Savoir détecter l'exposition des enfants à la violence entre partenaires intimes, qu'elle soit présumée ou divulguée, et savoir intervenir.

L'exposition des enfants à la violence entre partenaires intimes (EEVPI), qu'il s'agisse des parents ou d'autres proches, représente près de la moitié de tous les cas qui font l'objet d'une enquête et sont corroborés par les services de protection de l'enfance du Canada. Les atteintes affectives, physiques et comportementales associées à l'EEVPI sont semblables aux effets d'autres formes de maltraitance envers les enfants. Il peut être difficile d'établir quels enfants et adolescents sont exposés à la violence entre partenaires intimes (VPI) en raison des comportements non spécifiques parfois associés à une telle exposition, de même que de la stigmatisation et du secret entourant souvent ce type de violence. Par ailleurs, une intervention en toute sécurité auprès des enfants et des adolescents chez qui on présume une exposition à la VPI peut être compliquée par la nécessité d'également tenir compte de la sécurité et du bien-être d'un proche non contrevenant. Le présent document de principes propose une approche fondée sur des données probantes mise au point par le projet VEGA (Violence, Evidence, Guidance, Action ou violence, données probantes, conseils, action) pour détecter l'exposition des enfants et des adolescents à la VPI et intervenir en toute sécurité auprès d'eux.

Recognizing and responding to children with suspected exposure to intimate partner violence between caregivers.

Children's exposure to intimate partner violence (CEIPV) between parents and other caregivers accounts for nearly half of all cases investigated and substantiated by child welfare authorities in Canada. The emotional, physical, and behavioural impairments associated with CEIPV are similar to effects of other forms of child maltreatment. The identification of children and youth who have been exposed to intimate partner violence (IPV) can be challenging due to the non-specific behaviours sometimes associated with such exposure, and the stigma and secrecy that often characterize IPV. Also, responding safely to children and youth with suspected CEIPV can be complicated by the need to consider the safety and well-being of a non-offending caregiver. This position statement presents an evidence-informed approach developed by the Violence, Evidence, Guidance, Action (VEGA) Project for the safe recognition and response to children and youth who are suspected of being exposed to IPV.

CHAMPP4KIDS: Mixed methods study protocol to evaluate acceptability and feasibility of Parenting for Lifelong Health materials in a Canadian context.

BACKGROUND: Parents and caregivers play a key role in children's healthy development and well-being. Traditional parenting interventions promote positive parenting practices and are key to preventing child maltreatment. However, numerous barriers can limit access to programs, barriers which were further exacerbated by the COVID-19 pandemic. The Parenting for Lifelong Health group developed mass media and public health communication materials to promote positive caregiving behaviours on a population level. The Champions of Positive Parenting 4 Kids (CHAMPP4KIDS) study will examine the acceptability and feasibility of these materials for service providers and caregivers of children aged 2-6 years in Ontario, Canada. METHODS: This study will use a convergent mixed-methods design. Consenting service providers (n = 200) and caregivers (n = 100) will complete a quantitative survey to rate, rank and give feedback on Parenting for Lifelong Health tip sheets and social media ads. Caregivers will also complete self-report scales measuring depression and anxiety. We will hold focus group discussions with a sub-sample of surveyed providers (n = 40) and caregivers (n = 25). An adapted Trials of Improved Practices methodology will explore caregiver perspectives after implementing the tip sheets. Primary quantitative outcomes will be descriptive statistics of rankings, Likert Scale scores and descriptive analysis of caregiver depression and anxiety. Qualitative data will be analyzed using Rapid Qualitative Inquiry and triangulated through a convergent coding matrix. DISCUSSION: The Parenting for Lifelong Health COVID-19 parenting materials offer succinct, engaging parenting information in a mass media format that addresses some challenges associated with accessing in-person programming. The CHAMPP4KIDS study will provide mixed methods insights on the materials' acceptability and feasibility from different groups in a Canadian context, with a focus on marginalized families. The use of Trials of Improved Practices methodology could prove a useful tool for participant-led adaptation of existing parenting, early childhood development and other health intervention materials.

