Predictors of family-focused practices among mental health workers in Quebec.

Context: Engaging family members in the ongoing care of individuals with mental illness is a practice known to bolster the client's recovery journey and enhance the overall wellbeing of both children and families involved. Despite its potential benefits, there remains a dearth of understanding surrounding the implementation of family-focused practices (FFP) by mental health professionals serving adults, as well as the factors that could either promote or hinder such practices. This knowledge gap is particularly pronounced within North American settings. Goal: The goal of this study was to identify potential hindering and enabling factors of FFP used in adult mental health services. Methods: A sample of 512 professionals working with adult mental health clients, from all regions of Quebec, Canada, with a variety of disciplinary backgrounds and working in different work settings, completed the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Multinominal logistic regression analysis was performed to assess the impact of several factors - organizational, professional, and personal - on the degree of family-based practices of mental health workers. Results and discussion: Findings of this study show that the strongest predictors for the adoption of higher FFP levels among adult mental health professionals in Quebec, are being employed on a full-time basis, perceiving a higher level of skills, knowledge, and confidence toward FFP, and having a supportive workplace environment. Results underscore the need to address both organizational and worker-related aspects to effectively promote better FFP in mental health services.

Physically Violent Parental Practices: A Cross-Cultural Study in Cameroon, Switzerland, and Togo.

Violence against children and adolescents is a widespread problem. However, most studies conducted in this field has been carried out in Western countries and studies are needed in non-Western countries, especially in Sub-Saharan Africa, where rates of child physical violence are high. The present study aimed firstly to document the different forms of physical violence and attitudes toward corporal punishment (CP) across Cameroon, Switzerland, and Togo. The second objective aimed, on the one hand, to understand the influence of cultural context, childhood physical abuse, and parental attitudes on physically violent parental practices in these three different cultural contexts. On the other, this study aimed to investigate the mediating role of childhood physical abuse and parental attitudes on the effect of cultural contexts on parental practices. Five hundred and forty-seven parents from Togo, Cameroon, and Switzerland filled out questionnaires concerning violent parental practices (ICAST-P), childhood physical abuse (CTQ-SF), and parental attitudes in favor of CP. Firstly, results highlighted some cultural differences regarding parental attitudes and practices. Secondly, the hierarchical regression showed that physical violence could be partially predicted by the cultural context, childhood abuse, and attitudes in favor of CP. Finally, childhood abuse and parental attitudes mediated the link between the cultural context and parental practices. This study underscores the importance of considering the cultural context when examining parental practices. Moreover, these results provide a better understanding of these types of parental practices in less studied contexts.

Fear of COVID-19 and parental violence: The mediating role of parental burnout and child perceived as difficult.

BACKGROUND: Since the beginning of the COVID-19 pandemic, there has been a worldwide increase in the incidence of child abuse. Studies show that the pandemic context contributes to exacerbate several risk factors usually associated with the use of violent disciplinary practices. OBJECTIVE: This study aims to better understand the role of parental burnout and child perceived as difficult as a parental stressor in the link between fear of COVID-19 and the use of parental violence (minor and severe physical violence and repeated psychological aggression). PARTICIPANTS: The sample includes 467 mothers living in Québec (Canada) with a child aged 5 or less. METHOD: An online questionnaire, administered one year after the beginning of the COVID-19 pandemic in Québec (March to May 2021), was used to measure parental violence, parental burnout, parental stress related to the perception of the child as difficult and fear of COVID-19. Serial mediation analyses were performed. RESULTS: The main analyses confirmed the indirect association between fear of COVID-19 and the three forms of parental violence studied, through parental burnout and the child perceived as difficult. Unlike physical violence (minor and severe), the association between fear of COVID-19 and repeated psychological aggression is explained only by parental burnout. CONCLUSIONS: This study has identified new mechanisms that allow a better understanding of processes underlying parental violence during the pandemic. It also shows that parental violence can also occur in low-risk families. It is crucial to develop strategies to prevent the use of violent disciplinary practices in future socio-health crises such as the COVID-19 pandemic.

Comparative efficacy of the Triple P program on parenting practices and family violence against children.

