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IntroductionResilience is a key factor in healthy development of children who have experienced adversity in early life. Current methods of assessment involve using questionnaires - few of which are appropriate for young children, most are time consuming and rely on parent recall, thereby introducing bias. Additionally, widespread implementation of these would be costly, making population-level assessment of resilience impractical. The current study will leverage multi-sector, linkable, whole-population data from health, education, justice and social services to explore alternative ways to assess resilience in children.
Objectives and ApproachThe purpose of this study is to identify factors in administrative data that emerge as significant determinants of resilience, demonstrated by children who experience adversity in early life but develop normally. Children born in Manitoba between 2000-2012 will be included. Adversity will be identified as families receiving income assistance, and/or the presence of adverse childhood experiences (ACEs) in linked databases such as Justice (incarcerated parent) and Health (parent with mental or substance use disorder). Development will be measured using the Early Development Instrument (EDI). EDI outcomes will be assessed according to severity and frequency of adversity. Pre-identified covariates that map onto sub-constructs of resilience will be assessed using multivariable linear regression to determine whether they are associated with higher EDI scores in the context of adversity.
ResultsThe identification of administrative data variables associated with resilience in children will serve as a valuable tool for population-level assessment of resilience among children who experience adversity at young ages.
Conclusion / ImplicationsWhile complete eradication of childhood adversity is unlikely, the continued development of programs and policies that build resilience in children is crucial. The results of this study will provide a means for population-level evaluation of such programs and policies, ultimately improving evidence for policy and decision-makers in the area of child development.

IntroductionThe Manitoba Centre for Health Policy has provided international leadership in organizing and accessing administrative databases, linking and analyzing data and translating the findings of research into policy for three decades. During this period, MCHP has addressed numerous challenges in each of these areas.
Objectives and ApproachLinked data research is expanding rapidly in terms of access to new data sources, different types of data, sharing of data across jurisdictions, and advances in data analytics. Technical advances such as computing power and artificial intelligence support these developments while governance structures and ethical issues challenge them. This presentation will describe some of the challenges MCHP has met with a view to gaining insight into how solutions evolved and how experience can guide the future of linked data research.
ResultsThe scaling up of linked data research will need to address specific challenges including de-identification of free text, accessing and linking data from private enterprise such as wearables, and interdisciplinary collaboration to incorporate new techniques developed by computer scientists. Cross-jurisdictional data analysis presents challenges in addressing differences in data architecture. Inter-jurisdictional and international data sharing create ethical and governance challenges. Experience has demonstrated the critical role that relationship building plays in addressing each of these. These relationships are different depending on the partners. They are all based on the development of common use of language, understanding the motivation and concerns of each party, clearly articulating the benefits of the relationship and data use and attention to the cultural and political environment.
Conclusion/ImplicationsLessons from the past can guide us in addressing challenges posed by the exciting opportunities available to us all. While many of these challenges will be solved with technical solutions, we should not overlook the importance of human relationships in building a culture of trust and collaboration as we move

The purpose of this paper was to use a life course approach to investigate the association between family structure histories and high school completion. Using data from a population-based data registry for the 1984 Manitoba birth cohort, we selected a sample of children born or adopted at birth into a married or cohabiting two-parent household (n = 9,493) and derived family structure histories for each child up until the age of 18. Marital disruption occurred for 1,876 children (19.8%), with 531 children (5.6%) of the total sample experiencing multiple changes in family structure. Logistic regression models showed that children who experienced marital disruption before the age of 18 were significantly less likely to complete high school than children in intact households, and that children who were younger at the time of a first change in marital status were more vulnerable than children who were older when their parents' marriage ended. Further work is needed to elucidate the pathways that link family structure histories to child outcomes.

OBJECTIVES: In Manitoba, government policy is for public health nurses to screen families with newborns within 1-week post-discharge for risk factors associated with poor child developmental health. The purpose of this study was to compare the characteristics of families who are screened for intimate partner violence (IPV) with families without a documented response to an IPV screen item. This information can be used to help identify and target families in need of support whose needs are not being met within the current system. METHODS: Manitoban women giving birth to a live singleton in the province from January 1, 2003 to December 31, 2006 were included in the analyses (N = 52,710). Data were part of a larger research study following these families for several years to examine longer-term developmental outcomes. Administrative databases from the Manitoba Centre for Health Policy provided data for the study. Descriptive statistics and logistic regression were used to examine relationships between IPV screen status and socio-demographic covariates and birth outcomes. RESULTS: In the study population, 66.7% of the sample were screened for IPV. Women less than 20 years of age, not in married or common-law unions, and living in lower income areas were less likely to have a documented response to the IPV screen item. A low number of prenatal care visits, prenatal mental health problems, and prenatal substance use, as well as premature and low birthweight delivery, were associated with a decreased likelihood of having a documented response to the IPV screen item. CONCLUSION: Incorporating violence screening into routine prenatal and postnatal care, rather than only screening women after birth, may help to better identify families with unmet needs and ensure more timely referrals to positive strengths-based supports and services.