Routine screening for adverse childhood experiences (ACEs) still doesn't make sense.

When a serious health or social problem is identified as both prevalent and in need of attention, a common response is to propose that various systems implement routine identification, such as universal screening. However, these well-intentioned responses often fail to consider the key requirements necessary to determine whether benefits outweigh harms. Unfortunately, this continues to be the case for calls to implement routine screening for Adverse Childhood Experiences (ACEs). Persistent evidence gaps for this type of screening include the lack of any randomized controlled trials demonstrating that ACEs screening programs lead to any benefits. Rather than being informed by established screening principles, the calls to proceed with ACEs screening appear to rely on the assumption that simply identifying risk factors can lead to beneficial outcomes that outweigh any risk of harms. This may reflect a gap in understanding that patterns identified at the population level (e.g., that more ACEs are associated with more health and social problems) cannot be directly translated to practices at the level of the individual. This commentary does not question the importance of ACEs; rather it identifies that directing limited resources to screening approaches for which there is no evidence that benefits outweigh harms is problematic. Instead, we advocate for the investment in high-quality trials of prevention interventions to determine where best to direct limited resources to reduce the occurrence of ACEs, and for the prioritization of evidence-based treatment services for those with existing health and social conditions, whether or not they are attributed to ACEs.

Do parenting behaviors intended as discipline vary by household religious affiliation in Cameroon?

BACKGROUND: Religious affiliation may account for some variance in parenting behaviors used for disciplinary intent. However, most reported studies of this relationship are limited to high-income countries focused on Christianity. OBJECTIVE: This study aimed to determine whether parenting behaviors vary by religion in a low- and middle-income country between Protestant, Catholic, and Muslim groups. It was hypothesized that Protestant households would have higher odds of select parenting behaviors. PARTICIPANTS & SETTINGS: Data from the 2014 Cameroonian Multiple Indicator Cluster Survey, containing a nationally representative household sample, were used. METHODS: Adult caregivers in selected households with a child aged 1-14 years of age participated in interviews containing a standardized disciplinary measure asking about the exposure of one randomly selected child to a series of parent behaviors in the preceding month. RESULTS: Of the 4978 households, 41.6 % were Catholic, 30.9 % Protestant and 27.6 % Muslim. Spanking was the most common of the six types of physical punishments across groups with no association with household religion. In contrast, children in Protestant households had higher odds of being hit with an object compared to the other two groups, but only for younger children. Children in Protestant households also had higher odds of exposure to a combined approach, i.e., use of physical, psychological, and non-violent parent behaviors. CONCLUSIONS: This study advances the examination of the potential influence of household religion on parenting behavior, however further inquiry is needed to examine these patterns in other settings with additional indices of religiosity and disciplinary beliefs.

Factors influencing the implementation of an intimate partner violence intervention in nurse home visiting: A qualitative descriptive study.

