Search

• Many mental health disorders first emerge during early childhood or adolescence. • Wait times for children's mental health services have been an international and widespread problem. • Long wait times prolong the emotional distress of children and/or adolescents and their caregivers which can exacerbate mental health difficulties. • The majority of research in this area has been conducted in the United Kingdom and Canada and focus on one waitlist strategy. • Common strategies include alternative service delivery models, increasing system capacity, and improving intake and assessment processes. Background: Although many mental health disorders first emerge during early childhood or adolescence, there is a significant gap between demand and availability of mental health resources, leading to long waitlists for services. Objective: The objective of this scoping review was to identify and characterize the research literature related to the range of waitlist management strategies that have been implemented in outpatient child and adolescent mental health care. Methods: Electronic databases reviewed included: Medline (Ovid), Embase (Ovid), PubMed, PsychINFO, SCOPUS, CINAHL, and ISI Web of Science. Grey literature databases included: OpenGrey, Conference Papers Index, and Proquest Digital Dissertations. Articles were screened by two reviewers in two steps: first by title and abstract, then full text level. Data were extracted using an a-priori developed data extraction framework, which was piloted and modified iteratively. Results: A total of 119 papers related to waitlist interventions in child and adolescent mental health were reviewed. Of these 119 papers, 11% were reviews, summary, or theoretical papers; 8% used a randomized control trial design and 2.5% were trial protocols. Most studies used less rigorous designs, such as uncontrolled before-and- after designs. The large majority focused on just one waitlist strategy each. The most commonly used approaches included: prioritization/triage and initial assessment; brief consultation and advice or brief therapy approaches; group-based models; interim services; increasing capacity; and strategies to decrease non-attendance. Most studies were conducted in the United Kingdom or Canada. Discussion: While mental health systems are complex, most studies examining waitlist initiatives explored the implementation of single initiatives. It is unlikely that a single waitlist strategy can be effective in managing wait times for children's mental health. Rather, consistent and systemic approaches to address wait times that consider the impact of the reduction approach on the patient, the program, and the community are needed. [ABSTRACT FROM AUTHOR]

• This study examines a diverse range of life circumstances and outcomes for youth accessing homelessness services who have a history of involvement with child protection services. • Data presented is drawn from the 2019 Without a Home: The National Youth Homelessness Survey—which is the largest study ever conducted in Canada on youth homelessness (n = 1375). • This study presents risk factors that are likely to be associated with the first experience of homelessness, including adverse childhood experiences and involvement with child protection services. Youth leaving or being discharged from child protection services (CPS) are a particularly vulnerable population in Canada that could be at an increased risk of homelessness, which has many adverse consequences including declining physical and mental health, school disengagement, involvement with the justice system, and substance use disorders. In this paper, we examine the extent to which youth accessing homelessness services with a history of involvement with CPS differ from their peers who have not interacted with CPS using the 2019 Without a Home: The National Youth Homelessness Survey—which is by far the largest study ever administered in Canada on youth homelessness (n = 1375). This examination includes a diverse range of life circumstances and outcomes, including quality of life, relationships with friends and family, criminal records, education, and adverse childhood experiences (ACEs). Furthermore, controlling for demographic characteristics, we present risk factors that are likely to be correlated with youth homelessness, including ACEs and the CPS history, and conclude by discussing policy implications and proposing future research avenues. [ABSTRACT FROM AUTHOR]

