Academic literature on the topic 'Child care services – Government policy – Canada'

AbstractEarly childhood education and care (ECEC) policies and services in Canada exhibit marked gaps in access, creating ‘childcare deserts’ and distributional disadvantages. Cognate family policies that support children and families, such as parental leave and child benefits, are also underdeveloped. This article examines the current state of ECEC services in Canada and the reasons behind the uncoordinated array of services and policy, namely, a liberal welfare state tradition that historically has encouraged private and market-based care, a comparatively decentralised federal system that militates against coordinated policy-making, and a welfare state built on gendered assumptions about care work. The article assesses recent government initiatives, including the federal 2017 Multilateral Framework on Early Learning and Child Care, concluding that existing federal and provincial initiatives have limited potential to bring about paradigmatic third-order change.

AbstractThis article explores neo-conservative ideology in the industrialized West through a comparative analysis of the arguments advanced against a strong role for the federal government in regulating child care services in the United States and Canada. Existing analyses of neo-conservatism suggest that it is composed of many different elements which may lead to contradictory policy prescriptions; this literature also downplays the presence of a “pro-family” component in the Canadian context. The article illustrates the presence of an “anti-statist,” a “pro-market” and a “pro-family” strand of neo-conservatism in each country, and shows that they converge in opposing federal regulation of child care services. It also suggests that, while there appears to be a shared neo-conservative vision of the appropriate relationship between families and the state across national contexts, discussions of the state and its relationship to the market take on a distinctive tone in each country.

Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains®, Grand Challenges Canada® funded ECD portfolio across 23 low- and middle-income countries (LMIC). Using an adapted programme cycle, findings from evaluation related to partnerships and leadership, situational analyses, and design for scaling ECD were considered. 39 projects (5 ‘Transition to Scale’ and 34 ‘Seed’) were evaluated. 63% were delivered through health and 84% focused on Responsive Caregiving and Early Learning (RCEL). Multilevel partnerships, leadership and targeted situational analysis were crucial to design and adaptation. A theory of change approach to consider pathways to impact was useful for design, but practical situational analysis tools and local data to guide these processes were lacking. Several RCEL programmes, implemented within government services, had positive impacts on ECD outcomes and created more enabling caregiving environments. Engagement of informal and private sectors provided an alternative approach for reaching children where government services were sparse. Cost-effectiveness was infrequently measured. At small-scale RCEL interventions can be successfully adapted and implemented across diverse settings through processes which are responsive to situational analysis within a partnership model. Accelerating progress will require longitudinal evaluation of ECD interventions at much larger scale, including programmes targeting children with disabilities and humanitarian settings with further exploration of cost-effectiveness, critical content and human resources.

IntroductionSouth Africa’s evolving burden of disease is challenging due to a persistent infectious disease, burgeoning obesity, most notably among women and rising rates of non-communicable diseases (NCDs). With two thirds of women presenting at their first antenatal visit either overweight or obese in urban South Africa (SA), the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and NCDs.Methods and analysisBukhali is the first individual randomised controlled trial in Africa to test the efficacy of a complex continuum of care intervention and forms part of the Healthy Life Trajectories Initiative (HeLTI) consortium implementing harmonised trials in Canada, China, India and SA. Starting preconception and continuing through pregnancy, infancy and childhood, the intervention is designed to improve nutrition, physical and mental health and health behaviours of South African women to offset obesity-risk (adiposity) in their offspring. Women aged 18–28 years (n=6800) will be recruited from Soweto, an urban-poor area of Johannesburg. The primary outcome is dual-energy X-ray absorptiometry derived fat mass index (fat mass divided by height2) in the offspring at age 5 years. Community health workers will deliver the intervention randomly to half the cohort by providing health literacy material, dispensing a multimicronutrient supplement, providing health services and feedback, and facilitating behaviour change support sessions to optimise: (1) nutrition, (2) physical and mental health and (3) lay the foundations for healthier pregnancies and early child development.Ethics and disseminationEthical approval has been obtained from the Human Ethics Research Committee University of the Witwatersrand, Johannesburg, South Africa (M1811111), the University of Toronto, Canada (19-0066-E) and the WHO Ethics Committee (ERC.0003328). Data and biological sample sharing policies are consistent with the governance policy of the HeLTI Consortium (https://helti.org) and South African government legislation (POPIA). The recruitment and research team will obtain informed consent.Trial registrationThis trial is registered with the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za) on 25 March 2019 (identifier: PACTR201903750173871).Protocol version20 March 2022 (version #4). Any protocol amendments will be communicated to investigators, Institutional Review Board (IRB)s, trial participants and trial registries.