AIMS: To identify factors that influenced: (1) integration of an intimate partner violence intervention into the Nurse-Family Partnership programme and (2) utilization of the intervention with fidelity to the clinical pathway by nurses in their home visits. DESIGN: A qualitative descriptive study embedded in the intervention arm (n = 7 sites) of a 15-site cluster randomized clinical trial to evaluate the intimate partner violence intervention. METHODS: Semi-structured interviews (n = 13) were conducted with supervisors. Nurses at the seven sites shared their experiences in focus groups conducted at two time points (n = 14 focus groups, 12 months after baseline and following collection of client trial data). Qualitative data were generated between May 2012 and September 2016, with this post hoc analysis completed in 2021. Focus group data were analysed using a rapid qualitative analysis technique. Conventional content analysis was used to categorize data from the supervisor interviews. RESULTS: Integration was negatively impacted by: (1) a lack of centralized programme support and (2) competing programme demands. At the practice level, multiple factors related to supervisor capacity, preservation of the nurse-client relationship and nurse, client and intervention attributes influenced nurses' capacity to address intimate partner violence with fidelity to the clinical pathway. A lack of privacy in home visits was the most common barrier to addressing clients' experiences of violence. The need for increased time for nurses to develop clinical expertise prior to the evaluation of the intervention was also identified. CONCLUSION: Before implementing an intimate partner violence intervention, home visitation programmes need to attend to site readiness, provide support to supervisors to facilitate implementation, and provide nurses with time to develop the expertise and clinical judgement required to use a complex intervention whilst also respecting clients' agency to determine when and how they will respond to the violence in their relationships.ImpactWhat problem did the study address? Given the positive impacts that participating in the Nurse-Family Partnership intimate partner violence education had on nurse home visitors' attitudes and confidence to address this type of violence experienced by first-time mothers, it was important to understand what factors contributed to the low fidelity of intervention implementation in practice, a factor that may help to explain the lack of client-level impacts on maternal outcomes. What were the main findings? Implementation of an intimate partner violence intervention in a nurse home visiting programme was influenced by contextual factors at both programme and practice levels. At the practice level, a lack of privacy in the home limited nurses' capacity to use the intervention. Supervisors were identified as having an important role to support nurses develop the expertise to use the intervention. Nurses also consistently balanced the intervention requirements to address intimate partner violence with an understanding of the complexity of this type of violence in young women's lives and respect for clients' agency to determine when and how they will respond to the violence in their relationships. Where and on whom will the research have an impact? These findings will be of interest to: (1) researchers developing and evaluating complex nursing interventions to address intimate partner violence in home visitation programmes and (2) stakeholders leading the implementation of novel innovations in the Nurse-Family Partnership programme.

Stressors and symptoms associated with a history of adverse childhood experiences among older adolescents and young adults during the COVID-19 pandemic in Manitoba, Canada. / Facteurs de stress et symptômes associés à des antécédents d'expériences négatives dans l'enfance chez les grands adolescents et les jeunes adultes pendant la pandémie de COVID-19 au Manitoba (Canada).

INTRODUCTION: The COVID-19 pandemic has had major economic, social and psychological consequences for adolescents and young adults. It is unclear whether those with a history of adverse childhood experiences (ACEs) were particularly vulnerable. We examined whether a history of ACEs was associated with financial difficulties, lack of emotional support, feeling stressed/anxious, feeling down/depressed, increased alcohol and/or cannabis use and increased conflict with parents, siblings and/or intimate partners among 16- to 21-year-olds during the pandemic. METHODS: Data were collected in November and December 2020 from respondents aged 16 to 21 years (n = 664) participating in the longitudinal and intergenerational Well-being and Experiences Study (Wave 3) conducted in Manitoba, Canada. Age-stratified associations between ACEs and pandemic-related stressors/symptoms were examined with binary and multinomial logistic regression. RESULTS: A history of ACEs was associated with pandemic-related financial difficulties (adjusted relative risk ratio [aRRR] range: 2.44-7.55); lack of emotional support (aRRR range: 2.13-26.77); higher levels of feeling stressed/anxious and down/depressed (adjusted odds ratio [aOR] range: 1.78-5.05); increased alcohol and cannabis use (aOR range: 1.99-8.02); and increased relationship conflict (aOR range: 1.98-22.59). Fewer associations emerged for older adolescents and these were not to the same degree as for young adults. CONCLUSION: Adolescents and young adults with a history of ACEs reported increased odds of pandemic-related stressors and symptoms, and may need more resources and greater support compared to peers without an ACE history. Differences in results for adolescents and young adults suggest that interventions should be tailored to the needs of each age group.

Conceptualizing Physicians' Roles in Addressing Intimate Partner Violence: A Critical Discourse Analysis of Resources for Canadian Physicians.

Resources addressing intimate partner violence (IPV) play a role in shaping how physicians conceptualize and perform their roles in caring for affected patients. This study combines environmental scanning with critical discourse analysis (CDA) to parse how roles of physicians were represented in 28 education materials and policy documents about IPV, taking the Canadian training milieu as an example. We developed a cyclical model of three core physician roles in addressing IPV-learning about IPV, identifying patients experiencing IPV, and responding to patients' disclosures of IPV. The construction of these physician roles is suggestive of an ongoing process of medicalization of IPV.

