Search

PurposeTo elicit stakeholder perspectives on the findings from our scoping review on youth participation in mental health policymaking, we conducted a global consultation with young people and adults directly involved in mental health policymaking.MethodForty-four stakeholders from 16 countries, including 15 young people, 9 policymakers and 20 facilitators of youth participation, took part in individual interviews and/or focus groups. They were asked about how the review findings contrasted with their own experiences in mental health policymaking. The transcribed data were thematically analyzed.ResultsAll participants viewed lived experience as valuable in identifying policy gaps. Youth pointed out that children and youth with disabilities, diverse sexual orientations, and/or gender identities were often excluded, and spoke about feelings of being an “accessory”, illustrating a lack of power-sharing in a tokenized policymaking process. Adult participants’ accounts highlighted the challenges inherent in policymaking such as the need for political knowledge and institutional time constraints. A range of cultural, socio-economic, and political barriers to youth participation, that were often context-specific, were identified.ConclusionsThe diverse perspectives of stakeholders extended the review results. Based on our findings, we recommend that adults and institutions: (1) recognize lived experience as expertise in shaping mental health policies; (2) include diverse groups; (3) reduce tokenistic relationships through the creation of safer spaces, adult feedback, co-production, and social accountability; and (4) adopt an intersectional approach to address cultural, socio-economic, and political barriers to participation. Methodologically, our work demonstrates why stakeholder consultations are an essential component of scoping reviews.

Research from industrialized settings has linked inadequate child supervision with various negative consequences. Nevertheless, empirical research in lower- and middle-income countries about correlates of inadequate child supervision has been scarce. The few studies that exist tended to focus on individual- and household-level factors, and reported associations that are not significant or in mixed directions depending on the context. Structural factors are left underexplored, but taking a more macro-level lens in settings with high regional disparities can hold the key to explaining increases in prevalence of inadequate child supervision. Exploring the evolution over time of child supervision practices can also enrich this explanation. We use data from two rounds of Ghana Multiple Indicator Cluster Surveys to examine factors associated with children left home alone, and employ regional analysis using strata-level mixed effects. We found that in Ghana, the prevalence of children left home alone without adult supervision increased by 8.5% between 2011 and 2018 – an increase of more than 500,000 children over seven years. Statistical analyses suggest that variation between regions likely are associated with the growth of inadequate child supervision in this country. Future research should pay closer attention to how structural conditions, proxied by regions, can serve as either barriers or facilitators to adequate child supervision practices, helping shed light on residual variance unexplained by individual- and household-level factors.

Purpose: Although youth participation is oft-acknowledged as underpinning mental health policy and service reform, little robust evidence exists about the participation of children and youth in mental health policymaking. Method: A scoping review based on Arksey and O’Malley’s framework was conducted to identify and synthesize available information on children and youth’s participation in mental health policymaking. Published studies up to November 30, 2020 were searched in Medline (OVID), PsycINFO (OVID), Scopus, and Applied Social Sciences Index and Abstracts (PROQUEST). Unpublished studies were identified through Google Scholar and targeted web searches October to December, 2020. Three reviewers performed screening and data extraction relevant to the review objective, followed by an online consultation.Results: From 2,981 records, 25 publications were included. A lack of diversity among the youth involved was found. Youth were often involved in situational analysis and policy design, but seldom in policy implementation and evaluation. Both the facilitators of and barriers to participation were multifaceted and interconnected. Despite a range of expected outcomes of participation for youth, adults, organizations, and communities, perceived and actual effects were neither substantially explored nor reported.Conclusions: Our recommendations for mental health policymaking highlight the inclusion of children and youth from diverse groups, and the creation of relational spaces that ensure safety, inclusiveness, and diversity. Identified future research directions are: the outcomes of youth participation in mental health policymaking, the role of adults, and more generally, how the mental health of children and youth shapes and is shaped by the policymaking process.

International migration to North America continues to rise, and with it the meeting of different cultural norms surrounding child caregiving and supervision. Previous research shows that high rates...

During the first COVID-19 lockdown in Namibia (March-September 2020), the Ministry of Health and Social Services reported there were an estimated 14,983 teenage pregnancies in 2020, an increase from the prior year’s estimated 13,552. The regions of Kavango East and West were particularly impacted. In response to these figures, the Ombetja Yehinga Organisation (OYO), a youth-focused Namibian non-governmental organization, facilitated an after-school intervention in 2021 to discuss key sexual and reproductive health knowledge. An identical questionnaire was administered at both pre- and post-test, in order to provide baseline information for assessing the effectiveness of a school-based intervention to promote safe sexual behaviours. A total of 18 schools in the regions of Kavango East and West participated in the intervention between May-September 2021, and 638 learners aged 13-25 were included in data analysis after completing both the pre- and post-tests. Prior to the intervention, knowledge on sexual and reproductive health, including safe sexual behaviours and accessing contraceptives was limited. Results obtained at post-test indicate there were significant increases in participants’ level of knowledge between pre- and post-test, suggesting that school-based interventions (such as the OYO program) may be effective in disseminating this crucial information to at-risk populations.

