[Intra-family violence: identification and ways forward]. / Les violences intrafamiliales : repérage et pistes de réflexion.

For many professionals, coercive control is still a new concept. Yet all caregivers should be familiar with it, in order to be aware of and understand domestic violence. This article, based on the experience of a nursery nurse, looks at the ways in which such violence can be identified, particularly during maternal and child protection missions.

The Role of the Medical Director and Psychiatric Medical Director in Child Welfare Serving Agencies.

Collaboration between the child welfare system and health care practitioners has become increasingly necessary in order to meet the often-significant health needs of system-involved youth. Child welfare medical directors and psychiatric medical directors have been implemented as a means to address this need in several state child welfare systems. Building on the core principles of the National Guidelines for Child and Youth Behavioral Health Crisis Care, medical and psychiatric medical directors can help ensure youth receive the least-restrictive, most appropriate level of behavioral health care; prioritizing care involvement with caregivers in community-based settings.

Health visiting in the UK in light of the COVID-19 pandemic experience: (RReHOPE) findings from a realist review.

Background: Child health programmes in the United Kingdom offer every child and their family an evidence-based programme to support child health and development. During the COVID-19 pandemic, health visiting services in many areas were reduced to a partial service, with significant variability between and within the four United Kingdom countries. This study investigated the impact of the pandemic on health visiting services and developed recommendations for policy and practice. Objectives: Conduct a realist review of relevant literature. Engage with key stakeholders in policy, practice and research across the United Kingdom. Identify recommendations for improving the organisation and delivery of health visiting services, with a focus on services being equitable, effective and efficient. Review methods: The realist review followed Pawson's five iterative steps and involved key stakeholder representatives at every step. We searched five electronic databases and references of included articles, as well as relevant organisational websites, to find quantitative, qualitative, mixed-methods and grey literature related to health visiting services in the United Kingdom during the COVID-19 pandemic. An assessment of their relevance to our initial programme theory determined inclusion in the review. Data were extracted, organised and presented as draft context, mechanism and outcome configurations. These were iteratively refined through meetings with 6 people with lived experience of caring for babies during the pandemic and 23 professional stakeholders. Context, mechanism and outcome configurations were then translated into findings and recommendations. Results: One hundred and eighteen documents contributed to the review and collectively revealed the far-reaching, uneven and enduring impact of the COVID-19 pandemic on babies and families. Data uncovered significant concerns of families and practitioners amidst the pandemic, along with the service's corresponding actions. These concerns and responses underscored the critical importance of fostering and sustaining trusting relationships between health visitors and families, as well as conducting holistic assessments for early intervention. Although we found minimal evidence of decision-making within organisational/managerial levels, the data illustrated the diverse and complex nature of health visiting work and the need for flexibility and resourcefulness. Limitations: The primary limitation of this review was a lack of specific evidence from the United Kingdom nations other than England. There was also a lack of data focusing on changes during the COVID-19 pandemic at a local management level. Conclusions: The needs of babies, children and families, and the delivery of services to support them, were not prioritised in the early phase of the pandemic response. Our data show that the health visiting service was concerned with maintaining visibility of all children, and especially supporting families with a new baby. Health visiting services adapted in numerous ways to respond to these concerns. Implications for policy and practice are presented, identified from our analysis and discussions with stakeholders. Future work: The RReHOPE study is part of a jigsaw of evidence, which will provide a much stronger evidence base for future policy and practice. This realist review presents several areas for future research, including how health visiting is organised at local management level; how to optimise limited resources; factors affecting differing uptake in different regions; and analysis of the effectiveness of health visiting using large cohort studies. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme under award number NIHR134986.

