进入家庭外照料的影响：加拿大曼尼托巴省原住民及其他儿童福利机构的纵向队列研究。
Impact of being taken into out-of-home care: a longitudinal cohort study of First Nations and other child welfare agencies in Manitoba, Canada.
作者信息
Brownell Marni, Nickel Nathan C, Frank Kayla, Flaten Lisa, Sinclair Scott, Sinclair Stephanie, Murdock Nora, Enns Jennifer E, Pfau Jamie, Durksen Anita, Scatliff Colette, Prior Heather, Walld Randy, Turnbull Lorna, Levasseur Karine, Mayer Teresa, Chartrand Jennifer, Nash Chris, Decaire Elizabeth, Casiano Hygiea, Bennett Marlyn, Casidsid Hera J M, Hunter Mikayla, Owczar Hannah, Brownell Emily, Stukel Therese A
机构信息
Manitoba Centre for Health Policy, University of Manitoba, Canada.
First Nations Family Advocate Office, Assembly of Manitoba Chiefs, Canada.
出版信息
Lancet Reg Health Am. 2024 Sep 11;38:100886. doi: 10.1016/j.lana.2024.100886. eCollection 2024 Oct.
BACKGROUND
Across Canada, Child Protection Services (CPS) disrupt Indigenous families by apprehending their children at alarmingly high rates. The harms borne by children in out-of-home care (OoHC) have been extensively documented. We examined the impact of OoHC on Manitoba children's health and legal system outcomes to provide rigorous evidence on how discretionary decision-making by CPS agencies can affect these outcomes.
METHODS
In partnership with First Nations researchers, we used linked administrative data to identify Manitoba children (born 2007-2018) served by First Nations and other Manitoba CPS agencies. We compared those taken into OoHC (n = 19,324) with those never in care but with an open CPS file due to child protection concerns (n = 27,290). We used instrumental variable analysis (CPS agency rates of OoHC as the instrument) to obtain odds ratios (aOR) and 95% confidence intervals adjusted for child, maternal, and family factors.
FINDINGS
Mean age (yrs ± standard deviation) at first CPS contact for children taken into OoHC was 2.8 ± 3.7 (First Nations) and 3.0 ± 3.8 (other), and for children never in care was 4.5 ± 4.5 (First Nations) and 5.1 ± 4.7 (other). Among children served by a First Nations agency, males made up 50.6% (n = 5496) in OoHC and 51.0% (n = 6579) never in care. Among children served by other agencies, males made up 51.0% (n = 4324) in OoHC and 51.0% (n = 7428) never in care. Odds of teen pregnancy (First Nations aOR 3.69, 1.40-9.77; other aOR 5.10, 1.83-14.25), teen birth (First Nations aOR 3.23, 1.10-9.49; other aOR 5.06, 1.70-15.03), and sexually transmitted infections (other aOR 7.21, 3.63-14.32) were higher for children in care than children never in care, as were odds of being accused (other aOR 2.71, 1.27-5.75), a victim (other aOR 1.68, 1.10-2.56), charged with a crime (other aOR 2.68, 1.21-5.96), or incarcerated (First Nations aOR 3.64, 1.95-6.80; other aOR 1.19, 1.19-8.04).
INTERPRETATION
Being in OoHC worsened children's health and legal system outcomes. The importance of reducing the number of children taken into care was emphasized in briefings to provincial and First Nations governments. The government response will be monitored.
FUNDING
Social Sciences and Humanities Research Council (no. 890-2018-0029).
背景
在加拿大全国范围内，儿童保护服务机构（CPS）以惊人的高比例拘押原住民儿童，从而破坏原住民家庭。儿童在家庭外照料（OoHC）中所遭受的伤害已有大量记录。我们研究了家庭外照料对曼尼托巴省儿童健康和法律系统结果的影响，以提供关于儿童保护服务机构的自由裁量决策如何影响这些结果的严谨证据。
方法
我们与原住民研究人员合作，利用关联行政数据识别由原住民及曼尼托巴省其他儿童保护服务机构服务的曼尼托巴省儿童（出生于2007年至2018年）。我们将那些被送入家庭外照料的儿童（n = 19324）与那些因儿童保护问题虽未接受照料但有儿童保护服务机构公开档案的儿童（n = 27290）进行比较。我们使用工具变量分析（将儿童保护服务机构的家庭外照料率作为工具）来获得优势比（aOR）以及针对儿童、母亲和家庭因素调整后的95%置信区间。
结果
被送入家庭外照料的儿童首次与儿童保护服务机构接触时的平均年龄（岁±标准差），原住民儿童为2.8±3.7，其他儿童为3.0±3.8；未接受照料的儿童，原住民儿童为4.5±4.5，其他儿童为5.1±4.7。在由原住民机构服务的儿童中，家庭外照料中的男性占50.6%（n = 5496），未接受照料的男性占51.0%（n = 6579）。在由其他机构服务的儿童中，家庭外照料中的男性占51.0%（n = 4324），未接受照料的男性占51.0%（n = 7428）。与未接受照料的儿童相比，接受照料的儿童青少年怀孕（原住民aOR 3.69，1.40 - 9.77；其他aOR 5.10，1.83 - 14.25）、青少年生育（原住民aOR 3.23，1.10 - 9.49；其他aOR 5.06，1.70 - 15.03）和性传播感染（其他aOR 7.21，3.63 - 14.32）的几率更高，被指控（其他aOR 2.71，1.27 - 5.75）、成为受害者（其他aOR 1.68，1.10 - 2.56）、被指控犯罪（其他aOR 2.68，1.21 - 5.96）或被监禁（原住民aOR 3.64，1.95 - 6.80；其他aOR 1.19，1.19 - 8.04）的几率也更高。
解读
接受家庭外照料会使儿童的健康和法律系统结果恶化。在向省级和原住民政府的简报中强调了减少被照料儿童数量的重要性。将对政府的应对措施进行监测。
资金来源
社会科学与人文研究理事会（编号890 - 2018 - 0029）
Zotero 插件