Case conceptualization in child welfare: an underused resource to improve child, family, and provider outcomes.

Case conceptualization, formally known as case formulation, is one tool that assists in determining the best course of action for children and families experiencing family violence that has been under-utilized in child welfare. In this article we present a step-by-step case conceptualization process that considers the child welfare context. We then present a hypothetical case example of a 10-year-old child referred by a child welfare worker to evidence-based treatment for mental health and behavioural concerns. Mental health services are not helpful for the child and further consultation is enlisted. To more effectively guide intervention and treatment planning and ultimately improve outcomes for the child, we present case conceptualization as a process that incorporates relevant aspects of the child and family's history and circumstance. We conclude with a succinct case conceptualization and treatment plan to show how the prognosis of the child can be improved when case conceptualization is employed.

Child Maltreatment and Intimate Partner Violence in Mental Health Settings.

Intimate partner violence (IPV) and child maltreatment (physical, emotional, sexual abuse, neglect, and children's exposure to IPV) are two of the most common types of family violence; they are associated with a broad range of health consequences. We summarize evidence addressing the need for safe and culturally-informed clinical responses to child maltreatment and IPV, focusing on mental health settings. This considers clinical features of child maltreatment and IPV; applications of rights-based and trauma- and violence-informed care; how to ask about potential experiences of violence; safe responses to disclosures; assessment and interventions that include referral networks and resources developed in partnership with multidisciplinary and community actors; and the need for policy and practice frameworks, appropriate training and continuing professional development provisions and resources for mental health providers. Principles for a common approach to recognizing and safely responding to child maltreatment and IPV are discussed, recognizing the needs in well-resourced and scarce resource settings, and for marginalized groups in any setting.

Child Welfare Reform: A Scoping Review.

While there have been ongoing calls to reform child welfare so that it better meets children's and families' needs, to date there have been no comprehensive summaries of child welfare reform strategies. For this systematic scoping review, we summarized authors' recommendations for improving child welfare. We conducted a systematic search (2010 to 2021) and included published reviews that addressed authors' recommendations for improving child welfare for children, youth, and families coming into contact with child welfare in high-income countries. A total of 4758 records was identified by the systematic search, 685 full-text articles were screened for eligibility, and 433 reviews were found to be eligible for this scoping review. Reviews were theoretically divided, with some review authors recommending reform efforts at the macro level (e.g., addressing poverty) and others recommending reform efforts at the practice level (e.g., implementing evidence-based parenting programs). Reform efforts across socioecological levels were summarized in this scoping review. An important next step is to formulate what policy solutions are likely to lead to the greatest improvement in safety and well-being for children and families involved in child welfare.

Foster children's perspectives on participation in child welfare processes: A meta-synthesis of qualitative studies.

The objective of this meta-synthesis was to systematically synthesise qualitative research that explores foster children's perspectives on participation in child welfare processes. Searches were conducted in Medline (OVID), Embase, PsycINFO, and Social Science Citation Index. Children in non-kinship foster care in any setting (high-income, middle-income, low-income countries) who self-reported their experiences of care (removal from home, foster family processes, placement breakdown) were eligible for inclusion. Selected studies took place in 11 high-income countries. A total of 8436 citations were identified and 25 articles were included in this meta-synthesis. Studies summarized the views of 376 children. Children had been in foster care between two weeks and 17 years. Findings synthesize 'facets' of children's participation (e.g., being asked vs making decisions), as well as children's perceived barriers and facilitators to participation. A main priority for children was the quality of their relationships, especially in terms of values (e.g., fairness, honesty, inclusivity). No one way of participating in child welfare processes is better than another, as some children more clearly expressed a desire for passive listening roles and others indicated a desire for active roles in decision-making. However, meaningful adults in foster children's lives have a responsibility to act in a way that strengthens the emphasis on children's needs and voices.