Health visiting services are a core part of child health programmes in the United Kingdom. Health visitors provide support to all new babies and families, helping every child to have the best start in life. The COVID-19 pandemic disrupted these services, changing the support families received. Our project aimed to understand how health visiting services across the United Kingdom adapted during the pandemic, and how this affected families and health visiting teams. We reviewed the literature on health visiting during the pandemic using an approach called 'realist review'. We studied 118 documents that gave us useful information about how health visiting services changed. Findings were grouped into three themes: health visiting contacts, health visiting connections and the health visiting workforce. When pandemic restrictions made it harder for health visitors to conduct their usual assessments, they were concerned about missed needs among families. While remote contacts were sometimes useful, face-to-face interactions were seen as crucial for building trust and understanding family contexts. Disruptions in community services and in connections between different services affected how families accessed wider support. They also made it harder for health visitors to do their job. The pandemic placed greater workload and stress on health visitors. Our recommendations emphasise that when health visitors meet with families it is a chance to learn about their needs, offer all-around support and connect them with other helpful services. We suggest there should be enough staff and time to provide these services, especially via face-to-face home visits. More research is needed on how health visiting services are organised and delivered in different places, and the implications for staff and families. Health visiting has a vital role to play, particularly during and after a pandemic, in keeping children healthy and safe. Our findings can be used to inform policy, practice and future research.

Risk Prediction Model for Child Sex Trafficking Among Female Child Welfare-Involved Youth: Welfare-Involved Female Sexual Exploitation Risk Assessment Tool.

Background: Female child welfare-involved youths who are removed from the home are at risk of commercial sexual exploitation of children (CSEC). The aim of this study was to develop a prediction model to identify those at greatest risk of trafficking. Methods: Data were from the Florida Department of Children and Families' Florida Safe Families Network Database. A Cox proportional hazard regression of 60 cases and 3857 controls generated the proposed risk model. Results: Factors found to be associated with a higher risk of trafficking were quantified into point scores, generating the Welfare-Involved Female Sexual Exploitation Risk Assessment (WISER) tool with a cutoff of 20 points: first out-of-home placement at ≥15 years of age (11 points); run away from home in past year and age <15 years (40 points) or ≥15 years (16 points); English spoken as other language (14 points); on a psychotropic drug (17 points); congregate first placement (14 points); runaway/abducted status first "placement" (16 points); psychiatric facility experience (9 points); residential facility experience (7 points); and no time in temporary shelter (9 points). Of those who experienced CSEC, 92% had a WISER score above 20. Discussion: The WISER tool achieved good discrimination and calibration ability with a receiver operating characteristic for the validation data set of 0.923. The WISER tool can (1) inform risk assessment for CSEC among child welfare-involved females and (2) identify youths at greatest risk before they are harmed by trafficking.

[Knowledge and implementation of institutional safeguarding measures in German hospitals as part of medical child protection]. / Wissen zu und Umsetzung von institutionellen Schutzkonzepten in deutschen Krankenhäusern als Teil des medizinischen Kinderschutzes.

BACKGROUND: Recent studies show the high prevalence of child maltreatment in Germany and that assaults by hospital staff also pose a problem. Since 2020, the Joint Federal Committee has been calling for institutional safeguarding measures (ISM) to protect and support those affected in hospitals. The aim of this study is to analyze the level of knowledge and action competencies regarding child maltreatment among hospital staff and the extent to which ISM are implemented in hospitals. METHODS: A survey was administered to 1011 participants before they took part in two online courses on child protection and protection measures in hospitals, with questions regarding self-assessed level of knowledge and competence on child protection and the occurrence of cases of maltreatment and protective measures in their own institution. Data were analyzed using descriptive methods. RESULTS: It becomes apparent that the knowledge and competencies of hospital staff regarding child protection are in the middle range. In hospitals, cases of maltreatment that occur outside the institution are particularly common, but violence by staff or other patients of the same age also plays a significant role. Of the respondents, 93.6% stated that their institution had already developed at least one element of an ISM, but only 1.0% of respondents reported that all the elements surveyed had already been fully developed. DISCUSSION: Hospitals in Germany seem to be largely on the path to better protect children and adolescents from maltreatment and to support those affected. However, there are still deficits in the competencies of employees and the implementation of the ISM elements. More resources need to be made available by hospital operators and the public sector for this purpose.

Closing the Gap: Foster Parents' Lived Experiences and Recommendations for Interdisciplinary Health-Care Providers.

