programs that relied on the ARR program to accept the care of youth with serious mental illness for whom an acute inpatient admission did not allow sufficient stabilization.  Given the importance of this program within the continuum of child and adolescent mental health services, I would suggest that a broad range of stakeholders advocate for its return.            

Thank you for allowing me to express my concerns.  I am doing so out of great respect for the tremendous work that has been done over many years by the adolescent program at Ontario Shores.  I am hoping that the emerging vision for this program will evolve out of a deep understanding of the unique elements and complexities of adolescent mental health and the unique needs, capacities and vulnerabilities of the youth and families we serve.

Yours truly,

 

Krista Lemke, MD, FRCPC
Child and Adolescent Psychiatrist
Medical  Director, Child and Adolescent Mental Health Services
Toronto East General Hospital


 

Letter from Dr. Gabrielle Ledger, MD.

Dec 26, 2010

To whom it may concern:

I am writing to outline my significant concerns regarding the changes underway in the Adolescent Program at the Ontario Shores Centre for Mental Health Sciences. I was previously the staff psychiatrist on the adolescent Assessment, Stabilization, Treatment and Transition (ASTT) program from September 2009 until December 2010. I resigned from my position as a direct result of the changes currently being implemented in this program.

My colleague, Dr. Krista Lemke, Medical Director of Child and Adolescent Mental Health Services at Toronto East General Hospital has recently written a letter outlining her concern that the impact of the changes underway in the Adolescent Program at Ontario Shores will be felt throughout the continuum of children’s mental health services in the province. I share her concerns and hope to expand on them in this letter.

As of December 13, 2010, the administrators of Ontario Shores have declared their intention to replace two thirds of the current frontline staff, Child and Youth Counsellors, with nurses. As a specialist in the field of children’s mental health, I am keenly aware of the differences in training and expertise of these two groups of professionals. They serve unique but complimentary roles in delivering high quality health care for our provinces most vulnerable youth. Their roles, however, do not overlap to the extent that one group can be replaced by the other. I fear that those proposing this exchange are insufficiently aware of the specifics involved in caring for mentally ill children. In my opinion, this proposed change reflects the hospital’s attempt to apply an adult model of mental health services to a non-adult population. This is a significant step backwards towards a model that is thirty years out of date; the child and youth counsellor representatives in inpatient children’s mental health programs are the product of a long, healthy evolution.

Another significant change already implemented in the adolescent inpatient programs at Ontario Shores concerns the elimination of half of the social work positions. This occurred in early 2010 and was the first decision that shook my confidence in the decision-makers at Ontario Shores. Inpatient adolescent mental health programs utilize social workers intensively. The most unwell young people admitted to psychiatric hospitals in Ontario deserve expert assessments of the family dynamics affecting their illness and their recovery. Once again, applying an adult mental health social work staffing model to youth is inappropriate.

Finally, the decision to eliminate the longer term Adolescent Residential Rehabilitation (ARR) program at Ontario Shores further reflects a lack of understanding of the unique function of this highly specialized program within the province. The program offers young people diagnosed with illnesses such as schizophrenia an opportunity to attempt a gradual reintegration to life outside the hospital setting by building a bridge to the rest of the world. Programming in ARR (designed by the child and youth counsellors) facilitated a progressive and successful return to social, family and academic functioning outside of the institution, but within the safety of the hospital and prevented repeated “bounce-backs” when young people return to crisis and require readmission. Sadly, one gradual but successful attempt at reintegration is less financially rewarding to institutions reliant on “results-based funding” wherein the revolving door pays.

The adolescent programs at Ontario shores are staffed by highly skilled, extremely experienced teams of professionals, some of whom have collaborated for over 25 years to carefully craft the best treatment for the most marginalized and most vulnerable youth. Unfortunately, the recent decisions made by the administrators of this newly divested hospital suggests that they may be unaware of the history of the programs and the careful evolution that occurred before their tenure at Ontario Shores. It saddens and concerns me that the transformation of the adolescent programs at Ontario Shores may be taking place without benefitting from a sophisticated understanding of the past, present and future of adolescent mental health.