Following the 6th Conference of the International Society for Child Indicators (Montreal, 2017), this Special Issue was compiled to advance an interdisciplinary understanding of the complexity of conceptualizations, determinants, consequences, and measurement of child neglect around the world and to highlight the need for reforms in child protection systems. The most common type of child maltreatment with long term damaging consequences for children, families, and societies child neglect continues to receive limited scientific and public attention, particularly in resource low settings and in the field of child indicators. Lack of clarity in definition and measures, weak multi-sectoral coordination, and unclear accountability lines, are among the factors that contribute to the insufficient attention to neglect in research and action. Adopting an eco-systemic perspective of child neglect allows us to incorporate the perspectives of families and to question the role and responsibility of the State and the broader conditions within which parents operate. Sound statistical and qualitative indicators of child wellbeing in cases of neglect are urgently needed across geographic areas and over time. Combining child-centredness and attention to socio-economic, cultural, and political context issues will be important in advancing the field.

Asian immigrant parents often expect their children to pursue higher education and to succeed academically; this may be reinforced as parents lose social status upon arrival to the host country. In response, Asian immigrant youth often experience psychological distress and alienation from their parents. We studied Asian immigrant youth’s exposure to parental expectations and parents’ struggles post-migration to Canada, in conjunction with Asian immigrant youth’s career and academic choices and level of distress. Forty-nine first- and second-generation Asian immigrant university students from a single Canadian university institution completed an on-line survey assessing their migration trajectory, parents’ expectation and influence in choosing their field of study, and distress. Parental difficulties and participants’ awareness of those were highly correlated with perceptions of high parental expectations and filial piety. Whereas second-generation youth focused more on how they received direct pressure from parents to succeed according to parental standards, first-generation youth placed higher emphasis on how their own awareness of parental difficulties acted as a source of internal motivation. The average depression score of first-generation respondents was significantly higher than that of second-generation respondents, and association between family’s financial struggle and guilt was observed. This study provides insight on possible contributors to distress in Asian immigrant youth related to parental expectations and struggles post-migration.

Children exposed to violence are at risk of a range of adverse outcomes. Given the unique cultural and social context, understanding what fosters children's resilience in resource-limited areas such as sub-Saharan Africa, is vital.Using data from the International Survey of Children's Well-Being (ISCWeB), this paper explores individual-, family-, and school-level factors associated with positive outcomes for children who have experienced some form of violence in Khomas region, Namibia.Using a cross-sectional survey design, the ISCWeB questionnaire, assessing cognitive, affective, and psychological dimensions of well-being, child protection factors and violence exposure was administered to 2124 Grade four and six children.Our sample had a mean age of 11.2 years. Overall, 56.8 % of children reported at least one incident of violence from an adult caregiver at home and 86.0 % of children reported some form of peer violence at school. Materially deprived children experienced higher incidence of both family and peer violence. The quality of children's relationships at home (β = 0.17, p0.001), and school (β = 0.07, p0.001) emerged as important protective factors for children's well-being for both types of violence, suggesting that supportive family and school relationships may be more important to the subjective well-being of children who experienced violence than material wellbeing, violence severity, and individual child factors.Providing positive social interaction and emotional security in contextually and culturally appropriate ways within children's proximal systems should be prioritized while challenging norms that support violence in Namibian families and schools.

Nearly thirty years ago, the world recognised the participation rights of children with the adoption by the United Nations Convention on the Rights of the Child. Since then childhood researchers in the Global South and Global North have been at the forefront of promoting these rights. The increased involvement of children and youth in research has challenged ‘traditional’ adult research practices in numerous ways. This article explores the role and contributions of Child and Youth Advisory Committees (CYACs) in the research process. It discusses the establishment of CYACs and how they supported the International and Canadian Child Rights Partnership (ICCRP). The ICCRP began as a three-year multi-country research project addressing children’s rights to participation and protection and monitoring this connection internationally within several Global South and North countries: Brazil, Canada, China and South Africa. This article describes the creation and functioning of the ICCRP CYACs and the strengths, challenges, and creative processes in implementation. Findings presented relate to ethics regulation, differing expectations and assumptions about CYAC involvement, and virtual communication. These are discussed with the inclusion of adult researchers’ and the CYAC members’ perspectives. The article shares lessons learned about the role and significance of dialogue to support other child and youth advisory bodies in research at the local and global levels.

