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In 2018, the child welfare system in Ontario, Canada, expanded the age of protection to include 16 and 17 year olds for the purpose of mitigating risk of harm for older adolescents. To date, there is little information regarding investigations of older adolescents, particularly in Ontario; this study will address this gap. Data used for this analysis were drawn from the Ontario Incidence Study of Reported Child Abuse and Neglect‐2018. The Ontario Incidence Study of Reported Child Abuse and Neglect‐2018 sample data were weighted to derive an annual incidence estimate of 155 649 maltreatment‐related investigations conducted in Ontario in 2018. Child, caregiver, household, and investigation characteristics were compared across three age groups: children (0–10), younger adolescents (11–15), and older adolescents (16–17). Characteristics and differences in the likelihood of a service response (referral to nonchild welfare services, transfer to ongoing child welfare services, or placement in out‐of‐home care during the investigation) were examined descriptively and using chi‐square automatic interaction detection. Half of investigations involving older adolescents received a service response, and they were more likely to receive a service response when there were concerns about future risk of harm, where there were concerns about the relationship between the adolescent and their caregivers, where internalizing or externalizing symptoms were noted, where caregivers had few social supports, and where the household experienced economic hardship. These findings suggest that older adolescents are being triaged for circumstances that reflect concerns about their vulnerability, including mental health needs, attachment concerns, and caregiver isolation. [ABSTRACT FROM AUTHOR]

Background: During the SARS-CoV-2 global pandemic, one of the longest lockdowns worldwide occurred in Ontario, Canada, during the first wave. For parents and children managing care at home and at risk for COVID-19, the impact on their psychosocial functioning is unknown. Methods: A total of 122 families of children aged 2–18 years were enrolled as part of the prospective cohort of childhood nephrotic syndrome and completed a survey during the first wave of the pandemic (August 21–December 10), 2020. In a subset, 107 families had data available pre-pandemic to assess change. Validated measures included the McMaster Family Assessment Device (FAD) for parents and children ≥ 12 years for family functioning, the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) for both parent and child, and Pediatric Quality of Life Inventory (PEDSQL™-V4) for children only. Scores were compared using Student's t-test or the Mann–Whitney U test, as appropriate. Results: Among the 107 children, 71% were male with a mean age of 9 years old at the time of questionnaire completion, and the mean age of parents was 41 years old. Parents and children reported that family functioning improved during COVID (parent: p < 0.01; child: p = 0.05). Children's overall HRQOL declined (p = 0.04), specifically increased sleep disruption (p = 0.01). Increasing child age was associated with a greater sleep disruption (β = − 1.6 [IQR: − 2.6, − 0.67]) and a related decrease in QOL (β = − 1.0 [IQR: − 1.7, − 0.2]), adjusted for sex. Conclusions: Despite the positive effects of family dynamics during the first wave, there were negative effects of sleep disruptions and reduced quality of life in children, especially among older children. [ABSTRACT FROM AUTHOR]

More than 10% of children in Ontario have an additional need that may influence long-term lifestyle patterns, including physical activity (PA). This study sought to assess the status of PA as well as the barriers to and facilitators of PA for families in southwestern Ontario raising children with and without disabilities. Complete survey data were collected for 128 families for this study. Data were analysed using a series of statistical tests such as Mann-Whitney U tests, chi square tests for homogeneity, and descriptive analysis. Compared to families raising typically-developing children, families raising disabled children reported reduced enjoyment from PA, were more likely to report programs as too expensive, were more likely to report their PA needs were not met in the region, and placed more importance on inclusive PA. Further, families raising disabled children were less likely to report benefits of PA, including physical fitness, sense of identity, and self-esteem, and were more likely to report negatives associated with PA, including lack of self-esteem, social anxiety, feeling inadequate, and concerns with body image. These results point to the importance of developing inclusive and affordable programming in the region to enhance PA enjoyment for all participants, particularly those with disabilities. [ABSTRACT FROM AUTHOR]

