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Background: In response to child victims of sex crimes, Canadian police agencies are required to work collaboratively with child victim oriented community organizations. Such collaborations involve the navigation of potentially competing objectives of partner agencies., Objective: In our research, we examine police interpretations of collaborative responses to child victims of sex crimes in order to assess the challenges and benefits of police and community partnerships., Participants and Setting: We conducted 52 semi-structured interviews and focus groups with police officers working on one of different ten police service organizations across Canada in order to unpack the joint responses of police and community partner agencies to child victims of sex crimes., Methods: We coded and analysed focus group and interview transcripts for emergent themes pertaining to police interpretations of their collaborations with governmental and non-governmental organizations when responding to child victims of sex crimes. In focusing on the management and sharing of information, the complexities and practicalities of joint responses to child sexual abuse are revealed., Conclusion: Collaborative tensions, such as differing mandates and blurred boundaries, were present in all participating policing agencies, but police working in and alongside CACs were more likely to recognize that the safety and best interest of children was a shared goal across partner agencies. Operating in successful partnership requires clearly demarcated roles and mutual understanding and respect between both police and partnerships agencies., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: Second-hand smoke (SHS) can attain high concentrations in cars. To protect children's health, nine Canadian provinces have enacted legislation prohibiting smoking in privately owned vehicles when children are present; Quebec is the only province with no such legislation. The objective of this study was to estimate the proportion of smokers in Quebec who smoke while travelling in a private vehicle in which children are present, and to compare the characteristics of smokers who do and do not smoke in cars., Methods: In 2011-12, 754 daily smokers who recently travelled in a car with children completed a telephone survey in which they reported how frequently they smoked in a car, if there were smoking restrictions, and perceptions about the effectiveness of legislation prohibiting smoking in cars when children are present., Results: Twenty-three percent of daily smokers smoked at least occasionally in their car when children were present. This proportion was higher among smokers who knew that there was no legislation in Quebec prohibiting smoking in cars, compared to smokers who believed that such legislation was already in effect (32% vs. 12%). Smokers with a university degree and those who reported that smoking was prohibited at home were less likely to expose children to SHS in cars. Most daily smokers (75%) believed that legislation would be effective., Discussion: The results of this study suggest that legislation prohibiting smoking in cars is necessary to protect children from SHS, that such legislation would be effective, and that it may be relatively easy to implement.

In 2008 Ontario, Canada the Goudge Inquiry arose following increasing concerns about practices surrounding forensic pathology and the investigation of paediatric deaths. Some of the considerations and recommendations have relevance to child protection/forensic paediatricians, particularly in relation to their responsibilities in opinion formulation and as expert witnesses. By examining the Inquiry recommendations, this paper applies them in relation to child protection/forensic paediatrics by discussing forensic medicine and its legal context, how interpretation of published reports and data should be used in opinion formulation; issues of 'diagnosis' versus 'opinion'; issues specific to child protection paediatrics; quality control; aspects of report writing and terminological considerations. It concludes with an adaptation of key recommendations directly from those of Goudge, applied to the context of paediatric forensic medicine undertaken in child protection assessments., (Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Rates of reported child maltreatment nearly doubled in Canada over the period 1998-2003, an increase that reflects growing awareness of the harmful effects of an expanding array of parental behaviors, including corporal punishment, lack of supervision, and exposure to intimate partner violence (IPV). Some of these situations may benefit from voluntary family support programs outside of the child welfare system. Analyzing a sample of 11,807 investigations, this paper compares cases where the sole concern is exposure to IPV, or hitting a child, or neglect, or other forms of investigated maltreatment. Situations where exposure to IPV or potentially abusive hitting were the sole reason for investigation presented with fewer risk factors and were less likely to lead to ongoing child welfare interventions compared to other maltreatment investigations. While situations involving alleged neglect presented a higher risk profile and elicited a more intensive child welfare response than did exposure to IPV or hitting, opportunities for alternative services were nevertheless identified. The study also found that visible minority families were overrepresented in cases involving hitting and that Aboriginal families were overrepresented in cases involving neglect. Overall the findings support the development of alternative response programs in Canada.

