This was an exploratory qualitative study conducted in St. John's, NL with front-line service providers from health and social services. This study aimed to explore strategies and effective practices to prevent and/or overcome adverse experiences in early childhood. We adopted the definition of children's adverse experience from the Adverse Childhood Experience study, which recognizes psychological, physical, sexual abuse, emotional neglect, traumatic parental divorce suffered by a child, or growing up in a household with an alcoholic, drug user, mentally ill or violent person as possible contributors to adverse experience in childhood. However, considering that adverse experiences and different kinds and levels of stress are part of life, we also assumed that protective factors in the environment are crucial to counteracting the potential negative effects. Protective factors include not only parents and caregivers, but - using a social justice approach - society as a whole should be co-responsible in caring and nurturing the development of children and of the most vulnerable populations.
The study design included two parts: Part I, consisting of document analysis and key informant interviews related to the child protection system, and Part II, an exploratory study with front line professionals working with children.
For the first part, we examined current policies and protocols in place to deal with vulnerable children/family situations and the kinds of knowledge that informs these policies, protocols, and intervention tools. We also interviewed four (4) key informants familiar with the child protection system in the province to identify any changes since the creation of the Department of Child, Youth, and Family Services in 2009 regarding: 1) the child protection system, 2) children (in care), 3) their families, and 4) front-line workers. Within this stage, it became evident that dealing with these extreme situations of children's adverse experiences is cumbersome for all involved - children, parents, front-line workers, authorities, and policy makers. When a system is already in crisis, critical incidents are practically impossible to predict, as they are usually a result of complex, interrelated range of factors. We observed that despite all the changes in the legislation and the increasing number of protocols and forms of management and control, these may not be as efficient as expected.
In the second part of research, we conducted twenty-two (22) face-to-face, semi-structured interviews with front-line professionals (health care workers, community health nurses, pediatricians, and family doctors, education professionals, social workers, and community service providers) working with children and their families in the St. John's metro area. A purposeful sampling technique allowed for the selection of participants well-versed on the topic. Eligibility criteria for participants were to: a) have at least three years of experience in a front-line position in practice, and b) have a willingness to participate in the study. Employing a snowball sampling technique, participants were recommended by word of mouth by co-investigators and other service providers. Throughout the interviews, participants shared their insights, opinions, and experiences about adverse experiences in childhood, as well as the kinds of practices and interventions available in the institutional context where the participants worked and the knowledge and values informing their practices. Although a question guide framed the interview, participants were provided opportunities for spontaneous discussion on topics of interest.
Our research shows that despite the existing material, social, and cultural resources, there are too many families and children falling through the cracks of the system. Participants highlighted that the current focus for intervention is on the child already in crisis, while family/parental supports and concerted multi-sectorial actions to prevent children's adverse experiences are insufficient or lacking coordination, emphasizing the need for timely supports and follow-up. Framed by an ecological approach, we analyzed the recurring themes to orient action indicated by participants, clustered by level of influence. We believe that this kind of analysis allows us to raise awareness and promote a climate of reflexive analysis and deliberation to motivate policy makers, front line workers, and citizens into actions that would make a difference.
Find the full report here.