Chartier, M., Enns, J. E., Nickel, N. C., Campbell, R., Phillips-Beck, W., Sarkar, J., Boram Lee, J., Burland, E., Chateau, D., Katz, A., Santos, R., & Brownell, M. (2020). The association of a paraprofessional home visiting intervention with lower child maltreatment rates in First Nation families in Canada: A population-based retrospective cohort study. Children and Youth Services Review, 108, 104675.
Indigenous children are over-represented within the child welfare system. The Families First Home Visiting (FFHV) in Manitoba was evaluated to determine its success in reducing the rate of maltreatment of young children within the 2003-2009 cohort of First Nations families eligible for services. Facilitated by a Public Health Nurse (PHN), the FFHV program utilizes a screening method with all new mothers to identify risk factors for child maltreatment. This screening method aimed to determine which mothers were referred into the program. While 4,010 families were eligible to receive the program, only 1,681 completed it due to the program being at capacity or because they were not interested in participating in the voluntary program. The authors compared families who received the FFHV to those who did not. They focused their secondary analysis on how the FFHV program impacted the following child outcomes: whether a child was placed into the care of a child welfare system in the first year of their life, whether a child was placed into the care of a child welfare system in the first two years of their life, whether a child was hospitalized for maltreatment-related injuries in first three years of life, and whether a child witnessed or was a victim of a crime.
The First Nations mothers who participated in the FFHV had a reduced risk (9.4%) of a child being placed into the care of a child welfare system in comparison to children of mothers who did not receive services (14.8%). The other outcomes were not significantly predicted by the independent variables. The authors note that these outcomes may be more sensitive to confounding factors.
The FFHV program in Manitoba appears to have had a positive effect in reducing the likelihood of First Nation children requiring out-of-home care during the first year of their life. The authors note that further resources and supports are required to facilitate engagement with “hard to reach” families, specifically in the timeliness of Truth and Reconciliation.
The authors utilized retrospective observational methodology examining the data stored with the Manitoba Centre for Health Policy. There were 1681 First Nations families that participated in the FFHV and 2329 who did not (for the reasons as indicated above). To account for the differences of the two groups, the authors weighted the variables associated with the assessment completed by the PHN. These variables consisted of various risk factors, such as a lack of prenatal care, social isolation, and family violence. By weighting the variables, families who had higher scores on the initial assessment and recommendations for entrance into the program, but did not participate, were given more weight within the comparison group. In addition, the families who had a lower scores but participated in the program were given less weight. By shifting the variable weights, the authors were able to compare the two groups, focusing on vulnerable families who had higher scores during their screenings.
This is a retrospective study, and as such, the factors that may have impacted the findings could not be explored. The authors were not able to take into account whether mothers had child welfare involvement and were mandated to participate in a parenting program or voluntarily participated in the FFHV program. The program did not ensure cultural matches between families and their in-home worker, and it was not based in First Nation culture or traditions, and thus it would be interesting to assess these areas further.