BACKGROUND: The Triple P - Positive Parenting Program was rolled-out in two communities in Quebec, Canada, in order to prevent child maltreatment. OBJECTIVES: (1) Evaluate the effects of Triple P versus care as usual on positive parenting practices, dysfunctional disciplinary practices, and family violence towards the child; (2) verify whether the observed changes persisted over time. PARTICIPANTS AND SETTING: A quasi-experimental protocol with an active comparison group was used. Participants were 384 parents or parental figures of at least one 0-12-year-old child, assigned to one of two groups: Triple P (n = 291) and Care as usual (n = 93). We conducted a follow-up study with 164 parents from the Triple P group. METHODS: We administered questionnaires at pretest, post-test, and follow-up. Standardized instruments measured positive parenting practices, dysfunctional disciplinary practices (overreactivity, laxness, hostility), and family violence towards the child (repeated psychological aggression, minor physical violence). The intervention dose received by each parent was calculated from data provided by practitioners. RESULTS: Belonging to the Triple P group was associated with increased positive practices and decreased overreactive and hostile discipline. A higher dose of intervention was associated with a decrease in laxness. All observed changes were maintained at follow-up, with medium (η2p = 0.073, hostility) to large (η2p = 0.271, overreactivity) effect sizes. Also, Triple P was more effective in reducing minor physical violence, this effect persisting over time (from 36 % to 21 %). CONCLUSIONS: This study supports the sustainable efficacy of the Triple P parenting program, except for repeated psychological aggression towards children.

[Family-focused practices among adult mental health professionals: A portrait of the situation in Quebec]. / Pratiques centrées sur la famille chez les professionnels en santé mentale adulte : un portrait de la situation au Québec.

Context Children living with a mentally ill parent are a vulnerable population, at higher risk of various psychosocial and mental health problems. They are overrepresented in youth mental health and child protection services. Adult mental health services that treat parents have the opportunity to identify and support children in these families. However, to date, there is still little knowledge on the extent of family-centered practices offered by professionals from different disciplinary fields in Quebec. Objective This study aims to document the family-focused practices of adult mental health professionals according to different disciplines (social work, nursing, psychoeducation, psychology, and special education). Method A total of 524 participants, from all regions of Quebec and working with adult mental health clients, responded to an online provincial survey. A subsample of 380 participants, members of a professional order or association, was retained for the present study. These come from five discipline: social work (n=127), nursing (n=99), psychoeducation (n=57), psychology (n=56) and special education (n=41) A MANCOVA analysis was performed to compare groups on the five subscales of the French version of the Family Focused Mental Health Practice (FFMHPQ-FR, Piché et al., in press), controlling for gender, years of experience working in mental health services and estimated proportion of clients with a parental role. Results Significant differences were found between social workers and psychologists in reported family-focused practices. Participants also reported very different levels of facilitating factors such as workplace support, openness to training, perceived knowledge and skills, and attitudes towards these practices. Discussion This study helps to increase knowledge on the use of family-focused practices by professionals from different disciplinary fields, in the context of adult mental health services in Quebec. The results allow to better support the adoption of such practices in mental health services.

[Responding to children's emotional and cognitive needs: Applying the cumulative model to the general population]. / La réponse aux besoins affectifs et cognitifs de l'enfant : Application du modèle cumulatif à la population générale.

OBJECTIVES: Several risk factors are associated with neglectful behaviors. Yet their cumulative effect, which refers to the accumulation of risk regardless of the presence or absence of specific factors, remains unknown. This study aims to determine whether risk accumulation predicts caregivers' responses to children's emotional and cognitive needs in the general population and to examine the presence of clinical thresholds. METHOD: A total of 1102 maternal figures of children aged 5 to 9 years old living in Quebec were questioned through a telephone survey. The response to children's emotional and cognitive needs was measured using a validated version of the Parent-Report Multidimensional Neglectful Behavior Scale. Ten individual, family and socioeconomic risk factors were combined to compute a cumulative risk index. RESULTS: Results indicate that the cumulative index predicts the response to children's emotional and cognitive needs in the general population. This effect is observed for families exposed to at least two risk factors and it increases considerably when risk exposure reaches 5 factors. CONCLUSIONS: This study supports the cumulative risk hypothesis, which until now had mainly been examined in vulnerable or clinical samples. It fosters a better statistical understanding of contexts compromising an optimal response to school age children's emotional and cognitive needs in the general population. This breakthrough is particularity important considering the challenges of identifying children at risk of having their needs neglected.