Objectives We assessed the effectiveness of the child restraint legislation (CRL) introduced in Chile in December 2005 and the National Decree enacted in February 2007, which regulated the technical characteristics of child restraint devices with the goal of reducing child occupant fatalities and severe injuries nationally and within Chile’s regions. Methods An interrupted time–series design was used to measure the effect of CRL and the National Decree on two dependent variables—number of child occupant deaths in traffic collisions and number of child occupants severely injured in traffic collisions per vehicle fleet from 2002 to 2014 (police data). Our analyses compared the incidence of these outcomes in the post-intervention period (2006 to 2014) with the period prior to these interventions (2002–2005) nationally and by region, controlling for several confounders. Results Nationally, the child restraint policies were associated with a 39.3% (95% CI: 4.7; 73.9) reduction in child occupant fatalities, but no significant decrease was observed in child severe injuries. These interventions were associated with a 75.3% (95% CI: 15.6; 135.1) reduction in the rate of child occupant fatalities in the southern regions, and a 32.9% (95% CI: 1.1; 67.0) reduction in the rate of children severely injured in the northern regions. Conclusion In the short term, the CRL and the National Decree were associated with fewer child occupant fatalities, at the national level and in the southern regions, and severely injured child occupants in traffic collisions in Chile’s northern regions. These results demonstrate a limited temporal and territorial impact. This suggests that to effectively protect vulnerable populations across all territories, efforts should be expanded more consistently and sustained over time.

Background In 2010, Brazil introduced child restraint legislation (CRL). We assessed the effectiveness of CRL in reducing child (aged 0–8 years) injuries and fatalities by race. We performed an evaluation study with an interrupted time–series design. Methods We measured the effect of CRL on two outcomes—number of child deaths and number of child injured in traffic collisions per child population, stratified by race, from 2008 to 2014. We controlled for time, unemployment rate and oil consumption (barrels/day in thousands). Results The CRL was associated with a 3% reduction in the rate of child injuries among whites (incidence rate ratio (IRR): 0.97; 95% CI: 0.96–0.99), but no reduction in child injuries among non-whites (IRR: 0.99; 95% CI: 0.99–1.00). In the first month after the implementation of Brazil’s CRL we observed a 39% reduction in all child fatalities (IRR: 0.61; 95% CI: 0.44–0.84), including a 52% reduction among whites (IRR: 0.48; 95% CI: 0.33–0.68), but no reduction in non-white fatalities (IRR: 0.87; 95% CI: 0.55–1.37). Conclusions Our results support the hypothesis that socially advantaged populations were more likely to consistently adopt and employ restraint devices following the reform. Countries should also consider complementary policies that facilitate an equitable distribution of safety devices that reach vulnerable populations.

Despite the importance of adequate supervision to child wellbeing, the academic conversation around this topic is scattered across disciplines and for this reason is difficult to follow. Researchers and decision-makers would benefit from a preliminary overview of conceptualizations, cultural variations, and facilitators and barriers to providing supervision to children in low- and middle-income countries (LMICs). A scoping review was conducted. Two searches of the literature were run within Embase, Medline, PsycInfo, Social Sciences Full Text, ERIC, SocIndex with Full Text, and Academic Search Complete. Additional papers were identified through a call to experts. Out of 2049 publications initially identified, 44 studies met our inclusion criteria, thus reflecting the scarcity of scientific evidence in LMICs. Child supervision was addressed in the literature in terms of links to psychological, health, social and academic outcomes, suggesting a multidisciplinary interest in the topic. However, a vague conceptualization of child supervision emerged across studies. Of importance, cultural and socio-economic influences interacted to shape caregivers' vision of the family, the child, and the decision-making process regarding supervision practices. Barriers and/or facilitators to adequate child supervision were addressed only in 18 studies. There was substantial variation in how cultural influences on child supervision were taken into account across studies. Our review aims to inform and guide future research and action on child supervision practices in LMICs and calls for a more coherent and comprehensive body of literature on this matter. Programming and policy efforts should take socio-economic and cultural influences into account, as well as be tailored according to the specificities of each child, caregiver(s), and setting.

