[State of practice: service trajectories and services for at risk or neglected children and their families]

Dussault J, Gaumont C, Moreault B
Record ID 32018002653
Original Title: État des pratiques - Les trajectoires de services et les services pour les enfants à risque de négligence ou en situation de négligence et leur famille
Authors' objectives: For several years now, neglect has been a source of concern in Quebec for a number of workers and managers involved with the children so affected (0-18 years of age) and their family, i.e., within health and social services, early childhood care services, school and community settings. Work of national scope on neglect has been carried out by many researchers to support the development of practices. Similarly, as early as 2007, the MSSS (Ministry of Health and Social Services) prioritized this issue in its network by, recommending, among other things, the implementation of neglect intervention programs for youth in difficulty and their families. The Ministry reiterated its commitment in the 2015-2020 strategic plan, which notably raised the issues of access delays for front-line psychosocial services and the reduction in the use of youth protection services. In 2020, MSSS put forward trajectory management, described as a promising practice in terms of accessing services and mobilizing stakeholders concerned by the issue. 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 familiy should be adopted in Quebec, and what would be the indicators used to monitor the resulting (operational) regional trajectories? This report documents: • the extent of the problem of neglect in Quebec; • the prevention and intervention services offered to at-risk or neglected children and their family as well as the current trajectories of services in Quebec; • the current trajectories of services in other jurisdictions.
Authors' results and conclusions: RESULTS: Twelve studies formed the basis of an analysis of the extent and risk of neglect among children in Quebec. The results indicate that a significant number of children are affected, to varying degrees, by this phenomenon. In addition, neglect remains the predominant reason for youth protection reporting. Although data collected from parents indicates that adolescents appear to be the most affected by negligent parental behaviour, it is young people aged 12 and under who are most often reported and taken into care by Youth Protection Services. The pathways of children taken into care by Youth Protection Services due to neglect seem to differ from those of children taken into care for other reasons of abuse. The situations experienced by neglected children end up in court more often, and their abuse is more likely to be recurrent in nature. There are also reports of an over-representation of First Nations children who have been taken into care by youth protection due to neglect. An analysis of the questionnaires and documents from Quebec health and social services institutions indicated that: • most of the interventions implemented by the health and social services network (RSSS) to counter neglect are found within the NIPs, in accordance with welldefined stages (from referral to the program to end-of-intervention assessment). Few interventions are offered for the specific purpose of preventing neglect; • the basic effectiveness components of these programs indicate a generally good implementation in the regions; • however, some regions experience more difficulty in successfully integrating all of these components; • other prevention services are available to families who fail to meet all of their children’s needs; however, they do not specifically target the needs of children before they receive youth protection services and in various sectors; • the provision of services for situations of risk of neglect or neglect is rarely conceptualized as a trajectory. Seven grey literature documents, all from the UK, were identified. They describe four service trajectories designed to counter neglect. These generally include six stages (from first contact with local services to reporting to youth protection). These trajectories rest on four guiding principles drawn from the analysis: early identification of neglect through the monitoring of all children; provision of additional assistance to children with greater needs; referral to protection services as soon as safety and development are compromised; and monitoring and tracking the progress of the children’s situation. Moreover, there is a shared responsibility for local authorities to promote interinstitutional collaborations aimed at improving the well-being of all children. Mechanisms that ensure service continuity and coordination in the trajectories have been identified, such as the use of a key practitioner and team meetings on the needs of the child. Several conditions conducive to the implementation of the trajectories were also highlighted, e.g.: an integrated intersectoral government strategy focused on prevention; the adoption and monitoring of indicators related to the risk of neglect and neglect; and inter-institutional strategies that promote multidisciplinary work and intersectoral collaborations. CONCLUSION: This work has shed light on current conditions that are favourable to implementing trajectories in Quebec aimed at offering services to at-risk or neglected children and families, namely: • mobilizing intersectoral partners who share responsibility for child development and security; • the existence of a consensus around the importance of adopting a continuum of intersectoral services to respond to neglect; • the presence of a service offer: – in prevention, which is more developed for children aged 0 to 5, in order to maximize their chances of growing up in favourable environments; – in interventions, to meet the specific needs of children (0-18 years) and their family, more specifically through general social services, via a number of family-child-youth and other service programs, such as Mental Health and Addictions; – in intensive (once or twice a week) and long-term (over a two-year period) interventions, with families experiencing periodic or recurrent neglect, based on similarly structured and evidence-based programming in the various regions (i.e., NIPs). On the other hand, it is clear from the work that improvements should be made, such as: • integration and complementarity of the services for children and families offered in various sectors (health and social services, school, early childhood, community); • explicit availability of interventions and services designed to prevent neglect; • clarification of the mechanisms that link the various services and activities offered in the area of neglect (promotion, prevention, intervention) beyond mere referrals; • a participatory approach to principles that are more forceful and include a crosssectoral presence, in particular: – criteria for NIP access that mobilizes families by involving them in all decisions that affect them; – strategies to encourage reluctant parents to collaborate or commit to NIPs; • revising the criteria for terminating NIP services for families experiencing more complex neglect situations and who may need these services for longer than two years. In order to better meet the needs of at-risk or neglected children and their family, these elements will be taken into account as we continue our work on developing service trajectories and monitoring indicators.
Authors' methods: To document the extent of neglect in Quebec, 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 the relevant information was extracted from them. The results of the analysis are presented in the form of a thematic summary. A questionnaire was sent to institutions in the Quebec health and social services network to find out about the services offered to at-risk or neglected children and their family. Designed in collaboration with a research team, it contains questions on five components of a program that is recognized for its effectiveness in dealing with neglect. Descriptive statistics were produced for the quantitative data. The responses to the open-ended questions were codified and analyzed quantitatively. In these same institutions, a review was conducted of the documents on the clinical administrative aspects of the services offered to this clientele and on the trajectories of these services. Relevant information was extracted using an extraction grid. A thematic analysis was then performed. The key stages of neglect intervention programs (NIPs) were also identified. A quick review of the grey literature was carried out to determine existing trajectories of neglect in other jurisdictions. The search was conducted using 71 national and international websites and was limited to documents published between the years 2011 and 2021. The selection was made following a comprehensive reading of the documents and in accordance with predefined criteria. Information was extracted using a grid, and a thematic analysis is presented.
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 Health Services
  • Child Protective Services
  • Child Welfare
  • Child Abuse
  • Risk Factors
  • Risk Assessment
  • Aid to Families with Dependent Children
  • Family Health
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.