For more than 30 years, the Manitoba Centre for Health Policy has been conducting research and evaluation to provide timely and critical evidence to answer real-world policy questions. Our experienced team of research scientists, analysts and other staff work extensively with policy-makers at the macro, meso and micro levels of government to support evidence-informed policy and program development in an effort to ensure that policy initiatives provide the greatest benefit possible to individuals and society as a whole. Using the widely recognized whole-population Manitoba Population Research Data Repository, which comprises approximately 100 different datasets from multiple sectors, we employ sophisticated and state-of-the-art research methods and data science technologies, and then translate the results into meaningful insights or recommendations for policy-makers.
Our long and productive history of working with policy-makers has taught us much about making our research relevant to policy-makers. In this article, we outline some examples of how research evidence has been used to influence policy in Manitoba, and the key lessons we have learned about what makes relationships between researchers and policy-makers work. In essence, policy-makers have supported the growth of the Repository over the last 30 years, because researchers have "closed the loop" by sharing valuable and policy-relevant research results with them. This ability to inform policies, programs and service delivery with scientific evidence continues to benefit individuals, communities and our society as a whole.

IntroductionManitoba Public Health Nurses (PHNs) attempt to visit all families with newborns shortly after discharge from birth hospitalizations. Since 2000, PHNs have completed the Families First Screen (FFS) at these visits, to identify families at risk for child maltreatment. The information captured in FFS is a valuable tool for research.
Objectives and ApproachOur objective was to clean and validate FFS data and link to health data in the Manitoba repository in order to determine the percent of births in Manitoba hospitals that had FFS. We identified all babies born in Manitoba hospitals 2000-2015 using ICD-9-CM /ICD-10-CA codes. Mothers were identified through the Health Registry (Mom_Baby Link File) using scrambled Personal Health Identification Numbers (sPHINs). FFS data were linked to births via baby's sPHIN. Determining which FFS records linked to babies required several steps of cleaning and validating the data to account for differences in birthdates between files, missing sPHINs, and multiple records.
ResultsFor example, in 2014 there were 16,079 births and 14,002 FFS records; 13,524 FFS had mother and/or baby sPHIN. For those missing baby sPHIN (9,295), 99.8% were retrieved via the Mom_Baby Link File. Linking the FFS to the hospital births we found: 3,043 births didn't have an FFS; 12,762 had a single FFS, and 274 births had multiple FFS (i.e., baby associated with more than one mother, FFS and/or form date). To ensure that the baby was only associated with one mother and one FFS the most current FFS was kept. We found that in 2014, 81.07% (13,036/16,079) of the births had an FFS. In the longitudinal analysis, the percent of births with an FFS ranged from 74.6% in 2000 to 81.1% in 2014.
Conclusion/ImplicationsWe were able to achieve good linkage between FFS and health registry data, allowing this rich data source to be used for research on maternal and child health. Information on percent of births with FFS has been shared with policy-makers over the years and changes to screening practices implemented.

ABSTRACT
ObjectivesManitoba has one of the highest rates of children in out-of-home care in the world. Our aims were to: 1) describe characteristics of children in care; 2) determine differences in educational outcomes for children in care, children receiving in-home protection services and children not involved with child welfare; and, 3) identify factors contributing to educational success for children in care.
ApproachPopulation-level administrative data from the Population Health Research Data Repository at the Manitoba Centre for Health Policy, were used. Several data sources were linked together at an individual level: child welfare services (e.g., in care, in-home services; hospital birth records (e.g., birth weight, gestational age); health status (e.g., from hospitalizations, physician visits); family risk factors (e.g., maternal prenatal smoking and/or drinking, maternal education); family characteristics (e.g., number of children in family, receipt of income assistance); education assessments at kindergarten, grades 3, 7, 8, 9 and 12. Children in care from 1998 onward were included. Number of children analyzed differed depending on the educational outcome examined: e.g., analyses at kindergarten include 1,893 children in care, 4,229 children receiving in-home services, and 32,280 children not involved with child welfare services; for high school completion these numbers were 11,234, 40,671, and 162,265 respectively. Multivariate regressions identified characteristics associated with educational outcomes for children in care.
ResultsOver one-third of children in care first entered care as infants, and of those, close to half were apprehended at birth. 5.5% of children in Manitoba spent some time in care before their 15th birthday, with an almost tenfold difference for Indigenous (16.6%) and non-Indigenous (1.7%) children. Across the range of educational outcomes, children in care did more poorly than children receiving in-home services, who in turn did more poorly than children with no child welfare involvement. For example, only 33.4% of children in care completed high school compared to 66.8% of children receiving in-home services and 89.3% of children with no child welfare involvement. Adjusting covariates reduced differences but all remained statistically significant. Factors associated with positive outcomes for children in care differed depending on the outcome and included measures like poverty (at Kindergarten, p<0.05; at high school, p<0.0001) and total number of care placements (at Kindergarten, p<0.05; at grade 9, p<0.01).
ConclusionsChildren in care are at risk of experiencing poor educational outcomes, from school entry onwards. Identifying factors associated with educational success for children in care can inform policy and program development.

