Toward the full and proper implementation of Jordan's Principle: An elusive goal to date.

First Nations children experience service delays, disruptions and denials due to jurisdictional payment disputes within and between federal and provincial/territorial governments. The House of Commons sought to ensure First Nations children could access government services on the same terms as other children when it unanimously passed a private members motion in support of Jordan's Principle in 2007. Jordan's Principle states that when a jurisdictional dispute arises regarding public services for a First Nations child that are otherwise available to other children, the government of first contact pays for the service and addresses payment disputes later. Unfortunately, the federal government adopted a definition of Jordan's Principle that was so narrow (complex medical needs with multiple service providers) that no child ever qualified. This narrow definition has been found to be unlawful by the Federal Court of Canada and the Canadian Human Rights Tribunal. The present commentary describes Jordan's Principle, the legal cases that have considered it and the implications of those decisions for health care providers.

Les enfants des Premières nations sont aux prises avec des reports, des perturbations et des refus de services en raison de conflits en matière de paiement entre les gouvernements fédéral, provinciaux et territoriaux ou au sein de chacune de ces instances. En 2007, pour garantir l'accès des enfants des Premières nations aux services gouvernementaux selon les mêmes modalités que les autres enfants, la Chambre des communes a adopté à l'unanimité la motion d'un député en appui au principe de Jordan. Selon ce principe, lorsqu'un conflit de compétences se pose entre deux parties en ce qui concerne le paiement de services pour un enfant des Premières nations et que ces services sont offerts aux autres enfants canadiens, l'instance de premier contact paie les services, puis voit à la résolution du conflit. Malheureusement, le gouvernement fédéral a adopté une définition du principe de Jordan si étroite (besoins médicaux complexes exigeant l'apport de multiples dispensateurs de soins) qu'aucun enfant n'y a jamais été admissible. La Cour fédérale du Canada et le Tribunal canadien des droits de la personne ont d'ailleurs jugé cette définition illégale. Le présent commentaire décrit le principe de Jordan, les poursuites juridiques qui s'y sont attardées et les conséquences de ces décisions pour les dispensateurs de soins.

Parent-Child Separations and Mental Health among First Nations and Métis Peoples in Canada: Links to Intergenerational Residential School Attendance.

First Nations children are over 17 times more likely to be removed from their families and placed in the child welfare system (CWS) than non-Indigenous children in Canada. The high rates of parent-child separation have been linked to discriminatory public services and the Indian Residential School (IRS) system, which instigated a multi-generational cycle of family disruption. However, limited empirical evidence exists linking the IRS to subsequent parent-child separations, the CWS, and mental health outcomes among First Nations, Inuit, and Métis populations in Canada. The current studies examine these relationships using a nationally representative sample of First Nations youth (ages 12-17 years) living in communities across Canada (Study 1), and among First Nations and Métis adults (ages 18+ years) in Canada (Study 2). Study 1 revealed that First Nations youth with a parent who attended IRS had increased odds of not living with either of their biological parents, and both IRS and not living with biological parents independently predicted greater psychological distress. Similarly, Study 2 revealed that First Nations and Métis adults with familial IRS history displayed greater odds of spending time in the CWS, and both IRS and CWS predicted elevated depressive symptoms. The increased distress and depressive symptoms associated with parent-child separations calls for First Nations-led interventions to address the inequities in the practices of removing Indigenous children and youth from their families.

Indigenous ontology, international law and the application of the Convention to the over-representation of Indigenous children in out of home care in Canada and Australia.