Canada's system of health services has been shaped by the forces and values in the Canadian political, cultural, social, and economic environment; these forces continue to place constraints on future changes. We distinguish between “corporatization” and “privatization,” and the implications of each for improved efficiency of the system. Although the organization of health services is, in certain provinces, undergoing significant structural changes, there is evidence that rather than privatizing, the system may actually be continuing to experience what we have termed deprivatization, as the scope of government involvement expands to include a more comprehensive definition of health care. Trends in Canada differ considerably from those in the United States; universal health insurance has curbed the ability and desire of institutions to exclude members of some socioeconomic groups from receiving care. U.S.-based models, if applied to Canada, could lead to both higher costs and lower quality of care. Considerable efficiencies can be realized within Canada's current system.

Since the introduction of universal health insurance in Canada in the late 1960s, the federal and provincial governments have been concerned with cost savings, efficiency of service delivery, equity in service provision, enhanced citizen participation, and increased accountability of decision-makers. A plethora of government royal commissions and task forces have recommended a similar range of options for addressing these concerns. Central to the reforms has been a proposed regionalized health system with an intermediary body responsible for functions previously assigned to local or central structures. For its supporters, regionalization offers a means of better coordinating and integrating health care delivery and controlling expenditures, and promises a more effective provision of services and an avenue for citizen participation in health care decision-making. All provincial governments except Ontario have introduced regional structures for health care, with the hope that these changes will increase efficiency, equity, and responsiveness. However, despite the alleged benefits, regionalization presents significant challenges. It faces obstacles to integrating and coordinating services in a manner that produces economies of scale; it requires an enhanced level of information that may be difficult to achieve; it is unlikely to involve citizens in health care decision-making; and it may actually lead to increased costs.

The World Trade Organization (WTO) creates new challenges for the Canadian health care system, arguably one of the most “socialized” systems in the world today. In particular, the WTO's enhanced trade dispute resolution powers, enforceable with sanctions, may make Canadian health care vulnerable to corporate penetration, particularly in the pharmaceutical and private health services delivery sectors. The Free Trade Agreement and its extension, the North American Free Trade Agreement, gave multinational pharmaceutical companies greater freedom in Canada at the expense of the Canadian generic drug industry. Recent challenges by the WTO have continued this process, which will limit the health care system's ability to control drug costs. And pressure is growing, through WTO's General Agreement on Trade in Services and moves by the Alberta provincial government to privatize health care delivery, to open up the Canadian system to corporate penetration. New WTO agreements will bring increasing pressure to privatize Canada's public health care system and limit government's ability to control pharmaceutical costs.

In this article, an overview of the barriers to accessing mental health services in Canada is provided and the recent federal funding commitments toward increasing the availability of evidence-based and cost-effective solutions to improve access to mental health services are highlighted. Barriers pertain mainly to costs, not knowing where to get help, excessive wait times, and insufficient funding. Through the Common Statement of Principles on Shared Health Priorities agreement, action is being taken by all jurisdictions in Canada to increase community-based mental health promotion programs and early interventions, especially those targeting children and youth. A growing body of evidence is demonstrating how specific community and primary care-based interventions are both effective and cost-effective. These integrated community solutions, shown to be effective for increasing access to appropriate services for patients while saving costs to the healthcare system, would benefit from the recent funding investments put in place by the federal government.

For years, care has been at the fore of social policy among local government authorities in Greece. In a context of budgetary constraints and protracted austerity policy, both of which lead to a retrenchment in social protection, the contribution of local government authorities has become essential. Our study engages with the present-day context, and with the features, objectives and prospects for the dynamic role of local government authorities in preschool care. We highlight those features that shape the new environment, while accounting for the demand and supply of the relevant services, the funding of the facilities, and finally, their contribution to social protection, as the latter proliferates at the local level.

In this article, Livio Di Matteo provides an overview of expenditures on health care in Canada over the long term. He examines changes in the size, relative importance, growth, and composition of health expenditures, with an additional focus on provincial-territorial government spending since the 1970s. Di Matteo links the evolution of health-care spending to factors affecting the demand for and supply of health services, including income, demographic changes, technological development, cost, policy, and public finances.