Objective This paper builds upon the analyses presented in three companion papers using data from the 2003 and 2008 cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003 and CIS-2008) and the Ontario Child Abuse and Neglect Data System (OCANDS) to examine disproportionality and disparity of child welfare involvement for Asian-Canadian children involved in the child welfare system. Methods This study used CIS-2008 data adjusted by Census child population data to examine rates per 1000 and three disparity indexes (population-based disparity index [PDI], decision-based disparity index [DDI], and maltreatment-based disparity index [MDI]) to determine the representation of child maltreatment investigations for Asian-Canadian versus White-Canadian children involved in the child welfare system. Logistic regression analyses were conducted to determine the odds of case closure for substantiated child maltreatment investigations, and whether Asian ethnicity remained significant while controlling for child demographics and household composition, case characteristics, and clinical concerns. Results This study found that Asian-Canadian children were underrepresented in the child welfare system compared to White-Canadian children (13.9 per 1000 Asian children in the Canadian population vs. 36.1 per 1000 White children in the Canadian population). Child welfare involvement for Asian-Canadian children are almost 2 times more likely to close after an investigation than White-Canadian children. The three disparity indexes (PDI, DDI, MDI) showed substantially different results with respect to the representation of child maltreatment investigations involving Asian-Canadian versus White-Canadian children for physical abuse, sexual abuse, neglect, emotional maltreatment, and exposure to domestic violence. Conclusions Disproportionality and disparity are complex phenomena. The variation in results derived from different methods of calculating representation suggests the need for greater clarity and consistency in the definitions and methodology in examining racial disparity in child welfare research. Some methodological considerations for future child welfare research with Asian-Canadian populations were discussed. [ABSTRACT FROM AUTHOR]

Abstract Compared to the vast amount of literature on what drives young people to homelessness and what keeps them there, there is notably less empirical evidence on the experiences of young people who have left the streets and attempted to integrate into the mainstream. Over the course of ten months, we followed nine young people from Canada's largest city – Toronto, Ontario – who had exited street life and were living independently. In this paper, we discuss how the participants attempted to carve out new identities and how these identities were challenged. We argue that it is crucial to incorporate identity into the way social integration is conceptualized and facilitated for young people attempting the daunting task of transitioning away from homelessness. Highlights • Formerly homeless young people want to distance themselves from their old identities. • Social service supports can be stigmatizing and reinforce homeless identities. • Strong identities can be used as currency (identity capital) to assist with social integration. [ABSTRACT FROM AUTHOR]

• The Finnish Baby Box provides parents of newborns with a wide range of infant clothing and other basics. • The cardboard box in which the infant can sleep was emphasized by the media and commercial companies outside Finland. • The box preventing SIDS was advanced by private companies and the media. • This was less the case in Wales and Scotland, a result of their being governed by authorities with a "left" orientation. For over 80 years the Finnish state has provided expectant mothers with a cardboard box containing an extensive collection of clothing, bathing products for the baby, nappies, bedding and a small mattress. Numerous jurisdictions have implemented it in some form. We investigated through a critical case study methodology whether its translation into the liberal welfare states of Canada, UK, and USA experienced message distortion (the box as a means of preventing SIDS), commercialization, watering down of content; and separation from the complex of Finnish welfare state policies that support families with children. We find that only Scotland and Wales recognized the decommodification and equity roles played by the baby box. This study identified numerous barriers to building progressive public policy in Canada, UK, and USA: the structures and processes of the liberal welfare state, commercial interests that skew public policymaking and media logic that limits news reporting to the concrete and simple, eschewing complex analysis. [ABSTRACT FROM AUTHOR]

The decision to substantiate child maltreatment is one of the many complex decisions workers must make daily. Utilizing data from the Ontario Incidence study 2013, this paper examines what child, family and environmental characteristics workers paid attention to when making the determination that a child had experienced maltreatment. This study adds to the Canadian body of research on factors that influence the decision to substantiate maltreatment by exploring the Ontario population. Caregiver risk factors, uncooperative parents, older children, and children with emotional or mental health concerns all increase the likelihood of substantiation. The decision to substantiate current maltreatment was strongly influenced by the workers' assessment of the future risk of maltreatment. Further research is need to explore worker and organizational factors that also influence this risk focus and how much of an influence the current risk assessment tools have on the workers' assessment of future risk and substantiation. [ABSTRACT FROM AUTHOR]

