Children should be placed in care as ‘a last resort’ Devon Freeman inquest hears

Information sharing - or a lack thereof - has been at the centre of much of the testimony at the inquest into the death of Hamilton teen Devon Freeman.

The 16-year-old died by suicide while in the care of the Children's Aid Society (CAS) of Hamilton after disappearing from his group home Oct. 7, 2017. His body was found more than six months later in a pine tree on the grounds of Lynwood Charlton Centre's Flamborough site.

The inquest has heard the various agencies involved in Devon's care were not aware of certain aspects of his life - including past suicide attempts. Nor was his grandmother, Pam Freeman, or his First Nation community, Chippewas of Georgina Island, kept up to date or involved in his plan of care. Devon was very unhappy at Lynwood and would run away often.

On Tuesday, the inquest heard from Kim Loiselle, who was Devon's children service worker at Hamilton CAS from December 2016 until June 2017. Prior to Loiselle, Hamilton CAS had been working with Pam and Devon to find supports for his complex mental-health needs, including Devon spending months at a program called Jeb's Place. The inquest has heard Devon liked the program there, but was unable to stay; he ended up in foster care and then eventually at Lynwood.

Loiselle said Devon came to be in the care of children's aid because of a lack of community resources to keep him in his grandmother's custody. At the time, the beds at the Flamborough site were only for children in the care of a children's aid society.

It absolutely is a last resort for any child or youth," she said, of the need for a child to be in care.

Loiselle said it's her biggest recommendation that there is a need for more community care spaces so that young people like Devon do not end up in care.

Once Loiselle took control of Devon's care, his file was started anew and she did not have access to any information contained in his CAS family service file.

Loiselle said she met with Devon and requested various medical, school and other records. But she did not have records from Jeb's Place. That meant she was not aware of a previous suicide attempt where Devon had returned to the residence with ligature marks on his neck, or about him talking about wanting to kill himself.

On May 30, 2017, Devon told a staff member at Lynwood that the day before he had tried to hang himself from a tree but was cut down by a friend. Loiselle was away on vacation when this happened, but staff filling in were informed by Lynwood.

When she returned to work in June she was told that Devon was no longer suicidal, that he declined to call a crisis line and that staff were monitoring him.

The inquest has previously heard witnesses from Lynwood who said the practice was that it was the role of CAS to communicate, including with First Nations communities. Loiselle said she advocated for an open relationship with Pam and agreed this suicide attempt ought to have been shared.

In June, Devon became a Crown ward, which meant that he was transferred to a different CAS worker. Loiselle said she met with Devon and that worker at Lynwood. She didn't ask about the May 29 suicide attempt, because she thought it was an isolated incident and Devon was in good spirits. Had she known about Devon's past attempts, she said she would have pressed the issue and contacted Devon's doctor.

That is a huge regret," she said, wiping tears.

Loiselle's caseload at that time ranged between 20 to 23 clients, who were between the ages of newborn to 18. On at least a weekly basis, she said they deal with kids who say they want to kill themselves.

Loiselle said good communication between agencies is important, including everyone being able to access the same information. But she also acknowledged barriers to good communication, including time and not knowing who to call.

I think for our youth in care, any youth, the more support the better," she said.

In the years since Devon's death, there have been a number of changes at Hamilton CAS with how it works with Indigenous communities, including having an Indigenous unit, Indigenous case reviews and mandatory training through the Hamilton Regional Indian Centre. There is also a letter that goes out to band representatives after intake.

Loiselle described Devon as fun, polite and always wanting to do better. She emotionally recalled a story about meeting Devon at court. He was well-dressed and arrived before her. He was looking out the window and saw what appeared to be a homeless man - Devon decided to give his only $4 to the man.

That's who he was, how I want people to know him," she said.

The inquest continues Wednesday.

Nicole O'Reilly is a crime and justice reporter at The Spectator. noreilly@thespec.com