Background Little research in sub-Saharan Africa has looked at factors that predict mental health problems in adolescents living with HIV (ALHIV). This study examines the psychological impact of HIV in adolescents in Namibia, including risk and protective factors associated with mental health. Methods Ninety-nine fully disclosed ALHIV between the ages of 12 and 18 were interviewed at a State Hospital in Windhoek. A structured questionnaire assessed mental health, using the SDQ (Goodman, 1997), sociodemographic factors, poverty, social support, adherence and stigma. Results Mean age was 14.3 years, 52.5% were female and most were healthy. Twelve percent scored in the clinical range for total mental health difficulties and 22% for emotional symptoms. Poverty was associated with more total mental health difficulties, t(96) = -2.63, p = .010, and more emotional symptoms, t(96) = -3.45, p = .001, whereas better social support was a protective factor, particularly caregiver support (r = -.337, p = .001). Adherence problems, HIV-related stigma and disclosing one's own HIV status to others were also associated with more total mental health difficulties. Poverty (β = -.231, p = .023) and stigma (β = .268, p = .009) were the best predictors for total mental health difficulties, whereas stigma (β = .314, p = .002) predicted emotional symptoms. Social support had a protective effect on peer problems (p = .001, β = -.349). Conclusions Several contextual factors associated with poorer mental health in ALHIV are identified.

The 14-year civil conflict in Liberia resulted in the separation of many children from their families. A population-based, multi-stage random cluster knowledge, attitudes, and practices (KAP) survey of 1157 child caregivers was conducted in 12 districts in Liberia. Knowledge of alternative care and adoption is low and varies significantly by residence. Common misunderstandings include thinking that biological parents may migrate in cases of inter-country adoption (42% of rural and Greater Monrovia (GM); p = 0.2138), and that there is a legal obligation to place children in institutions whenever they cannot be cared for by their parents (42% urban, 35% rural; p = 0.0009). Willingness is high to foster children across all settings; and to send children to live with relatives, non-relatives, or in orphanages, particularly in rural areas (p < 0.0001). Willingness to foster children with special needs is higher in GM (p < 0.0001). Access to schooling is the main reason children are separated from their parents. Relocating with spouse is common in GM (p = 0.0540) and to assist relatives or friends in rural and urban areas (p = 0.5047). Financial need drives child separation, mostly in GM (p = 0.0723). Regulatory measures and public education campaigns must be developed and evaluated overtime with due consideration of residence.

IntroductionThere is a gap in research regarding transnational family support (emotional, practical, spiritual, informational and financial) as a resource for migrant families with children. From the perspective of migrant families and their family back home, the objectives of this study are to (1) identify the types and ways that transnational family support is provided to migrant families in Canada; (2) assess for patterns in the data that may suggest variations in the nature of this support (eg, by migration status, time in Canada, children’s ages, family circumstances) and over time and (3) explore the impact (positive and negative) in receiving and providing transnational support, respectively.Methods and analysisA focused ethnography is planned. We will recruit 25–35 migrant families with children with different migration histories (eg, economic or forced migration from a mix of countries) and family circumstances (eg, single parenthood, families living with extended family, families with children in the home country) living in Montreal, Canada. Families will be recruited through community organisations. Data will be gathered via semistructured interviews. To capture the perspective of those providing support, family members in the home country for each migrant family will also be recruited and interviewed through communication technology (eg, WhatsApp). Data collection will also involve observation of ‘transnational interactions’ between family members in Montreal and those back home. Data will be thematically analysed and results reported in a narrative form with an in-depth description of each theme.Ethics and disseminationEthical approval was obtained from the sciences and health research ethics committee at the University of Montreal. Study results will be shared through traditional forums (publication, conference presentations) and via other knowledge dissemination/exchange activities (eg, ‘lunch and learn conferences’ and seminars) through the research team’s research centres and networks to reach front-line care-providers who interface directly with migrant families.

IntroductionEvery year, up to 1 billion children are victims of violence worldwide. Most child abuse takes place in the context of punishment. The Families First Programme, an adaptation of the Positive Discipline in Everyday Parenting Programme to the West Java context, is a parenting support programme anchored on children’s rights that gives parents guidance on child development, parenting and positive discipline practices. This trial will evaluate the effectiveness of the Families First Programme compared with a waitlist control group.Methods and analysisThis is a pragmatic, parallel-group, stratified, cluster-randomised controlled trial. Twenty rural and urban villages in the Cianjur District, Indonesia, involving 720 caregivers of children up to 7 years of age, will be randomised. Villages will receive either a parenting programme consisting of 10 group sessions and four home visits over 3 months and standard community health and social services or just the latter. After completion of the trial period, the programme will be offered to those in the delayed group. Outcome data will be collected before randomisation (baseline), immediately postintervention (3 months postrandomisation) and 6 months later (9 months postrandomisation). The primary outcome will be frequency of physical and emotional punishment as measured by a weighted sum from three self-report items. Primary outcome analysis will use Poisson regression with generalised estimating equations and assess the interaction between intervention and time over baseline and 3 and 9 months postrandomisation assessments. Concurrent process evaluation will be conducted to assess programme satisfaction and facilitators and barriers to the implementation of the programme generalisable to other settings.Ethics and disseminationEthics approval was obtained from McGill University and Universitas Katolik Indonesia Atma Jaya. Results will be published in peer-reviewed journals and presented at scientific conferences and events for decision-makers, including in the participating communities.Trial registration numberNCT03374761.