Collaboration between child welfare and adult mental health service providers is important to address parental risk factors that may affect child wellbeing. The aim of this paper is to describe findings from a survey which identified barriers and facilitators to collaboration between these two sectors. A semi-structured instrument, adapted from Frederico et al. (2014), was used for data collection. A total of 339 service providers in Ontario, Canada, completed the survey. The collaborative strategies used most frequently were co-working with staff from other services and case conferences; yet, these strategies were only used by just over one half of all respondents. Several barriers and facilitators to collaboration were identified by respondents. To improve collaboration between child welfare and adult mental health services, respondents recommended better clarity of roles and goals, increased information sharing, capacity building across sectors and new models of integrated service delivery. [ABSTRACT FROM AUTHOR]

Institutional ethnography (IE) is a method of inquiry that offers emancipatory possibilities. This paper reveals how IE's emancipatory value is linked to identifying and examining disjunctures , which are discrepancies and disconnections between what is understood to be happening versus what is actually being experienced. Using examples from an IE study that examined the social organization of supports and services for children medically diagnosed with fetal alcohol spectrum disorder (FASD) in an urban community in eastern Canada, four specific disjunctures are revealed and discussed. These disjunctures make various disconnections between school-aged children diagnosed with FASD and institutional supports visible. Furthermore, I illustrate how the ambiguity of institutional policies and communication makes it difficult for children living with FASD to thrive. This study also reveals how caregivers are required to be FASD experts while not being seen or treated as experts. By uncovering and making disjunctures visible, I argue that IE studies can draw evidence-based attention to specific institutional policies and practices that are missing or require change. [ABSTRACT FROM AUTHOR]

• Exposure to intimate partner violence is the most investigated form of maltreatment in Ontario, CA. • Exposure to emotional violence is the most frequently noted subtype of intimate partner violence. • The main source of referral for investigations involving children's exposure to IPV is the police. Exposure to intimate partner violence (IPV) is the most investigated form of maltreatment in Ontario, Canada. Given the potential for negative outcomes for children exposed to IPV, a better understanding of these cases is needed to provide the most optimal service response. The purpose of this paper is to examine the the increase in exposure investigations between 2008 and 2013. Three forms of exposure to IPV are considered in this study: (1) direct witness to physical violence, (2) indirect exposure to physical violence, and (3) exposure to emotional violence. Methods: The study used the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) data from 2008 and 2013. The OIS is a cyclical, cross sectional provincial child welfare study conducted every five years. Changes in the characteristics of IPV were examined by exploring key variables including the incidence of the specific form of IPV, referral source, and decisions made by child protection workers. Results: There were an estimated 22,347 investigations for exposure to IPV in 2008 and an estimated 31,300 investigations 2013. The overall substantiation rate for this type of investigation also increased with some important variations between subtypes. The number of substantiated investigations for exposure to emotional violence increased significantly between 2008 and 2013, from a rate of 4.21 investigations per 1000 children to 7.16 investigations per 1000 children. There was also a slight increase in the rate of investigations for direct witness to physical violence, but this increase was not statistically significant. In 2013, cases for exposure to emotional violence were 1.6 times more likely to be opened for ongoing child protection services than in 2008, while the rate of transfer to ongoing child welfare services for other exposure subtypes remained unchanged. The main sources of referral for IPV exposure investigations were police (59%), custodial parents (12%), and schools (9%). The proportion of police referrals has remained relatively stable between 2008 and 2013, but referrals by schools and custodial parents have changed within subtypes. Referrals by custodial parents for exposure to emotional violence investigations have doubled. Referrals by schools for direct witness to physical violence investigations have grown by a factor of 2.2. Conclusions and Implications: The continued increase in investigations referred for children's exposure to IPV is concerning given that the service response remains unchanged. Custodial parents appear to be one of the primary sources of this increase. These results have important policy and practice implications and suggest that a true differential service response is needed for child protection cases referred for exposure to IPV, particularly exposure to emotional violence. These cases would benefit from a more comprehensive response by professionals, including police, shelter and support services, child protection, and schools. Better service coordination and inter-agency collaboration may also prevent families from being re-referred to child protection services. [ABSTRACT FROM AUTHOR]