Mental Health Help-Seeking in Parents and Trajectories of Depressive and Anxiety Symptoms: Lessons Learned From the Ontario Parent Survey During the COVID-19 Pandemic.

Tracking parents' mental health symptoms and understanding barriers to seeking professional help are critical for determining policies and services to support families' well-being. The COVID-19 pandemic has posed enormous challenges to parents' mental health and the access to professional help, and there are important public health lessons that must be learned from the past 2 years' experiences to inform future mental health responses to social- and family-level stressful events. This study examines the trajectories of parents' depressive and anxiety symptoms over a year during the pandemic as related to their mental health help-seeking. Data were collected from a sample of parents residing in Ontario, Canada at baseline (May-June, 2020; Wave 1) and again 1 year later (Wave 2; referred to as W1 and W2 below). Parents (n = 2,439; M age = 39.47, SD = 6.65; 95.0% females) reported their depressive and anxiety symptoms at both waves. Mental health help-seeking, including self-reported contact with professional help and perceived unmet mental health needs, was measured at W2. Parents were classified into four groups by mental health help-seeking. Inconsistent seekers and non-seeking needers, both reporting perceived unmet needs for professional help, showed greater increases in depressive and anxiety symptoms, whereas parents with no need or needs met showed smaller increases in depressive symptoms and decreases in anxiety symptoms. Belief in self-reliance and time constraints were the leading reasons for not seeking help. These findings suggest that over a year into the pandemic, parents with perceived unmet mental health needs were at greater risk for worsening depressive and anxiety symptoms. Recognizing the demands for mental health services when families experience chronic stressors and targeting the identified barriers may promote family well-being during and beyond this pandemic.

Adolescent health outcomes: associations with child maltreatment and peer victimization.

BACKGROUND: Child maltreatment (CM) and peer victimization (PV) are serious issues affecting children and adolescents. Despite the interrelatedness of these exposures, few studies have investigated their co-occurrence and combined impact on health outcomes. The study objectives were to determine the overall and sex-specific prevalence of lifetime exposure to CM and past-month exposure to PV in adolescents, and the impact of CM and PV co-occurrence on non-suicidal self-injury, suicidality, mental health disorders, and physical health conditions. METHODS: Adolescents aged 14-17 years (n = 2,910) from the 2014 Ontario Child Health Study were included. CM included physical, sexual, and emotional abuse, physical neglect, and exposure to intimate partner violence. PV included school-based, cyber, and discriminatory victimization. Logistic regression was used to compare prevalence by sex, examine independent associations and interaction effects in sex-stratified models and in the entire sample, and cumulative effects in the entire sample. RESULTS: About 10% of the sample reported exposure to both CM and PV. Sex differences were as follows: females had increased odds of CM, self-injury, suicidality, and internalizing disorders, and males had greater odds of PV, externalizing disorders, and physical health conditions. Significant cumulative and interaction effects were found in the entire sample and interaction effects were found in sex-stratified models, indicating that the presence of both CM and PV magnifies the effect on self-injury and all suicide outcomes for females, and on suicidal ideation, suicide attempts, and mental health disorders for males. CONCLUSIONS: Experiencing both CM and PV substantially increases the odds of poor health outcomes among adolescents, and moderating relationships affect females and males differently. Continued research is needed to develop effective prevention strategies and to examine protective factors that may mitigate these adverse health outcomes, including potential sex differences.

Prevalence of childhood exposure to intimate partner violence in low-income and lower-middle-income countries: a systematic review.