The current study examined the efficacy of Pathways to Permanence 2: Parenting Children who have Experienced Trauma and Loss© (Pathways), a trauma-informed curriculum designed for resource (adoptive, foster and kinship) parents. This initial study examined data from the implementation of a resource training intervention in Ontario, Canada. Participants included 177 resource parents. The current study used a pre-experimental, pre-post design. Preliminary findings from this study indicate positive changes in several dimensions, including resource parent resilience, family functioning, nurturing and attachment. The findings of this initial evaluation are promising and highlight the need for further research. [ABSTRACT FROM AUTHOR]

Neonatal abstinence Syndrome (NAS) is a postnatal withdrawal condition in infants exposed to opioids in-utero. Infants with NAS are frequently reported to child welfare, although not all parents lack parental capacity. The purpose of the research was to explore decision-making among community service providers concerning safety of infants with NAS and reports to child welfare. Interviews with 21 individual providers in Ontario, Canada revealed four themes including, 1) Assessment of Cumulative Risk, 2) Proceeding with Caution 3) Therapeutic Relationship 4) Voluntary Engagement with Child Welfare. Findings support the complexity of decision-making regarding safety of infants with NAS and the impact of reporting decisions on the therapeutic relationship. [ABSTRACT FROM AUTHOR]

Though summer learning loss has been widely documented across both the United States and Canada, there is little knowledge on how parents and teachers view the use of technology in the context of summer vacation, and what the role of digital tools are in potentially alleviating achievement gaps due to summer learning loss. Drawing on 71 parent and 37 teacher interviews from a large-scale Canadian study examining summer learning loss in Ontario through summer literacy and numeracy programs for students (grades 1–3), this study highlights the complexities associated with using digital tool in both home and school life in the summer. Through extensions of Bourdieu's theory of cultural capital, we suggest that digital tools are becoming a new type of valued skillset that parents and educators are acknowledging. In specific, our main findings center around three interrelated themes: i) comfort with technology; ii) home-school connections; and iii) perception of children as digital natives. Results may be fruitful for parents, educators, and policymakers to understand the larger role that digital technology plays amongst Canadian families and teachers during the summer months and school year. Capturing these discussions can maximize both school and home use of digital tools. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Most infants hospitalized with respiratory syncytial virus (RSV) do not meet common "high-risk" criteria and are otherwise healthy. The objective of this study was to quantify the risks and relative importance of socioeconomic factors for severe, early-life RSV-related illness. We hypothesized several of these factors, particularly those indicating severe social vulnerability, would have statistically significant associations with increased RSV hospitalization rates and may offer impactful targets for population-based RSV prevention strategies, such as prophylaxis programs. METHODS: We used linked health, laboratory, and sociodemographic administrative data for all children born in Ontario (2012-2018) to identify all RSV-related hospitalizations occurring before the third birthday or end of follow-up (March 31, 2019). We estimated rate ratios and population attributable fractions using a fully adjusted model. RESULTS: A total of 11 782 RSV-related hospitalizations were identified among 789 484 children. Multiple socioeconomic factors were independently associated with increased RSV-related admissions, including young maternal age, maternal criminal involvement, and maternal history of serious mental health and/or addiction concerns. For example, an estimated 4.1% (95% confidence interval: 2.2 to 5.9) of RSV-related admissions could be prevented by eliminating the increased admissions risks among children whose mothers used welfarebased drug insurance. Notably, 41.6% (95% confidence interval: 39.6 to 43.5) of admissions may be prevented by targeting older siblings (eg, through vaccination). CONCLUSIONS: Many social factors were independently associated with early-life RSV-related hospitalization. Existing RSV prophylaxis and emerging vaccination programs should consider the importance of both clinical and social risk factors when determining eligibility and promoting compliance. [ABSTRACT FROM AUTHOR]

