The emergency call to the children’s aid society came late on a weekday afternoon. An 11-year-old boy with complex special needs was ready to leave a Toronto hospital, but his parents were refusing to take him home.
Eight days earlier, the boy had been admitted while suffering a mental health crisis, his violent outbursts making him a risk to himself and his family. Now that he was stable, hospital staff had determined he no longer needed intensive care.
But no live-in treatment programs in Toronto could take him. Wait times for a bed stretched up to three months. And his parents, who feared for the safety of their younger child, said they could no longer care for their son on their own.
At an impasse, hospital staff called the Catholic Children’s Aid Society of Toronto to get the boy an emergency placement. He would soon be discharged and the hospital needed his bed for another patient.
The 11-year-old was placed in the care of the society. He became one of more than 60 kids and teens in Toronto with complex health needs currently in the care of the child welfare system not because of protection concerns such as abuse or neglect, but because they have nowhere else to go.
Priscilla Manful, chief executive at Catholic CAS of Toronto, who described the boy’s experience, said such cases are becoming increasingly common in child welfare. Manful is calling on the Ontario government to address the crisis, saying a parent should not have to relinquish rights to their child because of a lack of access to treatments and supports.
“It’s against moral grounds for any parent who has to do that, especially in a rich city like Toronto,” Manful said.
Currently, Catholic CAS of Toronto is caring for 19 children age 17 and under with complex needs who do not have protection issues as their primary concern.
“Parents are at their wits’ end, they are exhausted, they are burnt out, and they don’t know where to turn for help,” Manful said.
In interviews, child welfare leaders said their agencies are receiving an increasing number of calls from hospitals and treatment centres after parents refuse to take their child with complex needs home, citing safety concerns, burnout and a lack of community support.
Children with complex health needs have two or more mental health, developmental or behavioural conditions, such as autism and depression, and their families typically struggle to get adequate care. They represent at least 10 per cent of all kids seeking mental health treatment in Ontario, according to a June 2024 report by researchers at the University of Toronto, though they say it’s difficult to estimate the total number of kids with complex needs in the province.
Child welfare leaders also report that it’s getting harder for families — and their own agencies — to access health services and live-in treatment programs due to long wait times or because children are excluded, their needs deemed “too complex.”
In Toronto, home to Canada’s largest children’s aid society, the challenge is particularly profound.
Lisa Tomlinson, chief executive of the Children’s Aid Society of Toronto, said the agency has 43 kids and teens with complex needs in its care with no child protection concerns. Their parents, unable to access medical treatment and supports, have been told by people working in the health and social services systems they need to “abandon” their kids to CAS to get help, Tomlinson said.
“They’re coming to our door solely because other systems aren’t able to meet their needs.”
Currently, CAS Toronto is serving 91 kids and teens with complex needs. Of those children, 48 have come into care due to protection concerns, while the other 43 have none.
Tomlinson said child welfare agencies lack the resources and skilled staff to provide treatment and support for children with complex needs, adding they would receive better care in the health system.
“I can confidently say that our organization is not able to best serve these specific young people and their families.”
The Ford government said the review of the province’s 37 non-Indigenous children’s aid societies, led by an outside contractor, will examine agencies’ operating costs as well as the quality of child protection services. It will also analyze funding spent on services for kids with complex needs coming into the care of welfare agencies. A final report is expected in the spring.
Lisa Tomlinson, chief executive of the Children’s Aid Society of Toronto. “They’re coming to our door solely because other systems aren’t able to meet their needs.”
Nick Lachance/Toronto Star
Tomlinson said CAS Toronto, as a government-funded agency, will participate in the audit and work with the Ministry of Children, Community and Social Services to look for improvements, including dealing with the cost of caring for many children with complex needs. Ministry officials have previously said agencies’ deficits, despite increases in provincial funding, are among the reasons the government launched an audit.
Tomlinson said CAS Toronto would not be running a deficit if children with complex needs were receiving appropriate treatment funded by the Ministry of Health.
“My hope is the audit will look at how these young people end up on our doorstep,” she said.
In a statement to the Star, the Ministry of Children, Community and Social Services said the government has been working to improve the child welfare system, with investments and “new legislation focused on high-quality services that prioritize safety, protection and the needs of children and youth.” Spokesperson Kristen Tedesco said “that work is continuing” with the audit, which will examine “the degree to which societies act as ‘service providers of last resort’ where there may be no protection concerns.”
The ministry is working with the Health Ministry, Tedesco said, “to support easier, more co-ordinated access to services,” including for children with complex needs. She said children’s aid societies can work with Coordinated Service Planning to help families with children with complex needs, for whom there are no protection concerns, “navigate the multiple services that may be required through a single, co-ordinated plan.”
She said the ministry understands the needs of some children “may not match what is available locally.” When that happens, Tedesco said, “Coordinated Service Planning is expected to work within a local service resolution process to explore other options and develop creative service solutions.”
Nancy Ansong-Danquah, chief operating officer of CAS Toronto, said according to feedback from Toronto mental health agencies, youth with a developmental disability will sometimes not consent to mental health treatment, thereby excluding them from a service. Or, she said, mental health agencies may refuse to accept a child or teen with a developmental disability, claiming it prevents them from benefiting from treatment.
“Which is challenging for us because young people with disabilities still have the right to receive treatment for mental health illnesses,” said Ansong-Danquah.
One of four child welfare agencies in the city, Native Child and Family Services of Toronto serves Indigenous children and youth. It said it plans to “openly address” the issue of children with complex needs in CAS care.
Talyah Breslin, CEO of Jewish Family and Child Service of Greater Toronto, said that while fewer children with complex needs come into her agency’s care, it’s also seeing a shortage of appropriate treatment options, including early intervention.
For children in crisis who require mental health or developmental intensive services, Breslin said many treatment facilities are refusing to accept them, saying “they don’t have the resources or capacity or ability to meet the needs.”
In its response to the Star, the ministry pointed to recent government investments in pediatric health care, including a $97 million pilot program for kids with complex special needs at three children’s hospitals, funding to “expand access to community-based intensive services” with complex mental health needs and 10 new complex care beds.
Janet McCrimmon, executive director of Strides Toronto, the city’s lead agency for child and youth mental health, said the recent investments, while welcomed, are not reaching many of the kids who need it most. She said more funding is required for children with complex mental health needs.
Compounding the problem, she said, is that community treatment programs have a hard time competing with related sectors for staff because they cannot pay competitive wages. And when agencies have staffing shortages, “the wait lists get longer,” McCrimmon said.
Manful of Catholic CAS said although children with complex needs make up one-third of youth in its care, they account for more than 50 per cent of its costs.
Manful said implementing these recommendations “will help ease or address some of the gaps.”
The 11-year-old boy who earlier this year came into the care of Catholic CAS Toronto is now at a live-in treatment program and receiving appropriate support. But the program is outside Toronto; the agency could not find a permanent placement in the city.
Manful said living far away from his family is yet another trauma the boy must now face.
The Toronto Star is investigating how and why children with complex special needs are not getting the treatment, care and support they need. If you have a story or tip to share, email [email protected] and [email protected]
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