Impact of being taken into out-of-home care: a longitudinal cohort study of First Nations and other child welfare agencies in Manitoba, Canada

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2024-09-11 DOI:10.1016/j.lana.2024.100886

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引用次数: 0

Abstract

Background

Across Canada, Child Protection Services (CPS) disrupt Indigenous families by apprehending their children at alarmingly high rates. The harms borne by children in out-of-home care (OoHC) have been extensively documented. We examined the impact of OoHC on Manitoba children's health and legal system outcomes to provide rigorous evidence on how discretionary decision-making by CPS agencies can affect these outcomes.

Methods

In partnership with First Nations researchers, we used linked administrative data to identify Manitoba children (born 2007–2018) served by First Nations and other Manitoba CPS agencies. We compared those taken into OoHC (n = 19,324) with those never in care but with an open CPS file due to child protection concerns (n = 27,290). We used instrumental variable analysis (CPS agency rates of OoHC as the instrument) to obtain odds ratios (aOR) and 95% confidence intervals adjusted for child, maternal, and family factors.

Findings

Mean age (yrs ± standard deviation) at first CPS contact for children taken into OoHC was 2.8 ± 3.7 (First Nations) and 3.0 ± 3.8 (other), and for children never in care was 4.5 ± 4.5 (First Nations) and 5.1 ± 4.7 (other). Among children served by a First Nations agency, males made up 50.6% (n = 5496) in OoHC and 51.0% (n = 6579) never in care. Among children served by other agencies, males made up 51.0% (n = 4324) in OoHC and 51.0% (n = 7428) never in care. Odds of teen pregnancy (First Nations aOR 3.69, 1.40–9.77; other aOR 5.10, 1.83–14.25), teen birth (First Nations aOR 3.23, 1.10–9.49; other aOR 5.06, 1.70–15.03), and sexually transmitted infections (other aOR 7.21, 3.63–14.32) were higher for children in care than children never in care, as were odds of being accused (other aOR 2.71, 1.27–5.75), a victim (other aOR 1.68, 1.10–2.56), charged with a crime (other aOR 2.68, 1.21–5.96), or incarcerated (First Nations aOR 3.64, 1.95–6.80; other aOR 1.19, 1.19–8.04).

Interpretation

Being in OoHC worsened children's health and legal system outcomes. The importance of reducing the number of children taken into care was emphasized in briefings to provincial and First Nations governments. The government response will be monitored.

Funding

Social Sciences and Humanities Research Council (no. 890-2018-0029).

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接受家庭外照料的影响：对加拿大马尼托巴省原住民和其他儿童福利机构的纵向队列研究

背景在加拿大各地，儿童保护服务机构（CPS）以惊人的高比率逮捕土著儿童，从而破坏土著家庭。家庭外照料（OoHC）对儿童造成的伤害已被广泛记录在案。我们研究了家庭外照料对马尼托巴省儿童的健康和法律系统结果的影响，为儿童保护机构的自由裁量权决策如何影响这些结果提供了严谨的证据。我们比较了那些被纳入 OoHC 的儿童（n = 19,324 人）和那些从未被照料但因儿童保护问题而有开放 CPS 档案的儿童（n = 27,290 人）。我们使用工具变量分析法（以 CPS 机构的 OoHC 使用率为工具）得出了几率比（aOR）和 95% 的置信区间，并对儿童、母亲和家庭因素进行了调整。研究结果首次接触 CPS 的 OoHC 儿童的平均年龄（岁 ± 标准差）为 2.8 ± 3.7（原住民）和 3.0 ± 3.8（其他），从未接受过照料的儿童的平均年龄为 4.5 ± 4.5（原住民）和 5.1 ± 4.7（其他）。在由原住民机构提供服务的儿童中，男性占 OoHC 儿童的 50.6%（n = 5496），占从未接受过照料儿童的 51.0%（n = 6579）。在由其他机构提供服务的儿童中，男性在 OoHC 中占 51.0%（n = 4324），在从未接受过照料的儿童中占 51.0%（n = 7428）。受照料儿童的少女怀孕几率（原住民 aOR 3.69，1.40-9.77；其他 aOR 5.10，1.83-14.25）、少女生育几率（原住民 aOR 3.23，1.10-9.49；其他 aOR 5.06，1.70-15.03）和性传播感染几率（其他 aOR 7.21，3.63-14.32）均高于从未受照料儿童，被指控几率也是如此（其他 aOR 2.71，1.27-5.75）。其他 aOR 2.71，1.27-5.75）、受害者（其他 aOR 1.68，1.10-2.56）、被指控犯罪（其他 aOR 2.68，1.21-5.96）或被监禁（原住民 aOR 3.64，1.95-6.80；其他 aOR 1.19，1.19-8.04）。在向省政府和原住民政府介绍情况时，强调了减少被收留儿童人数的重要性。将对政府的回应进行监督。资助社会科学与人文科学研究委员会（编号：890-2018-0029）。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.