This national study of child custody disputes within the context of child protection investigations confirms and reinforces the perception in the field that child custody disputes are more likely to reopen for investigations, include higher rates of malicious referrals and involve a higher proportion of children with emotional and functioning issues compared to non-custody-related investigations. Future research might consider the reasons for these higher rates so to improve the identification of these cases and to make more informed decisions about how best to respond to these families. The greatest contribution of this study is that it provides important new evidence to reinforce the need to prioritize child custody disputes within the context of child protection services given the unique challenges and opportunities for making well-informed case plan decisions.

Background: Preschoolers spend a substantial portion of their day in childcare; therefore, these centers are an ideal venue to encourage healthy active behaviors. It is important that provinces'/territories' childcare legislation encourage physical activity (PA) opportunities. The purpose of this study was to review Canadian provincial/territorial childcare legislation regarding PA participation. Specifically, this review sought to 1) appraise each provincial/territorial childcare regulation for PA requirements, 2) compare such regulations with the NASPE PA guidelines, and 3) appraise these regulations regarding PA infrastructure., Methods: A review of all provincial/territorial childcare legislation was performed. Each document was reviewed separately by 2 researchers, and the PA regulations were coded and summarized. The specific provincial/territorial PA requirements (eg, type/frequency of activity) were compared with the NASPE guidelines., Results: PA legislation for Canadian childcare facilities varies greatly. Eight of the thirteen provinces/territories provide PA recommendations; however, none provided specific time requirements for daily PA. All provinces/territories did require access to an outdoor play space., Conclusion: All Canadian provinces/territories lack specific PA guidelines for childcare facilities. The development, implementation, and enforcement of national PA legislation for childcare facilities may aid in tackling the childhood obesity epidemic and assist childcare staff in supporting and encouraging PA participation.

The death in 2003 of Zachary Turner, a child in receipt of children’s protection services in Foxtrap, Newfoundland, sparked an independent inquiry into his death. Subsequently, other reviews were completed of children’s protection services. These were not the first reviews or inquiries of this kind in Newfoundland and Labrador. In 1991, Justice Samuel Hughes had conducted a public inquiry into children’s protection services. This article is a critical historical analysis of selected aspects of children’s protection services. The authors uncover repeated failures by government in its child protection systems and discuss implications for future concerns.

In this article we examine decision-making about complementary and alternative medicine use when the patient is an adolescent. A case scenario describes patient-parent conflict when a 14-year-old boy who was diagnosed with ulcerative colitis that has continued to progress even with medication refuses recommended surgery despite his physician's and parents' support for that option; he prefers homeopathy instead. We address (1) who has decision-making authority about treatment for young people, (2) how to determine if a young person can consent to or refuse treatment, (3) special considerations when counseling and treating adolescents (whether they can decide about treatment for themselves), and (4) parent-child conflicts about treatment. In addition, we suggest ways that health care providers can foster a trusting relationship with patients and parents.

