Original Title: Avis - Balises pour améliorer les services destinés aux enfants à risque de négligence ou en situation de négligence et à leur famille

Authors' objectives: Neglect is defined as a lack – or even an absence – of response to children’s needs and is often presented on a continuum, ranging from situations of risk to serious situations of neglect. The signs of neglect can be difficult to distinguish when a situation occurs. Neglect can take many forms, such as physical, educational, supervisory, affective, emotional or cognitive. It is a concern for many stakeholders, decision-makers and researchers, who all agree on the importance of taking a multifactorial intervention approach to prevention or neglect in all sectors concerned. Over the years, the ministère de la Santé et des Services sociaux (MSSS) and other government bodies have made a number of investments to guide actions and activities aimed at reaching vulnerable families, fostering children’s development, their well-being and that of their family, and thus better meeting their needs. Despite the efforts that have been made, the needs of many children and their families remain unmet. Moreover, in Quebec, a significant number of children are at risk of neglect or are being neglected. These situations are likely to interfere, to varying degrees, in several areas of their development and to have negative effects throughout their lives. It is in this context that the MSSS mandated INESSS to produce recommendations on service trajectory benchmarks for at-risk or neglected children and their family. The service trajectories identified for dealing with neglect in other parts of the world are flexible and encourage families to move between services as they change and develop. They are similar to a hub model, where services are coordinated and delivered from a central service point and by a key person who supports families. Far from a chain model, this type of conceptualization of the “trajectory” forms the basis of this work and the resulting recommendations.

Authors' results and conclusions: RESULTS (#1 GUIDING PRINCIPLES): Five guiding principles were formulated to underpin the population, socio-cultural, organizational and clinical orientations of the neglect services trajectory. (#2 FINDINGS AND RECOMMENDATIONS): Through an integration of knowledge, several findings and recommendations were formulated, around four themes. Each of the recommendations is accompanied by details on the terms and conditions for its operationalization. The first theme is the collective response to the needs of children and families. The findings relate to intersectoral mobilization, intersectoral governance strategy, and accessibility, and coordination of services. These findings led to two recommendations: 1) That the MSSS make neglect a priority by adopting an interdepartmental prevention and intervention strategy and, in doing so, that it strengthen conditions conducive to coordinating actions among intersectoral partners in order to meet the developmental needs of children, notably through support for their family. 2) That the centres intégrés de santé et de services sociaux (CISSS) and the centres intégrés universitaires de santé et de services sociaux (CIUSSS), in collaboration with their partners, ensure service accessibility and a smooth pathway for families. The second theme addresses community outreach. The findings concern the development of informal and formal support for families, the importance of reaching families that are geographically isolated and the contributions of the outreach activities offered to families. These findings led to a third recommendation. 3) That the CISSS/CIUSSS, with their partners, strengthen and implement local interventions based on identified needs. The next theme deals with interventions tailored to the needs of children and families. The findings are formulated around applying the ecosystemic perspective and the participatory approach in interventions, together with the supporting clinical tools. This led to two recommendations. 4) That CISSS/CIUSSS managers and workers, in collaboration with their partners, consistently apply the ecosystemic perspective of neglect and the participatory approach to interventions at every stage of the process (situation analysis, planning of interventions and services, their implementation and clinical review). 5) That CISSS/CIUSSS managers and caregivers, in collaboration with their partners, diversify and adapt interventions for children at risk of neglect or in situations of neglect and their family. Finally, the last theme focuses on clinical and organizational support for caregivers. The related findings address the skills expected of these workers, their training, the clinical support they require and the organizational adaptability needed to work in a context of neglect. A final recommendation stems from this. 6) That the MSSS, the CISSS/CIUSSS and their partners improve professional training, both initial and continuing, as well as clinical and organizational support to workers in the areas of risk of neglect or neglect in order to promote evidence-based learning and development and supervised reflective practices. CONCLUSION: Due to the diverse needs of children at risk of neglect or in situations of neglect and their family, a surrounding network of caregivers and close friends or relatives must be set up to provide support and promote their self-determination. From a caring perspective and with its primary focus on prevention, the current service offer needs to be redesigned to strengthen ecosystemic practices regarding neglect, the use of the participatory approach, community-based interventions, and interdisciplinary and intersectoral work. These families require a helping hand, community-based services and support and guidance whenever a need arises, no matter how complex their circumstances. They must be supported in meeting their needs and be seen as having expert knowledge of their situation when they come to a service site. For this to become a society-based project, an interdepartmental strategy must be put in place, and clinical and organizational support must be more structured and solid. A number of collaborations with partners must be strengthened, including collaborations with educational childcare services, schools and family support organizations since they are in daily contact with the children and their family.

Authors' recommendations: RECOMMENDATION #1: That the MSSS makes neglect a priority by adopting an interdepartmental prevention and intervention strategy and, in doing so, that it strengthen conditions conducive to coordinating actions among intersectoral partners in order to meet the developmental needs of children, notably through support for their family. RECOMMENDATION #2: That the CISSS/CIUSSS, in collaboration with their partners, ensure service accessibility and a smooth pathway for families. That the CISSS/CIUSSS, with their partners, strengthen and implement local interventions based on identified needs. RECOMMENDATION #3: That the CISSS/CIUSSS, with their partners, strengthen and implement local interventions based on identified needs. RECOMMENDATION #4: That CISSS/CIUSSS managers and workers, in collaboration with their partners, consistently apply the ecosystemic perspective of neglect and the participatory approach to interventions at every stage of the process (situation analysis, planning of interventions and services, their implementation and clinical review). RECOMMENDATION #5: That CISSS/CIUSSS managers and caregivers, in collaboration with their partners, diversify and adapt interventions for children at risk of neglect or in situations of neglect and their family. RECOMMENDATION 6: That the MSSS, the CISSS/CIUSSS and their partners improve professional training, both initial and continuing, as well as clinical and organizational support to workers in the areas of risk of neglect or neglect in order to promote evidence-based learning and development and supervised reflective practices.

Authors' methods: The results presented in this report were produced by integrating a number of scientific, experiential and contextual data sources. The data was drawn from the key findings of a state of knowledge report and a state of practice report, previously published by INESSS; from a narrative (non-systematic) review of the scientific and grey literature; and from consultations with some stakeholders (approximately 70 people, including parents). A data triangulation process produced results that made it possible to identify points of convergence and divergence, with their commonalities lending support to the findings. A few nuances have been highlighted. The data was synthesized according to the targeted contents of interest.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/balises-pour-ameliorer-les-services-destines-aux-enfants-a-risque-de-negligence-ou-en-situation-de-negligence-et-a-leur-famille.html

Year Published: 2023

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/balises-pour-ameliorer-les-services-destines-aux-enfants-a-risque-de-negligence-ou-en-situation-de-negligence-et-a-leur-famille.html

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

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: L'Institut national d'excellence en sante et en services sociaux (INESSS)