Thesis (DPhil (Social Work))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: The changes in child and youth care policies over the last fifteen years have had profound consequences for the staff at Youth Care and Education Centres (hereafter referred to as YCECs). These changes included systemic changes, philosophical changes, and changes in the way services are rendered to children and youth in their care. It was thus expected of team members to not only change their behaviours but to also make mind shifts. The mandates were that they move from working in silos (educators, residential educators and support team) to working in teams; from rendering generic services to developing individualised plans for children and youth; from following a medical (deficit) approach in service delivery to following a strength based- and developmental approach. Whereas a punitive approach to discipline was followed in the past staff members now have to follow a restorative approach. In addition, the emphasis on children’s rights, in general, and the abolishment of corporal punishment, in particular, brought about changes in the nature of the adultchild relationship. It was required of the team members to learn to use alternatives to this form of punishment. The study explored how the members of the institutional level teams at the four YCECs in the Western Cape were experiencing the implementation of changed child and youth policies. A combined quantitative and qualitative research methodology was followed in obtaining the data from the residential educators, as well as the educators and the support team members comprising of psychologists, school social workers, occupational therapists, and school nurses. The points of departure were the organisational learning model and the phases of team development. Findings derived from the empirical study were that the difference between the way the participants embraced and implemented changed policies and legislation had much to do with the guidance that the principal and senior management provided for them. Where the principal set the tone and conveyed the message that the implementation of the policies were not negotiable and gave staff members the opportunity to thoroughly discuss these changes, they eventually shared the underlying principles of the changed policies. Where the principal provided direction, support and encouragement for the implementation of the changed policies the participants felt secure and empowered. Where this support was not present participants felt uncertain and to some extent let down. When a shared vision was articulated to them the participants were able to align their personal visions thereto, which further led to a greater understanding of their roles within the team. Where participants, however, were not clear on the shared vision they seemed to struggle with role division and status and power issues. When team members were left to their own devices a measure of personal mastery still took place due to the commitment of individuals but team learning was either limited or virtually nonexistent. Systems thinking remained a challenge due to the forming of subgroups within the YCEC and the limited or nonexistent services rendered by external social workers to the families of the children and youth. The most important recommendations resulting from the study indicate that provision must be made for frameworks for the implementation of changes in policy and guidelines for team processes. To ensure that new staff is informed about the policies that guide their services an orientation programme must be in place. Training for principals in effective introduction and implementation of change should also be provided. To ascertain what the staff complement should be to effectively implement changes in the policies, a work-study and a fast track pilot project should be conducted. From this, job descriptions should be developed that make provision for the incumbent’s role within the team. Consideration should also be given to the incentive system that currently only makes provision for individual performance and could hamper teamwork.
AFRIKAANSE OPSOMMING: Die veranderinge in kinder- en jeugsorgbeleide oor die laaste vyftien jaar het diepgaande gevolge ingehou vir personeel by Jeugsorg- en Onderwyssentrums (hierna verwys as JSOS). Hierdie veranderinge het sistemiese en filosofiese veranderings, asook verandering in die wyse waarop dienste gelewer word, aan kinders en jeug in hul sorg, meegebring. Dit word dus van die spanlede verwag om nie net hul gedrag nie, maar ook hul denkwyse te verander. Die mandate vervat in die beleide is dat personeel skuif van werk in silos (opvoeders, residensiële opvoeders en ondersteuningspan) na werk in spanne; van die lewer van generiese dienste tot die ontwikkeling van individuale planne vir kinders en jeug; van die volg van ‘n mediese benadering aangaande dienslewering tot ‘n sterkte-gebaseerde- en ontwikkelingsbenadering. Waar daar in die verlede ‘n strafgerigte benadering gevolg is moet daar nou beweeg word na ‘n helende benadering. Verder het die klem op kinderregte in die algemeen, en die afskaf van lyfstraf in besonder, veranderings meegebring in die aard van die volwasse-kind verhouding. Dit was verwag van die spanlede om te leer om alternatiewes tot die vorm van straf aan te leer. Die studie het ondersoek ingestel na hoe lede van die inrigtingsgebaseerde span by die vier JSOS in die Weskaap die implementering van veranderde kinder- en jeugbeleid ervaar. ‘n Gekombineerde kwantitatiewe en kwalitatiwe navorsing metodologie was gevolg in die insamel van data van die residensiële opvoeders, die opvoeders en die lede van die ondersteuningspan (sielkundiges, skool maatskaplike werkers, arbeidsterapeute en skool verpleegkundiges). Die vertrekpunt was the organisasieleer model en die fases van spanontwikkeling. Bevindings wat gemaak is uit die empiriese studie was dat die verskille tussen die wyse waarop die deelnemers die veranderde beleid aanvaar en implementeer het baie te doen gehad het met die mate van leiding wat die prinsipaal en senior bestuur vir hul gegee het. Waar die prinsipaal die toon aangegee het en die boodskap oorgedra het dat die implementering van die beleide nie onderhandelbaar was nie en personeellede die geleentheid gebied is om die veranderings deeglik te bespreek, het hul geleidelik ingekoop in die veranderde werkswyses. Waar die prinsipaal rigting en ondersteuning vir die implementering van die veranderde beleid gebied het, het die deelnemers veilig en bemagtig gevoel. Waar die ondersteuning egter ontbreek het, het die deelnemers onseker en, tot ’n mate, in die steek gelaat gevoel. Wanneer ‘n gedeelde visie oorgedra is aan hulle was die deelnemers in staat om hul persoonlike visies in lyn te bring daarmee. Dit het verder aanleiding gegee tot beter begrip vir hul rolle binne die span. Waar deelnemers egter nie duidelik was oor die gedeelde visie nie, het dit geblyk dat hulle probleme gehad het met rolverdeling, status en magaangeleenthede in die span. Wanneer spanlede oorgelaat is aan hul eie lot het ‘n mate van persoonlike bemeestering nog plaasgevind as gevolg van die persoonlike toewyding van individue, maar spanleer was óf beperk óf feitlik afwesig. Sisteem denke was steeds ‘n struikelblok as gevolg van die vorming van subgroepe binne die JSOS en die beperkte of afwesige dienslewering deur eksterne maatskaplike wekers aan gesinne van die kinders en jong mense. Die belangrikste aanbevelings, wat voortspruit uit die studie, dui aan dat voorsiening gemaak moet word vir raamwerke vir die implementering van beleidsveranderings en riglyne vir spanprosesse. Om te verseker dat nuwe personeel ingelig is omtrent die beleide wat hul dienslewering rig moet ‘n oriënteringsprogram in plek wees. Opleiding van prinsipale in die effektiewe bekendstelling en implementering van veranderings moet ook voorsien word. Om vas te stel wat die aanvulling vir personeel moet wees om die veranderings in die beleid te implementeer, behoort ‘n werkstudie en ‘n snel loodsprojek onderneem word. Hieruit kan pligstate opgestel word wat voorsiening maak vir die ampsdraer se rol in spanverband. Oorweging moet geskenk word aan die aansporingstelsel wat tans net voorsiening maak vir individuele werksverrigting en wat spanwerk kan strem.

