The MAP Study: Knowledge Creation & Knowledge Translation
- 1. The MAP StudyThe MAP Study:: Knowledge Creation & Knowledge TranslationKnowledge Creation & Knowledge Translation -- creating evidence for evidence-based practice andcreating evidence for evidence-based practice and evaluating the use of evidence in practice and policyevaluating the use of evidence in practice and policy
- 2. Page 2 Maltreatment and Adolescent PathwaysMaltreatment and Adolescent Pathways (MAP) Study Team(MAP) Study Team Investigators: Organizations: Staff: . Christine Wekerle (PI) University of Western Ontario Carolyn James Harriet MacMillan Children’s Aid Society of Toronto Jennifer Fong Nico Trocme Catholic Children’s Aid Society (Toronto) Meghan Tyrrell Michael Boyle Peel Region Children’s Aid Society Sara Kalibar Eman Leung McMaster University Kristen Bausch Randall Waechter McGill University Maria Chen Bruce Leslie OACAS (knowledge translation) Sofia Pannia Deb Goodman Susan O’Rinn Brenda Moody Paula McLaughlin Andrew Fong Solmaz Zanjani Janu Gopallapillai
- 3. Page 3 AcknowledgementsAcknowledgements The MAP project is made possible with the support of numerous funding agencies: – The Canadian Institutes of Health Research (CIHR), Community Action Health Research and the Institute of Gender and Health – The Ontario Ministry of Children & Youth Services – The Children’s Hospital of Eastern Ontario (CHEO) Centre of Excellence in Child & Youth Mental Health – Canadian Institutes of Health Research / Ontario Women’s Health Council Mid-Career Award (to C. Wekerle) – The Public Health Agency of Canada – The Centre for Excellence in Research in Child Welfare
- 4. Page 4 The MAP StudyThe MAP Study The MAP is an epidemiological, longitudinal study Key Objectives: 1. To describe the health and well-being of adolescents involved in the CAS system in Toronto catchment area 2. To describe trajectories over 2.5 years at different levels of risk (continuing high-risk, resilience) 3. To examine causal models in the maltreatment-outcome linkage – e.g., Posttraumatic stress disorder (PTSD) symptomatology highlighted as key mediating factor in Developmental Traumatology Theory (DeBellis, 2002) 4. To test knowledge translation impact by comparing CAS test site staff usage with other MAP CASs’ on youth outcomes
- 5. Page 5 Participants: – Greater Toronto Area youth aged 14 – 17, random selection from all active files regardless of care status – Multiple data points every 6 months over 2.5 years to examine trajectories over mid-adolescence – Current initial testing N = 345 (52% female) – Youth ineligible if they could not feasibly be reached to complete the survey. Ineligible criteria includes: Youth discharged from care, severe developmental delay, AWOL, severe psychological health issues, out of age range – Initial recruitment rate: 70% – 6-month retention rate: 81% The MAP Study: MethodologyThe MAP Study: Methodology
- 6. Page 6 – Most youth tested in their residences and paid $28 for any single assessment session (mean testing time = 2.5 hours) – Mean age of youth in the study: 15.67 years (SD 1.08) – Ethnicity of youth: 29% Caucasian, 24% Blacks, 2% Aboriginal, 12% Other, 33% Biracial / Multiracial – Living arrangement: 37% foster parent, 27% group home, 22% biological parent, 14% Other The MAP Study: MethodologyThe MAP Study: Methodology
- 7. Page 7 Procedure: Lists of all current active caseloads (sorted by CPS ID) between 14 - 17 years of age forwarded to MAP team. Lists of youth randomly selected for each CPS branch. List forwarded to MAP CPS liaison member at each branch CPS Liaison contacts worker affiliated with each youth. Workers determine eligibility of youth for participation. Workers contact youth on their caseload to explain the study and obtain permission for MAP researchers to contact the youth Worker faxes signed “recruitment form” if the youth agrees, “inability to recruit form” if youth ineligible/refuses MAP researchers meet youth for consent/data collection. Consent forms and data separated to maintain confidentiality. Guardian signs consent for youth under 16 yrs. The MAP Study: MethodologyThe MAP Study: Methodology
- 8. Page 8 Physical abuse – Worker assessment:50% was rate as having experienced some form of physical abuse – Youth report: • 65% reported being pushed, grabbed or shoved as a way to hurt, 61% before grade 6, 81% parental perpetration. • 43% reported being kicked, bit or punched as a way to hurt, 56% before grade 6, 78% parental perpetration Emotional abuse – Worker Assessment:84% was rated as having experienced some form of emotional abuse – Youth report: • 70% witnessed verbal abuse by parents, 63% before grade 6 • 43% witnessed physical abuse by parents, 55% before grade 6 • 74% were victims of verbal abuse by parents,59% before grade 6 Sexual abuse – Worker Assessment:23% was rated as having experienced some form of sexual abuse – Youth Report: • 32% touched or forced to touch another’s private part, 54% before grade 6, 33% perpetrated by a non-relative male adult. • 26% coerced into having sex, 43% before grade 6, 33% perpetrated by a non-relative male adult. Neglect – Worker Assessment:73% was rated as having experienced some form of neglect – Youth Report: • 40% not having enough to eat. • 22% parent too drunk or high to take care of the family. • 25% had to wear dirty clothes. • 54% “I believe that I was neglected.” The MAP Study: Statistics on MaltreatmentThe MAP Study: Statistics on Maltreatment
- 9. Page 9 Based on the ON legal definition of child abuse and neglect, caseworkers rated MAP youth on maltreatment occurrence Multiple maltreatment types: – 14% experienced all four types of maltreatment – 33% experienced 3 types of maltreatment – 29% experienced 2 types of maltreatment – 11% experienced 1 type of maltreatments – 13% experienced no known maltreatment according to worker’s assessment The MAP Study: Statistics on MaltreatmentThe MAP Study: Statistics on Maltreatment
