Minister acknowledges failure in case of youth in St. John’s boarding house fire

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Youth advocate report details problems in system that failed youth, makes recommendations

There were a lot of questions following the shocking, early morning Nov. 17, 2011 fire in which a 54-year-old man died in a St. John’s boarding house set ablaze by a troubled 16-year-old boy who was living in the same house.

The boy, no longer with his family and living in the boarding house on Springdale Street for seven months, had ignited his mattress and called 911.

Four other men living in the house escaped the fire.

When firefighters and police arrived on the scene that morning, the teen was on his knees on the sidewalk sobbing uncontrollably.

A year later in court, the youth was sentenced to a three-year youth term. He had pleaded guilty to manslaughter, three counts of arson with disregard to human life, along with single counts of arson causing bodily harm, and breaching two youth court orders.

Judge Colin Flynn at the time called it a tragic case, “a tragic set of social circumstances, in light of this (teenager), has led to a second set of tragic circumstances, the death of a 54-year-old man.”

The case prompted an investigation by the province’s Advocate for Children and Youth, Carol Chafe.

Tuesday, in St. John’s, Chafe said the investigation identified deficiencies in services being provided to the youth by various government departments and agencies. This included a lack of collaboration and sharing of information, and a lack of documentation and assessments.

The scathing report entitled “Sixteen” contains 30 recommendations to improve the system and reduce the risk of another child going through a similar experience.

There were 40 interviews conducted which included the youth, his family members and the professionals involved in his life. Two out-of-province psychiatrists were contracted to provide their expert opinion. An intensive review of policies, procedures and legislation was also completed.

“This investigation reveals the story of a child who was crying out for help,” Chafe says in the forward to the report.

“Due to deficiencies in the system, there were times when his voice was not heard, his rights were not respected and his right to services was not upheld.”

The youth was born in 1995 and resided with his mother until he was 15 when he was removed from her care by the Department of Child, Youth and Family Services and placed in an Alternate Living Arrangement (ALA). Several weeks later, on his 16th birthday, he signed a Youth Services Agreement (YSA) and moved from the ALA to a shelter. Following stays at two different shelters, he moved to a bedsitting room where he remained for seven months until the house was destroyed by the fire in November 2011.

Child, Youth and Family Services Minister Paul Davis acknowledged that there was a major failure back in 2011.

“They're a very difficult set of circumstances and a very tragic set of circumstances. There were failures in relation to that young person, and there were gaps,” he said. “I can tell you, as a department, we have taken many many steps since then to work to close these gaps to provide the best service that we can for children and youth.”

Davis said that the department was in “transition” back in 2011, as a result of services being spun off from the Department of Health and other parts of government into the stand-alone Child, Youth and Family Services.

“We were going through a process of transition as a department at that point in time,” he said. “The recommendations that are made in her report appear to be similar to recommendations that we've seen in other reports — and recommendations that we've implemented.”

But at the same time, Davis would not say how long it will be before the department can even say if it'll accept Chafe's recommendations.

“We are committed to working with the advocate,” Davis said. “I think it would be pretty difficult to put a timeframe on it at this point in time. I think the next big, important step for us is to, once we've had a good comprehensive look at the recommendations, is to meet with the advocate and have a good discussion with her.”

Liberal House Leader Andrew Parsons said that wasn't good enough. He called it a “scathing report, and necessarily so.”

As for the timeframe, Parsons said action needs to happen right away.

“It's really troubling, and I think government needs to answer to this,” he said. “They can't do this fast enough. There shouldn't be a delay.

In the report’s conclusion, it states that despite the involvement of professionals from the Department of Child, Youth and Family Services, Department of Justice, Department of Health and Community Services (DCYFS), the RNC and Eastern Health, the youth’s best interests were not at the forefront of service provision.

“While (youth) an active client of the DCYFS on paper, he was not of primary concern throughout the program areas he encountered,” the conclusion states. “There was significant evidence of nonadherance to policies and/or best practices by social workers involved.

“Additionally, there was evidence of misinterpretation of the DCYFS policies at the management level. Failure to complete comprehensive assessments, delays in the input of file documentation and delays in file transfer further impeded the continuity of service provision in all of the DCYFS programs.”

On his 16th birthday, the youth “began an inadequately supported journey to independent living” and “a lack of appropriate housing for youth was evidenced by (the youth’s) living conditions after his 16th birthday which identified a major gap in services for youth in this province who are part of the Youth Services Program.”

The report also stated that multiple agencies were involved in dealing with the youth but there seemed to be a lack of co-ordinated effort. In part this was due to poor communications between the agencies.

“(The youth) was not mature enough, emotionally, nor did he have the coping skills to be placed in what was, for the most part, an unsupervised placement,” the report states.

“Impulsive, intermittently expressing both suicidal and homicidal ideation, increasingly helpless and hopeless and with a serious substance abuse problem in many respects, (the youth) was set up for failure.”




