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Fetal alcohol spectrum disorder (FASD) is the leading non-genetic cause of developmental disability in Canada. It poses many challenges at the individual, family and societal levels. This study explores adoptive parents’ experiences of having a child with FASD in their family and how these experiences impact family well-being and, specifically, parenting, family dynamics, sources of support and coping strategies. Using an Interpretive Phenomenological Analysis (IPA) approach, in-depth semi-structured interviews were conducted with eight adoptive parents of children with FASD. Four main themes emerged, each with several subthemes: (1) managing individuals with FASD; (2) navigating family cohesion; (3) psychological warfare; and (4) experiences of supports. Findings showed how FASD affects all aspects of family life and has a constant and cumulative effect on the family’s well-being. Hope, community and parents feeling successful in their efforts were found to have strong connections to well-being.

The prevalence of Fetal Alcohol Spectrum Disorder (FASD) may be underestimated as it can be difficult to diagnose in early childhood possibly reflecting unique developmental trajectories relative to other Neurodevelopmental Disabilities (NDDs). Using data collected via the Early Development Instrument (EDI) between 2010 and 2015, we examined the prevalence of kindergarten children with FASD and their concurrent developmental outcomes. We found that the prevalence of FASD ranged from 0.01 to 0.31%. A greater percentage of children with FASD had teacher-reported home problems that interfered with their classroom functioning. Overall children with FASD had higher mean scores on the developmental domains compared to children with NDDs. Results of the current study can inform strategies and policies for early identification and intervention. Electronic supplementary material The online version of this article (10.1007/s10803-020-04545-w) contains supplementary material, which is available to authorized users.

Despite anxiety being a prevalent mental health problem in children, little data exist on the pervasiveness and levels of anxiety symptoms in kindergarteners. Data from the Early Development Instrument, a teacher-completed, population-level measure of child development, were collected across Canada from 2004 to 2015. The final analytic sample consisted of 974,319 children of whom 2.6% were classified as “highly anxious”. Compared to children who exhibited “few to none” anxious behaviors, highly anxious children were more likely to be male, have English/French as a second language, and have a special needs designation. Furthermore, compared with their less anxious peers, highly anxious children had between 3.5 and 6.1 higher odds of scoring below the 10th percentile cut-off in physical, social, language/cognitive and communication domains. Our findings suggest that anxious behaviors are related to children’s overall health and illustrate the consistency and extensiveness of anxiety at a very young age among Canadian children.

Despite the best efforts, persistent educational gaps remain between Indigenous and non-Indigenous children when they begin school. This evaluation explores the impact of the Abecedarian Approach for early education on the language development of First Nations and non-First Nations children, living in a low-resource, urban neighborhood in Canada. A treatment group received the Abecedarian Approach in a child care center, supplemented by home visiting, and comprised 20 families with 41 children of whom 51% were First Nations. The control group comprised 27 families with 39 children of whom 46% were First Nations. The analyses presented explore child language outcomes at the end of the second year of participation and take account of child and family characteristics, as well as the baseline language scores. Results indicate that children in the treatment group had stronger language outcomes than the control group. While First Nations children in the treatment group had lower levels of language development than non-First Nations children, at baseline, both groups progressed at about the same rate. While the findings do not guarantee that achievement gaps would close during the school years, improved language development in the years before school is likely to be associated with better achievement during school.

ObjectiveTo determine whether the Families First Home Visiting (FFHV) programme, which provides home visiting services to families across Manitoba, is associated with improved public health outcomes among First Nations families facing multiple parenting challenges.DesignRetrospective cohort study using population-based administrative data.SettingManitoba, Canada.ParticipantsFirst Nations children born in Manitoba in 2003–2009 (n=4010) and their parents enrolled in FFHV compared with non-enrolled families with a similar risk profile.InterventionFFHV supports public health in Manitoba by providing home visiting services to First Nations and non-First Nations families with preschool children and connecting them with resources in their communities.OutcomesPredicted probability (PP) and relative risk (RR) of childhood vaccination, parental involvement in community support programmes and children’s development at school entry.ResultsFFHV participation was associated with higher rates of complete childhood vaccination at age 1 (PP: FFHV 0.715, no FFHV 0.661, RR 1.08, 95% CI 1.03 to 1.14) and age 2 (PP: FFHV 0.465, no FFHV 0.401, RR 1.16, 95% CI 1.08 to 1.25), and with parental involvement in community support groups (PP: FFHV 0.149, no FFHV 0.097, RR 1.54, 95% CI 1.27 to 1.86). However, there was no difference between FFHV participants and non-participants in rates of children being vulnerable in at least one developmental domain at age 5 (PP: FFHV 0.551, no FFHV 0.557, RR 1.00, 95% CI 0.91 to 1.11).ConclusionsFFHV supports First Nations families in Manitoba by promoting childhood vaccination and connecting families to parenting resources in their communities, thus playing an important role in fulfilling the mandate of public health practice.

