Recurrent child protection post-investigation services for First Nations children in the province of Quebec.

BACKGROUND: The longitudinal trajectory of Indigenous children within child protection (CP) services, including their recurrent involvement, has yet to be documented. OBJECTIVES: 1) To document whether First Nations children were at increased risk of a first recurrence of post-investigation CP services compared to children from the majority group. 2) To identify the characteristics associated with recurrence for First Nations children, and to compare these results to those for children from the majority group. METHOD: Anonymized CP administrative data (2002-2014; n = 1150) of a region in the province of Quebec were used to conduct Cox proportional hazards modeling, in partnership with an advisory committee. RESULTS: The risk of recurrence of First Nations children did not significantly differ from the risk for children from the majority group (HR: 0.980, n.s.) while controlling for covariates. Among First Nations children (n = 459), being under two at the case closure (HR: 2.718, p < .05), having received short-term intervention (HR: 5.027, p < .001) and coming from a family already known to the CP agency (HR: 2.023, p < .001) were associated with an increased risk of recurrence. CONCLUSIONS: The findings highlight the importance of studying First Nations children's trajectories within CP services as a group deserving full attention and for First Nations to be able to design or demand appropriate services responding to their population's needs. A family-based research perspective is recommended to understand better the full family history leading to and in relation to CP services, which could provide more sound practice recommendations.

Implementing a sexual violence prevention program in two Canadian Indigenous communities: Challenges and lessons learned.

BACKGROUND: The prevalence of child sexual violence remains overwhelming, particularly among Indigenous populations, despite increased awareness. Therefore, implementing efficient initiatives is crucial in preventing and reducing sexual violence rates among these groups. OBJECTIVE: This study aimed to examine the processes involved in the implementation of a sexual violence prevention program in two Indigenous communities in Canada and assess application of culturally safe practices. METHOD: Eight Indigenous and non-Indigenous project managers underwent semi-structured interviews before the program's implementation; five of them also participated in the follow-up interviews. Moreover, thirteen Indigenous service providers from the two communities answered open-ended questions when the included training ended. RESULTS: Thematic analysis revealed the importance of following an ongoing process (not only before implementing a program) to assess the needs of community members and involving them in decision-making. Administrative injunctions were also identified as a significant challenge during implementation. Results showed that participants reported the taboo of sexual violence as a challenge but that constant discussions about the prevention of sexual violence helped defuse the discomfort and foster trust between Indigenous and non-Indigenous professionals. Finally, participants provided recommendations to improve research and intervention practices. CONCLUSIONS: Several takeaways were discussed to improve research practices with, by, and for Indigenous peoples, such as using collaborative communication, developing common understanding relative to work agendas, and increasing cultural competencies to build trust within the partnership.

Childhood Sexual Abuse, Intellectual Disability, and Subsequent Physical and Mental Health Disorders: A Matched Cohort Study.

This study assesses whether children with intellectual disability (ID) are more at risk of sexual abuse and whether they have similar consultation rates for physical and mental health disorders than children without ID. The matched-cohort design study uses administrative databases of children who had a sexual abuse report corroborated by a child protection agency and a matched group from the general population. Children with ID were 3.5 times more likely to have a corroborated sexual abuse report when compared to their peers without ID and a higher post-abuse number of medical consultations for physical and mental health disorders. Children with ID are more at risk of sexual abuse and physical and mental health disorders and may also be more vulnerable to the effects of abuse.

Child maltreatment investigations and substantiations in child protection services: Factors distinguishing children with intellectual disabilities.

BACKGROUND: Children with intellectual disabilities (ID) are more vulnerable to maltreatment than children without ID. Few studies focused on understanding the experiences of maltreatment of children with ID, limiting our capacity to adequately care for them. OBJECTIVE: This study examined the types of maltreatment with which ID is associated among child protection investigations, and identified the individual, environmental, and service-related factors distinguishing children with ID from those without, among children with substantiated maltreatment. METHODS: Secondary data from an incidence study on investigated child maltreatment including 2053 children aged 6-17 years old were analyzed through univariate and multivariate logistic regressions. ID was present for 5.7% (n = 117) of the children. RESULTS: ID was associated with increased odds of being investigated for neglect and decreased odds of being investigated or substantiated for psychological maltreatment. The factors that most distinguished children with ID from other children were physical disabilities (8.45, p < 0.001) and autism spectrum disorder (11.33, p < 0.001) in the child and having at least one parent with ID (16.21, p < 0.001). Two other environmental factors, including having been reported by a professional (2.13, p = 0.047), distinguished children with ID from the other children. CONCLUSIONS: Children with ID who experienced maltreatment present with greater adversity than children without ID. Professionals play a preponderant role in reporting situations of maltreatment for children with ID and need additional training to properly respond to maltreatment of children with ID.