Children exposed to domestic violence may be at risk of homicide. Through an analysis of 140 domestic homicide cases in Ontario, Canada, this study sought to identify unique factors that heighten the risk for children in these circumstances. Two groups of domestic homicide cases were compared: cases with no children (No Children, n = 39) and cases where children were part of the family system (Children, n = 101). Further comparison was made of cases in which children were killed (n = 20) to cases in which children were present but not killed (n = 81). Overall, there were few unique differences between the groups and most of the significant findings were based on expected demographic characteristics related to having children in the family. Other significant results included a higher percentage of reports made to legal counsel/services within child-specific cases and a higher percentage of reports made to family members in cases where children were not killed. These results indicate that children who lose parents to domestic homicide share similar high-risk circumstances as children who have been killed in this context. Practical implications of the study's findings are discussed. Highlights: This study examined children's risk of homicide in the context of domestic violence. The study compared domestic homicide cases of families with and without children. Study results generally indicated few unique differences between groups. Results suggest that children exposed to domestic homicide are at similar risk to children who are not domestic homicide victims. [ABSTRACT FROM AUTHOR]

Substance use and addiction constitute a prominent factor contributing to families becoming engaged in the child welfare system. Nine key informants, four supervisors and five front line staff, from five different child welfare organizations across Ontario, Canada provided insights into the training they have received during their careers and what additional training they would value to enhance their ability to deal with this issue. The importance of this was highlighted as the majority of service users on participants' caseloads were reported to have addiction issues. Study participants also reported that the training they had received from their organizations did not fully prepare them to work with this issue that was so prominent in their clients' lives. All nine key informants indicated that they required additional training and education to better meet the primary mandate of child welfare: to keep children safe. [ABSTRACT FROM AUTHOR]

Objectives: The Healthy Kids Community Challenge is a large-scale, centrally-coordinated, community-based intervention in Ontario, Canada that promotes healthy behaviours towards improving healthy weights among children. With the goal of exploring tools available to evaluators, we leveraged electronic medical records from primary care physicians to assess child weights prior to launch of the Healthy Kids Community Challenge. This study compares the baseline (i.e. pre-intervention) prevalence of overweight and obesity in children 1–12 years of age living within and outside Healthy Kids Community Challenge communities. Design: Cross-sectional analysis of a primary care patient cohort. Setting: Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Participants: A cohort of 19 920 Ontario children who are rostered to an EMRALD physician. Children were 1–12 years of age at a primary care visit with recorded measured height and weight, between January 1, 2014 and December 31, 2015. Outcome measure: Overweight and obesity as determined by age- and sex-standardized body mass index using World Health Organization’s Growth Standards. Results: In Healthy Kids Community Challenge communities, 25.6% (95% CI 24.6–26.6%) of children had zBMI above normal (i.e. >1) compared to 26.7% (95% CI 25.9–27.5%) for children living outside of Healthy Kids Community Challenge communities. Conclusions: Despite some differences in sociodemographic characteristics, zBMI of children aged 1–12 years were similar inside and outside of Healthy Kids Community Challenge community boundaries prior to program launch. [ABSTRACT FROM AUTHOR]

This study investigates quality-of-life impacts (QOL) associated with managing a chronic inflammatory disease (CID) among first and second generation South Asian children and parents in the Greater Toronto Area, Ontario. While empirical evidence on both the rise of CIDs among immigrants and the QOL impacts of managing a CID is increasing, little attention has been given to the QOL impacts of managing a CID among immigrant adult children and their families. Drawing on analysis of 24 in-depth interviews with adult children and parents (14 adult children, 10 parents) the results indicate that first and second generation South Asian adult children and parents experience challenges acquiring a CID diagnosis (e.g., bureaucratic issues, transportation, inconsistent and unavailable physician care), and encounter multidimensional short- and long-term QOL implications associated with CID management. These challenges are compounded further by culturally insensitive care and language barriers in the health system. QOL impacts associated with CID management among adult children ranged from comfort and peace of mind due to increased ability to participate in daily life, while others reported intensified anxiety, stress and depression due to their inability to fully engage in daily life. Although all parents reported heightened stress due to their child's CID diagnosis and new management regimens, parents employed different coping mechanisms that created new short term QOL challenges for their families. The findings suggest that a patient centered approach to CID diagnosis and management, informed by personal experiences, cultural sensitivities and lived experiences of QOL representations are needed to mitigate negative QOL outcomes across a patient's life and deliver appropriate evidence informed care for those in need. • Examines South Asian immigrant children and family CID quality of life (QOL) impacts. • Bureaucratic, linguistic and culturally insensitive systems undermine CID management. • CIDs create multidimensional short and long term positive and negative QOL impacts. • Parent coping mechanisms create new QOL challenges for children and families. • QOL measures should be person centered, culturally sensitive, and reflect lived realities. [ABSTRACT FROM AUTHOR]