Purpose: This study explored barriers and facilitators to utilizing health-care services for foster youth, from the perspective of foster parents. Background: There are nearly 437,283 youths in the United States foster care system. Youths living in locations that are different from their familial home situations have a significantly higher occurrence of physical and mental health illnesses than children who remain in their familial homes, increasing risk for homelessness, substance use and abuse, chronic long-term illnesses, and incarceration, thus placing additional burden on the health-care system. Design and Methods: This study utilized a qualitative descriptive design with purposive sampling, with video focus groups to explore 15 foster parents' experiences in accessing health-care services for foster youth. Results: Barriers and facilitators to accessing health care and care coordination were identified, including logistics, transportation, electronic health record access, location of health care, and the impact of the social worker. Practice Implications: Nurses are well-positioned to aid in closing gaps in care for foster youth. Conclusions: These experiences provide important insights and implications for health-care providers and for future research and policy development.

A Mediating Effect of Public Service Motivation on Retention Intention Among Child Welfare Students: Task Self-Efficacy.

PURPOSE: This study investigates the role of Public Service Motivation (PSM) in retaining highly skilled and qualified child welfare graduates within the public child welfare sector. MATERIALS AND METHODS: Three entire cohorts of child welfare student social workers over three years (N = 125) in BSW and MSW child welfare programs at seven universities in a Southern state were surveyed to examine the effects of task self-efficacy achieved through the curriculum and public service motivation on retention intention among social work students specializing in child welfare practice at both the baccalaureate and master's levels. Mediation analysis was conducted to estimate the indirect effect of self-efficacy on students' retention intention. RESULTS: The self-efficacy of child welfare students, operationalized as their confidence in performing competencies, significantly influences their intention to remain in the field of child welfare. Furthermore, self-efficacy among child welfare students has a statistically significant effect on their PSM. PSM, in turn, significantly impacts their intention to persist in child welfare work. DISCUSSION: The findings indicate that PSM partially mediates the relationship between students" self-efficacy and their intent to remain in child welfare work, even when controlling for educational background. We recommend that child welfare agencies recognize and nurture workers" PSM by incorporating practices that promote PSM.

Corrigendum: The transition of Chilean adolescents from the child welfare system to the adolescent justice system: a continuation or an accumulation of adverse factors?

[This corrects the article DOI: 10.3389/fpsyg.2023.1194294.].

The relationship between commercial sexual exploitation and foster care placement in the U.S.: A scoping review.

BACKGROUND: There is evidence youth in foster care may be vulnerable to commercial and sexual exploitation of children (CSEC) in the U.S. Youth in care may show vulnerabilities such as running away, identifying as sexual/gender minorities, or exhibiting complex behavioral and mental health needs. However, the nature and nuances of the relationship between CSEC and foster care placements has been largely unexamined. OBJECTIVES: This review explores the literature on trafficking among foster care youth to establish what is known about risk factors, vulnerable populations, and leverage points for prevention and intervention. METHODS: This scoping review was conducted using PRISMA-ScR guidelines. Eight databases were searched, and the screening process resulted in 16 final articles in the analysis. RESULTS: Sixteen articles were screened into the current study. In reviewing the content, a few distinct themes emerged. First, the articles focused on three different populations of CSEC youth. Second, there was variability in the definitions of CSEC used by scholars. Third, there was a range of terms used to describe youth who were trafficked. Finally, there were broad differences in study methodology. This included the data sources used and the array of outcomes explored (e.g. substance use, mental health diagnoses, housing stability). CONCLUSIONS: It is important for scholars to use common language and definitions when studying the sex trafficking of minors. Developing national databases and improving state and federal data sharing is needed to inform prevalence estimates and explore various pathways to youth experiencing CSEC.

Examining associations between child welfare workforce well-being and utilization of casework skills with children and families.