Highlights • COVID-19 lockdown left parents as the sole respondents for their children’s needs. • We examine parents’ reports on the response their child received to their needs during the lockdown. • Parents of older children reported less fulfillment of children’s needs. • Societies must ensure pandemics do not create context for child neglect., Background The ecosystemic approach to children’s needs demands a cohesive response from societies, communities, and families. During the COVID-19 pandemic, the choices societies made to protect their community members from the virus could have created contexts of child neglect. With the closure of services and institutions, societies were no longer available to help meet the needs of children. Objective The purpose of this study is to examine parents’ reports on the response their children received to their needs during the COVID-19 crisis. Methods During the period of the spring 2020 lockdown, 414 parents in the province of Quebec, Canada, completed an online questionnaire about the impact of the crisis on the response their children received to their needs. Results Compared to parents of younger children, parents of older children reported less fulfillment of their child’s needs in three measured domains, namely cognitive and affective, security, and basic care needs. Conclusion These results are discussed in light of the policies and the resources societies have put in place during the crisis to help families meet the needs of their children. Societies must learn from this crisis to put children at the top of their priorities in the face of a societal crisis. Thoughtful discussions and energy must be given to ensure that, while facing a crisis, the developmental trajectories of children are not sacrificed.

This introduction provides the rationale for the special issue of the International Journal of Human Rights on the topic of the children’s right to participation and protection in international development and humanitarian efforts. It summarises selected contributions relating to an international conference entitled ‘Facilitating Child Participation in International Child Protection’ that took place 5–6 October 2015 at Ryerson University in Toronto (Canada). The concepts of child participation and child protection are explored. Then, the challenges and opportunities are highlighted regarding the actual and potential participatory role of children and young people in effective child protection. Finally, an overview of the articles included in this collection is provided.

A scoping review of the literature on parenting programmes that target the promotion of adolescent mental health was conducted to examine the quality of the studies and unique content of programmes for parents from ethnoculturally diverse communities. PsycINFO and Web of Science were searched in April, 2011 (for all publications prior to that date) and again in August, 2015 (for publications from April, 2011 to August, 2015) using specific keywords and inclusion criteria. A hand search was also conducted. Overall, 107 studies met inclusion criteria for final data extraction and included evaluations of interventions targeted at substance use, early/risky sexual activity and behavioural problems. Eighteen of the 107 studies described programmes targeting parents of adolescents from diverse ethnocultural communities; the quality of these 18 studies was assessed using a marginally modified version of the Downs and Black Checklist (Downs & Black 1998). Their average quality assessment score was 16 out of 28. In addition, two key themes reflected in successful interventions emerged: strengthening parent-adolescent relationship through communication, and importance of community engagement in designing and implementing the intervention. Findings indicate gaps in service delivery to parents of adolescents from ethnoculturally diverse communities; there are a limited number of studies on programmes targeting ethnoculturally diverse parents of adolescents, and the quality of studies that do exist is overall low. Given increasing diversity, more emphasis should be placed on developing and modifying programmes to meet the needs of ethnoculturally diverse communities. More rigorous, standardised efforts should be made to evaluate programmes that do exist.

Introduction According to the 2012 Lao Social Indicator Survey, 6 % of children in Laos live with neither one of their parents. This study explores the determinants of child-parent separation and the consequences of existing alternative care arrangements from the perspectives of adults and young people.

This paper addresses how personal and professional values and experiences of professionals working with children and families from diverse cultural backgrounds interweave in their understanding of (in)adequate child supervision and how this influences their decision-making around supervisory neglect. Eleven focus group discussions involving 67 service providers were held in two of the largest cities in the province of Quebec, Canada. Participants were recruited through public school boards, municipal police agencies, child protection agencies, and health and social services. Service providers who were recruited to offer their professional perspective on children’s supervision, responded with examples from both their professional and personal contexts. Whereas personal examples, including those related to culture, were used to qualify, contextualize, deepen analysis, and better assess the boundaries of a supervisory situation, professional examples were used to refer to the legal sphere. Besides using professional decision-making tools, service providers could benefit from incorporating their personal experiences to advance reflection about supervisory neglect and from reconciling their professional and personal dimensions for more ethical decision-making in this field. The latter would require clinical (not just administrative) support, a good network of colleagues, and training. Seeking depth and sensitivity beyond what structured decision grids allow is particularly needed in ethnoculturally diverse contexts.