For more than 30 years, the Manitoba Centre for Health Policy has been conducting research and evaluation to provide timely and critical evidence to answer real-world policy questions. Our experienced team of research scientists, analysts and other staff work extensively with policy-makers at the macro, meso and micro levels of government to support evidence-informed policy and program development in an effort to ensure that policy initiatives provide the greatest benefit possible to individuals and society as a whole. Using the widely recognized whole-population Manitoba Population Research Data Repository, which comprises approximately 100 different datasets from multiple sectors, we employ sophisticated and state-of-the-art research methods and data science technologies, and then translate the results into meaningful insights or recommendations for policy-makers. Our long and productive history of working with policy-makers has taught us much about making our research relevant to policy-makers. In this article, we outline some examples of how research evidence has been used to influence policy in Manitoba, and the key lessons we have learned about what makes relationships between researchers and policy-makers work. In essence, policy-makers have supported the growth of the Repository over the last 30 years, because researchers have "closed the loop" by sharing valuable and policy-relevant research results with them. This ability to inform policies, programs and service delivery with scientific evidence continues to benefit individuals, communities and our society as a whole.

IntroductionHigh dimensional propensity scores (HDPS) aim to account for unmeasured confounding. However, it is unclear to what extent HDPS are able to attain this.
Objectives and ApproachThis study aimed to test how well HDPS can account for confounding due to social determinants of health when using only health data. A retrospective cohort study was used to examine the effect of exposure to prescription opioids in utero on childhood outcomes (ADHD, school readiness, NICU admission, and hospitalization within the first year of life). Administrative health and social data were linked at the individual level and HDPS for each outcome were calculated using the mothers' health data. Exposed and unexposed mother-child dyads were then matched. Standardized differences of mothers' social factors (history of teen birth, lowest income quintile, ever received income assistance (i.e., welfare), ever lived in social housing, history with child protection services, residential mobility, and contact with the justice system) were compared before and after matching to determine to what degree the HDPS could account for differences in social determinants of health. Additional HDPS analyses were performed with social factors included in the HDPS with the health data.
ResultsBefore matching, standardized differences between exposed and unexposed groups for the social factors ranged between 0.40-0.75. Income assistance and lowest income quintile consistently had the greatest and smallest standardized difference for all outcomes, respectively. After matching, using health data only, standardized differences decreased considerably, ranging from 0.05-0.27. When including social factors into the HDPS, the addition of income assistance produced the smallest standardized differences with a range of 0.01-0.13 for all outcomes.
ConclusionsUsing the HDPS with health data only can reduce confounding due to social factors. If data are available, including income assistance in the HDPS may further reduce confounding for all social determinants of health.

IntroductionOn their 18th birthday children in custody of provincial Child and Family Services (CFS) age out, and are adults in control of their own care. An additional extended transitional services program was introduced several years ago to address gaps in the provicion of, and access to, adult social services during this change.
Objectives and ApproachUsing linked population based data from the Manitoba Population Research Data Repository, children in the custody of CFS who turned 18 during a 10 year study period were compared to children not in custody. For those in custody of CFS, we also compared individuals who participated in the extended transitional care services to those who opted out. Outcomes included use of health services and prescription drugs, social assistance, involvment with the justice system, living in social housing, and mental health outcomes. For most outcomes, the two year period prior to the 18th birthday and the two year period after were measured.
ResultsDuring the study period, 4656 children in care of CFS turned 18 while in custody. There were 2811 permanent wards, of which 1663 participated in the extended transitional services program. An additional 1845 non-permanent wards also turned 18 during the study period. Permanent wards were much more likely to be long term wards (greater than six years, ~65\%) compared non permanent wards (~17\%). Opioid prescription rates more than doubled in the two years after their 18th birthday and were about 6 times greater than prescription rates for those not in care of CFS. Criminal accusation rates did not change after their 18th birthday, were about equal for permanent and non-permanent wards. For the majority of outcomes, the transitional services program appeared to have little impact.
Conclusion/ImplicationsCompared to children not in care of CFS, rates of most outcomes were considerably higher for wards. Not all outcomes demonstrated a significant change over the transition period. By linking data from so many different government departments, extra attention can be focused on areas likely to have the greatest impact.