OBJECTIFS: Plusieurs facteurs de risque sont associés à des conduites à caractère négligent. Leur effet cumulatif, soit l'accumulation du risque indépendamment de la présence ou de l'absence de facteurs spécifiques, est toutefois méconnu. La présente étude a pour objectif de déterminer si le cumul prédit la réponse aux besoins affectifs et cognitifs de l'enfant dans la population générale et d'examiner la présence d'un seuil critique. MÉTHODE: Un total de 1 102 figures maternelles ayant des enfants âgés de 5 à 9 ans vivant au Québec ont été questionnées par le biais d'un sondage téléphonique. La réponse aux besoins affectifs et cognitifs de l'enfant a été mesurée à l'aide d'une adaptation validée de l'échelle multidimensionnelle des conduites de négligence. Dix facteurs de risque individuels, familiaux et socioéconomiques ont été combinés afin de calculer un indice de risque cumulatif. RÉSULTATS: Les résultats montrent que l'indice cumulatif prédit la réponse aux besoins affectifs et cognitifs de l'enfant dans la population générale. Cet effet est observé pour les familles présentant au minimum deux facteurs de risque et augmente de manière importante lors d'une exposition à cinq facteurs. CONCLUSIONS: La présente étude appuie l'hypothèse du cumul, qui avait jusqu'à présent, principalement été examinée au sein d'échantillons vulnérables ou cliniques. Elle favorise une meilleure compréhension statistique des contextes qui rendent difficiles la réponse de l'environnement de l'enfant d'âge scolaire à ses besoins affectifs et cognitifs dans la population générale. Cette avancée est d'autant plus importante considérant les défis liés à l'identification des enfants à risque de voir leurs besoins négligés.

Prediction of health, education, and psychosocial professionals' attitudes in favor of parental use of corporal punishment.

BACKGROUND: To date, there have been few studies pertaining to the knowledge and attitudes regarding the use of corporal punishment (CP) among professionals working with parents and children. Yet, many parents turn to these professionals for advice on child discipline. OBJECTIVE: This study aimed to describe professionals' legal knowledge about parental use of CP and their attitudes toward this practice. METHOD: A study was conducted among professionals working directly with children or their parents through an online questionnaire. PARTICIPANTS: A total of 1,758 respondents from three sectors of training (psychosocial, health, education) completed the questionnaire. RESULTS: The results showed that professionals have little knowledge of the legal guidelines surrounding the use of CP in Canada. This poor knowledge as well as the perceived impacts of CP on children acted as predictors of favorable attitudes toward this disciplinary practice. According to the regression analyses, other personal and professional factors also explain a person's approval of CP, including violence in childhood, religious practice, and sources of knowledge. The results also highlighted some findings related to the respondents' professional sectors. CONCLUSIONS: The study results emphasize the need to better train professionals by targeting cognitive, personal, as well as professional factors.

Community Readiness for Child Maltreatment Prevention: The Challenge of a Brief Assessment.

In this paper, we address the assessment of community readiness (CR) for the prevention of child maltreatment in the context of a community survey. A mail survey was administered to 222 service providers and 54 supervisors and managers from 35 different organizations serving children and their families in four Canadian communities. Eleven items from the short version of the Readiness Assessment for the Prevention of Child Maltreatment (RAP-CM) were used, in combination with questions assessing knowledge of family support programs offered in the community and a measure of inter-agency collaboration. Findings show that a consistent and valid indicator of "Lack of knowledge of the environment" can be derived from the RAP-CM items and used for screening key informants. Overall, CR appears mixed in the communities studied, the weakest dimensions of which are the will to address the problem and the dynamism of informal social resources. Leadership emerges as a major gap that needs to be addressed.

[Prevalence and associated factors of depression symptoms in fathers of children aged 6 months to 17 years in Québec]. / Prévalence et Facteurs Associés aux Symptômes Dépressifs chez les Pères d'enfant 6 mois-17 ans au Québec.

OBJECTIVES: In fathers, depression symptoms experienced during pregnancy and after childbirth represent a depression risk factor during the child first months. Since depression can have a huge impact on their subsequent involvement with the child, this issue is worrisome and requires consideration. Until now, however, few studies have dealt with paternal depression and its determinants beyond the perinatal period. METHOD: This study uses data from a representative provincial survey conducted with 1342 fathers of children aged 6 months to 17 years. It documents the prevalence of moderate and severe depression symptoms with the CES-D scale as well as associated factors. RESULTS: Findings show prevalence rates ranging from 3% to 10% depending on depression symptom severity and children age. Associated factors include problematic use of alcohol, no employment, stress related to balancing work and family, domestic violence environment, and low revenue and social support. CONCLUSION: These results are interpreted in light of the role and involvement fathers keep in their child's life. They also stress the importance of identifying depression symptoms in this population beyond the perinatal period while monitoring the symptom intensity.