"How many times did I not want to live a life because of him": the complex connections between child sexual abuse, disclosure, and self-injurious thoughts and behaviors.

BACKGROUND: Meta-analyses have confirmed an association between child sexual abuse (CSA) and non-suicidal and suicidal self-injurious thoughts and behaviors (SITB), yet the mechanisms linking these factors are, to date, poorly understood. The goal of the current study is to explore one potential influencing factor acting in the association between CSA and SITB, which is the disclosure experience. Disclosure has been identified as a prominent factor in the healing process of survivors, with a lack of support following disclosures heightening negative outcomes. Exploring the impact of CSA disclosure on SITB is necessary to build effective prevention and intervention strategies. METHODS: This qualitative study is part of a larger initiative spanning diverse research sites in Canada and in Ireland and aiming to lend voice to young people who were sexually abused in childhood/adolescence. Participants were recruited from community-based sexual abuse/assault agencies, hospital-based specialized clinics and child advocacy centres. The Long Interview Method, based on a branch of phenomenology, was used to guide research design and data collection. The current thematic analysis, informed by a stress-diathesis model, is based on a sample comprised of 21 ethnically diverse youth aged 15 to 25 who self-reported a sexual abuse experience in their childhood or teenage years and who, as part of the interview on their disclosure processes, revealed past or current SITB. RESULTS: The thematic analysis led to the identification of four main themes that both confirmed past research and conceptual models on SITB, and provided new insights. Participants perceived a clear link between their CSA experience and SITB and other mental health issues. They offered their views on the meanings of SITB for CSA victims: to cope with abuse; to end the abuse; to express self-hatred and loneliness; and to let people know about their suffering. They described how negative disclosure experiences led to more nonsuicidal and suicidal SITB. Yet, participants also revealed that receiving support for their SITB created opportunities for CSA disclosure and support. CONCLUSIONS: This study showed complex connections between CSA experiences, disclosure and nonsuicidal and suicidal SITB. Understanding the reciprocal influences between SITB, CSA disclosure and help-seeking could better equip mental health professionals and caregivers to provide support and foster healing and recovery in CSA victims.

Recurrent involvement with the Quebec child protection system for reasons of neglect: A longitudinal clinical population study.

Studies in several jurisdictions have found that families become recurrently involved with child protection systems most frequently for reasons of neglect. Child protection involvement for reasons of neglect is shown to correlate with various socioeconomic vulnerabilities. OBJECTIVE: This study, the largest of its kind in Canada, examines when and for whom recurring conditions of neglect were most likely to occur for all children involved with child protection in the province of Quebec over a span of fifteen years. PARTICIPANTS AND SETTING: Specifically, the study population includes all children whose ongoing child protection intervention in Quebec closed between 2002 and 2017 (N = 76,176). METHODS: This clinical population study uses a longitudinal research design drawing anonymized clinical administrative data from all of Quebec's child protection jurisdictions spanning 15 years, and Quebec data extracted from the 2011 Canadian National Household Survey to estimate socioeconomic vulnerability. RESULTS: Of the total population studied, 32.5 % (N = 24,816) experienced a recurrence of maltreatment during the study period, of which more than one third (N = 8707) experienced a recurrence for reasons of neglect. CONCLUSIONS: Because the association between socioeconomic vulnerability and recurrence of neglect indicates a gap in material and social supports-which child protection systems have neither the mandate nor the resources to fill-we propose additional avenues that we urge policymakers and practitioners to consider in supporting the demonstrated needs of these families.

A preliminary mapping of individual, relational, and social factors that impede disclosure of childhood sexual abuse.

Uncovering the pathways to disclosures of child sexual abuse (CSA) and the factors influencing the willingness of victims to talk about the abuse is paramount to the development of powerful practice and policy initiatives. Framed as a long interview method utilizing a grounded theory approach to analyze data, the objective of the current study was to provide a preliminary mapping of the barriers to CSA disclosures through an ecological systemic lens, from a sample of 67 male and female CSA adult survivors, all of whom had recently received counselling services. The current project led to the identification of three broad categories of barriers that were each comprised of several subthemes, namely: Barriers from Within (internalized victim-blaming, mechanisms to protect oneself, and immature development at time of abuse); Barriers in Relation to Others (violence and dysfunction in the family, power dynamics, awareness of the impact of telling, and fragile social network); and Barriers in Relation to the Social World (labelling, taboo of sexuality, lack of services available, and culture or time period). This study points to the importance of using a broad ecological framework to understand the factors that inhibit disclosure of CSA, as barriers to disclosure do not constrain solely the victims. Results are discussed in light of their implications for research, prevention and intervention programs, and social policies and media campaigns, as the burden is on the larger community to create a climate of safety and transparency that makes the telling of CSA possible.