This paper explores the efficacy of the United Nations Convention on the Rights of the Child (Convention, UN General Assembly, 1989) through the lens of the over-representation of First Nations children placed in out-of-home care in Canada and Aboriginal and Torres Strait Islander children in Australia. A general overview of Indigenous worldviews frames a discussion on the coherence of international human rights law and instruments, including the Convention, account for Indigenous Peoples' ontologies. The authors argue that the United Nations Declaration on the Rights of Indigenous Peoples (UN General Assembly, 2007) and a new theoretical framework published by the Pan American Health Organization (2019) on health equity and inequity are useful tools to augment the Convention's coherence with Indigenous ontologies. The paper discusses how the Convention can be applied to structural and systemic risks driving the over-representation of First Nations and Aboriginal and Torres Strait Islander children in out of home care in Canada and Australia. These two countries are included as First Nations and Aboriginal and Torres Strait Islander peoples in these countries have both had significant impact in advocating for their children despite experiencing similar barriers including contemporary colonialism. The advocacy work of the First Nations Child and Family Caring Society in Canada and the Victorian Aboriginal Child Care Agency in Victoria, Australia are discussed. The paper ends by outlining some of the challenges ahead that include the need to meaningfully recognize Indigenous self-determination and equitable funding and resources to enable the actualization of self-determination. Further research contrasting international human rights instruments with Indigenous ontologies could help inform possible amendments to international human rights treaties and general comments.

Exploring alternate specifications to explain agency-level effects in placement decisions regarding Aboriginal children: Further analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect Part C.

A series of papers using data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) explored the influence of clinical and organizational characteristics on the decision to place Aboriginal children in out-of-home placements at the conclusion of child maltreatment investigations. The purpose of this paper is to further explore a consistent finding of the previous analyses: the proportion of investigations involving Aboriginal children at a child welfare agency is associated with placement for all children in that agency. CIS-2008 data were used in the analysis, which allowed for inclusion of previously unavailable organizational and contextual variables. Multi-level statistical models were developed to analyze the influence of clinical and organizational variables on the placement decision. Final models revealed that the proportion of investigations conducted by the child welfare agency involving Aboriginal children was again a key agency-level predictor of the placement decision for any child served by the agency. Specifically, the higher the proportion of investigations of Aboriginal children, the more likely placement was to occur for any child. Further, this analysis demonstrated that structure of governance, an organizational-level variable not available in previous cycles of the CIS, is an important agency-level predictor of out-of-home placement. Further analysis is needed to fully understand individual and organizational level variables that may influence decisions regarding placement of Aboriginal children.

Placement decisions and disparities among Aboriginal children: further analysis of the Canadian incidence study of reported child abuse and neglect part A: comparisons of the 1998 and 2003 surveys.

OBJECTIVE: Fluke et al. (2010) analyzed Canadian Incidence Study on Reported Child Abuse and Neglect (CIS) data collected in 1998 to explore the influence of clinical and organizational characteristics on the decision to place Aboriginal children in an out-of-home placement at the conclusion of a child maltreatment investigation. This study explores this same question using CIS data collected in 2003 which included a larger sample of Aboriginal children and First Nations child and family service agencies. METHODS: The decision to place a child in an out-of-home placement was examined using data from the Canadian Incidence Study of Reported Child Abuse and Neglect-2003 and a reanalysis of CIS-1998 data (Fluke et al., 2010). The CIS-2003 dataset includes information on nearly 12,000 child maltreatment investigations from the time of report to case disposition. The CIS-2003 also captures information on the characteristics of investigating workers and the child welfare organizations for which they work. Multi-level statistical models were developed to analyze the influence of clinical and organizational variables using MPlus software. MPlus allows the use of dichotomous outcome variables, which are more reflective of decision-making in child welfare and facilitates the specific case of the logistic link function for binary outcome variables under maximum likelihood estimation. RESULTS: Final models revealed the proportion of investigations conducted by the child welfare agency involving Aboriginal children was a key single agency level predictor of the placement decision. Specifically, the higher the proportion of investigations of Aboriginal children, the more likely placement was to occur. Contrary to the findings in the first paper (Fluke et al., 2010), individual Aboriginal status also remained significant in the final model at the first level. CONCLUSIONS: Further analysis needs to be conducted to further understand individual and organizational level variables that may influence decisions regarding placement of Aboriginal children. There is also a need for research that is sensitive to differences among, and between, Métis, First Nations and Inuit communities. Results are not generalizable to Québec because data from this province were excluded.