OBJECTIFS: Chez les pères, les symptômes dépressifs vécus pendant la grossesse et après la naissance représentent un facteur de risque de la dépression dans les premiers mois de vie de l'enfant. Puisque celle-ci peut avoir de lourdes conséquences sur leur engagement ultérieur auprès de l'enfant, cette problématique est préoccupante et nécessite qu'on s'y attarde. Or à ce jour, peu d'études ont porté sur la dépression paternelle et sur ses déterminants au-delà de la période périnatale. MÉTHODE: Cette étude utilise les données d'une enquête provinciale représentative réalisée auprès de 1342 pères d'enfants âgés de 6 mois à 17 ans. Elle documente la prévalence des symptômes dépressifs modérés et graves à l'aide du CES-D ainsi que leurs facteurs associés. RÉSUTATS: Les résultats montrent des prévalences variant de 3% à 10% selon la gravité des symptômes dépressifs et l'âge des enfants. Parmi les facteurs associés, on retrouve la consommation problématique d'alcool, l'absence d'un emploi, le stress lié à la conciliation famille-travail, le climat de violence conjugale ainsi que de faibles revenu et soutien social. CONCLUSION: Ces résultats sont interprétés à la lumière du rôle et de l'engagement des pères dans la vie de l'enfant et soulèvent l'importance d'identifier auprès de cette population les symptômes dépressifs au-delà de la période périnatale tout en portant une attention à l'intensité de ces symptômes.

Community Violence and Associated Psychological Problems Among Adolescents in the General Population.

Based on a populational survey conducted among 1400 adolescents aged between 12 and 17 years old, the aim of this study is to assess the relationships between their community violence experiences and their psychological health (anger, depressive symptoms, and post-traumatic stress disorder symptoms). One MANOVA confirms that both boys and girls who report at least one incident of physical community violence present more psychological difficulties, especially anger. Subsequent MANOVAs show that anger intensity varies depending on whether the youth was a direct victim or a witness only, as well as on the diversity of the types of violent manifestations and on acquaintance with the perpetrator, whereas the presence of injuries has no significant effect. This study highlights the importance of considering the context of the community violence incident, to clearly understand its relationships with the youth's psychological difficulties.

Recall and understanding of a communication campaign designed to promote positive parenting and prevent child maltreatment.

Evidence-based parenting support programs are among effective strategies for preventing child maltreatment. The launch of mass media campaigns accompanying the implementation of such programs has been recommended to optimize reach and parent enrollment. This paper focuses on a communication campaign developed to support the implementation of the Triple P - Positive Parenting Program in two French-Canadian communities. Proximal outcomes (recall and understanding) were assessed through a randomized telephone survey conducted between January and April 2017 among 1029 mothers of children aged 6 months to 8 years. Distribution and correlates of the respondents' recall and understanding of the campaign were examined. Results show that 32.1% of respondents recalled having seen the campaign material. Among these, a large majority reported having understood the intended messages (parenting difficulties are normal, seeking help is the right thing to do, and/or effective support is available). However, some respondents also retained unintended messages blaming parents and/or children, and almost half the sample retained mixed messages (intended and unintended). Multivariate logistic regression analyses revealed that community of residence, annual household income, and psychological aggression towards the child at home were three significant correlates of campaign recall + intended messages understood. None of the examined factors were associated with recall + mixed messages understood. Findings suggest a neighborhood effect on the proximal outcomes of the campaign, and a slightly higher reach and understanding among better-off families as well as families struggling with psychologically violent parenting practices. These results are discussed in light of the outcomes of similar campaigns.

Child and family needs profiles among cases substantiated by child protection services.

Differential individual and family needs are explored in a sample of children (n = 1455) whose case has been substantiated by Child Protection Services. Using data from Quebec's 2014 cycle of Incidence Study, latent class analyses led to the identification of 5 profiles, each displaying a specific range of individual and family needs. Profile characteristics were explored in order to obtain a deeper understanding of their specific needs, beyond the initial referral motive. Further, referred services were explored in order to verify their adequacy regarding the identified needs. Together, the obtained results support the relevance of a more in-depth needs assessment when child protection services are solicited, and the necessity to better match the referred services to these needs.

[Epidemiology of depressive and anxiety disorders among Quebec children and adolescents]. / Épidémiologie des troubles dépressifs et anxieux chez les enfants et les adolescents québécois.

