[State of knowledge: needs of children at-risk or in situation of neglect and those of their family]

Dussault J, Gaumont C, Moreault B
Record ID 32018002414
Original Title: État des connaissances - Besoins des enfants à risque ou en situation de négligence et ceux de leur famille
Authors' objectives: INESSS was mandated by MSSS to provide an answer to the following decision-making question : Based on recognized best practices, what model trajectory of services for at-risk or neglected children and their family should be adopted in Quebec, and what would be the indicators used to monitor the resulting (operational) regional trajectories? This report initially consists of an overall picture of the needs of the above-mentioned clientele. These needs are addressed in such terms as the risk and protective factors; the characteristics of the children and parental figures; and the consequences on the development of children (0–18 years of age). The analytical framework used derives from the ecosystem model, while the analysis of neglect takes into account the role played by the various systems in which a child grows and develops, as well as the child’s own characteristics and those of his or her parents. Various living contexts are examined as factors that may or may not promote the emergence of developmental consequences on children in the short and long terms. Complementary works, published in a later report, focus on the scope of the problem in Quebec; on the services offered in the province; and on the care and service pathways of families at risk or in situation of neglect. The findings from these two reports and future consultations will ultimately enable the development of a model trajectory of services and the establishment of indicators for monitoring trajectories of neglect.
Authors' results and conclusions: RESULTS: In total, 39 studies were selected to document the needs of children at risk or in situation of neglect and those of their family. Thirteen cohort studies sought to identify risk or protective factors associated with child neglect. The results of these studies and of the secondary analyses of Quebec data highlighted the multifactorial and multidimensional nature of the etiology of neglect. These risk factors are: • deprived family living environments (physical locations, access to resources); • difficult socio-economic living conditions (poverty and lack of social support); • momentary stressful life events; • characteristics and difficulties (psychosocial and health) of the parental figures that interfere with the actualization of appropriate parenting styles; • difficulties (health and developmental) faced by the children. Children who are at risk or who are victims of neglect present similar living conditions and functional difficulties. The chronic cases of neglect seem to be due to a greater vulnerability of children (particularly because they are younger) in several aspects of their lives. Finally, social support would act as a protective factor against neglect. Five cohort and six cross-sectional studies analyzed the potential consequences of neglect on children aged 0 to 12 years. These studies pointed to a greater likelihood of developing internalized, externalized or cognitive problems; encountering academic difficulties; having post-traumatic stress disorder; or having poor coping skills. Indeed, children with a background of neglect would be at greater risk for some of these problems or difficulties than children who have not been neglected or abused. Moreover, poverty, which is recognized as entailing serious consequences for children, would cause those who are already neglected to be even more vulnerable. Sixteen cohort studies examined the link between exposure to neglect and possible repercussions during adolescence. According to these studies, adolescents with a background of neglect would be more predisposed to having certain internalized or externalized problems and to turning at an early age to high levels of substance use, compared to adolescents who are not neglected or abused. Serious neglect would be more damaging. Adolescent victims of neglect present social relationships that also seem to be degraded, which would exacerbate certain problems. Conversely, meaningful social relationships with their peers could diminish the presence of such problems. CONCLUSION: The overall picture of the needs of at-risk or neglected children outlined here highlights a number of key elements that can guide the development of a model trajectory of services for neglected children and their family. • The ecosystem perspective in neglect prevention and intervention is the preferred way to promote the development of children in the presence of multiple factors, possible mutual influences and heterogeneous contexts that seem to contribute to the emergence of neglect. – In particular, the factors that influence the ability of parents to meet the needs of their children are of great interest, especially those factors related to their environment, their access to resources and services and their difficulties. • Interventions that are tailored to the various situations and diverse needs of the families are required to address neglect. The entire continuum of health and social services is likely to be mobilized to address various degrees of neglect, which may range from risks of neglect to situations of serious neglect: – children in the general population who are exposed to negligent parenting as well as their family can benefit from support resources in targeted services (from the RSSS and its intersectoral partners); such services could alleviate their social, economic and health difficulties through prevention; – children who are assessed by Youth Protection services for neglect or serious risk of neglect but whose risks prove to be unsubstantiated would be less impacted in their development than children with substantiated neglect. They can benefit from frontline interventions in a timely manner to keep their situation from deteriorating; – children considered to be at serious risk of neglect who end up in Youth Protection services are younger and seem less affected in their functioning than children with substantiated neglect. All the same, their living conditions and functional difficulties may be causes for concern. Frontline interventions could prevent their situation from worsening. In practice: – it is important for families to receive targeted appropriate and early support services, during both the perinatal period and early childhood, since it is known that the most significant consequences of neglect occur early in the development of children; – similarly, more serious or chronic neglect engenders greater consequences, and these require longer and more intensive interventions. • Both the consequences of neglect and the factors that modulate them (e.g., age, gender of the child or relationships with peers) are important benchmarks to consider for intervention. Knowledge of these consequences and factors calls for an ecosystem perspective and requires: – taking a global look at each unique situation; – making the children’s needs the central concern of the various actors around them and ensuring that these concerns complement one another. Not all of the consequences of exposure to neglect are immediately apparent. The consequences that have been observed over the longer term necessitate the implementation of interventions based on the life course of each child and adapted to his or her needs and stages of development.
Authors' methods: Two methodological strategies were used to paint an overall picture of the needs. First, a rapid review of the literature was carried out based on documents published from 2015 to 2020 and listed in targeted bibliographic databases or in the grey literature. These documents were selected using predefined inclusion criteria, and relevant information was extracted from them. The results of the analysis are presented in the form of a thematic summary. Secondary analyses were then conducted. The first were based on data on negligent behaviour from the survey La violence familiale dans la vie des enfants du Québec collected in 2018 by the ISQ (Institut de la Statistique de Québec). The association between individual factors and neglect was assessed. Separate analyses were produced for children between the ages of 6 months and 5 years and for children aged 6 to 12 years. Other secondary analyses were performed based on data from the Quebec Incidence Study of Reported Child Abuse and Neglect dated from 2014. This study provides estimates of the annual rate of children whose situation was investigated by Youth Protection services in 2014, together with the characteristics and living environments of the children concerned. Stakeholders completed a form for a randomly selected sample of 4,000 children (50%). Bivariate analyses were produced in order to compare: 1) children with at least one substantiated incident of neglect to children with a serious risk of substantiated neglect and those with any other type of substantiated incident; 2) children who had been assessed for neglect, based on whether the status of the incident was substantiated or unsubstantiated
Project Status: Completed
Year Published: 2022
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Child Abuse
  • Child Poverty
  • Child Welfare
  • Family Health
  • Risk Factors
  • Child Health
  • Child Health Services
  • Adolescent Health
  • Adolescent Health Services
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.