• The interRAI YJCF identified youth with mental health and substance use problems. • Substance use and traumatic life events were reported for the majority of youth in detention. • CAPs triggered for most youth for interpersonal conflict and traumatic life events. • For half the youth, CAPs were triggered for harm to others and suicidality/purposeful self-harm. Detained youth display substantive mental health and substance use problems. However, Canadian information is limited. The purpose of this study was (1) to assess mental health and substance use problems of youth in residential detention/custody facilities in Ontario, Canada, at intake, using the interRAI Youth Justice in Custodial Facilities (YJCF), and (2) to explore the added value of using the YJCF in addition to the facilities' standard intake tool. This paper presents the findings of this pilot study. Drawing on all 20 youth secure custody facilities in Ontario, Canada, two groups were created through stratified random group assignment: 10 intervention and 10 non-intervention sites. Staff recruited eligible admitted youth aged 16–19 years between November 2014 and May 2016, with 164 in intervention and 143 in non-intervention arms. Substance use and traumatic life events were reported for the majority of youth. For youth who were assessed using the YJCF, a substantial number of integrated evidence-informed care plans, or Collaborative Action Plans (CAPs) were triggered for specific areas of risk and need. The majority of intervention group youth with YJCFs had CAPs triggered for substance use, interpersonal conflict, traumatic life events, education challenges, transitions and family functioning problems, while for almost half the youth, CAPs were triggered for harm to others and suicidality/purposeful self-harm. The YJCF, compared to the standard admission tool, identified a greater percentage of youth with mental health and substance use problems. Implications for providing expanded assessment for youth are discussed. [ABSTRACT FROM AUTHOR]

• Despite consensus on importance of relationships in RCC, theorisation is limited. • Relational practice most prominently identified as threshold in transatlantic study. • All 5 characteristics of threshold concepts were reflected across interview data. • There was an emphasis on the troublesome nature of relationship boundaries. • The relational nature of teaching and learning relational practice was identified. Despite growing international consensus around the complex and demanding nature of residential child care for children and young people, consensus is lacking around how to develop a workforce equal to the task. Similarly, there is near unanimity about the essential nature of relationships, particularly the relationship between practitioner and child, for good residential care. At the same time, theorization on how those relationships are enacted and how to support practitioners' related development of practice is underdeveloped or even absent in some contexts. This second of a two-part paper discusses stage two of a two-stage, transatlantic study aimed at identifying and exploring threshold concepts in residential child care. Threshold concepts are central concepts in a given discipline which are transformative but troublesome for many. They are important to their given discipline because they shape thinking and practice, but they are often difficult to master. In stage one, relational practice was the most prominently discussed potential threshold concept in focus groups comprised of educators and practitioners who had studied, practiced and/or taught in the UK, Canada and/or the US. In stage two, in-depth individual interviews were carried out with practitioners around their threshold experiences of relational practice. Analysis found all five characteristics of threshold concepts reflected in the data, with a particular emphasis on the troublesome nature of relationship boundaries. A further theme around the relational nature of teaching and learning relational practice was identified, raising important parallels between the relational experiences practitioners have as part of their training, and their relational practice in the field. Implications are discussed, including the misfit between the demarcation of professional boundaries as applied by cognate fields and the actual requirements of ameliorative relationships in residential child care. [ABSTRACT FROM AUTHOR]