- 10. Page 10 The MAP Study Outcome Statistics:The MAP Study Outcome Statistics: Physical HealthPhysical Health Healthcare cost – Maltreatment history is robustly linked to chronic pain, gynecological problems in adults Data trend: CAS youth report poorer physical health compared to age-matched, non CAS-involved teens in Ontario MAP CAS teens Ontario (OSDUS) non-CAS teens How would you rate your physical health? (poor) 6% 3%
- 11. Page 11 The MAP Study Outcome Statistics:The MAP Study Outcome Statistics: Life TurbulenceLife Turbulence Residential Instability is linked with lower social and academic development of youth Data trend: CAS youth have greater life turbulence compared to age-matched, non CAS-involved teens in Ontario MAP CAS teens Ontario (OSDUS) non-CAS teens # of moves in the past 5 years? Median=3.94 Median=never
- 12. Page 12 The MAP Study Outcome Statistics:The MAP Study Outcome Statistics: School AchievementSchool Achievement School achievement predicts quality of living, including lower reliance on social assistance Data Trend: CAS teens fail and drop-out more from school compared to age-matched, non CAS-involved teens in Ontario MAP CAS teens Ontario (OSDUS) non-CAS teens Grade usually get in class (Failed) 3.1% 0.2% Dropouts 18.4% not in school 1.3% not likely/not very likely to grad
- 13. Page 13 The MAP Study Outcome Statistics:The MAP Study Outcome Statistics: Labour Market ParticipationLabour Market Participation Job attainment provides youth with finances, skills, and self-efficacy Data Trend: CAS teens were less likely to be employed as compared to age-matched, non CAS-involved teens in Ontario MAP CAS teens Ontario (OSDUS) non-CAS teens Currently holding a pay job 30% 51%
- 14. Page 14 The MAP Study Outcome Statistics:The MAP Study Outcome Statistics: Violent Crime InvolvementViolent Crime Involvement Young offending is a predictor of persistence criminality Data Trend: CAS teens engaged in violent crime in the past 12 months more than matched non CAS-involved ON teens MAP CAS teens Ontario (OSDUS) non-CAS teens Hurt someone on purpose 20% 10% Carry weapon 20% 8% Gang fights 10% 3%
- 15. Page 15 The MAP Study Outcome Statistics:The MAP Study Outcome Statistics: Substance UseSubstance Use Early age-of-onset in marijuana use is a predictor of future persistence drug use Data Trend: CAS teens have earlier age-of-onset in substance use compared to age-matched, non CAS- involved teens in Ontario MAP CAS teens Ontario (OSDUS) non-CAS teens Use marijuana under age 13 17% 5%
- 16. Page 16 The MAP Study Outcome Statistics:The MAP Study Outcome Statistics: Driving Under the InfluenceDriving Under the Influence Drinking Under the Influence is one of the leading cause of death among teenagers Data Trend: CAS teens were more likely to drive under the influence compared to age-matched, non CAS- involved teens in Ontario MAP CAS teens Ontario (OSDUS) non-CAS teens Driving within an hour after drinking 13% 8% Driving within an hour after using marijuana 18% 13%
- 17. Page 17 The MAP Study Outcome Statistics:The MAP Study Outcome Statistics: Dating Violence VictimizationDating Violence Victimization Dating violence among teens predicts later involvement in abusive partner relationships Data Trend: CAS teens were more likely to be a victim of dating physical assault in the past 12 months as compared to age-matched, non CAS-involved teens in Ontario MAP CAS teens US. (CDC) population teens Been hit, slapped or physically hurt by partner 27% 9%
- 18. Page 18 The MAP Study Outcome Statistics:The MAP Study Outcome Statistics: Risky Sexual PracticesRisky Sexual Practices Early entry into sex is an indicator of risky sexual practice that put teens at risk of STD and unwanted pregnancies Data Trend: CAS teens engaged in sexual activities earlier compared to age-matched, non CAS-involved teens in Ontario MAP CAS teens US. (CDC) population teens Had sexual intercourse before age 13 18% 6%
- 19. Page 19 The MAP Study Outcome Statistics:The MAP Study Outcome Statistics: DepressionDepression Depression is the #1 cause of work-day loss in US. and Canada Data Trend: CAS teens exhibited greater acute depressive symptomatology compared to age-matched non CAS-involved teens in Ontario MAP CAS teens Ontario (OSDUS) non-CAS teens Feeling blue past 7 days: quite a bit/extremely 21% 15%
- 20. Page 20 The MAP Study Outcome Statistics:The MAP Study Outcome Statistics: Suicidal IdeationSuicidal Ideation Suicidal Ideation is a risk factor for self-harm, suicide attempt and death Data Trend: CAS teens exhibit more acute suicidal ideation compared to non CAS-involved teens in Ontario MAP CAS teens (Past 7 days) Ontario (OSDUS) non-CAS teens (Past 12 months) Suicidal Ideation 27% 15%
- 21. Can caseworkers predict suicidalCan caseworkers predict suicidal attempts?attempts? MAP youth report on suicidal ideation at initial and 6-months MAP youth report on whether any there were any suicidal attempts in the past 12 months at the 1-year testing Caseworker ratings of youth’s global functioning at MAP study intake did not predict youth suicidal attempts at 1 year MAP youth who self-report suicidal ideation at both initial and 6- month testings are those youth more likely to report attempts at year 1, as compared to reporting suicidal ideation at either testing point High value to MAP youth self-report data, MAP youth caseworker data, and possible linkages to MAP youth CAS administrative data Timely evidence to transfer to practice Page 21