Background: Food insecurity is associated with a wide array of negative health outcomes and higher health care costs but there has been no population-based study of the association of food insecurity and mortality in high-income countries. Methods: We use cross-sectional population surveys linked to encoded health administrative data. The sample is 90,368 adults, living in Ontario and respondents in the Canadian Community Health Survey (CCHS). The outcome of interest is all-cause mortality at any time after the interview and within four years of the interview. The primary variable of interest is food insecurity status, with individuals classed as “food secure”, “marginally food insecure”, “moderately food insecure”, or “severely food insecure”. We use logistic regression models to determine the association of mortality with food insecurity status, adjusting for other social determinants of health. Results: Using a full set of covariates, in comparison to food secure individuals, the odds of death at any point after the interview are 1.28 (CI = 1.08, 1.52) for marginally food insecure individuals, 1.49 (CI = 1.29, 1.73) for moderately food insecure individuals, and 2.60 (CI = 2.17, 3.12) for severely food insecure individuals. When mortality within four years of the interview is considered, the odds are, respectively, 1.19 (CI = 0.95, 1.50), 1.65 (CI = 1.37, 1.98), and 2.31 (CI = 1.81, 2.93). Interpretation: These findings demonstrate that food insecurity is associated with higher mortality rates and these higher rates are especially large for the most severe food insecurity category. Efforts to reduce food insecurity should be incorporated into broader public health initiatives to reduce mortality. [ABSTRACT FROM AUTHOR]

Importance: RSV is a common illness among young children that causes significant morbidity and health care costs. Objective: Routinely collected health administrative data can be used to track disease incidence, explore risk factors and conduct health services research. Due to potential for misclassification bias, the accuracy of data-elements should be validated prior to use. The objectives of this study were to validate an algorithm to accurately identify pediatric cases of hospitalized respiratory syncytial virus (RSV) from within Ontario’s health administrative data, estimate annual incidence of hospitalization due to RSV and report the prevalence of major risk factors within hospitalized patients. Study Design and Setting: A retrospective chart review was performed to establish a reference-standard cohort of children from the Ottawa region admitted to the Children’s Hospital of Eastern Ontario (CHEO) for RSV-related disease in 2010 and 2011. Chart review data was linked to Ontario’s administrative data and used to evaluate the diagnostic accuracy of algorithms of RSV-related ICD-10 codes within provincial hospitalization and emergency department databases. Age- and sex-standardized incidence was calculated over time, with trends in incidence assessed using Poisson regression. Results: From a total of 1411 admissions, chart review identified 327 children hospitalized for laboratory confirmed RSV-related disease. Following linkage to administrative data and restriction to first admissions, there were 289 RSV patients in the reference-standard cohort. The best algorithm, based on hospitalization data, resulted in sensitivity 97.9% (95%CI: 95.5–99.2%), specificity 99.6% (95%CI: 98.2–99.8%), PPV 96.9% (95%CI: 94.2–98.6%), NPV 99.4% (95%CI: 99.4–99.9%). Incidence of hospitalized RSV in Ontario from 2005–2012 was 10.2 per 1000 children under 1 year and 4.8 per 1000 children aged 1 to 3 years. During the surveillance period, there was no identifiable increasing or decreasing linear trend in the incidence of hospitalized RSV, hospital length of stay and PICU admission rates. Among the Ontario RSV cohort, 16.3% had one or more major risk factors, with a decreasing trend observed over time. Conclusion: Children hospitalized for RSV-related disease can be accurately identified within population-based health administrative data. RSV is a major public health concern and incidence has not changed over time, suggesting a lack of progress in prevention. [ABSTRACT FROM AUTHOR]