Research has shown that surveys that require respondents to recall events can be subject to fairly high measurement error. Recall error tends be less problematic for highly salient events and events that have recently occurred. However, there is less information on whether some respondents are more or less prone to having problems with answering questions that involve recalling an event. This research uses data from the American Driving Study where people are asked to report the length of driving trips that they made yesterday. We analyze of over 16,000 reported driving trips from data collected from 7,913 respondents who reported having been the driver for at least one driving trip on the day before they were interviewed (yesterday). For this analysis, we are concerned with two types of recall problems; 1) the inability of the respondent to provide an estimate of either the length or duration of a driving trip; 2) providing an estimate of miles driven that is inconsistent given the duration and purpose of the trip. This paper finds difference in the characteristics of respondents who are more likely to have problems reporting their prior day driving behavior. But, the main finding is that longer trips were harder to report on and have a bigger impact on key survey estimates. We conclude with some discussion of important considerations that survey practitioners should keep in mind when designing surveys that include recall questions.

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.

Evaluations of prevention programs, such as the PAX Good Behavior Game (PAX), often have multiple outcome variables (e.g., emotional, behavioral, and relationship problems). These are often reported for multiple time points (e.g., pre- and post-intervention) where data are multilevel (e.g., students nested in schools). In this paper, we present both variable-oriented and person-oriented statistical approaches, to evaluate an intervention program with multilevel, longitudinal multivariate outcomes. Using data from the Manitoba PAX Study, we show how these two approaches provide us with different information that can be complementary. Data analyses with the variable-oriented approach (multilevel linear regression model) provided us with overall PAX program effects for each outcome variable; the person-oriented approach (latent transition analysis) allowed us to explore the transition of multiple outcomes across multiple time points and how the intervention program affects this transition differently for students with different risk profiles. We also used both approaches to examine how gender and socio-economic status related to the program effects. The implications of these results and the use of both types of approaches for program evaluation are discussed.

The article “The Abecedarian Approach in a Low-Resource Urban Neighborhood in Canada: An Impact Evaluation in a Child Care Setting”.

IntroductionFirst Nations people are descendants of Canada’s original inhabitants. In consequence of historical and ongoing structural injustices, many First Nations families struggle with challenging living conditions, including high rates of poverty, poor housing conditions, mental illness and social isolation. These risk factors impede caregivers’ abilities to meet their children’s basic physical and psychosocial needs. Home visiting programmes were developed to support child developmental health in families facing parenting challenges. However, whether home visiting is an effective intervention for First Nations families has not been examined. We are evaluating two home visiting programmes in Manitoba, Canada, to determine whether they promote nurturing family environments for First Nations children.Methods and analysisThis research builds on new and established relationships among academic researchers, government decision-makers and First Nations stakeholders. We will link health, education and social services data from the Manitoba Population Research Data Repository to data from two home visiting programmes in Manitoba. Logistic regression modelling will be used to assess whether programme participation is associated with improved child developmental health, better connections between families and social services, reduced instances of child maltreatment and being taken into out-of-home care by child welfare and reduced inequities for First Nations families. Non-participating individuals with similar sociodemographic characteristics will serve as comparators. We will use an interrupted time series approach to test for differences in outcomes before and after programme implementation and a propensity score analysis to compare differences between participants and non-participants.Ethics and disseminationApprovals were granted by the Health Information Research Governance Committee of the First Nations Health and Social Secretariat of Manitoba and the University of Manitoba Health Research Ethics Board. Our integrated knowledge translation approach will involve disseminating findings through government and community briefings, developing lay summaries and infographics, presenting at academic conferences and publishing in scientific journals.

