'The loss of Samara Sky Olson affects us all.'

Those were the words John Greschner, the deputy minister of Health and Social Services, used Thursday afternoon as he presented the findings, including 18 recommendations for the family and children's services branch, of an independent review on the 2004 killing of the seven-week-old infant in Dawson City.

The baby's mother, Justina Ellis, is serving a six-year prison sentence for manslaughter. The infant's body was found in a Dawson trash can.

The family had been receiving support from the family and children's services branch. Greschner directed the independent review be done shortly after Olson's death.

The review was conducted by Manitoba social worker Jan Christianson-Wood. It found the services provided to the family didn't meet Yukon standards. It also states there was a failure at the community level to thoroughly review Ellis' previous involvement with the branch.

While Christianson-Wood brought forward the nearly-20 recommendations, it will likely be at least next year before many of them are in place.

Seven are being considered as part of the current lengthy Children's Act review while another three will be dependent on the next territorial budget.

Greschner said it's impossible to foretell whether the government will approve the budget proposals, which would see audits done to ensure services meet standards.

However, he added, expanded programming for teen parents and creating a new position of child abuse co-ordinator or specialist wouldn't involve major costs.

'I'm confident we have a good case,' he said.

Other recommendations have officials reviewing and revising the policies and procedures to reflect a change or reviewing how other jurisdictions deal with a proposal.

Greschner told reporters at a Thursday news conference the most important aspect to come out of the 114-page report is the need to ensure good and adequate supervision. The key, he said, is adequate supervision.

Elaine Schroeder, director of the family and children's services branch, pointed out the review also takes note of how important it is that good policies are followed.

'The quality of monitoring and assessment required in a child protection case was not provided,' the findings read.

While family and children's services management was directed to review files associated with the case, this didn't occur, the review found.

'The lack of a team approach was identified by community service providers with respect to managing this high-risk case,' reads the summary of the findings.

Sufficient information wasn't shared with local service providers to create better awareness of the risk, the report found. As well, there was a lack of agreement about what should be reported to family and children's services to help protect the child.

The actual policies of the branch support a team approach in dealing with children.

Also, the report concludes, requests by management in family and children's services about what was needed in program standards, such as intake assessment, weren't dealt with in a timely manner and the quality of file management was inadequate. This included a failure to make recordings in the timely manner required and as requested by management.

'There is a lack of specific policies and procedures directed toward the management of high-risk or high-profile cases,' the report continues. 'There was not, it must be stated, a lack of knowledge or skill demonstrated at the supervisory level or within management concerning the conduct of this case.'

Christianson-Wood does credit staff involved with recognizing Ellis' name and initiating services in an effort to protect the child. It showed an appropriate level of concern about the risk of abuse recurring if concerns from a previous file remained.

However, after the file was reopened, the risk assessment done was inadequate and didn't meet the standards set.

Information known or available to the branch wasn't factored into the assessment, which meant the estimation of risk was inaccurate, it was noted.

Christianson-Wood goes on to point out that predicting a recurrence of child abuse is not as complicated as predicting it the first time.

'It may not be possible to predict every child maltreatment fatality on all child welfare caseloads, but patterns' or typologies of families where children are at risk of injury or death under particular conditions assist workers in protecting children,' it was noted.

Christianson-Wood also concluded another issue in the review of the death was a lack of a mandate to permit access to records kept by other government departments and service providers.

The findings did not come as a huge surprise to government officials. As Schroeder noted, the department did its own internal review as well.

Reviews of the branch's policies began shortly after the review was completed in February.

Greschner said the document wasn't released publicly until Thursday because officials in the department haven't been around at the same time to discuss the findings until recently.

Cabinet spokesman Peter Carr said this morning Health and Social Services Minister Brad Cathers is studying the review and will likely comment on it later.