Child Welfare Investigations of Exposure to Intimate Partner Violence Referred by Medical Professionals in Ontario: A Uniquely Vulnerable Population?

Victims of intimate partner violence (IPV) and their children may be at an increased risk for negative health outcomes and may present to healthcare settings. The objective of the current study is to examine the profile of medical-referred child welfare investigations of exposure to IPV in Ontario, Canada. Data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 were used. We compared medical-referred investigations with all other investigations of exposure to IPV. Descriptive and bivariate analyses as well as a logistic regression predicting transfers to ongoing services were conducted. Six percent of investigations of exposure to IPV conducted in Ontario in 2018 were referred by a medical source. Compared to other investigations of exposure to IPV, these investigations were more likely to involve younger children (p = 0.005), caregivers with mental health issues (p < 0.001) and few social supports (p = 0.004), and households noted to be overcrowded (p = 0.001). After controlling for clinical case characteristics, investigations of exposure to IPV referred by healthcare sources were 3.452 times as likely to be kept open for ongoing child welfare services compared to those referred by other sources (95% CI [2.024, 5.886]; p < 0.001). Children and their families who are identified in healthcare settings for concerns of exposure to IPV tend to receive extended child welfare intervention compared to those identified elsewhere. There is a clear difference in service provision in healthcare-originating investigations of exposure to IPV versus investigations originating from other sources. Further research into the services provided to victims of IPV and their children is needed.

The more we change the more we stay the same: Canadian child welfare systems' response to child well-being.

BACKGROUND: Child welfare services in Canada are guided by a dual mandate: to protect children from imminent harm and to promote their optimal development and well-being. To understand how child welfare systems respond to this dual mandate, Trocmé et al. (2014) developed a taxonomy to classify child welfare investigations as either being related to urgent protection or chronic needs. OBJECTIVE: To extend Trocmé et al.'s (2014) analysis using data from the Canadian Incidence Study of Reported Child Abuse and Neglect 2019 (CIS-2019). PARTICIPANTS AND SETTING: The CIS-2019 employs a file review methodology to collect information on child maltreatment-related investigations conducted in Canada in 2019. The study's unweighted sample included 41,948 investigations involving children aged 0-15 years. METHODS: Secondary analyses of the CIS-2019 were conducted including frequency counts and bivariate analyses. RESULTS: Ninety percent of investigations conducted in Canada in 2019 were focused on concerns related to chronic needs. Most investigations (90.9 % of urgent protection investigations and 98.3 % of chronic needs investigations) did not involve physical harm to the child. Urgent protection investigations were less likely to have been previously investigated and more likely to be substantiated, involve a child welfare court application, or involve a placement in out-of-home care. CONCLUSIONS: Most child welfare investigations in Canada continue to be focused on chronic needs. Yet, the investigation response seems designed to respond to urgent protection concerns. A truly differential model is needed to appropriately respond to the dual mandate of Canadian child welfare services and better serve children and families.

Understanding the roles of the healthcare and child welfare systems in promoting the safety and well-being of children.

Introduction: The accurate identification and appropriate investigation of child maltreatment is a key priority for promoting the optimal health and development of children. Healthcare providers are often well-positioned professionals to report suspected child abuse and neglect, and, therefore, interact regularly with child welfare workers. Little research has examined the relationship between these two groups of professionals. Methods: We interviewed healthcare providers and child welfare workers in order to examine the referral and child welfare investigation processes to understand strengths and identify areas of improvement for future collaboration. Thirteen child welfare workers from child welfare agencies and eight healthcare providers from a pediatric tertiary care hospital in Ontario, Canada were interviewed to meet the study's objectives. Results: Healthcare providers spoke about positive experiences making reports, factors impacting reporting decisions, areas for improvement (e.g., difficulties communicating, lack of collaboration, and disruption of therapeutic alliance), training, and professional roles. For interviews with child welfare workers, identified themes included healthcare professionals' perceived expertise and understanding the role of child welfare. Both groups brought up the need for increased collaboration as well as systemic barriers and legacies of harm. Discussion: Our core finding was a reported lack of communication between the groups of professionals. Other identified barriers in collaboration included a lack of understanding of each other's roles, hesitation for healthcare providers making reports, as well as legacies of harm and systemic inequities in both institutions. Future research should build on this examination by including the voices of healthcare providers and child welfare workers to identify sustainable solutions for increased collaboration.

High throughput profiling of charge heterogeneity in antibodies by microchip electrophoresis.

A high throughput microchip capillary zone electrophoresis (CZE) method was developed for the analysis of charge heterogeneity in antibodies. The method utilizes high speed microchip electrophoresis separation and is well-suited for high throughput charge profiling of antibodies during process and formulation development. The method involves derivatization of protein molecules with Cy5 N-hydroxysuccinimide ester (NHS-ester), which does not change the protein charge profile and enables fluorescence detection on a commercial microchip instrument. The sample preparation can be performed in 96-well microtiter plates within 1 h, and each sample analysis takes only 80 s. Protein charge variants with a pI difference of 0.1 can be readily resolved in the 12.5 mm microfluidic channel. Charge profiles similar to those obtained using conventional CZE technology were found for all antibodies tested (pIs in the range of 7.5-9.2). The separation efficiency corresponds to 1.2 × 10(4) theoretical plates (1.0 µm plate height). Assay performance is assessed by demonstrating specificity, carryover, linearity, limit of detection, and precision.

Characteristics of child welfare investigations reported by healthcare professionals in Ontario: secondary analysis of a regional database.

Objectives: This study examines the characteristics and outcomes of child welfare investigations reported by hospital-based and community-based healthcare professionals. Methods: A sample of 7590 child maltreatment-related investigations from the Ontario Incidence Study of Reported Child Abuse and Neglect-2018, a cross-sectional study, was analysed. Bivariate analyses compared characteristics of hospital and community healthcare-reported investigations. Chi-square automatic interaction detector analyses were used to predict the most influential factors in the decision to provide a family with services following a child welfare investigation from each referral source. Results: Community healthcare-reported investigations were more likely to have a primary concern of physical abuse while hospital-reported investigations were more likely to be focused on assessing risk of future maltreatment. Hospital-reported investigations were more likely to involve noted primary caregiver (eg, mental health issues, alcohol/drug abuse, victim of intimate partner violence (IPV)) and household risk factors. The most significant predictor of service provision following an investigation was having a caregiver who was identified as a victim of IPV in hospital-reported investigations (χ2=30.237, df=1, adj. p<0.001) and having a caregiver for whom few social supports was noted in community healthcare-reported investigations (χ2=18.892, df=1, adj. p<0.001). Conclusion: Healthcare professionals likely interact with children who are at high risk for maltreatment. This study's findings highlight the important role that healthcare professionals play in child maltreatment identification, which may differ across hospital-based and community-based settings and has implications for future collaborations between the healthcare and child welfare systems.