BACKGROUND: While child welfare scholarship has paid much attention to workforce well-being such as burnout, secondary traumatic stress (STS), and compassion satisfaction, few studies have investigated how these outcomes influence utilization of casework skills. OBJECTIVES: This study aimed to understand the relationship between child welfare workforce well-being and use of casework skills. Specifically, we examined associations between burnout, STS, and compassion satisfaction and casework skills including parent/youth engagement, safety and risk assessment/case planning, and relative/kin connections. PARTICIPANTS AND SETTING: Participants comprised 786 child welfare direct service workers and supervisors in a Midwestern state. METHOD: Using a repeated cross-sectional design, data were collected via online surveys. Multivariate regression tested relationships between measures of well-being and casework skills. RESULTS: First, higher compassion satisfaction was positively associated (p = 0.000, f2 = 0.14) while higher burnout (p = 0.000, f2 = 0.04) and STS (p = 0.002, f2 = 0.01) were negatively associated with use of engagement skills. Similarly, higher compassion satisfaction was positively associated (p = 0.000, f2 = 0.18) and higher burnout (p = 0.000, f2 = 0.06) and STS (p = 0.001, f2 = 0.02) were negatively associated with use of assessment/case planning skills. Lastly, compassion satisfaction (p = 0.000, f2 = 0.06) was positively associated and burnout was negatively associated (p = 0.000, f2 = 0.02) with relative/kin connections. CONCLUSION: Child welfare workforce well-being may influence use of casework skills. More research is needed to understand how positive workforce well-being impacts service delivery and, ultimately, child and family outcomes.

Effectiveness of education focused wraparound services to improve academic success for foster youth: A pilot study.

BACKGROUND: Youth with foster care experience are disproportionality burdened with poor academic outcomes compared to non-foster experience youth. The Fostering Academic Success in Education (FASE) pilot program provides comprehensive onsite educational case management services to foster care youth. OBJECTIVE: We used mixed methods to explore the effects of FASE on participating youth's academic performance and perceived self-efficacy to manage mental health services and support. PARTICIPANTS AND SETTING: Between 2020 and 2023, the FASE pilot program was delivered to 40 middle and high school students involved in child welfare services and out-of-home placements. METHODS: Quantitative data comprised pre-post FASE intervention academic outcomes (GPA, attendance, and tardies) and the Youth Efficacy/Empowerment Scale-Mental Health (YES-MH). Paired sample t-tests and one-way ANOVA were used to assess difference in time outcomes. Qualitative generating questionnaires were administered to FASE youth and school personnel annually. RESULTS: After participating in FASE for one academic year, youths' GPA significantly improved (mean 2.38-2.80, p = .001), tardies significantly reduced (mean 3.78-3.1, p = .011), unexcused periods significantly reduced (mean 17.30-9.51, p = .018) and there was a significant improvement in YES-MH scores (mean 46.9-55, p = .001). Female youth had larger GPA and YES-MH score increases than male youth. FASE youth and personnel attributed academic success to the comprehensive support received by the program's educational social worker. CONCLUSIONS: The FASE program holds promise in improving academic performance and mental health self-efficacy among foster care-involved youth.

Trauma-informed care beliefs scale-comprehensive for child welfare carers using Rasch analysis.

BACKGROUND: The literature on trauma-informed care practices (TIC) indicates that this framework is beneficial for young people, carers, and staff. However, a significant gap in the literature and practice is the absence of psychometrically sound scales to measure carer adherence to TIC principles. Emerging evidence suggests that TIC practices shift carer attitudes and beliefs, which mediate positive outcomes for both carers and young people. OBJECTIVE: To develop a theoretically comprehensive and psychometrically sound measure of carer TIC beliefs using Rasch methodology. PARTICIPANTS AND SETTING: Active carers (N = 719, M = 43 years, SD = 10.7 years) from online support groups in Australia, Canada, the United States of America, the United Kingdom, and the Republic of Ireland completed the questionnaire online. METHODS: Based on previous research (e.g., limitations of the Trauma-Informed Belief Scale-Brief [TIBS-B]; Beehag, Dryer, et al., 2023a) and a scoping review of the TIC literature (Beehag, 2023), 61 candidate items were created that covered the three main characteristics of carer-related TIC theory (i.e., beliefs on TIC strategies to manage trauma symptoms, beliefs on the impact of adverse childhood experiences (ACE), and beliefs on the importance of self-care/reflection). The resulting data was subjected to Rasch analyses. RESULTS: Following analyses and minor modifications, a 35-item version of the questionnaire was confirmed, which fitted the Rasch model and demonstrated unidimensionality, reasonable targeting, and sound internal consistency reliability (Person Separation Index = 0.81). CONCLUSIONS: The TIBS-C is a psychometrically sound measure of child welfare carer TIC beliefs. Future studies are needed to provide further evidence of its validity (e.g., predictive validity), reliability (e.g., test-retest reliability) and clinical utility.