Objective: Although there is growing evidence that the emotional dimensions of child maltreatment are particularly damaging, the feasibility and appropriateness of including emotional maltreatment (EM) in child welfare statutes continues to be questioned. Unlike physical and sexual abuse where investigations focus on discreet incidents of maltreatment, EM is not as easily defined and delimited. Through a review of legislation and child welfare investigation practices in Canada, this paper examines (1) whether Canadian child welfare services respond to EM with the same level of perseverance as with other forms of maltreatment and (2) the extent to which the introduction in 2008 of a more specific EM taxonomy distinguishes between EM and family problems that could lead to EM., Method: Following an analysis of the legislative framework for EM across Canada, investigations practices in Canada are examined using data from the 1998, 2003 and 2008 cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS). Using data from the 2008 cycle, EM investigations are compared to other maltreatment investigations for all of Canada (N=15,980). Changes in EM investigations over time are then compared using data from the three cycles of the study, excluding Québec because of limited data availability in 2003 (N=5,360 in 1998, 11,562 in 2003 and 14,050 in 2008)., Results: EM is included as a form of reportable maltreatment in all provincial and territorial statutes in Canada. Over 11,000 cases of EM were substantiated in Canada in 2008, at a rate of 1.86 cases per 1,000 children. While EM investigations were substantiated at a lower rate as other forms of maltreatment, a higher proportion of EM cases were referred for specialized services, kept open for on-going child welfare services, lead to an out of home placement, and lead to an application to child welfare court. Using a broad definition of EM the number of investigations classified as EM in Canada, excluding Québec, nearly tripled from 1998 to 2003. In 2008, using more specific definitions focusing on caregiver definitions, the number of investigations classified as EM nearly returned to their 1998 level, with nearly twice as many cases being classified as risk of future maltreatment., Conclusion: EM is a well established category for child welfare intervention in Canada, however, more emphasis should be given to distinguishing between EM and family problems that place children at risk of EM., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The nutrition programs that developed in Montreal Protestant schools during the 1970s attest to a deepening awareness of child and adolescent welfare. The combination of grassroots activism and government support that brought about these initiatives took place in the context of post-Quiet Revolution Quebec, when Montrealers were grappling with the role that the newly activist state should play in social life. At the same time, school nutrition reform was part of a broader ongoing renegotiation of state responsibility. Both in Canada and the United States, governments were steadily assuming a mantle of responsibility for expanded liberal rights.

While the clinical promise of much stem cell research remains largely theoretical, patients are nonetheless pursuing unproven stem cell therapies in jurisdictions around the world--a phenomenon referred to as "stem cell tourism." These treatments are generally advertised on a direct-to-consumer basis via the Internet. Research shows portrayals of stem cell medicine on such websites are overly optimistic and the claims made are unsubstantiated by published evidence. However, anecdotal evidence suggests that parents are pursuing these "treatments" for their children, despite potential physical and financial risk. Physicians are in a unique position as they can be expected to be involved in, or privy to, such decisions. In this paper, we consider what duties physicians may have toward minor patients whose parents/guardians wish to engage in stem cell tourism on their behalf. We use the Canadian perspective to address the broadly relevant issues raised by this trend.

Governments in Canada have recently been exploring new accountability measures within intergovernmental relations. Public reporting has become the preferred mechanism in a range of policy areas, including early learning and child-care, and the authors assess its effectiveness as an accountability measure. The article is based on their experience with a community capacity-building project that considers the relationship between the public policy, funding and accountability mechanisms under the federal/provincial/territorial agreements related to child-care. The authors argue that in its current form, public reporting has not lived up to its promise of accountability to citizens. This evaluation is based on the standards that governments have set for themselves under the federal/provincial/territorial agreements, as well as guidelines set by the Public Sector Accounting Board, an independent body that develops accounting standards over time through consultation with governments.

Canada's original people consist of First Nations, Inuit and Metis peoples. Their estimated population is 1.17 million. The total fertility rate for the period 1996-2001 was 2.6 for Aboriginal women versus 1.5 for Canada (Statistics Canada 2006). Thus, a high proportion of this rapidly growing segment of the population are children. Numerous articles have reviewed the health status of Canada's Aboriginal children and shown comparatively high prevalence and incidence of most of the common diseases that affect children. This article highlights some of the more specific disparities, but also attempts to provide some historical context and a few composite case studies that illustrate how the social determinants, colonialism, jurisdictional issues, geography and healthcare can interact to amplify disproportionately the disadvantage these children have in so many ways. Much of the historical detail recounts the contact with First Nations people, the most numerous and the first group to have contact with European settlement.