• Threshold concepts are core concepts in a given field that are transformative. • They are important because they shape thinking and practice. • A transatlantic study was carried out to identify them in residential child care. • Relational Practice and Use of Self were prominently identified. • They have explanatory power in guiding workforce development. Despite growing international consensus around the complex and demanding nature of residential child care for children and young people, consensus is lacking around how to develop a workforce equal to the task. Threshold concept theory casts a light on related issues of training and education, and offers direction in addressing them. Threshold concepts are central concepts in a given discipline which are transformative but troublesome for many. They are important to their given discipline because they shape thinking and practice, but they are often difficult to master. This first of a two-part paper discusses the first of a two-stage, transatlantic study aimed at identifying and exploring threshold concepts in residential child care. Using focus groups and individual interviews with participants who had studied, practiced and/or taught in the UK, Canada or the US, it explored the views and experiences of educators who have contributed to knowledge production in the field, as well as front-line practitioners who have completed a dedicated course in child and youth care, residential child care or therapeutic child care. Findings included unanimous agreement about the relevance of threshold concept theory to their experiences, and strong support for its utility in considering how curricula should be taught. There was a greater degree of commonality than divergence between educator and practitioner views about what might be threshold, with relational practice the most prominently discussed. A theme around the self of the learner was identified in discussions of threshold concept theory more generally, particularly across the educator focus groups. Implications for pedagogical practice are discussed, including the concept of praxis which provides a useful counterpoint for conceptualising the relationship between threshold concept theory and the use of self in practice, especially in fields where the self is a primary instrument of the work. [ABSTRACT FROM AUTHOR]

• The strongest predictor of visible homelessness was child welfare involvement. • Being Indigenous was a significant predictor of visible and hidden homelessness. • University education not preventative against homelessness for Indigenous peoples. Existing evidence suggests that child welfare involvement has a deleterious impact on Indigenous peoples in Canada in terms of increasing their risk of becoming a visible or hidden homeless individual. Visible homelessness is generally understood as those individuals found sleeping in parks, cars, shelters, or on the streets and other locales such as in abandoned buildings or under bridges. Whereas the hidden homeless are those who find interim accommodations with friends, family members, and acquaintances. Although in saying this, many of the visible homelessness scenarios can also be considered hidden. Regardless, all situations of homelessness reflect uncertainty, lack of safety, and an increased vulnerability to abuse and exploitation. The pathways to homelessness are rooted in structural deficits in the society, which are multiplicative and intersectional in nature. They include housing affordability, oppression, conditions of physical and mental well-being, employment and employability, as well as family support and community connection. On the other hand, the greater the educational achievement experienced by Indigenous peoples the less the risk of being subjected to homelessness. The premise of this paper is that Indigenous peoples are multiplicatively oppressed and that these intersecting sites of oppression increase the risk of Indigenous peoples in Canada becoming homelessness. Hypotheses were tested using the 2014 panel of Canada's General Social Survey, including 1081 Indigenous peoples and 23,052 non-Indigenous white participants. Indigenous identity, involvement in the child welfare system, and level of educational achievement were all significantly associated with experiences of hidden and visible homelessness, p <.001. As hypothesized, the odds associated with being involved in the child welfare system (odds ratio [OR] = 4.15) were stronger than that associated with identifying as Indigenous (OR = 1.47). As predicted, achieving a university education served as a protection against becoming homelessness (OR = 0.27). The hypothesized relationship between ethnicity and child welfare system involvement interaction was not observed. However, Indigenous participants (7.1%) were nearly four times as likely to have been involved with the child welfare system than were non-Indigenous white people (1.9%). Thus, at the population level, Indigenous peoples are at far greater risk of having been involved in the child welfare system, and consequently experiencing homelessness than non-Indigenous peoples. Of note, the hypothesized ethnicity by educational attainment interaction was observed. Among white people in Canada, a university education likely prevents most (83%) of visible homelessness otherwise experienced by those who did not complete high school (OR = 0.17) and prevents a significant amount (18%) of hidden homelessness. Startlingly, no such prevention was associated with completion of university among Indigenous peoples in Canada. Implications and future research needs are discussed. [ABSTRACT FROM AUTHOR]