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The objective of this study is to determine which maternal events and diagnoses in the two years before childbirth are associated with higher risk for having a first child taken into care at birth by child protection services. A population-based retrospective cohort of women whose first child was born in Manitoba, Canada between 2002 and 2012 and lived in the province at least two years before the birth of their first child (n = 53,565) was created using linkable administrative data. A logistic regression model determined the adjusted odds ratios (AOR) of having a child taken into care at birth. Characteristics having the strongest association with a woman’s first child being taken into care at birth were mother being in care at the birth of her child (AOR = 11.10; 95% CI = 8.38–14.71), substance abuse (AOR = 8.94; 95% CI = 5.08–15.71), schizophrenia (AOR = 6.69; 95% CI = 3.89–11.52) developmental disability (AOR = 6.45; 95% CI = 2.69–14.29), and no prenatal care (AOR = 5.47; 95% CI = 3.56–8.41). Most characteristics of women deemed to be at high risk for having their child taken into care at birth are modifiable or could be mitigated with appropriate services.

Existing writing self-efficacy instruments have assessed the concept through mechanical and process features of writing to the neglect of the influence of situated context. The purpose of this study was to develop and test the Situated Academic Writing Self-Efficacy Scale (SAWSES) based on Bandura’s self-efficacy theory and a model of socially constructed writing. A sequential multimethod approach constituted the methods. A Delphi panel of 15 expert scholars conducted a theoretical evaluation of the scale and the items were piloted with 20 nursing undergraduate students using cognitive interviews. The scale was validated in two studies with independent samples of 255 nursing students (Study 1), and in an interdisciplinary sample of undergraduate (N = 543) and graduate students (N = 264) (Study 2). The three identified factors present a structure to the questionnaire which is developmental and has the potential to detect gaps in student self-assessed ability to master various facets of disciplinary writing: 1) Writing-Essentials – synthesis, emotional control, language; 2) Relational-Reflective – relationship building with writing facilitators (teachers, academic sources) and the self through reflection; and 3) Creative Identity – exploring gaps in student achievement of transformative writing (creativity, voice, and disciplinary identity), where confidence can help identify the most engaged writers.

Background In Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), which provides up to CAD $81.41/month during the second and third trimesters of pregnancy. In research conducted in partnership with the Manitoba Metis Federation, we examined the association of the HBPB with Metis birth and early childhood outcomes. Methods Using the whole-population administrative data repository at the Manitoba Centre for Health Policy, we identified all Metis women who gave birth in Manitoba 2003–2011 and limited the cohort to women who were low-income (receiving income assistance during pregnancy; n = 4891). We adjusted for differences between the treatment (received HBPB; n = 3702) and control (did not receive HBPB; n = 1189) groups with propensity score weighting, and then used propensity score weighted regressions to compare birth and early childhood outcomes between the groups. Results Receiving the HBPB was associated with a lower risk of low birth weight (adjusted Relative Risk [aRR] 0.74; 95% CI 0.59, 0.94) and preterm (aRR 0.78; 95% CI 0.65, 0.94) births, a higher risk of large-for-gestational-age births (aRR 1.21; 95% CI 1.06, 1.39) and neonatal readmission within 28 days (aRR 1.58; 95% CI 1.05, 2.37). HBPB receipt was also associated with increased childhood vaccinations at age 1 (aRR 1.08; 95% CI 1.00, 1.15) and 2 (aRR 1.12; 95% CI 1.06, 1.18). We observed no significant associations for Apgar scores, small-for-gestational-age births, breastfeeding initiation, birth hospitalization length of stay or child development scores. Conclusion A modest unconditional prenatal benefit provided to low-income Metis women was associated with improved birth outcomes and child vaccinations; however, an association with increased large-for-gestational-age births may warrant further exploration. Lack of significant associations between HBPB and child development measures suggests more sustained support may be necessary to improve longer-term outcomes.

Readiness for school learning is an important predictor of subsequent educational achievement, which in turn predicts health and social outcomes into adulthood. This longitudinal study used population-based administrative data from multiple sectors to follow a cohort of children (n = 8983) from the prenatal period to kindergarten to examine early childhood development factors associated with academic school readiness as measured on the language and cognitive development domain of the Early Development Instrument (EDI). Structural equation modelling was used to study the complex inter-relationships among the EDI scores and the explanatory variables, which included maternal prenatal health behaviors, child health at birth, family risk factors, and neighborhood socioeconomic status. Our findings suggest that when multiple influences on early childhood development are considered together, family risk factors are the key driver of academic school readiness, and family risk, in turn, is strongly influenced by neighborhood socioeconomic status.