Tribal sovereignty is a theory that has gained credibility over the past few decades, but one that the child welfare field has still not fully embraced. A mainstream reluctance to understand or accept customary adoption, unique to tribal culture, illustrates the lack of credibility given to tribal child welfare beliefs and practices. Roger Paul, a member of the Passamaquoddy and Maliseet Tribes, was asked to discuss customary adoption. His wide-ranging narrative response illuminates past abuses and current strengths of tribal child welfare practice and belief. Two primary policy and practice implications emerge. They are (1) that cultural and institutional oppression continue to be embedded in current policy and practice and continue to have a detrimental impact on tribal children, families, and communities and (2) that little recognition of or support for the child welfare structure exists in tribal communities, as exemplified by the Wabanaki experience. Child welfare practices embedded in traditional tribal social structure can be trusted and effective. The recognition and acceptance of these practices will expand permanency resources for American Indian/Alaskan Native children and will improve relationships between tribal, state, and federal child welfare systems.

Debates in the Canadian House of Commons in the last two decades of the nineteenth century revealed persistent differences between the Conservatives and the Liberals over federal Indian education policy and the administration of industrial schools. Until their defeat in 1896, the Conservatives supported a denominational industrial school system and a policy of rapid assimilation. The Liberals generally opposed denominational schools and believed the industrial school system was too costly and was not leading to rapid assimilation. After gaining power, the Liberals stopped construction of industrial schools in favour of boarding and day schools, but denominational influence remained strong. The Conservative emphasis on assimilation was replaced by measures that supported reserve-based segregation as earlier hopes for rapid assimilation diminished. Despite policy differences, neither the Conservatives nor the Liberals held Aboriginal cultures in high regard, and debates regarding the means and intent of Indian education played out against well-known, high mortality rates and often abysmal conditions in the schools.

Child maltreatment is associated with a huge burden of suffering, yet there are serious gaps in knowledge about its epidemiology and approaches to intervention. This article describes the development of a proposed national research framework in child maltreatment, as requested by the Department of Justice, Canada, based on (1) a review of the literature, (2) consultation with experts, and (3) application of evaluation criteria for considering research priorities. The article identifies gaps in knowledge about child maltreatment in Canada and proposes a research agenda to make evidence-based policy decisions more likely. Although this work was driven by gaps in Canada's knowledge about child maltreatment, the international scope of the review and consultation process could make the findings useful to broader research and policy audiences.

Epidemiological and toxicological studies established positive associations between environmental hazards and adverse child health outcomes, including cancer, learning disabilities, behavioral problems, developmental effects, low birth weight, and birth defects. The economic and societal costs associated with children's environmental health disorders were estimated to be substantial. The existence of knowledge gaps, lack of capacity, and the jurisdictional overlap of children's environmental health issues are some of the barriers that impede effective policy decision making. To improve children's environmental health and reduce economic and societal costs, current legislative frameworks could implement a series of amendments. The main federal, provincial, and municipal legislation used to protect children in Canada, either explicitly or implicitly, is reviewed. Recommendations for improving the existing framework for protecting and strengthening children's environmental health are proposed.

Objective: The goal of this review is to aid clinicians with ethical issues arising in the treatment of women who suffer from psychosis., Method: This paper is a synthesis of the recent literature in adult and child psychiatry, ethics, law, and child welfare pertaining to the topic of maternal psychosis. Topics include: family planning, the care of pregnant women with schizophrenia, postpartum psychosis, child custody, involuntary treatment, confidentiality issues, and service fragmentation., Conclusion: Appreciation of the particularized circumstances of issues arising in the treatment of mothers who suffer from psychosis serve the clinician better than the dispassionate application of a principle-driven ethic.