This study of early years services in India explores the take-up of the government ICDS (Integrated Child Development Services Scheme) and RGNCS (Rajiv Gandhi National Crèche Scheme), and the factors affecting their uptake by working mothers in a Delhi slum. Policy cannot assess programme outcomes effectively without understanding how services are implemented. Existing literature indicates that programme impact is related to programme take-up, with non-take-up being a complex phenomenon affected by factors operating at multiple levels of the policy process. The study makes original contributions by examining user perspectives on early childhood education and care (ECEC) in the Indian context; in being the first to research any aspect of the RGNCS; and in utilizing Critical Realism as the underlying philosophical, theoretical and methodological paradigm for studying programme uptake. It poses five research questions that examine mothers' childcare arrangements and needs/expectations from services, their take-up of government programmes and component services, and the combination of factors affecting uptake. Study findings are based on surveys with 200 working mothers and 37 children's centre workers, and interviews with 15 policy experts. Findings reveal childcare arrangements and needs/expectations to vary by family structure, child's age, and mother's age and employment. ICDS uptake is found to be higher (54.3% of all mothers), than RGNCS (18.6%). An explanatory framework for analysing take-up reveals that low take-up results from a combination of multiple factors, most significantly programme characteristics for the ICDS, and participant characteristics for the RGNCS. Two theoretical frameworks frame this analysis - Wolman's (1981) determinants of programme success and failure, and the 'barriers and bridges' to programme uptake. Critical policy analysis further identifies the effects of the policy meaning-making processes, and the role of local 'street-level bureaucrats' in take-up. Both programmes display 'conflicted policy success' vis-à-vis take-up when categorised using McConnell's (2010) criteria for programme 'success' and 'failure'. Policy implications include strategies for increasing programme uptake, and a policy focus upon service users and women in the informal economy, recognition of the dual role of ECEC, and the importance of evidence-creation for interactive governance.

