Suchergebnisse

IntroductionOn their 18th birthday children in custody of provincial Child and Family Services (CFS) age out, and are adults in control of their own care. An additional extended transitional services program was introduced several years ago to address gaps in the provicion of, and access to, adult social services during this change.
Objectives and ApproachUsing linked population based data from the Manitoba Population Research Data Repository, children in the custody of CFS who turned 18 during a 10 year study period were compared to children not in custody. For those in custody of CFS, we also compared individuals who participated in the extended transitional care services to those who opted out. Outcomes included use of health services and prescription drugs, social assistance, involvment with the justice system, living in social housing, and mental health outcomes. For most outcomes, the two year period prior to the 18th birthday and the two year period after were measured.
ResultsDuring the study period, 4656 children in care of CFS turned 18 while in custody. There were 2811 permanent wards, of which 1663 participated in the extended transitional services program. An additional 1845 non-permanent wards also turned 18 during the study period. Permanent wards were much more likely to be long term wards (greater than six years, ~65\%) compared non permanent wards (~17\%). Opioid prescription rates more than doubled in the two years after their 18th birthday and were about 6 times greater than prescription rates for those not in care of CFS. Criminal accusation rates did not change after their 18th birthday, were about equal for permanent and non-permanent wards. For the majority of outcomes, the transitional services program appeared to have little impact.
Conclusion/ImplicationsCompared to children not in care of CFS, rates of most outcomes were considerably higher for wards. Not all outcomes demonstrated a significant change over the transition period. By linking data from so many different government departments, extra attention can be focused on areas likely to have the greatest impact.

ObjectiveA multi-disciplinary E2A group was established as part of a linked administrative data study examining methamphetamine use in Manitoba. In this presentation we will share our experiences of establishing an E2A, embedding stakeholders in the research process, and outline an iterative engagement plan for the remaining study years.
ApproachThe E2A group is led by two researchers with expertise in patient and public engagement and guided by Pal's (2014) work on policy analysis and activation. Pal emphasizes a multidisciplinary and iterative process as the basis of a more inclusive approach to policy development for complex problems, such as the prevalence of methamphetamine use in Manitoba. Our goal in engaging public rightsholders, service providers and knowledge users in the research is to ensure that their first-hand knowledge and perspectives are reflected in the interpretations of the findings and that analyses address identified complexities in a culturally sensitive and equity-focused way.
ResultsIn the fall of 2020 E2A members were recruited, including persons with lived experience using methamphetamines and their families/care-givers, academics, clinicians, government, and non-government stakeholders. Training was provided on the topics of trauma-informed care, public engagement, effects of colonial and racist institutions, and cultural safety. The first E2A meetings co-developed guiding principles, a vision and mission, as well as provided capacity building around administrative data research. This work was done as a foundation for the next two years, wherein the group will make decisions about key variables (ie: between methamphetamine use and mental health), interpretation of results, knowledge mobilization, and policy development using an iterative self-evaluation process. To date challenges addressed included public health restrictions related to Covid-19 and adapting the research flow to centre lived-experience decision making.
ConclusionThe E2A group is a key component of this study and could serve as a model for other administrative data studies. The group prioritizes stakeholder knowledge, interprets results, flags potential biases in the data research process, and ensures the findings are relevant to the people they are meant to support.

IntroductionManitoba has one of the highest rates of children taken into care of child welfare services (Child and Family Services; CFS) in the world, and also one of the highest youth incarceration rates in Canada. Policy-makers recognize there is overlap between these systems; the extent of that overlap is unknown.
Objectives and ApproachWe linked CFS, Justice, and Population Health Registry data to quantify the overlap between having a history of CFS during childhood (0-17 years) and being charged with a crime as a youth (12-17 years). Using a cohort approach, we selected all individuals in Manitoba who were born in 1988 (N=28,178); those not in the province at any time from 12-17 years were excluded, leaving a final cohort of 18,182. The cohort was divided into 3 groups according to CFS involvement: CFS out-of-home care (1,148); CFS in-home services (3,395); no CFS (13,639). Criminal charges between 12-17 years were identified.
Results6.3% of our cohort had CFS out-of-home care, 18.7% received CFS in-home services, and 75% had no CFS involvement. 10.5% of the cohort were charged of a crime between 12-17 years. Almost half (46.6%) of youth who had CFS out-of-home care had criminal charges, compared to 19.4% of youth who had CFS in-home services, and 5.3% of youth with no CFS. Despite accounting for only 6.3% of the cohort, youth who had out-of-home care accounted for 28.0% of youth with criminal charges. Indigenous (First Nations (FN) and Metis) children/youth were over-represented in both systems; for example, 24.5% of FN youth had been in care compared to 3.1% of non-Indigenous; and 32.2% of FN youth were charged with a crime compared to 6.6% of non-Indigenous youth.
Conclusion/ImplicationsThere is substantial overlap between the child welfare and youth justice systems, with overrepresentation of Indigenous youth in both systems. Culturally appropriate programs and policies aimed at supporting parents, families and communities to care for their own children will likely have long-term positive impacts on the youth justice system.

ObjectivesPAX, a mental health promotion approach, has been shown to decrease negative mental health outcomes and improve academic achievement. These effects have yet to be shown among Indigenous children. We evaluated PAX for improving First Nations children's outcomes following a research process wherein community members and researchers work more collaboratively.
ApproachBuilding on a long-term relationship with Swampy Cree Tribal Council, community members, First Nations leaders and researchers worked together through all phases of the project. This cluster randomized controlled trial used population-based health, social services, and education administrative data that allowed de-identified individual-level linkages across all databases through a scrambled health number. Our cohort of 725 children from 20 First Nations schools were randomized to PAX (n=469, 11 schools) or wait-list control (n=256, 9 schools). We used propensity score weighting and multi-level modeling to estimate the differences over time (2011 up to 2020) between children exposed to PAX and those who were not.
ResultsDifferences in baseline characteristics were found between the two groups of children, despite the cluster randomization. After applying propensity score weights, children in the PAX group had significantly greater decreases in conduct problems (β:-1.08, standard error(se):0.2505, p<.0001), hyperactivity (β:-1.13, se:0.3617, p=.0018 ), and peer problems (β:-1.10, se:0.3043, p=.0003) and a greater increase in prosocial scores (β:2.68, se:0.4139, p<.0001) than control group children. The percentage of children in the PAX group who met academic expectations was higher than those in the control group, however, only grade 3 numeracy (odds ratio (OR):4.30, confidence interval (CI):1.34 – 13.77) and grade 8 reading and writing (OR:2.78, CI:1.01 – 7.67) met statistical significance. We found no evidence that PAX was associated with less emotional problems, diagnosed mental disorders or better student engagement.
ConclusionThese findings suggest that PAX was effective in improving First Nations children's mental health and academic outcomes in First Nations communities. Examining what works in Indigenous communities is crucial because approaches that are effective in some populations may not necessarily be culturally appropriate for remote Indigenous communities.