Marni Brownell , Nathan C. Nickel , Kayla Frank , Lisa Flaten , Scott Sinclair , Stephanie Sinclair , Nora Murdock , Jennifer E. Enns , Jamie Pfau , Anita Durksen , Colette Scatliff , Heather Prior , Randy Walld , Lorna Turnbull , Karine Levasseur , Teresa Mayer , Jennifer Chartrand , Chris Nash , Elizabeth Decaire , Hygiea Casiano , Therese A. Stukel
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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).
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.
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