In this study we explored the ways that mothers and fathers of children who have a chronic health condition coconstructed their parenting roles. We wanted to move beyond the standard focus on individual parenting behaviors and use a grounded theory approach to better capture the dyadic and interpersonal gestalt of how parents worked out their roles. We explored multiple factors that influenced their decision making and the unique models that each couple developed. We held conjoint qualitative interviews with 20 couples from the Toronto area, as well as follow-up interviews with individual partners in five of these couples. Our findings introduce several concepts (such as role negotiation, complementarity and symmetry of roles, and “good enough” role performance) that form an explanatory model. A key finding is the diversity of ways in which couples adapted to the parenting challenges they faced. Implications in conceptual, clinical, and research areas are presented. [ABSTRACT FROM AUTHOR]

Behavioural inhibition (BI) refers to a temperamental style of responding to unfamiliar people, objects, contexts and challenging situations with cautious, avoidant and restrained behaviour. Several lines of evidence suggest that variation in the genes of the arginine vasopressin system may be candidate genes for BI. We examined associations between BI and a total of eight single-nucleotide polymorphisms (SNPs) across the arginine vasopressin ( AVP) gene, the arginine vasopressin 1a ( AVPR1A) receptor gene, and the arginine vasopressin 1b ( AVPR1B) receptor gene. The sample consisted of 337 families from whom BI was coded from direct observation with two typically developing children per family. We performed single-marker analysis, and we also tested the combination of alleles, the haplotypes, for each gene for association with BI. Results revealed that SNP rs3761249 in the AVP gene region showed a significant association between allele C and BI measures. No other significant associations were found between BI and the other seven SNPs and haplotypes. The present exploratory study provides the first empirical evidence of a possible association between behavioural inhibition and variation in the AVP gene in humans. Findings are discussed within the context of vasopressin's influence on individual differences in social behaviour. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: Care giving for children with chronic diseases can lead to financial strain and compromised family well being. Little is known about whether these stresses lead to changes in residential movement patterns as they relate to income adequacy and proximity to care. Methods: We compared the residential movement patterns and associated changes in neighbourhood income of children with mild to severe chronic diseases compared with those that are healthy. A cohort of infants born from 2002-2007 in Ontario, Canada was followed for 5 years and divided into those with single- or multiple- body system complex chronic conditions (CCCs); low birth weight (LBW); asthma/recurrent wheeze (A/RW) and the control group of otherwise healthy children. Results: Of 598,716 children studied, 15,207 had a single CCC, 3,600 multiple CCCs, 33,206 LBW, 57,137 A/RW and 489,566 were healthy. Lowest income quintile children were most likely to move residence. Compared with healthy controls, chronic disease cohorts, apart from those with asthma, were more likely to be born in the lowest income quintile neighbourhood and to move. Among children who moved, all chronic disease cohorts were significantly more likely to move to a low income quintile neighborhood (adjusted odds ratios for all chronic disease cohorts of 1.1-1.2). There were no differences across cohorts in residential movement close to a children's hospital. Conclusions: Young children with chronic conditions, particularly those born in low income neighbourhoods, are more likely to move residence than other healthy young children. However, it does not seem that proximity to specialized care is driving this movement. Further research is required to determine if these movement patterns impact the ability of children with chronic conditions to secure health services. [ABSTRACT FROM AUTHOR]