Child maltreatment and behavioral health outcomes in child welfare: Exploring the roles of severity and polyvictimization.

BACKGROUND: Child maltreatment and polyvictimization are known risk factors for long-term detrimental health and development outcomes, including behavioral health challenges. However, effects from specific types and combinations of maltreatments are unclear. This study examined the association between maltreatment or polyvictimization and behavioral health in a child welfare sample. PARTICIPANTS AND SETTING: Medical records of children with child welfare involvement with at least one behavioral health condition (i.e., mental, behavioral or neurodevelopmental disorder, ICD-10 F01-F99) between 1/1/2018-12/31/2021 were extracted from a large, academic hospital system. METHODS: Behavioral health complexity was categorized as non-chronic, non-complex chronic, or complex chronic using the Pediatric Medical Complexity Algorithm. Partial proportional logistic regression models adjusted for age, sex, race/ethnicity, caregiver type, and physical health complexity generated odds of behavioral health complexity by maltreatment type (physical abuse, sexual abuse, neglect) and maltreatment combinations. RESULTS: The analytic sample included 3992 participants (mean age 7.6 (Standard Deviation, 5.0) 44 % female, 29 % white, 32 % black, 22 % Hispanic). Participants who experienced physical abuse (Odds Ratio [OR]: 1.79, 95 % Confidence Interval [CI]: 1.10-2.91), or neglect (OR: 1.69, 95 % CI: 1.38-2.07) were more likely to have increasing behavioral health complexity versus those without maltreatment. Participants with both physical abuse and neglect were over twice as likely (OR: 2.44, 95 % CI: 1.88-3.16) to have increasing behavioral health complexity versus those who did not experience maltreatment. CONCLUSION: Results emphasize the differential impacts of maltreatment and polyvictimization exposures on behavioral health complexity among children with child welfare involvement that can guide risk assessment and clinical care.

Children's right to participation in Swedish child welfare - The extent, nature and determinants of child interviews during investigations.

BACKGROUND: Children's right to participation in child welfare decision-making is highlighted in law and research. However, there is a lack of comprehensive empirical research on how such participation is actually fulfilled. OBJECTIVE: This article aims to describe and analyse the extent, nature and determinants of children's participation in child welfare investigations in Sweden as well as to discuss barriers to participation. PARTICIPANTS AND SETTING: The dataset comprises a cohort of 2123 children investigated during 2022 across eight municipalities in Stockholm County, Sweden. METHODS: The study is based on cross-sectional data where the responsible child welfare workers served as informant in a survey focusing child and case factors concerning 2123 children subject to child welfare investigations. The data is analysed by using descriptive and binary logistic regression analyses. RESULTS: In approximately 75 % of the child welfare investigations, child welfare workers held interviews with the child (with or without parental presence) while individual child interviews were carried out in about 50 % of the cases. Multiple interviews (≥3) occurred in 14 % of the cases. Reasons for not interviewing children included finding interviews to be unnecessary, perceiving the child as too young, and reluctance by the child as to participation. Investigations involving older children and referrals related to abuse increased the odds for participation. CONCLUSIONS: The study suggests that more children are interviewed by child welfare authorities than found in previous studies, but that there still is a gap between the legislative intention to facilitate child participation and the actual state of child welfare practice.

Child welfare predictive risk models and legal decision making.

BACKGROUND: Child welfare agencies around the world have experimented with algorithmic predictive modeling as a method to assist in decision making regarding foster child risk, removal and placement. OBJECTIVE: Thus far, all of the predictive risk models have been confined to the employees of the various child welfare agencies at the early removal stages and none have been used by attorneys in legal arguments or by judges in making child welfare legal decisions. This study will show the effects of a predictive model on legal decision making within a child welfare context. PARTICIPANTS AND SETTING: Lawyers, judges and law students with experience in child welfare or juvenile law were recruited to take an online randomized vignette survey. METHODS: The survey consisted of two vignettes describing complex foster child removal and placement legal decisions where participants were exposed to one of three randomized predictive risk model scores. They were then asked follow up questions regarding their decisions to see if the risk models changed their answers. RESULTS: Using structural equation modeling, high predictive model risk scores showed consistent ability to change legal decisions about removal and placement across both vignettes. Medium and low scores, though less consistent, also significantly influenced legal decision making. CONCLUSIONS: Child welfare legal decision making can be affected by the use of a predictive risk model, which has implications for the development and use of these models as well as legal education for attorneys and judges in the field.