Objective: Recent years have been fraught with investigations into the deaths of children receiving child welfare services throughout North America, Europe, and Australia. These inquiries have attracted considerable media attention and public outrage. Added to this have been increases in attempts to hold social workers in child welfare responsible for the abuse and deaths of children through the criminal and civil courts. As a result of fears regarding liability, many child welfare professionals are resorting to defensive practice strategies., Method: This article reviews recent court decisions and legislation in Canada regarding this issue in order to assess actual risks., Results: Social workers who act according to accepted standards of practice and who in good faith make difficult judgments to the best of their abilities, will not be held to be criminally culpable or civilly negligent., Conclusion: It is concluded that child welfare professionals who exercise reasonable caution and engage in good clinical social work practice, good record keeping, effective communication and verification of information, can continue to strive to offer the high quality services to children and their families as they have always done without any serious fear of recrimination.

Women's role in the formation of trade unions and development of collective bargaining, as well as in labor's historical struggle to improve day-to-day working conditions, has been conspicuously underplayed, if not ignored. Yet, when one reviews the history of the reduction of working hours, prohibition of child labor, elimination of homework in tenement slums, reform of factory legislation, and investigations into accidents precipitating early workers' compensation legislation, the literature is rich with women's investigative reports and studies on unhealthy and unsafe working conditions. This was the case from the late 19th century in North America up until the 1950s and the Cold War. The women's movement and political activities requiring factory reforms then seemed to go underground, re-emerging in full force during the 1960s. Women's involvement in the environmental movement, especially in the United States, has been significant in politicizing occupational health as well. Their efforts led to the 1970 passage of the U.S. Occupational Health and Safety Act.

Medical decisions involving children raise particular ethical issues for physicians and other members of the health care team. Although parents and physicians have traditionally made most medical decisions on behalf of children, the developing autonomy of children is increasingly being recognized in medical decision-making. This poses a challenge for physicians, who must work with the child's family and with other health care practitioners to determine the child's role in decision-making. A family-centred approach respects the complex nature of parent-child relationships, the dependence and vulnerability of the child and the child's developing capacity for decision-making.

The search for ways to mitigate the effects of family breakdown on parents and children includes legislative and clinical efforts which to some extent influence each other. In the past year much public interest has been aroused in Canada, and particularly in Ontario, in the issue of legislative changes which would make joint custody the usual or "preferred" legal disposition of custody cases. This paper provides a discussion of the legislated preference, or "rebutable presumption" of joint custody from a historical, legal and clinical point of view. Definition and elaboration of what joint custody is from the legal and practical perspectives is provided with an emphasis on Canadian laws and practice. The legal rights of the non-custodial parent are explained, and relevant case law is highlighted. The relationship between joint custody, support orders and relitigation rates are elaborated. Following this is a critical overview of the empirical research on joint custody as it relates to the adjustment of children and parent satisfaction is included. It is concluded that while there is little question that shared parenting can be beneficial to children, the enthusiasm of legislators for joint custody has not been supported by empirical data. It is necessary to examine under what circumstances and for which kinds of parents and children joint custody might be beneficial since it is unlikely that one solution will fit the needs of all families and all stages of family life.

Divorce is frequent in our society. It is a "marker" of high stress periods that precede and follow it. The events surrounding it have clear negative effects on the physical and mental health of all those involved. The issues and the reactions, different for fathers and mothers and for children, are determined by the sex and developmental stage. The effects are interactive and events subsequent to the divorce influence the restoration of competent functioning. This paper examines these differential effects, methods of helping in the resolution process and opportunities of preventive work with this high risk population.

This paper focuses on the medicolegal activities of a group of six pediatricians from the Winnipeg Children's Hospital. Increasing legal demands resulted in 93 court appearances for the group, during a 12-month period ending in December 1982. The educational processes and the individual court room issues confronted by both the courts and the six pediatricians, dealing with problems of child protection, are described. Major pediatric roles and principles of advocacy resulting from these experiences are delineated. Society's accountability is discussed with specific reference to the pediatrician's role.

The medical legal debate concerning committal is outlined and the recent scientific contributions to the committal debate are evaluated. It is noted that scientific surveys have made few significant contributions to the debate. Suggestions are made for further research in the hope that an increased contribution of scientific fact may help diffuse the heated exchange between the supporters and detractors of the committal process for the better care of a significant portion of our mentally ill.