Exploring alternate specifications to explain agency-level effects in placement decisions regarding aboriginal children: further analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect Part B.

OBJECTIVE: This paper builds upon the analyses presented in two companion papers (Fluke et al., 2010; Fallon et al., 2013) using data from the 1998 and 2003 cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-1998 and CIS-2003) to examine the influence of clinical and organizational characteristics on the decision to place a child in out-of-home care at the conclusion of a child maltreatment investigation. This paper explores various model specifications to explain the effect of an agency-level factor, proportion of Aboriginal reports, which emerged as a stable and significant factor through the two data collection cycles. It addresses the issue of data comparability between the two cycles and explores various re-specifications and descriptive analyses of reported models to evaluate their solidity with regards to the sampling schemes and the precise contribution of a multi-level specification. METHODS: The decision to place a child in out-of-home care was examined using data from the CIS-2003. This child welfare dataset collected information about the results of nearly 12,000 child maltreatment investigations as well as a description of the characteristics of the workers and organization responsible for conducting those investigations. Multi-level statistical models were developed using MPlus software, which can accommodate dichotomous outcome variables and are more reflective of decision-making in child welfare. The models are thus multi-level binary logistic regressions. RESULTS: Final models revealed that two agency-level variables, 'Education degree of majority of workers' and 'Degree of centralization in the agency' clarify the nature of the effect of 'Proportion of Aboriginal reports', a stable, key second level predictor of the placement decision. The comparability of the effect of this agency-level variable across the 1998 and 2003 cycles becomes further evident through this analysis. By using a unified database including both cycles and various specifications of models, the comparability was found to be robust, in addition to clarifying the precise contribution of a multi-level specification. CONCLUSIONS: This third paper in a series establishes the 'Proportion of Aboriginal reports' received by the child welfare agency as an important agency level predictor associated with a child's likelihood of being placed in the Canadian child protection system. While the more complex models give support to the notion that unequal resources subtend those results, more analyses are needed to confirm this hypothesis. Unequal resources for agencies with larger Aboriginal caseloads may explain the persistence of the results. These findings suggest that specific resource constraints related to worker education may be explanatory.

Placement decisions and disparities among aboriginal groups: an application of the decision making ecology through multi-level analysis.

OBJECTIVE: This paper examined the relative influence of clinical and organizational characteristics on the decision to place a child in out-of-home care at the conclusion of a child maltreatment investigation. It tested the hypothesis that extraneous factors, specifically, organizational characteristics, impact the decision to place a child in out-of-home care. A secondary aim was to identify possible decision making influences related to disparities in placement decisions tied to Aboriginal children. Research suggests that the Aboriginal status of the child and structural risk factors affecting the family, such as poverty and poor housing, substantially account for this overrepresentation. METHODS: The decision to place a child in out-of-home care was examined using data from the Canadian Incidence Study of Reported Child Abuse and Neglect. This child welfare dataset collected information about the results of nearly 5,000 child maltreatment investigations as well as a description of the characteristics of the workers and organization responsible for conducting those investigations. Multi-level statistical models were developed using MPlus software, which can accommodate dichotomous outcome variables, which are more reflective of decision making in child welfare. MPlus allows the specific case of the logistic link function for binary outcome variables under maximum likelihood estimation. RESULTS: Final models revealed the importance of the number of Aboriginal reports to an organization as a key second level predictor of the placement decision. It is the only second level factor that remains in the final model. This finding was very stable when tested over several different levels of proportionate caseload representation ranging from greater than 50% to 20% of the caseload. CONCLUSIONS: Disparities among Aboriginal children in child welfare decision making were identified at the agency level. PRACTICE IMPLICATIONS: The study provides additional evidence supporting the possibility that one source of overrepresentation of Aboriginal children in the Canadian foster care system is a lack of appropriate resources at the agency or community level.