OBJECTIVE: To determine the proportion of children in low-income and lower-middle-income countries exposed to intimate partner violence (IPV). DESIGN: Systematic review. DATA SOURCES: PubMed, CINAHL, ERIC, PsycINFO, Web of Science, WHO Global Index Medicus, and Violence and Abuse Abstracts, hand searching of specialised journals from inception until 19 May 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Primary quantitative studies that included a measure of self-reported exposure to IPV prior to age 18 and were conducted in low-income and lower-middle-income countries. DATA EXTRACTION AND SYNTHESIS: Data were screened, extracted and appraised by two independent reviewers. The prevalence estimates were pooled using a random-effects model. Outcomes included lifetime and past-year prevalence of childhood exposure to IPV. Meta-regression was used to explore heterogeneity. Publication bias was assessed using a funnel plot and Egger's regression test. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS: Sixty-two studies with a total of 231 512 participants were included. Eighty-five lifetime prevalence estimates and 6 estimates of past-year prevalence were available for synthesis. The average lifetime prevalence of childhood exposure to IPV was 29% (95% CI 26% to 31%). The average past-year prevalence in children was 35% (95% CI 21% to 48%). The lifetime prevalence disaggregated by WHO regions ranged from 21% to 34%. There were no statistical differences in prevalence estimates between samples of men and women. CONCLUSION: Almost one-third of children in low-income and lower-middle-income countries have been exposed to IPV in their lifetime. There was large heterogeneity between estimates that was not explained by available study and sample characteristics. Our findings indicate that children's exposure to IPV in low-income and lower-middle-income countries is common and widespread; prevention of this major public health exposure should be a priority. PROSPERO REGISTRATION NUMBER: CRD42019119698.

A Qualitative Description of Resident Physicians' Understanding of Child Maltreatment: Impacts, Recognition, and Response.

Child maltreatment (CM) is a public health problem with devastating effects on individuals, families, and communities. Resident physicians have varied formal education in CM, and report feeling inadequately trained in identifying and responding to CM. The purpose of this study is to explore residents' understanding of the impacts of CM, and their perceptions of their role in recognizing and responding to CM to better understand their educational needs. This study analyzed qualitative data obtained from a larger project on family violence education. Twenty-nine resident physicians enrolled in pediatric, family medicine, emergency medicine, obstetrics and gynecology, and psychiatry training programs in Alberta, Ontario, and Québec participated in semi-structured interviews to elicit their ideas, experiences, and educational needs relating to CM. Conventional (inductive) content analysis guided the development of codes and categories. Residents had thorough knowledge about the impacts of CM and their duty to recognize CM, but there was less consistency in how residents understood their role in responding to CM. Residents identified the need for more education about recognizing and responding to CM, and the need for educational content to be responsive to training, patient and family factors, and systemic issues. Despite knowledge about the impacts of CM and laws pertaining to mandated reporting, residents reported challenges with responding to concerns of CM. Findings of this study emphasize the need for better training in response to CM. Future educational interventions should consider a multidisciplinary, experiential approach.

Examining the unique contributions of parental and youth maltreatment in association with youth mental health problems.

BACKGROUND: Extensive research seeks to understand the intergenerational impact of child maltreatment. However, it remains unclear how parent's history of child maltreatment (PCM) is associated with child mental health, after accounting for children's experiences of maltreatment and other proximal risk factors. OBJECTIVE: This study examines the associations between PCM and youth internalizing and externalizing problems, while accounting for youth experiences of maltreatment (YM), and parent mental health and positive parenting. PARTICIPANTS AND SETTING: Youth aged 14 to 17 years (N = 2266) participated in the 2014 Ontario Child Heath Study. METHODS: Parents and youth reported their experiences of child maltreatment. Parent-report and self-reports of youth internalizing and externalizing problems were also collected. Number of subtypes of maltreatment and specific subtypes of maltreatment were examined. Parents reported their own mental health problems and positive parenting practices. RESULTS: Regarding number of maltreatment subtypes, initially PCM was associated with parent-reported, but not self-reported, youth internalizing and externalizing problems. After accounting for YM, parent mental health problems and positive parenting, only YM remained significant. Regarding specific subtypes of maltreatment, both parent and youth emotional abuse were related to parent- and youth-reported internalizing and externalizing problems, after controlling for other maltreatment subtypes. However, the effects of parent emotional abuse became nonsignificant after accounting for YM and proximal risk factors. CONCLUSIONS: Findings indicate: 1) the unique associations between specific PCM and YM subtypes and youth mental health problems; 2) the role of proximal risk factors in explaining the association between PCM and youth mental health; and 3) the importance of multiple informants of youth mental health problems.