In 2007 a study was conducted to identify the outcomes of an activity-based psychosocial intervention called Leading the Way, a program designed for children infected with and/or affected by HIV/AIDS, based in Toronto, Canada. Qualitative and quantitative data showed that children who were unaware of the HIV status of their families experienced heightened anxiety and depression when compared to children who were aware of the presence of HIV in their families. Furthermore, data indicated that though the intervention positively influenced children's senses of self and their ability to cope and problem solve, deep social stigma surrounding HIV continued to profoundly affect the lives of these children. The ethical dilemmas involved in serving populations of children who have not been disclosed to regarding their own or a family members' HIV status came to light in the development of the program and are discussed in the analysis of data. [ABSTRACT FROM AUTHOR]

• Police in Ontario have a mandatory reporting policy for all domestic violence calls. • This policy has resulted in exponential increase in child protection investigations. • Differential response and coordinated risk assessment can reduce burden on families. Over the past 20 years, Ontario child welfare agencies have seen an exponential increase in referrals for exposure to intimate partner violence (IPV) for children. Using a mixed methods approach, this paper examines the causes and consequences of the exponential increase in the incidence rates of IPV exposure between 1993 and 2013, providing important context for a maltreatment type that is not well understood in Ontario. The incidence of investigations related to IPV was derived and compared across cycles of the provincially representative Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) (1993, 1998, 2003, 2008, and 2013) and informational interviews were conducted with the primary referral source of IPV-related investigations, police departments, to understand the increase in referrals. Short term service dispositions were also compared across cycles. After the nearly two-fold increase of investigations for all maltreatment types in Ontario between 1998 and 2003, IPV investigations are the only type of maltreatment that continued to increase. In 2013, IPV was the most investigated and substantiated form of maltreatment, without a corresponding increase in the number of cases receiving ongoing services. The continued growth in the proportion of child welfare investigations for exposure to IPV that do not receive ongoing child protection services is a significant concern for Ontario. Intersystem collaboration between police, child welfare, and community services is needed to reduce repeated re-referrals and meet the needs of families experiencing IPV. [ABSTRACT FROM AUTHOR]

This article explores the cultural significance of family vacations and the role that these vacations play in the social construction of the family. Based on a series of semistructured interviews with members of families living in Ontario, Canada, the article examines the meanings and experiences associated with family vacations for parents of school aged children. Family vacations were seen as a form of escape from the pressures of everyday life, even though they involved organizational and emotional work, especially for mothers. Family vacations were valued as an opportunity for family togetherness and for improving patterns of family communication. Of particular importance was the long-term goal of creating memories that would enhance family cohesion and construct and support a positive sense of family. The findings indicate that the cultural meanings associated with family vacations, at least for these Canadian families, may be different in some important ways from other forms of tourism. [ABSTRACT FROM AUTHOR]

This study uses multilevel models to examine longitudinal associations between contextual influences (neighborhood and family) assessed in 1983 in a cohort of 2,355 children, 4–16 years of age, and educational attainment in 2001. Variation in educational attainment in 2001 attributable to between-neighborhood and between-family differences was 8.17% and 36.88%, respectively. The final model explained 33.64% of the variance in educational attainment, with unique variances of 14.53% for neighborhood and family-level variables combined versus 10.94% for child-level variables. Among the neighborhood and family-level variables, indicators of status (5.29%) versus parental capacity/family process (4.03%) made comparable predictions to attainment while children from economically disadvantaged families did not benefit educationally from living in more affluent areas. [ABSTRACT FROM AUTHOR]

The article examines the growing hegemony of the bourgeois family pattern among the Canadian working classes that accompanied the development of a welfare state and focuses on the legal institutionalization and regulation of childhood and sexuality in Ontario and British Columbia, particularly during the inter-war years. The discussion centers on similarities and differences between the provinces with respect to two major issues: first, the enactment of criminal and quasi-criminal legislation, ostensibly universal in application but directed primarily at poor children and the adults responsible for them, to force compliance with middle-class standards of morality and family life; and, second, the administration of many such statutes through the Toronto, Ontario and Vancouver Juvenile Courts. In Canada, as in other jurisdictions, demands for implementation and refinement of legislation aimed at upholding the norms of childhood and heterosexual marriages were accompanied by demands for new enforcement mechanisms.