The main objective of this data article is to present the data set which depicts the impact of child restraint legislation in Chile and its regions. The population of the study consisted of all car crashes records provided by the national police from 2002 to 2014, which included children aged 0–3. Auto Regressive Integrated Moving Average ARIMA and Poisson model were used to present the association between the dependent and independent variables of interest. When the data are analyzed, it will help to determine the degree of relationship and the strength of significance between child restraint legislation policies enacted in 2005 and 2007, and child occupant fatalities and injuries. The data are related to “Impact of child restraint policies on child occupant fatalities and injuries in Chile and its regions: An interrupted time-series study” (Nazif-Munoz et al., 2018).

Despite scarce empirical research in most countries, evidence has shown that young children are unsupervised or under the supervision of another young child while their adult caregivers attend work or engage in other activities outside the home. Lack of quality supervision has been linked to unintentional childhood injuries and other negative outcomes. Nationally representative, population-based data from rounds four and five of the Multiple Indicator Cluster Surveys (MICS) and four to eight of the Demographic and Health Surveys (DHS) from 61 low- and middle-income countries were used to estimate prevalence and socio-economic factors associated with leaving children under five years old home alone or under the care of another child younger than 10 years of age. Socio-economic factors included age and sex of the child, rurality, wealth, maternal education, and household composition. Large variations in the prevalence rates (0.1&ndash, 35.3% for children home alone and 0.2&ndash, 50.6% for children supervised by another child) and associated factors have been recorded within and across regions and countries. Understanding why and under what conditions children are home alone or under the supervision of another child is crucial to the development of suitable policies and interventions to protect young children, promote healthy growth, and support caregivers.

Processes associated with the formation of child-headed households (CHH) are complex. Findings are mixed with regard to the impact of living in CHHs on children. On the one hand, children in CHHs do not necessarily have more unmet basic needs than do peers in adult-headed households and, in fact, have more opportunities to develop self-esteem and care for others. Nonetheless, children in CHHs confront specific challenges to their well-being. This chapter summarizes the state of the literature pertaining to CHHs, with a particular focus on CHHs as indicators of “the breakdown of the extended family” as a safety net. The authors present two case studies from Namibia that illustrate changes in children’s relationships and other aspects of the CHH experience and explore immediate and deferred reciprocity as a measure of accessibility and strength of their relationships and as an indicator of the changing status of children and family dynamics.

Objectives To i) describe current community-based programs across Canada to support parents for the promotion of adolescent mental health, with special attention to ethno-cultural populations; and ii) identify needs, gaps, and opportunities for the development of a framework to support parents for the promotion of adolescent mental health. Methods We conducted an internet-based cross Canada scan of community-based parenting programs that promote adolescent mental health in ethno-culturally diverse populations, followed by structured phone interviews with program staff. Findings were categorized according to audience (ethnicity/culture and age group), geographical distribution and coverage, and program type. Barriers to access and outreach mentioned by interviewees were documented. Results We found a total of 47 programs that met our search criteria. The greatest numbers were found in the provinces of Ontario, British Columbia and Alberta, particularly in the Greater Toronto and Vancouver Areas. Most programs consisted of psycho-educational, information-based workshops, support groups, or used innovative approaches (e.g., arts, alternative medicine, mentorship, and skillsdevelopment courses). Five programs (11%) had parent and youth components. From the perspective of service providers, cultural distrust, stigma, financial constraints and language barriers pose challenges to outreach. Program evaluations are limited and often not publicly available. Conclusion There are gaps in geographic coverage and types of programs available to parents for the promotion of adolescent mental health in ethno-cultural communities. Inconsistent and insufficient funding [and other forms of institutional support] detract from the capacity of community-based organizations to adequately support families and conduct, publicize, and evaluate their programs.

The number of vulnerable migrants in Canada is on the rise. While debates on immigration policies have been at the forefront, there has been little dialogue regarding the health and well-being of refugees, asylum-seekers and non-status migrants despite the significant health inequities that these populations face. In this context, health research that aims to understand migrants' realities, develop appropriate health and social services and policies, and empower these populations, is needed more than ever. Participatory action research (PAR) is one approach for conducting relevant and empowering research with migrants, however it remains underutilized due to inadequate funding, infrastructure and support. PAR addresses real-life challenges, emphasizes collaboration with communities, and involves all stakeholders, including community-based organizations, in the co-construction and implementation of practical solutions. In this commentary, we call for more research with and for migrants, particularly in the form of PAR, as well as for more targeted funding initiatives and research conditions (University, funding agencies) that foster and support this type of research.

