New ways to treat bipolar disorder in youth

Even though bipolar disorder is a long-term condition, it can be managed. Once a careful diagnosis is made, there are two effective approaches for young people. One is medications. Aripiprazole and lithium reduce symptoms and improve overall functioning, although both cause side effects. The other approach is psychosocial. Three new family-focused programs, used together with medications, also reduce symptoms and improve functioning. For more information, see Vol. 13, No. 1 of the Children’s Mental Health Research Quarterly.

 

CHPC director provides messages of hope for faith leaders

Faculty members and students from the Vancouver School of Theology attended a Feb. 16, 2021 one-hour workshop about COVID-19 and children with Children’s Health Policy Centre director, Charlotte Waddell.

Aimed at future United Church ministers who will be working with children and youth, the workshop addressed how participants could be community leaders by providing messages of comfort to children.

Despite the current challenging situation in BC, Waddell advised participants to always give kids messages of hope. “Always be a role model — wearing a mask, washing your hands — but also point to the positive,” she said.

“We have excellent public health leadership and vaccines are getting out now,” she said. “We must tell kids we will get through this.”

Celebrating young people who have autism spectrum disorder

A longitudinal study of children with autism spectrum disorder from across Canada has shown that “doing well” is possible — even in the context of continuing to meet diagnostic criteria for the disorder. The Pathways study has been following children since they were first diagnosed — known as an inception cohort — and now is tracking children into their teens.

“These results support a strengths-based approach to treatment planning that should include robust support for children and youth and families to increase the likelihood of doing well,” the study concluded.

The paper was published March 29/21 in the Journal of the American Medical Association Open. Peter Szatmari from the University of Toronto is lead author. Charlotte Waddell, director of the Children’s Health Policy Centre, is also an author. She is a longstanding co-investigator with the team.

The paper can be viewed here.

This week marks World Autism Awareness Day

Created by the United Nations General Assembly, World Autism Awareness Day occurs on April 2 every year. Autism spectrum disorder refers to a group of complex neurodevelopment disorders. They are characterized by repetitive patterns of behaviour and difficulties with social communication and interaction. The symptoms are present from early childhood. Recently, Children’s Health Policy Centre director Charlotte Waddell, has been co-author of a new study on Autism Spectrum Disorder.  See full text of the article and a link to the study here.

International seminar addresses BC findings on Nurse-Family Partnership

Recently invited to deliver an international seminar about the British Columbia Healthy Connections Project, scientific director Dr. Nicole Catherine spoke to a group of researchers, policymakers and practitioners from around the world. Catherine began by describing the sustained research-policy-practitioner collaborations that support the 10-year Canadian scientific study of the Nurse Family Partnership (NFP) that is being conducted in BC in four Regional Health Authorities.

NFP was developed nearly 40 years ago by Dr. David Olds and colleagues in the United States, to help girls and young women and their children who are facing disadvantages such as low income. The program starts early — in pregnancy, before children are even born — and involves intensive home visits by public health nurses, continuing until children reach their second birthday.

The study is what Catherine described as a “robust” size, with 739 participants and their 727 children, with 200 of these mothers identifying as Indigenous. An analysis of participant characteristics at study entry, in early pregnancy, was published in 2019 showing that the trial reached pregnant girls and young women experiencing socioeconomic disadvantage (i.e., young age, preparing to parent while single, having limited income, having limited education).

Many (47–56%) had associated health and social adversities including unstable housing, a history of childhood maltreatment, or severe anxiety or depression. In fact, 90% were experiencing three or more adversities. “Our data show unacceptable rates of socioeconomic disadvantage for some BC girls and young women who are preparing to parent for the first time,” Catherine told the group. “NFP was designed to support these children and these young mothers.”

While the research interviews were completed in November 2019, analysis is continuing. Main outcome results showing how well NFP works in BC are expected to be announced in 2021/2022. In the meantime, two findings have already been identified.

  • Prenatal findings published in the academic journal, Canadian Medical Association Journal Open suggest that NFP reduced the number of cigarettes smoked, for pregnant smokers — which is important, given that even low-level cigarette smoking is harmful to a fetus. NFP also reduced prenatal cannabis use, an emerging public health problem.
  • The BC Healthy Connections Project achieved an outstanding participant retention rate (83%–91%) for the six research interviews conducted with each family starting in pregnancy and through until children reached aged two years. The study team successfully completed 4,000 in-person and telephone interviews over six years. This was especially encouraging, Catherine said, because girls and young women experiencing considerable disadvantage are often considered “hard-to-reach” by researchers and practitioners. The study team’s development and use of a standardized retention protocol helped them engage and retain this underserved population. “The onus is on us,” says Catherine. “It’s not that these families are ‘hard-to-reach’— it’s that we ‘need-to-reach’ them.”

The seminar was followed by a conversation with researchers, policymakers and practitioners in various countries around the globe currently considering, evaluating or implementing NFP. This list included Australia, Bulgaria, England, Northern Ireland, United States, Norway and Scotland. Videos from all presenters may be viewed here; Catherine’s presentation is third on the list.