Access to best-evidenced mental health support for care-experienced young people: Learnings from the implementation of cognitive therapy for PTSD.

OBJECTIVES: Rates of PTSD are up to 12 times higher in care-experienced young people (CEYP) compared to their peers. Trauma-focused CBTs (tf-CBT) are the best-evidenced treatment for youth with PTSD, yet, in practice, CEYP often struggle to access this treatment. We worked alongside services to understand barriers and facilitators of the implementation of cognitive therapy for PTSD (a type of tf-CBT) to CEYP. DESIGN: This was an active, open implementation trial. METHODS: We recruited 28 mental health teams across England, including general CAMHS, targeted CAMHS for CEYP and social care-based teams. From these teams, participants were 243 mental health professionals, from a wide variety of professional backgrounds. Following recruitment/intervention training, teams participated in rolling three monthly focus groups and individual interviews, to understand what helped and hindered implementation. Data were analysed using a framework analysis conducted using CFIR 2.0. RESULTS: Almost half of the teams were able to implement, but only approximately one quarter with CEYP, specifically. Universal barriers that were discussed by almost all teams particularly highlighted service structures and poor resourcing as major barriers to delivery to CEYP, as well as the complexities of the young person and their network. Unique factors that differentiated teams who did and did not implement included commissioning practices, the culture of the team, leadership engagement and style, and the development of supervision structures. CONCLUSIONS: Findings offer key considerations for mental health teams, service leads, commissioners and policy-makers to enhance delivery of best-evidenced mental health treatments like CT-PTSD, for CEYP.

Exploring self-care practices of African American informal kinship caregivers.

African American caregivers providing informal kinship care are vulnerable to chronic stress. Research has indicated stress increases individuals' risk for many adverse physical and mental health outcomes, including cardiovascular disease, Alzheimer's disease and depression. Given the adverse outcomes related to stress, identifying mechanisms to help these caregivers lower and manage their stress is critical to their overall health and well-being. This pilot qualitative study aimed to explore the self-care practices of 12 African Americans providing informal kinship care using a phenomenological approach. Three themes emerged: (a) behaviours to manage stress levels, (b) support network reminding caregivers to take care of themselves and (c) prioritizing my own needs. Specifically, our findings indicate that some caregivers have high-stress levels and engage in maladaptive coping behaviours. The children they cared for reminded them to take care of themselves by attending doctors' appointments or getting their nails done. Nevertheless, some caregivers prioritized their needs by participating in positive self-care behaviours, such as listening to jazz and gospel music and exercising. Prevention and intervention programs that focus on improving caregivers' health should consider the role of self-care practices.

Children picturing their own worlds: Using photovoice to amplify children's voice in sociological research.

This research note highlights an emerging transdisciplinary research method-photovoice-and why it is particularly suited for sociological studies of children and youth. Traditional social science data collection methods can be limited in their ability to capture both the depth and breadth of childhood experiences and children's perceptions of their experiences. We describe an emerging method, photovoice, that is used more frequently in other disciplines, and its suitability for sociologically studying youth and children. We describe the limitations of traditional social science methods and how photovoice can help overcome some of these limitations. Photovoice engages participants as lived experts who contribute to both the data collection and analysis in an individual and collective manner. Through taking photos and discussing their meaning, participants can share abstract feelings and discuss sensitive topics in an imaginative format and express themselves creatively. We describe how previous research has used photovoice to work with youth from vulnerable circumstances and those who have experienced trauma as well as demonstrate how photovoice is well situated to bolster the tenets of sociological research.

Faces of Oppression: Future directions for Ergonomics and Human Factors.