Researchers have paid little attention to non-adult child supervision and the prevalence and factors influencing this practice in low-income countries. A better understanding of this phenomenon is needed to inform the development and implementation of policies and interventions to enhance child supervision in those settings. This study explores the prevalence and factors associated with young children being home alone or under the care of another young child in Lao People's Democratic Republic. Using the 2011-2012 Lao Social Indicator Survey (N = 10,740 for the subsample of 'child was home alone' and N = 10,539 for the subsample of 'child cared by another child10 years of age'), multi-level Poisson regressions were performed to determine the number of days children under five years of age were home alone or under the care of another child younger than 10 years of age. Large discrepancies across provinces and between urban and rural populations within each province were found. Children living in rural areas were more than five times more likely to be unsupervised than children living in urban settings (incidence rate ratio, IRR 5.2; 95% CI: 1.8-15.2), and children living in rural areas were nearly twice more likely to be under the care of another child than children living in urban settings (IRR 1.9; 95% CI: 1.3-2.8). Age was also a common factor in explaining variation in both dependent variables. Policies aimed at facilitating adequate child care and supervision should consider rurality to increase children's protection.

This pilot study explores children's understanding of informed consent (IC) and the potential of participatory visual methods for improving the IC process. Strategies used to improve the IC process have generated mixed evidence as to their ability to increase understanding and willingness to participate among potential research participants. Two workshops with 13 children aged 8–12 years were held to discuss the content of IC forms, particularly confidentiality and voluntary participation, and the children took photographs to represent these concepts. Simplified written IC forms generated boredom, disengagement, and/or anxiety for some children. Preliminary results of this pilot study indicate the potential to enhance the IC process by using participatory visual methods with children to make visual IC forms.

After 14 years of civil war and two rounds of democratic elections, Liberia is working to reduce child abuse and exploitation. Young children’s perceptions on protection and risk are rarely elicited to inform program planning and intervention. The aim of the present study was to explore young children’s perceptions of child protection and risk in a post-conflict setting and how visual methodologies may facilitate this process. Six group discussions using visual methodologies were conducted with 59 children aged 7–11 years living in family and residential care in rural and urban settings in Central and Western Liberia. Data were analysed using inductive coding. There was no unanimous concept of ‘child’, which included people with limited capabilities between the ages of 5–46 years. Children identified a number of risk and protective factors. Normative knowledge (e.g., smoking) elicited unanimous reactions whereas survival-related life experiences (e.g., violence or food) yielded ambivalent understandings of risk and protection. Visual methods facilitated active and thoughtful participation among young children. These findings add to the scarce literature on child participation in public decision-making in child protection. They also have practical implications. Children’s own and community transmitted perceptions of life experiences need to be taken into account to inform service planning and implementation. Visual methods are recommended to that end as they increase participation among young children and help avoid pre-conceived notions of dangerous and protective practices.

A diverse group of 103 children aged 7-11 years old living in family and residential care in rural and urban settings in two northern provinces in Lao People's Democratic Republic participated in group discussions using images and community mapping. Children's identified sources of risk and protection illustrate primary public health and protection concerns and resources. Young children worried about lack of hygiene, unintentional injuries, corporal punishment, and domestic violence. They also expressed concern about gambling and children sleeping in the streets, even if they had never seen any of the latter in their communities. In contrast, food and shelter; artistic, religious, and cultural practices; supportive interpersonal relationships; and schooling largely evoked feelings of safety and belonging. Images that prompted conflicting interpretations surfaced individual and contextual considerations that nuanced analysis. Researchers and decision-makers will benefit from using this developmentally appropriate, context-sensitive child-centred visual method to elicit young children's views of risk and protection. It may also serve as a tool for public health education. Involving young children in the initial selection of images would further enhance the efficiency of the method.

At the end of 2011, 34 million people worldwide were living with HIV/AIDS (PLWHA), 68% of these in Sub-Saharan Africa (UNAIDS, 2012). HIV and AIDS remain a major public health challenge that continues to affect the lives of millions of people globally. Gender inequality has been recognised as a key factor to understand the dynamic and impact of the epidemic, particularly in Sub-Saharan Africa (Niens & Lowery, 2009; Steinitz & Ashton, 2007; UNAIDS, 2012).