Epidemiology of child and adolescent mental health is a relatively new discipline, particularly in the province of Quebec. Some work has however estimated the prevalence of the most common mental disorders among young people, such as anxiety and depression, as well as identified associated individual, family and socio-economic variables. This article has two objectives: to present a review of major epidemiological research findings in child psychiatry conducted in the province of Quebec and highlight the contribution of these findings for public health. To achieve these objectives, this article presents the results of research related to three themes: 1) measurement and identification of anxiety and depressive disorders in children and adolescents, 2) the prevalence of these disorders and comorbidity, 3) the correlates of anxiety and depressive disorders identified in epidemiological studies. The authors will then highlight future implications of these results across Québec policies in the field of public health.

The Impact of Lifetime Victimization and Polyvictimization on Adolescents in Québec: Mental Health Symptoms and Gender Differences.

This study documents lifetime experiences of victimizations, polyvictimization, and trauma symptoms among 1,400 adolescents from the province of Québec. The vast majority (81%) of adolescents were victimized during their lifetime, with most victims (82%) being the target of more than one form of victimization. Polyvictimization accounted for most variability in scores of depression, posttraumatic stress disorder (PTSD), and anger/ aggression compared to individual victimization categories. Sexual victimization and maltreatment still made an independent contribution in predicting all trauma scores once polyvictimization was considered. Gender differences were found in the victimization experiences contributing to the prediction of mental health symptoms. Sexual victimization was a significant predictor of PTSD and anger/aggression symptoms for girls, whereas witnessing violence predicted anger and PTSD symptoms for boys, and assault predicted their anger. This study outlines the importance of assessing various types of victimization among adolescents. Systematic data and observation of trends on child victimization are needed in Canada and elsewhere.

Typological Analysis of Victimization Profiles of Young Children.

Although the scope of violence against children has been well documented, the reality of this phenomenon remains to be examined. Using data collected during a populationbased survey on the polyvictimization of children between 2 and 11 years old, this study explores the profiles of 972 children who are victims of many forms of violence (in family, school, and/or community). Cluster analyses identified 4 groups (minimal victimization, generalized victimization, threatening environment, aggressive environment), which differ according to the forms and extent of the violence experienced. The role of age, gender, and adverse life events in forming groups is also examined, as are the links with mental health disorders. Fostering the examination of the phenomenon of violence against children in all its diversity, this taxonomy presents advantages for researchers and professionals, which are discussed.

[Not Available]. / Collaboration entre les centres de pédiatrie sociale en communauté et les réseaux des services sociaux public et communautaire pour venir en aide aux familles : quelle place et quels enjeux pour les acteurs?

OBJECTIVES: Over the past twenty years, numerous community social pediatrics centres (CSPCs) have been established in Quebec. Because the needs of the children followed are so complex, collaboration with organizations in social services and public and community health networks is paramount. The purpose of this study is to document CSPCs'level of integration into these networks and the issues and challenges involved in such collaborations. METHOD: Telephone surveys were conducted with 75 respondents from public and community networks and with representatives from CSPCs that have been open for at last one year. Two questionnaires were used to document the depth and quality of connections and an open question helped identify certain collaboration-related issues and challenges. RESULTS: CSPCs perceive a higher level of collaboration with the social services and public health network than with the community network. Similarly, CSPCs want to collaborate more with the public network than with the community network. With respect to the quality of collaborations, the climate is more positive and the level of joint coordination is higher between CSPCs and the public network. Although they are similar, the issues related to collaboration can be seen differently in terms of challenges, depending on the stakeholders' network. CONCLUSION: Results are discussed in light of challenges that characterize the collaborations between CSPCs and the networks, which include the recognition of their identity and the funding of the organizations.

Prevalence, co-occurrence and decennial trends of family violence toward children in the general population.

OBJECTIVES: In Quebec, three population-based surveys have documented the prevalence of psychological aggression, and minor and severe physical violence toward children. This paper aims to present 1) the results of the 2012 survey with regard to the frequency and annual prevalence of violence, and 2) the trends in all three forms of violence between 1999 and 2012 according to children's age. METHODS: The three independent surveys were all conducted through telephone interviews in 1999, 2004 and 2012 by the Institut de la Statistique du Québec and reached a total sample of 9,646 children living with a mother figure. Psychological aggression, and minor and severe physical violence were measured using the Parent Child Conflict Tactics Scales. RESULTS: The results show that repeated psychological aggression, after having increased between 1999 (48%) and 2004 (53%), slightly decreased in 2012 (49%). Minor physical violence decreased steadily between 1999 and 2012, from 48% to 35%, and severe physical violence remained stable (6%). These three forms of violence varied by the age category of the children. Finally, the results show that the co-occurrence of the use of physical and psychological violence remained high in all three surveys. CONCLUSION: The results are consistent with trends in North America and are discussed in terms of services to support families.