The government of Malawi established the community based childcare (CBCC) programme with the aim of addressing early childhood problems and achieve national development in the long run. The CBCC programme, as one of the approaches to early childhood development (ECD), is guided by the national early childhood development policy. It promotes some practices that somehow deviate from the traditional childcare ways that communities have always known. Experience has shown that programmes that have elements of conflict with commonly held beliefs are bound to meet with resistance in society. The study employed a mini survey, focus group discussion, observation and document review to understand how the CBCC childcare practices in Malili intersect with commonly held beliefs about childcare as well as how they reflect on the national ECD policy. The study also focused on understanding the perceptions of community members on the CBCC programme. The study revealed that while some aspects of CBCC delivery conform to commonly held beliefs about childcare in the area under study, others diverge from such beliefs. Such convergence and divergence appear to be in line with the propositions of transformalist globalisation theory- one of the perspectives adopted for the study. The study also found that care practices at CBCC are not a true reflection of the national ECD policy as community members’ perceptions, poor community participation, poverty and lack of caregiver training in ECD contribute towards poor quality of care in CBCC, contrary to what is defined in the national ECD policy. The study also found that while both CBCC caregivers and sampled community members perceived the quality of care at the centers as poor, caregivers had a more positive perception towards the CBCC than community members. The study indicated that CBCC are centres of desperation for low economic status communities. Findings from the research have revealed that cultural values and commonly held beliefs, and exposure to new knowledge through globalisation play a role in determining childcare practices as well as perceptions towards them. In this sense the study has indicated that meanings that communities attach to development interventions influence their actions and perceptions towards it.

While this study is partly theoretical it includes an exploratory case study in which theoretical insights are applied. In the theoretical part of this study, criteria for a successful poverty alleviation project were developed, guided by sustainability theory and complexity theory. It was proposed that researchers could assess existing projects according to these criteria to show where they were successful and where they could improve. The second part of this research consists of a case study, where an actual poverty alleviation project (The Nomzamo Special Care Centre, Peddie, Eastern Cape) was assessed according to the criteria developed in the first part. For this exploratory case study a non-random sample of 9 participants was drawn from the Nomzamo Special Care Centre and other stakeholders in the Ngqushwa Local Municipality in the Eastern Cape. Data was collected using questionnaires, observation and interviews. The results obtained from analysis indicate that project members particularly experience challenges pertaining to financial resources, infrastructure and maintenance. It is recommended that project members receive assistance from the government departments in order for the project to remain sustainable.

Cette thèse propose trois essais économétriques ayant trait au capital humain et au bien-être de l'enfant. Chacun des essais présente une méthodologie distincte afin de répondre à l'objectif concerné. Dans le premier chapitre, nous évaluons les effets à long terme d'une politique de services de garde universels au Canada sur le bien-être de l'enfant (santé, comportement, développement moteur et social). Nous montrons que la réforme a un effet négatif sur le bien-être des enfants d'âge préscolaire, mais ces effets tendent à disparaître lorsque l'enfant devient plus âgé. Nous trouvons que cette tendance persiste même dix ans après la mise en place de la réforme. Le second chapitre s'intéresse à l'effet de l'intensité des services de garde sur le développement cognitif des enfants d'âge préscolaire. Nous utilisons la méthode d'appariement à traitements multiples pour répondre à cet objectif. Nous montrons que les effets des services de garde sont grandement hétérogènes. Leurs effets varient selon le statut socioéconomique des familles, la scolarité ou non de l'enfant, le niveau d'intensité des services de garde ainsi que le mode de garde utilisé. Le troisième chapitre porte sur la modélisation des trajectoires des performances mathématiques des enfants canadiens de 7 à 15 ans ainsi que sur l'identification des facteurs de risque durant la petite enfance susceptibles d'influencer l'appartenance à ces trajectoires. La méthode utilisée est celle du Group-Based Trajectory Modeling de Nagin (2005)
This thesis contains three econometric essays on child human capital and well-being. Each essay has a distinct methodology to meet the purpose. In the first chapter, we evaluate the long-term effects of a reform of universal child care in Canada on children's health, motor and social development, and behaviour. We show that the policy had negative effects on preschool children's well-being, but these effects tend to disappear as the child gets older. We find that this pattern persist even ten years after the implementation of the reform. The second chapter focuses on the effect of the intensity of child care on preschool children's cognitive development using propensity score matching with multivalued treatments. We show that the effects of child care are significantly heterogeneous and vary by family socioeconomic status, schooling or not of the child, the intensity of child care and the type of child care arrangement. The third chapter models mathematics trajectories of Canadian children aged 7 to 15 years and identifies risk factors during early childhood on the membership of these trajectories using Group-Based Trajectory Modeling (Nagin, 2005)

“Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship.

Today in Canada, child care is not perceived by the government, nor its citizenry, as a public good. Despite numerous reports from economic, health, social and psychological experts, Canadians remain complacent about the inadequate child care provisions in our country. As a society, we do not demand, or even anticipate, the public provision of universal, affordable, accessible child care. Instead, Canadians consider the care of children to be a predominantly private issue; unworthy of significant government intervention or assistance. Consequently, parents and children must improvise within a privatized, ad hoc, market-oriented patchwork of individualized child care arrangements. While it is true that certain "special" cases are acknowledged to deserve the government's support, - for example Aboriginal children and children with special needs, as well as the children of "welfare moms" - their exceptional status serves to reinforce the notion that the care of children is primarily a private parental responsibility. The purpose of this paper is to analyze and critique the current child care system (or lack thereof) in Canada. In addition, I intend to show that existing child care arrangements are unsatisfactory not only because of the immediate consequences for parents, children, and child care workers, but because of the way in which the privatized purchasing of child care reinforces other systemic shortcomings in our patriarchal, racialized, capitalist society. I will argue that current attitudes toward child care in Canada, as part of a patriarchal capitalist and racialized paradigm, rely on and perpetuate detrimental notions of class, gender and race, to the disadvantage of all citizens. Finally, I will discuss the possibilities for meaningful reform of the Canadian approach to child care.

This dissertation explores historical processes and daily practices of indigenization within the context of British Columbia's model for delegating Aboriginal agencies for child and family services. This research draws from historical data, examining the ways in which contemporary indigenization within Aboriginal child welfare is shaped by Canada's colonial past- most notably, the historical relationship between the Indian Residential School System and Aboriginal child welfare in Canada. Grounded in indigenous methodologies, research practice, and critical theory, this dissertation queries indigenization within the Pacific Aboriginal Child Welfare Association (PACWA). This dissertation explores the complexity of the urban setting in which PACWA operates, providing case studies of daily practices of indigenization within the association, considering the roles of Aboriginal Elders and Knowledge Keepers throughout this process, and arguing for the need to reframe urban Aboriginal child welfare in Canada. This dissertation asserts that Indigenization at PACWA is making significant differences in the lives of children and families involved in Aboriginal child welfare and that Aboriginal families continue to have their children removed at alarming rates most often because they are living in the aftermath of colonization, amidst contemporary conditions that continue to marginalize Aboriginal peoples. Indigenization is a process that can and is being achieved within the context of child welfare in British Columbia today. It is a process connected to Aboriginal sovereignty, self-government, identity and mainstream-Aboriginal relations. It is also a process that is making significant impacts in the lives of those connected to Aboriginal child welfare (Aboriginal and otherwise), while simultaneously being challenged by the structural inequalities and political eddies that continue to marginalize urban Aboriginal peoples. This research demonstrates that successful indigenization practice, at the level of large organizations such as PACWA, requires that various levels of Canadian government view them as true partners in a project of decolonization and indigenization. This requires a recognition and honouring of history and diversity of Aboriginal peoples in Canada, validated by means of mutual respect and sharing power.

This chapter examines different interpretations and objectives of in-home child care in Australia, the UK and Canada, and the ways in which these diverging interpretations are reflected in the policy mechanisms of ECEC that facilitate, or do not facilitate, different forms of regulated and unregulated in-home child care. It brings together scholarship on early education and women’s workforce participation to present different reasons and rationales for government investment and spending on ECEC. National governments and advocates, and international organisations, increasingly emphasise a human capital approach to social policy. This frames ECEC around children’s ‘early learning and development’ and concerns about child poverty, which often extends to include parents’ workforce participation. The chapter is based on analysis of primary policy documents and interviews conducted with key policy stakeholders across the three countries. The final section discusses tensions and contradictions across and within countries in relation to two dichotomies.