Sincerely, Gabrielle Ledger, MD, FRCPC


December 6, 2010

The Honourable Deborah Matthews
Minister of Health and Long Term Care
10th Floor, Hepburn Block
80 Grosvenor Street
Toronto, Ontario M7A 2C4

Dear Minister Matthews:

The Ontario Public Service Employees Union represents professional and support staff at Ontario Shores, formerly Whitby Mental Health Centre. These workers are among the more than 35,000 members we represent in Ontario’s health system.

As we await the release of the government’s 10-year mental health strategy, we would like to draw your attention to a valuable adolescent program that is under threat at Ontario Shores. This unique program draws hard-to-place youth from across the province.

The Adolescent Residential Rehab (ARR) is a longer-stay program that deals with youth whose prior experience has been a revolving door with Ontario’s mental health system. Most have had between three and seven previous hospitalizations. There is no other appropriate community-based program to send these adolescents to.

Almost two-thirds of the admissions to this program are from outside the Central East LHIN – an indication of its unique place in the mental health continuum.

Length of stay can be as much as six months. A very specialized program, in 2008/09 it had 14 patients enrolled. The average wait time to get into this program was 44 days in 2009/10.

While we have not had formal notice of changes coming to this unit, the adolescents and their families have told that the program will be merged into the shorter-stay ASTT program (Assessment-Stabilization-Treatment-Transition) sometime this spring. To communication these changes to patients and their families while refusing to indicate the specifics of these changes to affected staff is completely inappropriate. It has created unnecessary anxiety among caregivers and their families.

There has also been an indication that the experienced and specially trained Children and Youth Workers may also be replaced by nursing staff with little to no training in adolescent care. By contrast, Child and Youth Workers go through a comprehensive three-year program dealing with such issues as research and theories related to child maltreatment, child protection legislation, children’s rights, socio-economic factors, interpersonal communications, therapeutic recreational programming, boundaries and ethics, group dynamics, organizational behavior, diversity and advanced therapeutic interventions.

In Ontario this training is in the process from transitioning from a diploma to degree program. Ryerson University is already offering a degree in Child and Youth Care.

While we are confident of the skills of the Registered Nurses and Registered Practical Nurses we represent, these are very different skill sets.

We commend the province for recently putting more emphasis on the importance of child and youth workers in the health system. We cannot understand, therefore, why Ontario Shores would seek to diminish their participation in a program that has demonstrated success for more than four decades.

We would like assurances from the Ministry that this program will be left intact and expanded to meet the considerable needs for longer-term adolescent mental health care.

We would also like to receive assurances that these programs will not be jeopardized by replacing highly-skilled specialized workers with more general practitioners who lack appropriate training to carry out this work.

We look forward to your earliest possible response on this urgent matter.

Yours truly,

Warren (Smokey) Thomas
President, Ontario Public Service Employees Union (OPSEU)
 


Message from Jennifer Foster, BA CYC (Cert.)

CYWs who graduate from a community college or university program receive extensive training in working with some of the most difficult children and youth in the province.  Many of community partners have referred their clients to Ontario Shores in the past as they knew that their kids would receive great, professional, empathic care.

This is the discipline that employers want in their services for this 24/7 front line work.

Ontario Shores (formerly Whitby Mental Health) announced in December 2010 that they are laying off 13 full time CYWs and 15 part time CYWs.  They say that it is because they want to make sure that their clients receive the best possible and safest care to their kids.  If that is the reason, then why are they letting go of so many gifted and skilled individuals.  Ontario Shores says they want more regulated front line staff working with the kids.  They will be replacing the affected CYWs with RNs and RPNs.  We know that even though these professionals may be “good” people, they have not received the exhaustive training necessary in delivering therapeutic programming to the kids.

The OACYC was provided this information and has responded to Ontario Shores, media and respected MOH and MCYS.

We look to members for their support as well.  If you have any opinions or stories that will demonstrate to Ontario Shores and the field of Child and Youth Care, the value and importance of skilled Child and Youth Workers, specifically in the field of mental health, please forward to office@oacyc.org and we will ensure that our voices are heard.

Jennifer Foster BA CYC (Cert.)
Acting Executive Director, Ontario Association of Child and Youth Counsellors