Background The Families First Home Visiting (FFHV) program aims to enhance parenting skills and strengthen relationships between parents and their children. Previous research found FFHV to be effective at decreasing child maltreatment in the general population of Manitoba, but whether it is beneficial specifically for First Nation families has not yet been investigated. Methods De-identified home visiting program data from 4010 First Nation families with children born 2003–2009 were linked to population-based administrative data housed at the Manitoba Centre for Health Policy. We applied inverse probability of treatment weights to adjust for confounders related to enrollment in FFHV, and then compared rates of children taken into care of child welfare, maltreatment-related hospitalization, and children witnessing or being a victim of a crime in FFHV-enrolled families to rates in families eligible for but not enrolled in FFHV. Results FFHV enrollment was associated with lower rates of children being taken into care before the age of 1 (adjusted Risk Ratio [aRR] 0.687; 95% Confidence Interval [CI] 0.576–0.819) and age 2 (aRR 0.763; 95% CI 0.611–0.881), lower rates of hospitalization for maltreatment-related injuries by age 3 (aRR 0.429; 95% CI 0.187–0.983), and lower rates of children witnessing or being a victim of a crime (aRR 0.591; 95% CI 0.385–0.907). Conclusions Families enrolled in FFHV had lower rates of maltreatment-related indicators compared to families eligible for but not enrolled in the program. Strategies for increasing enrollment through partnerships with First Nation organizations are recommended.

Objectives (a) to apply an organisation-level, pre-implementation theory to identify and describe factors that may impact hospitals' readiness to achieve the Ten Steps and (b) to explore whether/how these factors vary across hospitals. Design a multisite, descriptive, qualitative study of eight hospitals that used semi-structured interviews of health-care professionals. Template analyses identified factors that related to organisation-level theory. Cross-site comparative analyses explored how factors varied across hospitals. Setting thirty-four health-care professionals from eight North Carolina hospitals serving low-wealth populations. The hospitals are participating in a quality improvement project to support the implementation of the Ten Steps. This study occurred during the pre-implementation phase. Findings several factors emerged relating to collective efficacy (i.e., the shared belief that the group, as a whole, is able to implement the Steps) and collective commitment (i.e., the shared belief that the group, as a whole, is committed to implementing the Steps) to implement the Ten Steps. Factors relating to both constructs included ‘staff age/experience,' ‘perceptions of forcing versus supporting mothers,' ‘perceptions of mothers' culture,' and ‘reliance on lactation consultants.' Factors relating to commitment included ‘night versus day shift,' ‘management support,' ‘change champions,' ‘observing mothers utilize breastfeeding support.' Factors relating to efficacy included ‘staffing,' ‘trainings,' and ‘visitors in room.' Commitment-factors were more salient than efficacy-factors among the three large hospitals. Efficacy-factors were more salient than commitment-factors among the smaller hospitals. Key conclusions and implications for practice interventions focused on implementing the Ten Step may benefit from improving collective efficacy and collective commitment. Potential approaches could include skills-based, hands-on training highlighting benefits for mothers, staff, and the hospital, and addressing context-specific misconceptions about the Steps.

Since 2011, we’ve worked to create a dialogue between Canada’s journalists and academic health policy experts to enrich the quality and quantity of health policy stories in the Canadian media. We work with a Media Advisory Board made up of journalists and professors of journalism from across the country who let us know what their needs, constraints and objectives are from a journalistic perspective. We also have a network of more than 80 health policy academics who are ready and available to be interviewed by the media and provide a non-partisan, evidence-based perspective from their areas of expertise.Working together, we have created a number of tools for enabling media coverage of health policy issues in Canada, including the preparation of media backgrounders, infographics, posters, podcasts and videos that highlight the evidence, and we conduct webinars, seminars and conferences by and for both journalists and academics alike.But our most successful initiative thus far has been having our academic experts authorOp-Ed articles on health policy issues — highlighting the evidence; they work with a professional editor to follow specific media guidelines, and then we publish the commentaries in the biggest media outlets across the country. The table below illustrates how successful this strategy has been and how receptive media outlets have been to these stories — increasingly so.This book is a selection of Op-Eds we’ve published in media outlets across the country (in both French and English) from October 2013 to October 2014. It thus provides a snapshot of Canadian health policy in the news. It is the third volume in our series (see also Canadian Health Policy in the News (2013) Making Evidence Matter in Canadian Health Policy (2014)) — all made available for free so that they may be read and used widely in educational settings.Topics are organized by chapter headings that address issues such as our challenges with providing Mental Health care; new models for Pharmaceutical Policy and commentaries that flag the myths and truths about our Aging Population and how it will impact health services. Health Care Costs and Spending are always a concern and are raised by many of the essays here including the costs of health human resources and technology. Many of our academics address the ways in which Health is More than Health Care including such issues as poverty, housing and education, while others caution that More Care is Not Always Better. Still other commentaries highlight the dangers and opportunities with Private, For-Profit Solutions to health care funding and delivery, and others compare Canadian and American Health Systems.Collected together, we hope these Op-Eds engage and enrich the dialogue and debate on a health care system that’s so important to Canadians. As we head into a federal election year in 2015, it seems certain that many of these issues will come to the fore, and it serves our democratic system that they be aired and discussed with evidence as the foundation. With journalists and academics in partnership to communicate health policy in the news, we can help navigate the evidence together.