Introduction Health disorders early in life have tremendous impact on children’s developmental trajectories. Almost 80% of children with health disorders lack the developmental skills to take full advantage of school-based education relative to 27% of children without a health disorder. In Canada, there is currently a dearth of nationally representative data on the social determinants of early childhood development for children with health disorders. Evidence from Canada and other countries indicate that poorer developmental outcomes in typically developing children are associated with lower socioeconomic status (SES). However, to date, it is not known whether this relationship is stronger among children with health disorders. The study’s objectives are to estimate the prevalence and to investigate social determinants of developmental outcomes for young children with health disorders, using the Early Development Instrument (EDI). Methods and analysis Study objectives will be achieved through three steps. First, using existing EDI data for 10 provinces and 2 territories collected from 2004 to 2015, we will investigate differences in developmental health outcomes among children with identified health disorders. Second, population-level EDI data will be linked with neighbourhood sociodemographic census data to explore associations between socioeconomic characteristics and rates of specific diagnoses among children aged 5–6 years, including trends over time. Third, for 3 of these 12 regions, additional health and/or education databases will be linked at an individual level. These data will be used to establish differences in EDI outcomes in relation to the age-of-onset of diagnosis, and presence of intervention or treatment. Ethics and dissemination Study methodologies have been approved by the Hamilton Integrated Research Ethics Board. The results of the analyses of developmental health outcomes for children with health disorders combined with SES will have implications for both health service delivery and school-based intervention strategies. Results will contribute to a framework for public policy.

Background In Manitoba, Canada, school-based clinics providing sexual and reproductive health services for adolescents have been implemented to address high rates of sexually transmitted infections (STIs) and pregnancies. Methods The objectives of this population-based study were to compare pregnancy and STI rates between adolescents enrolled in schools with school-based clinics, those in schools without clinics, and those not enrolled in school. Data were from the PATHS Data Resource held in the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy. Adolescents aged 14 to 19 between 2003 and 2009 were included in the study. Annualized rates of pregnancies and positive STI tests were estimated and Poisson regression models were used to test for differences in rates amongst the three groups. Results As a proportion, pregnancies among non-enrolled female adolescents accounted for 55 % of all pregnancies in this age group during the study period. Pregnancy rates were 2–3 times as high among non-enrolled female adolescents. Compared to adolescents enrolled in schools without school-based clinics, age-adjusted STI rates were 3.5 times (p

Evaluations of intervention programs, such as the PAX Good Behaviour Game (PAX) program often have multiple outcome variables (e.g., emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behaviour). These are often reported for multiple time points (e.g., pre- and post-intervention) where data are multilevel (e.g., students nested in schools). In this paper, we use latent transition analysis (LTA), a person-oriented statistical approach, to evaluate the PAX program with multilevel, longitudinal multivariate outcomes. Using data from the Manitoba PAX Study, we show how LTA helps explore the transition of multiple outcomes across multiple time points and how the intervention program affects this transition. The strengths and limitations of LTA are discussed.

Do governments take the measures that are supported by the best scientific evidence available? We present a brief review of the situation in: Australia, Canada, Germany, the Netherlands, Spain, the United Kingdom, and the United States. Our findings show surprisingly similar developments across countries. While all seven countries are moving towards evidence-based decision making regarding policies and programs to prevent violence, there remain a number of difficulties before this end can be achieved. For example, there continue to be few randomized controlled trials or rigorous quasi-experimental studies on aggression and violence. Results from experimental research are essential to both policy makers and researchers to determine the effectiveness of programs as well as increase our knowledge of the problem. Additionally, all noted that media attention for violence is high in their country, often leading to management by crisis with the result that policies are not based on evidence, but instead seek to appease public outrage. And perhaps because of attendant organizational problems (i.e., in many countries violence prevention was not under the guise of one particular agency or ministry), most have not developed a coordinated policy focusing on the prevention of violence and physical aggression. It is hypothesized that leaders in democratic countries, who must run for election every 4 to 6 years, may feel a need to focus on short-term planning rather than long-term preventive policies since the costs, but not the benefits for the latter would be incurred while they still served in office. We also noted a general absence of expertise beyond those within scientific circles. The need for these ideas to be more widely accepted will be an essential ingredient to real and sustaining change. This means that there must be better communication and increased understanding between researchers and policy makers. Toward those ends, the recent establishment of the Campbell Collaboration, formed to provide international systematic reviews of program effectiveness, will make these results more available and accessible to politicians, administrators and those charged with making key policy decisions.