Rates of out-of-home care among children in Canada: an analysis of national administrative child welfare data

INTRODUCTION

As a part of the public health approach to child welfare, data about children placed in out-of-home care are needed to assess population trends, understand drivers of social and health inequities, and examine outcomes for children and families. We analyzed administrative data from Canada to describe the population of children in out-of-home care, and estimate and compare rates of out-of-home care by province/territory, year, sex/gender, age group and placement type.

METHODS

We conducted a cross-sectional analysis of point-in-time data from all provinces and territories for the period 2013/2014 to 2021/2022. We used frequencies and percentages to describe the population of children (and youth up to age 21 years) in out-of-home care and estimated overall and stratified rates and rate ratios.

RESULTS

An estimated 61 104 children in Canada were in out-of-home care on 31 March 2022. The national rate of out-of-home care was 8.24 children per 1000 population. Rate variations by province/territory were substantial and changed over time. Rates were highest among males and children aged 1 to 3 and 16 to 17 years. Foster homes were the most common type of placement, although kinship homes accounted for an increasing share.

CONCLUSION

This analysis demonstrated that administrative data can be used to generate national indicators about children involved in the child welfare system. These data can be used for tracking progress towards health and social equity for children and youth in Canada.

Asking youth and adults about child maltreatment: a review of government surveys

OBJECTIVES

In this review we: (1) identify and describe nationally representative surveys with child maltreatment (CM) questions conducted by governments in low-income, middle-income and high-income countries and (2) describe procedures implemented to address respondents' safety and minimise potential distress.

DESIGN

We conducted a systematic search across eight databases from 1 January 2000 to 5 July 2021 to identify original studies with information about relevant surveys. Additional information about surveys was obtained through survey methods studies, survey reports, survey websites or by identifying full questionnaires (when available).

RESULTS

Forty-six studies representing 139 surveys (98 youth and 41 adult) conducted by governments from 105 countries were identified. Surveys implemented a variety of procedures to maximise the safety and/or reduce distress for respondents including providing the option to withdraw from the survey and/or securing confidentiality and privacy for the respondent. In many surveys, further steps were taken such as providing information for support services, providing sensitivity training to survey administrators when interviews were conducted, among others. A minority of surveys took additional steps to empirically assess potential distress experienced by respondents.

CONCLUSIONS

Assessing risk and protective factors and developing effective interventions and policies are essential to reduce the burden of violence against children. While asking about experiences of CM requires careful consideration, procedures to maximise the safety and minimise potential distress to respondents have been successfully implemented globally, although practices differ across surveys. Further analysis is required to assist governments to implement the best possible safety protocols to protect respondents in future surveys.

Sentinel surveillance of substance-related self-harm in Canadian emergency departments, 2011 - 19

Introduction

Self-harm is a public health concern that can result in serious injury or death. This study provides an overview of emergency department (ED) visits for patients presenting with substance-related self-harm.

Methods

Cases of self-harm in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database were extracted (April 2011 to September 2019; N = 15,682), using various search strategies to identify substance-related self-harm cases for patients 10 years and older. Cases involving alcohol, cannabis, illicit drugs, or medications (or any combinations of these) were included. Additional variables, including age and sex, location and the severity of injury (hospital admission) were examined. Proportionate injury ratios (PIR) were used to compare emergency department outcomes of self-harm and unintentional injuries involving substance use. Time trends were quantified using Joinpoint regression. For cases requiring hospital admission, text fields were analyzed for contextual factors.

Results

A total of 9470 substance-related self-harm cases were reported (28.1% of all intentional injury cases), representing 820.0 records per 100,000 eCHIRPP records. While age patterns for both sexes were similar, the number of cases for females was significantly higher among 15-19 year olds. Over half (55%) of cases that identified substance type involved medications, followed by multi-type substance use (19.8%). In the ED, there were proportionally more treatments, observations, and admissions presenting with substance-related self-harm compared to substance-related unintentional injury cases. Among those aged 20+ years, a statistically significant increasing trend of 15.9% per year was observed, while among those aged 10-19 years a significant annual percent change of 16.9% was noted (2011 to 2019). Text field analysis demonstrated suicide attempt or ideation was a reoccurring theme among all age groups. Poor mental health status or conflict with family or an intimate partner were reported stressors, depending on age group. Additional self-harming injuries, such as cutting, were reported among all age groups.

Conclusion

Our study found that hospital admission for substance-related self-harm was highest for patients aged 15-19 years, especially females, and that they were more likely to use medications. The statistically significant increasing trend of cases found between 2011 and 2019 is notable. Patients showed multiple types of adversities, demonstrating the complexity of this issue.

Autumn destabilization of deep porewater CO2 store in a northern peatland driven by turbulent diffusion

The deep porewater of northern peatlands stores large amounts of carbon dioxide (CO2). This store is viewed as a stable feature in the peatland CO2 cycle. Here, we report large and rapid fluctuations in deep porewater CO2 concentration recurring every autumn over four consecutive years in a boreal peatland. Estimates of the vertical diffusion of heat indicate that CO2 diffusion occurs at the turbulent rather than molecular rate. The weakening of porewater thermal stratification in autumn likely increases turbulent diffusion, thus fostering a rapid diffusion of deeper porewater CO2 towards the surface where net losses occur. This phenomenon periodically decreases the peat porewater CO2 store by between 29 and 90 g C m-2 throughout autumn, which is comparable to the peatland's annual C-sink. Our results establish the need to consider the role of turbulent diffusion in regularly destabilizing the CO2 store in peat porewater.