The growing interest in Diversity, Equity, and Inclusion (DEI) centred work in the field of Ergonomics and Human Factors (EHF) can greatly benefit from Iris Young's Five Faces of Oppression theory, which details how well-intentioned systems can perpetuate harm in a number of ways. We call for a greater focus on systems of oppression in EHF research and practice along with increased collaboration with social sciences to tackle important societal issues. This article reviews the current state of research in the child welfare domain and provides examples for how cognitive engineering approaches can take inspiration from the social sciences to help create a more equitable future. These examples outline the potential mutualism between social sciences and EHF and the way this collaboration might dismantle various oppressive systems.

EHF work is often situated within sociotechnical systems that can generate oppression, or injustices imposed on social groups by societal structures. This publication shows the value that social science frameworks and literature can bring to EHF practice by supporting a more nuanced understanding of these systems of oppression.

Mental health service use of young people in child welfare services in Quebec, Canada.

Background: Youth involved in child welfare have high rates of mental health problems and are known to receive mental health services from multiple settings. Still, gaps remain in our understanding of service use patterns across settings over the course of youth's involvement with child welfare. Objective: To examine the settings, reasons for contact, persons involved in initiating care, and timing of each mental health service contact for individuals over their involvement with the child welfare system, and to identify factors that predict multi-setting use. Methods: Data on mental health service contacts were collected retrospectively from charts for youth aged 11-18 (n=226) during their involvement with child welfare services in Montreal, Quebec. Logistic regression analysis was conducted to determine predictors of multi-setting mental health services use (defined as ≥3 settings). Results: 83% of youth had at least one mental health service contact over the course of their child welfare services follow-up, with 45% having multi-setting use. Emergency Departments were the top setting for mental health services. Youth with a higher number of placements and from neighborhoods with greater social and material deprivation were significantly likelier to use ≥3 mental health service settings over the course of their follow-up. Conclusion: These findings suggest a need for enhanced collaboration between youth-serving sectors to ensure that continuous and appropriate mental health care is being offered to youth followed by child welfare systems. The relationship between placement instability and multi-setting mental health service use calls for specific policies to ensure that young people do not experience multiple discontinuities of care.

Contexte: Les jeunes impliqués dans le système de la protection de la jeunesse ont des taux élevés de problèmes de santé mentale et il et ils reçoivent souvent des services de santé mentale dans plusieurs types d'établissements. Pourtant, des lacunes subsistent dans notre compréhension des trajectoires d'utilisation des services à travers divers contextes au cours du suivi d'un jeune dans le système de protection de la jeunesse. Objectif: Examiner les contextes, les raisons pour les contacts, les personnes impliquées dans l'initiation des soins, et le moment de chaque contact avec les services de santé mentale pour les personnes pendant la durée de leur suivi en protection de la jeunesse et identifier les facteurs qui prédisent une trajectoire impliquant de multiples établissements. Méthodes: Des données sur les contacts avec les services de santé mentale ont été recueillies rétrospectivement des dossiers de jeunes de 11 à 18 ans (n=226) leur suivi en protection de la jeunesse à Montréal, Québec. Une analyse de régression logistique a été menée pour déterminer les prédicteurs de l'utilisation des services de santé mentale multi-établissements (définie à ≥3 établissements). Résultats: Quatre-vingt-trois pour cent des jeunes avaient au moins un contact avec un service de santé mentale au cours de leur suivi en protection de la jeunesse, et 45 % avaient une trajectoire impliquant de multiples établissements. Les services d'urgence étaient l'établissement le plus fréquenté pour les services de santé mentale. Les jeunes ayant un nombre plus élevé de placements et provenant de quartiers d'une plus grande défavorisation sociale et matérielle étaient significativement plus susceptibles d'utiliser ≥3 établissements de services de santé mentale au cours de leur suivi. Conclusion: Ces résultats démontrent le besoin d'une collaboration améliorée entre les secteurs des services aux jeunes pour faire en sorte que les jeunes en protection de la jeunesse reçoivent des soins de santé mentale continus et appropriés. La relation entre l'instabilité de placement et les trajectoires complexes à travers les services de santé mentale exige de politiques spécifiques afin d'assurer que les jeunes ne connaissent pas de multiples discontinuités de soins.