Impact of being taken into out-of-home care: a longitudinal cohort study of First Nations and other child welfare agencies in Manitoba, Canada

Marni Brownell; Nathan C Nickel; Kayla Frank; Lisa Flaten; Scott Sinclair; Stephanie Sinclair; Nora Murdock; Jennifer E Enns; Jamie Pfau; Anita Durksen; Colette Scatliff; Heather Prior; Randy Walld; Lorna Turnbull; Karine Levasseur; Teresa Mayer; Jennifer Chartrand; Chris Nash; Elizabeth Decaire; Hygiea Casiano; Marlyn Bennett; Hera J M Casidsid; Mikayla Hunter; Hannah Owczar; Emily Brownell; Therese A Stukel

doi:10.1016/j.lana.2024.100886

Impact of being taken into out-of-home care: a longitudinal cohort study of First Nations and other child welfare agencies in Manitoba, Canada

Lancet Reg Health Am. 2024 Sep 11:38:100886. doi: 10.1016/j.lana.2024.100886. eCollection 2024 Oct.

Authors

Marni Brownell¹, Nathan C Nickel¹, Kayla Frank², Lisa Flaten¹, Scott Sinclair³, Stephanie Sinclair⁴, Nora Murdock⁵, Jennifer E Enns¹, Jamie Pfau⁶, Anita Durksen⁶, Colette Scatliff⁶, Heather Prior¹, Randy Walld¹, Lorna Turnbull⁷, Karine Levasseur⁸, Teresa Mayer³, Jennifer Chartrand², Chris Nash³, Elizabeth Decaire⁴, Hygiea Casiano⁹, Marlyn Bennett¹⁰, Hera J M Casidsid⁶, Mikayla Hunter⁶, Hannah Owczar¹, Emily Brownell¹, Therese A Stukel^{11

12}

Affiliations

¹ Manitoba Centre for Health Policy, University of Manitoba, Canada.
² First Nations Family Advocate Office, Assembly of Manitoba Chiefs, Canada.
³ Government of Manitoba, Canada.
⁴ First Nations Health and Social Secretariat of Manitoba, Canada.
⁵ Fisher River Cree Nation, Canada.
⁶ University of Manitoba, Canada.
⁷ Faculty of Law, University of Manitoba, Canada.
⁸ Faculty of Arts, University of Manitoba, Canada.
⁹ Department of Psychiatry, University of Manitoba, Canada.
¹⁰ Faculty of Social Work, University of Manitoba, Canada.
¹¹ Institute of Health Policy, Management and Evaluation, University of Toronto, Canada.
¹² ICES, Toronto, Canada.

Abstract

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).

Keywords: Administrative data; Canada; Child protection services; Child welfare; First Nations; Instrumental variable analysis; Legal system; Out-of-home care; Social policy.