Following changes to the Interim Federal Health (IFH) program in Canada in 2012, this study investigates health service providers’ knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40–49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues.

Access to health care for undocumented migrant children and pregnant women confronts human rights and professional values with political and institutional regulations that limit services. In order to understand how health care professionals deal with these diverging mandates, we assessed their attitudes toward providing care to this population. Clinicians, administrators, and support staff (n = 1,048) in hospitals and primary care centers of a large multiethnic city responded to an online survey about attitudes toward access to health care services. Analysis examined the role of personal and institutional correlates of these attitudes. Foreign-born respondents and those in primary care centers were more likely to assess the present access to care as a serious problem, and to endorse broad or full access to services, primarily based on human rights reasons. Clinicians were more likely than support staff to endorse full or broad access to health care services. Respondents who approved of restricted or no access also endorsed health as a basic human right (61.1%) and child development as a priority (68.6%). A wide gap separates attitudes toward entitlement to health care and the endorsement of principles stemming from human rights and the best interest of the child. Case-based discussions with professionals facing value dilemmas and training on children's rights are needed to promote equitable practices and advocacy against regulations limiting services.

In settings highly affected by HIV/AIDS, households headed by children may result from strained family relations, poverty, and stigma associated with the disease. Understanding local systems and dynamics of support is essential to planning comprehensive models of care. This study measured size and composition of the support and conflict networks of 27 children and youth heads of household in northern Namibia and documented their perceptions of adequacy. Results showed a strong presence of and satisfaction with kin and peers as supporters, which challenges the assumptions that these households have few functional ties to family and that adults are the sole providers of support. Assistance to children without parental supervision should build on existing local strategies and children's resources. Key Words: adolescence, African families, AIDS, children, family relations, social networks. In sub-Saharan Africa, extended families currently care for most orphans (Ansah-Koi, 2006; Arnab & Serumaga-Zake, 2006; Monasch & Boerma, 2004). Nonetheless, HIV/AIDS, urbanization, armed conflict, and widespread poverty often make families unwilling or unable to foster or provide appropriate care (Freeman & Nkomo, 2006; Hamra, Ross, Karuri, Orrs, & D'Agostino, 2005; Townsend & Dawes, 2007). In fact, with escalating adult mortality and orphans rates, the HIV/AIDS epidemic may be disrupting the family's capacity to care in unprecedented ways (Ankrah, 1993). For instance, double-orphan and skip-generation households or households headed by grandparents seem more frequent in contexts where the epidemic is severe (Zimmer, 2009). The emergence of child-only households, households headed by culturally "inappropriate" caregivers (e.g., matrilineal kin in patrilineal societies), and property grabbing by relatives after parental death also reflect the strain of the extended-family system (Foster & Williamson, 2000; Germann, 2006; Oleke, Blystad, & Rekdal, 2005). Whereas some argue that the family system is disintegrating in Africa, other authors believe in the resilience of the informal systems of care and contend that new patterns of social relations "with broad adaptive capacities" emerge in times of difficulty (Chirwa, 2002, p. 93; see also Abebe & Aase, 2007). This study explored the composition and dynamics of the social networks of youth-headed households in Namibia to illuminate this debate and to inform the development of appropriate interventions that build on already functioning ties and avoid sources of conflict. Historically, the extended family has played a key role in the care and social integration of orphans and other children in sub-Saharan Africa (Nyambedha, 2004). Child fostering, very common among Black families, was a survival strategy in times of adversity (Goody, 1982; Madhavan, 2004). Researchers have studied the changes in African families that followed specific crises. In northern Namibia, for instance, the 1 952 - 1 954 famine and the migrant labor system strained social relations and accelerated the redefinition of marital obligations (McKittrick, 1997). During apartheid and the Namibian War of Liberation (1968- 1988), forced separation of families resulted from labor migration, exile, and relocation by military forces (Frayne & Pendleton, 2001; Simon, 1996). Lack of access to food, sanitation, education, and medical care render children vulnerable, particularly in the absence of parental care (Funkquist, Eriksson, & Muula, 2007; Skinner et al., 2006). In assessing the capacity of families in sub-Saharan Africa to care for orphan children, however, research has shown the need to differentiate multiple dimensions of care, of which the provision of material resources is only one (Abebe & Aase, 2007). Advice, companionship, and emotional support oftentimes are the only resources available in contexts of widespread poverty. In addition, a growing body of literature shows that orphaned children experience poorer psychological outcomes than do nonorphans and that children orphaned by AIDS are more likely to report peer relationship problems (Atwine, Cantor-Graae, & Bajunirwe, 2005; Bhargava, 2005; Cluver, Gardner, & Operario, 2007). …