IntroductionOut-of-school programs for grade K-12 students support healthy behaviours, boost academic achievement, and strengthen social networks. The Boys and Girls Clubs of Winnipeg (BGCW) have been active for 40+ years; however, little is known about how participating in their programs influences students' short- and long-term health, educational and social outcomes.
Objectives and ApproachWe are investigating the association between participation in BGCW out-of-school programs using the individual-level data held in the population-based Manitoba Population Research Data Repository at the Manitoba Centre for Health Policy (MCHP). Data on BGCW program participation for children born 1987-2010 was linked with administrative records from the healthcare system, education system, and social services. The comparison group of non-participants was matched on age, sex, 3-digit postal code and school division. Outcomes of interest include health services use, teen pregnancy, grade repetition, high school graduation, enrollment in post-secondary institutions, receipt of income assistance, and involvement with the justice system.
ResultsWe conducted analyses of children (K-8) attending the Community Schools Investigator (CSI) summer enrichment program, an academic and recreational program that aims to combat learning loss for children in low-income neighbourhoods. After one summer of CSI, participants (n=970) were significantly more likely to repeat a grade than the matched comparison group (n=783) (5.4% CSI students repeated a grade [95% CI 3.9, 6.8] vs 2.76% comparison students [95% CI 2.20, 3.32]). However, the likelihood of CSI students repeating a grade dropped to the level of the comparison group after two or more years of participation in CSI (2.91% CSI students repeated a grade [95% CI 1.26, 4.56]). Ongoing analyses are examining how participating in CSI and other BGCW programs is linked to health and social outcomes.
Conclusion/ImplicationsOur findings suggest that engagement in a BGCW out-of-school summer program contributes to better educational outcomes for low-income students. Using the information-rich Data Repository at MCHP, we can examine additional outcomes across multiple sectors to demonstrate how out-of-school programs help young people achieve their full developmental potential.

IntroductionSocioeconomic gradients in health exist in Canada. Although multiple Canadian area-based socioeconomic measures (ABSM) have been developed, none have been specifically validated against relevant pediatric outcomes. Our objective was to use key pediatric health outcomes and compare the strength of association with a number of ABSM, including income quintile.
Objectives and ApproachThis is a retrospective cross-sectional assessment of the association between socioeconomic status (SES) measured by ABSM and key pediatric health outcomes at the population level. Data from the Manitoba Population Research Data Repository was used for residents aged 0-19y. The timeframe was 2010-2015. Outcomes included preterm births, birth weight, mortality, vaccination rates and teen pregnancy. Regressions used each outcome against various ABSM (e.g. CAN-Marg, SEFI2, INSPQ) or income quintile. Best model for each outcome was assessed by goodness of fit measure (AIC). Measures of inequality included SII (Slope Index of Inequality) and RII (Relative Index of Inequality, both RIImean and RIIratio).
ResultsIn our regression models, the 4 Can-Marg subcomponents consistently had about 15% lower AICs (best fit) across all 16 key pediatric outcomes compared to INSPQ (Raymond-Pampalon), income quintile or SEFI2 (Socioeconomic Factor Index - Version 2). Sex differences were small and inconsequential. Whether ABSMs were treated as continuous or categorical predictors was of little statistical consequence. Of note, 15 of the 16 outcomes had socioeconomic gradients identified by SII or RII on at least one of the ABSMs. Income quintile detected 12 of 15, CAN-Marg material deprivation detected 9; the combination of CAN-Marg material deprivation and ethnicity detected 13 of 15. SEFI2 detected only 3 and the National INSPQ detected 6.
Conclusion/ImplicationsThere are significant health inequalities in pediatric outcomes in Manitoba (15 of 16 studied). Combining CAN-Marg measures of poverty (material deprivation) and ethnic concentration identified 13/15 cases of documented inequality and was the best ABSM for capturing pediatric health gradients; it was similar to income quintile alone.