Abstract This chapter details the progression of Spanish residential care through a period of civil war followed by 40 years of dictatorship, when large institutions prevailed. The arrival of a democratic government in the late 1970s marked the beginning of a period of transformation in child welfare, including the introduction of family foster care and the expansion of family support services, the evolution of standards for residential care, and the development of research alliances with Spanish universities to identify effective strategies for residential staff training. Spain’s residential care population includes a high percentage of unaccompanied minors who, along with youth who present with severe behavioral and emotional problems, are a present focus of concern. The chapter concludes with the matrix used throughout the book, which provides information about the current policy context, key trends and initiatives, characteristics of children and youth served, preparation of residential care personnel, promising programmatic innovations, and present strengths and challenges.

The United Nations Convention on the Rights of the Child 1989 (UNCRC) and domestic legislation, such as the Children Act 1989 in England and Wales, provide a framework for the provision of state services for unaccompanied migrant youth. This chapter critically examines the implementation of legal and policy frameworks in practice with a focus on age assessments, the provision of care placements, support and leaving care services. Fundamental tensions are explored between immigration and care priorities, particularly for social workers in local authorities experiencing financial cuts and influenced by wider political discourses and government policies. While the vulnerabilities of unaccompanied young migrants and their needs as individuals for tailored support services must be recognised, so must their agency in making decisions about their lives. The chapter concludes with recommendations for policy and practice that promotes young people’s voices, rights and welfare within a social justice framework.

The Government of India has adopted a Reproductive and Child Health (RCH) approach as the basis of its new family welfare policy. One component of RCH is management of reproductive tract infections (RTIs). The Population Council's Asia and the Near East Operations Research and Technical Assistance (ANE OR/TA) Project, in collaboration with the State of Uttar Pradesh, Ministry of Health and Family Welfare, is conducting a study on the feasibility and cost of providing RTI case management at the primary-care level. The estimated annual cost of RTI case management at the district level would be about US$64,000. From the analysis, it is clear that the average annual drug budget of a Primary Health Care Centre in India is inadequate even if used only for subsidized RTI case management. Policymakers and program managers are examining the initial and continuing costs of RTI case management within the overall RCH package in India, with a focus on quality and sustainability. As noted in this paper, alternatives for controlling costs include better efforts at primary prevention, partner participation to reduce reinfection, user fees, and more private-sector involvement in reproductive health care.

Over the last 30 years, Bangladesh’s national family planning (FP) program has mainly concentrated its promotional efforts on women’s adoption of FP. While the government policy has been effective in influencing women to accept contraceptive methods, men’s role in FP has been completely neglected. Similarly, male RH services are hardly available at Health and Family Welfare Centres (HFWCs). This report describes a project aimed at integrating male RH services within the existing government female-focused health-care-delivery system. The study was implemented by NIPORT in collaboration with the Directorate of Family Planning and the Population Council. Interventions resulted in a substantial rise of male clients in the clinics, however nearly all came for the treatment of general health problems. Only a small number of male RTI/STI clients sought services from the clinics. Although unexpected, there was a substantial rise in the number of female clients. The study concluded that RH services for men could be easily integrated into HFWCs without affecting the female and child focus of the clinics and that augmentation of the total number of patients at HFWCs will lead to more effective use of resources and decreased cost of treatment.

Following the International Population and Development Conference in Cairo, there has been widespread consensus in the international community that family planning (FP) programs must be people-centered and focus not just on contraception, but on the reproductive health (RH) of men and women throughout their lives. This policy brief reviews the research and policy implications of promoting the Lactational Amenorrhea Method (LAM) as a component of FP counseling in India. The Government of India and the Population Council are using a pregnancy-based approach in Uttar Pradesh to improve the delivery of FP services through the rural primary health care system. Introducing pregnant women and their families to LAM offers a number of health benefits for mother and child. It promotes breastfeeding, which benefits the mother by reducing risk of postpartum hemorrhage and lowering risk of breast and ovarian cancers. The benefits to the fully breastfed infant include protection from hypothermia, neonatal hypoglycemia, and infections, in addition to nutritional advantages. Breastfeeding reduces postpartum fertility, thus delaying the need to use other contraceptive methods. LAM introduces couples to the concept of nonpermanent contraception and child spacing in a culturally acceptable way.