Provincial advisory committee provides crucial support

At the launch of the BC Healthy Connections Project in 2011, a Provincial Advisory Committee was immediately set up.

Why? The purpose of this important group of roughly 50 people was to gain expert practice and policy advice to help guide the scientific study — examining the effectiveness of the Nurse-Family Partnership (NFP) program. Later, another purpose of the group was to provide an effective and efficient way of communicating trial updates and findings. And, today, this same group helps to guide the ongoing delivery of NFP, while awaiting trial results on exactly ‘how’ NFP works in BC (expected in 2021/2022).

“This group really gives us a sustained, active and reciprocal way to collaborate,” scientific director Nicole Catherine says noting that the team includes senior policymakers from BC government ministries such as Health, Children and Family Development, and Mental Health and Addictions as well as managers and directors from each of the four regional health authorities involved in the trial: Fraser, Interior, Island and Vancouver Coastal.

Other members in the group include representatives from the First Nations Health Authority, Métis Nation of BC, the Public Health Agency of Canada, the Provincial Health Services Authority, Perinatal Services BC, Child Health BC, and the BC Midwives Association.

While the group meets quarterly and has often gathered by phone (an especially useful principle during COVID), they held an in-person meeting in June 2015 where members gathered for what they called a “pre-mortem.”

“The idea was to make sure we could sustain the program and to boost its chances of success,” Catherine says. The object of the pre-mortem was to consider potential obstacles to the project and then develop ways to prevent them from occurring.

“Although the idea of a ‘pre-mortem’ might sound negative,” Catherine says, “it was actually the opposite. When you’re so focussed on succeeding, it’s easy to overlook small but important roadblocks. This exercise helped us avoid doing that.”

“For this, and for all the other work the committee has contributed, we are very grateful for the many people who have been so generous with their time to help ensure the success of this project,” Catherine says.

Talk identifies risks, opportunities of COVID pandemic

Recently invited to deliver a Lager Lecture at McMaster University, Children’s Health Policy Director Charlotte Waddell spoke on Children’s Mental Health and COVID-19.

Speaking via Zoom on Feb. 24, Waddell began by describing the high level of children’s mental health needs prior to the pandemic.

Following the pandemic, she said, it’s expected that prolonged disruptions and diverted public resources will lead to additional hardships. Worldwide, somewhere between 42 and 46 million more children are expected to fall into extreme poverty with reduced access to basic healthcare, food and vaccines.

As well, she noted, school closures imposed by nearly 200 countries have affected 85 per cent — or 1.4 billion children — worldwide.

Citing a 2020 conclusion from the United Nations Waddell said, “Children are not the face of this pandemic but they risk being among its biggest victims.” It will be most damaging for those who are already experiencing the most disadvantage, she added.

Addressing the issue of cost, Waddell pointed out that 94 percent of provincial health budgets in Canada go to hospitals, drugs and physicians while only six percent goes to public health, including prevention.

“That low figure towards public health gives us a couple of clues about why we’ve had to scramble to respond to COVID,” she said — arguing that where government is prepared to spend more money on public health, it can realize great savings. In the US, for example, preventing just one case of a severe childhood problem such as conduct disorder can yield savings of more than $8 million CAD over a lifetime.

Waddell was invited to give the speech as a recent inductee to McMaster University’s Alumni Gallery. Waddell earned her MD from McMaster where she completed residencies in Family Medicine and Psychiatry. In 2006, she was recruited by SFU to take up the Canada Research Chair in Children’s Health Policy, Tier 2, and to become director of the Children’s Health Policy Centre.

The roughly 30-minute speech was followed by a lively question and answer session. The whole video may be viewed here.

Practitioners need to prescribe with care

Researchers have uncovered some troubling trends in prescribing practices with young people. In BC and Manitoba, antipsychotics have commonly been prescribed for conditions such as ADHD — where these medications lack both research evidence and regulatory approval. To better support young people, antipsychotic prescribing should be limited to conditions for which there is good research evidence and regulatory approval, such as schizophrenia and bipolar disorder. For more information, see Vol. 7, No. 4 of the Children’s Mental Health Research Quarterly

Prevention investments can pay off

When problematic substance use is prevented, the benefits extend beyond helping young people and their families. Society also benefits, including financially. In particular, net benefits for effective skill-based programs were an estimated $160 to $1,850 dollars per youth. For more information, see Vol. 4, No. 2 of the Children’s Mental Health Research Quarterly

Help youth with eating disorders

Eating disorders can be effectively treated. For youth with anorexia, Family Therapy is the first choice. For those with bulimia, both Family Therapy and Cognitive-Behavioural Therapy (CBT) show positive results. And for those with binge-eating disorder, CBT is also highly effective. All young people with eating disorders should be easily able to receive these effective treatments. For more information, see Vol. 9, No. 3 of the Children’s Mental Health Research Quarterly