At-a-glance - The Child Maltreatment Surveillance Indicator Framework

The federal health portfolio has conducted surveillance on child maltreatment as a public health issue since the 1990s. The Public Health Agency of Canada (PHAC) is now releasing the Child Maltreatment Indicator Framework, to take its place alongside other PHAC frameworks, such as the Suicide Surveillance Indicator Framework. Based on a scoping review of existing reviews and meta-analyses, this Framework, along with the online interactive data tool, presents child maltreatment outcome indicators and risk and protective factors at the individual, family, community and societal levels, disaggregated by sex, age and other sociodemographic variables. This Framework will function as a valuable resource pertaining to an issue that affects at least one in three Canadian adults.

Current forest carbon fixation fuels stream CO2 emissions

Stream CO2 emissions contribute significantly to atmospheric climate forcing. While there are strong indications that groundwater inputs sustain these emissions, the specific biogeochemical pathways and timescales involved in this lateral CO2 export are still obscure. Here, via an extensive radiocarbon (14C) characterisation of CO2 and DOC in stream water and its groundwater sources in an old-growth boreal forest, we demonstrate that the 14C-CO2 is consistently in tune with the current atmospheric 14C-CO2 level and shows little association with the 14C-DOC in the same waters. Our findings thus indicate that stream CO2 emissions act as a shortcut that returns CO2 recently fixed by the forest vegetation to the atmosphere. Our results expose a positive feedback mechanism within the C budget of forested catchments, where stream CO2 emissions will be highly sensitive to changes in forest C allocation patterns associated with climate and land-use changes.

A systematic review of childhood maltreatment assessments in population-representative surveys since 1990

BACKGROUND

Population-representative surveys that assess childhood maltreatment and health are a valuable resource to explore the implications of child maltreatment for population health. Systematic identification and evaluation of such surveys is needed to facilitate optimal use of their data and to inform future research.

OBJECTIVES

To inform researchers of the existence and nature of population-representative surveys relevant to understanding links between childhood maltreatment and health; to evaluate the assessment of childhood maltreatment in this body of work.

METHODS

We included surveys that: 1) were representative of the non-institutionalized population of any size nation or of any geopolitical region ≥ 10 million people; 2) included a broad age range (≥ 40 years); 3) measured health; 4) assessed childhood maltreatment retrospectively; and 5) were conducted since 1990. We used Internet and database searching (including CINAHL, Embase, ERIC, Global Health, MEDLINE, PsycINFO, Scopus, Social Policy and Practice: January 1990 to March 2014), expert consultation, and other means to identify surveys and associated documentation. Translations of non-English survey content were verified by fluent readers of survey languages. We developed checklists to abstract and evaluate childhood maltreatment content.

RESULTS

Fifty-four surveys from 39 countries met inclusion criteria. Sample sizes ranged from 1,287-51,945 and response rates from 15%-96%. Thirteen surveys assessed neglect, 15 emotional abuse; 18 exposure to family violence; 26 physical abuse; 48 sexual abuse. Fourteen surveys assessed more than three types; six of these were conducted since 2010. In nine surveys childhood maltreatment assessments were detailed (+10 items for at least one type of maltreatment). Seven surveys' assessments had known reliability and/or validity.

CONCLUSIONS AND IMPLICATIONS

Data from 54 surveys can be used to explore the population health relevance of child maltreatment. Assessment of childhood maltreatment is not comprehensive but there is evidence of recent improvement.

Utilization of the Canadian Incidence Study of Reported Child Abuse and Neglect by child welfare agencies in Ontario

INTRODUCTION

The purpose of this study was to analyze how child maltreatment surveillance data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) is used by senior child welfare decision makers.

METHODS

This triangulation mixed-methods study included quantitative and qualitative methods to facilitate an in-depth exploration from multiple perspectives. We interviewed Ontario child welfare decision makers to measure utilization of the CIS in policy development.

RESULTS

The majority of respondents were aware of the CIS data. Decision makers reported using these data to determine resource allocation, understand reported maltreatment trends and validate findings at their own agencies. Urban agencies used the data more than did rural agencies.

CONCLUSION

This study is the first to triangulate data to understand and improve utilization of child maltreatment surveillance data. The study participants indicated considerable appreciation of the data and also provided ideas for improvements across the surveillance cycle.

Introduction to the "space-control theory of paramedic scene management"

BACKGROUND

Scene management is a critically important aspect of paramedic practice but, to date, there has been no formal research in this area.

OBJECTIVE

To generate a substantive theory of paramedic scene management practice.

METHOD

A grounded theory methodology was used to conduct a qualitative inquiry that involved interviewing paramedics concerning their approach to scene management. Paramedics were selected from rural, suburban and urban settings and were categorised by competence level as novice, experienced and expert.

RESULTS

A theory was generated that describes how paramedics coordinate key specific social processes to establish "space control" at the scene.

CONCLUSION

This study introduces the first formal theory of paramedic scene management and suggests that recognition of this aspect of practice will improve both pre- and in-service educational programming and assist with medical quality assurance.