(Earlier story)

Advocate releases scathing report of how departments failed youth arrested in 2011 fatal fire in St. John’s

The province’s Advocate for Children and Youth, Carol A. Chafe, said this morning an investigation into the circumstances that led to a tragic and fatal fire, which resulted in the arrest of a 16-year-old male youth in late 2011, found evidence of a profound lack of collaboration and sharing of relevant information by all departments and agencies involved in the youth’s case.

There were also deficiencies in documentation and assessment by the Department of Child, Youth and Family Services.

Chafe held a news conference in St. John’s this morning releasing the report.

The investigation began on Dec. 12, 2011. It looked into whether the services provided by the Department of Child, Youth and Family Services, the Department of Justice, the Department of Health and Community Services and the Eastern Regional Integrated Health Authority met the needs of this youth and whether his right to services was upheld.

“Due to deficiencies within the system, there were times when his voice was not heard, his rights were not respected and his right to services was not upheld,” Chafe said in a prepared statement.

“It is very evident throughout this investigation that this youth’s age had a direct impact on the services he received. This story illustrates the need for professionals to be able to balance providing opportunities for youth to participate in decisions about their health, safety and well-being, while at the same time determining whether or not they have the capacity to make life-altering decisions — such as opting out of care and providing informed consent.

“In addition, it reveals the harsh reality of the inadequate services that are provided to many youth who choose, at just sixteen (16) years of age, to live on their own.”

 There are 30 recommendations resulting from the completion of the investigation; two of which are the joint responsibility of more than one department and agency.

The report can be viewed on the Advocate for Children and Youth website at

More details later.



Organizations: Department of Child, Youth and Family Services, Department of Justice Department of Health and Community Eastern Regional Integrated Health Authority

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Recent comments

  • graci
    December 04, 2013 - 03:03

    As a child who grow up in and out of the cyfs system and is now on youth services i can tell you that the system has holes in it they say they are doing what is best for the kids but how is ripping a child out of a moms arms and makeing someone fight for there child helping the kid i grew up in differnt foster care and group homes cyfs does not care where the place you and they do not care where they put you i was in a foster home where the lady use to beat me and my brother and sister and then i lived in a group home and the day i turned 16 i was kicked out and put in a homeless shelter being on youth servicea they put me in a house on cabot street where drugs where everywhere ans i got into drugs bad i had a baby almost 3 months ago and cyfs came in 4 hours afther she was born and never gave me no chance at all witch in my books is not far tnhey think they know what is best for the kids but as someone growing up in the system i dont think it is unless there should be a real resion to take someones child cyfs used the fact that i was removed from my moms care at the age of 1 agensed me how is that my falt

  • Sad Grandparent
    December 03, 2013 - 20:55

    A Sad Grandparent Writes: The system, what a joke, i have been involved with this system for over 5 years, trying to save my grandson, for 5 years now i have heard, we are doing whats in his best interest, he needs to return to his home, we will train them to be loving. We will train them to be caring Its a joke, how do you train people to love and care, people from a lifetime of systemic abuse,,,a lifetime of abusing yourself,,and now you have children and place them in their care so they can put the abuse both psychological and physical onto those most vulnerable. Where was the system for Zachery Turner, but yet they still do not learn from the mistakes, where was the system in Mt Cashel, they did not learn from the mistakes, as adults I have heard all the cliches from them,,,we know what is in the best interest of the child,,,,,yet time and time again what has been in the best interest of the child has been tragic, sad, and even deathly as we have seen. Well my grandson has a chance, i say publicly, I have kept very accurate records, names and dates of the "professionals" who are doing what is in his best interest. If he is lost to this infamous system, a system which I am bound to, as I do not want to lose the only chance left to save him, You see like so many others they will tie us up with bureaucratic mumble jumble, they will cover and protect their proverbial asses, their pensions, their paychecks, their jobs. By the time they " i do not recall that incident", "it's outside our control, we are sorry", or "we are assessing we will monitor what is happening" it may be too late. He too maybe 16 and in a situation where he too feels he may not have any other escape, lost in a world of narcisstic adults. Me i am just a sad grandparent, caught between towing the system line, or risk losing a beautiful grandson. Its a fear which haunts me daily, as those like Ms. Chafe have the power, for now.

  • Corporate Psycho
    December 03, 2013 - 18:10

    So if there was a major failure in 2011 why isn't Charlene Johnson speaking to this. Another huge failure for her.

  • W Bagg
    December 03, 2013 - 17:34

    At 16 yrs old, you can't buy alcohol, you can't buy cigerettes yet someone thought it was OK to let a 16 yr old live on his own in a boarding house to fend for himself. Think about that.

  • William
    December 03, 2013 - 14:25

    CYFS serves to facilitate ridiculous claims made by women who are simply trying to gain an upper hand in family court. CYFS does not help children, it hurts them.