Data gaps for children should be addressed as part of the COVID response

Children are not the immediate face of COVID-19, but they are the face of its future.

That is the key message of a recent article in the Globe and Mail newspaper, co-authored by Children’s Health Policy director Charlotte Waddell.

Written with senior academics from McMaster University, the Toronto Hospital for Sick Children and the University of Ottawa, the piece argues that unlike other countries, Canada does not have a national long-term study of children and youth. The need for such evidence on childhood health and well-being was urgent before COVID-19 and is even more urgent now.

But there is also some coincidental good news. Statistics Canada conducted a survey on children and youth in 2019, which means there are pre-pandemic data about how children were doing before COVID-19. (This survey involved a nationally, representative sample of more than 42,000 children aged 1 to 17 years across the country.)

The article argues that, “investing in a comprehensive follow-up survey represents our best opportunity to obtain accurate information about how the pandemic is affecting all Canadian children, and how some are being disproportionately affected.”

Such a follow up survey would also create a unique opportunity to assess how COVID-19′s impact may have differed across provinces and territories. As a result, it could also assess the impact of various public health and policy responses.

 

Let’s acknowledge anti-bullying day

The original anti-bullying day was established in Canada in 2007 when two Nova Scotia teens bought and distributed 50 pink shirts after a male ninth grade student was bullied for wearing a pink shirt during the first day of school. The last Wednesday in February — this year, Feb. 24 — is now the national anti-bullying day in the country. A focus on self-regulation — including paying attention and inhibiting impulsivity — is crucial for healthy child development and a step in reducing bullying. Parents can promote this skill by being responsive to their children, providing positive feedback during challenging tasks, and supporting older children and teens to be more autonomous. For more information, see Vol. 10, No. 4 of the Children’s Mental Health Research Quarterly

Mental health education can start as early as kindergarten

Should mental health be taught in school? Yes, according to Charlotte Waddell, the director the Children’s Health Policy Centre, speaking in a recent interview with the Tyee.

Waddell said that anxiety — what it is and how to deal with it — would be a highly appropriate topic for all students from kindergarten to high school. “Anxiety would be a fantastic teaching module — for example, the physiological reactions that everybody has experienced, that are in some ways evolutionary and protective when there’s a threat.”

“Then you couple that with: What are healthy responses for managing anxiety? How do you know when it starts to tip into something that’s not as helpful for you?” Waddell said.

But Waddell also noted that only 44 per cent of young people experiencing a mental disorder in B.C. are getting access to treatment. And we wouldn’t accept such low treatment numbers for illnesses such as cancer or diabetes. So mental healthcare for young people has a long way to go.

As well, COVID is likely to lead to increases in anxiety, depression and post-traumatic stress among youth who’ve been quarantined or isolated. This makes dealing with questions relating to mental health even more urgent, she says.

For details of the Centre’s report on COVID to the B.C. Representative of Children and Youth, see here.

Read the whole story on mental health education here.

Research project is guided by steering committee

When the BC Healthy Connections Project announced its first results, via a paper in the Canadian Medical Association Journal Open, researchers were pleased.

The study had shown that the program being examined — Nurse-Family Partnership — reduced the number of cigarettes used by smokers during pregnancy and reduced prenatal cannabis use for all participants.

But, then, a nurse spoke to a member of the BCHCP steering committee. “Is this a good news story?” she asked.

“At first, this question took me aback,” says Nicole Catherine, Scientific Director of the project. “We knew it was a good news story — a positive result — but then we realized that the tone required by academic journal publication is so low key, that our communications needed to be refined for sharing with our policy and practitioner partners.”

Catherine says she was grateful to get this feedback thanks to the group’s steering committee, a seven-member board established in 2012 and involving a sustained and reciprocal research-policy-practice partnership.

Members include senior policymakers from the BC Ministry of Health, the Ministry of Children and Family Development and the Ministry of Mental Health and Addictions, as well as senior scientific team trial leaders.

At the start, the committee met every two weeks (via teleconference) addressing crucial issues such as study design, eligibility criteria and the interpretation of mixed trial findings from the Netherlands and England.

As the trial continued, meetings dropped to once monthly, providing advice on recruitment closing, data collection completion and communicating the positive prenatal trial findings.

Now, the group meets every two months, continuing to provide valuable advice and feedback as the scientific team continues with the primary outcome analysis, relating to reducing childhood injuries.

“We are very grateful to all members of the steering committee for their continued involvement in this important project,” Catherine says.

Opportunities to help kids during COVID

During the COVID-19 pandemic, Canada has a unique opportunity to be a world leader in children’s mental health, according to Charlotte Waddell, director of the Children’s Health Policy Centre.

Speaking in an interview with the CBC public affairs radio program The House, Waddell said that nearly 800,000 Canadian children are already coping with mental disorders and this will only worsen with the pandemic.

Based on evidence from previous public health disasters, such as SARS and floods, “we anticipate the needs will increase dramatically — perhaps two to tenfold,” she said. In particular, anxiety, behaviour problems, depression and post-traumatic stress disorder (PTSD) are all expected to increase.

But the good news is that Statistics Canada recently completed a high-quality survey of 45,000 children, just before the pandemic began. According to Waddell, this “trove of pre-pandemic data” gives us the opportunity to repeat the survey to compare pre- and post-pandemic numbers.

Such analysis will lead to better, more strategic support for children. “We have an ethical imperative to act,” Waddell says. “And if we don’t act, we run the risk of causing damage to a generation of kids.”

The complete interview with The House can be heard here.

LGBTQ+ kids can thrive

Most LGBTQ+ youth successfully navigate adolescence and thrive as adults. Yet everyone around these young people can help create conditions that further ensure they flourish. For instance, schools can use gender-neutral language, model acceptance, be aware of LGBTQ+ issues and create positive environments. For more information, see Vol. 11, No. 2 of the Children’s Mental Health Research Quarterly.

Schools can help reduce depression

Most children spend more than a third of their waking hours in school. So, beyond academics, schools as a venue have tremendous mental health potential. For example, students in schools with safe environments, including high levels of peer and teacher support, have a lower risk for depression. For more information, see Vol. 8, No. 4 of the Children’s Mental Health Research Quarterly

BCHCP research faces minimal impact from the pandemic

The COVID-19 pandemic has killed more than two million people worldwide, put extraordinary pressure on mental health (especially that of children), and affected the financial wellbeing of frontline workers — cleaners, grocery store clerks and other essential services.

But it also has an impact on other areas, including that of researchers. The BC Healthy Connections Project (BCHCP) — a scientific evaluation of the Nurse-Family Partnership program (NFP) — has been fortunate that the pandemic has resulted in only minimal effects.

“We are lucky that all of our in-person work was finished before the first lockdown, says BCHCP Scientific Director Dr. Nicole Catherine, referring to the order by Dr. Bonnie Henry in March 2020. “If this pandemic had occurred before we’d been able to complete our in-person research interviews with children, our data would have been seriously affected.”

While some of the visits to study participants could have been conducted by phone, observing the cognitive skills of children would have been close to impossible.

The study — a randomized controlled trial — was launched in October 2013. The study team followed 739 families until all 737 children had reached their second birthday, by November 2019.

The aim of the study is to determine how NFP, an intense nurse-visiting program for young, disadvantaged families, compares with existing health and social services in British Columbia.

Upon notice of the first lockdown, researchers at Simon Fraser University began working from home. Similar to other researchers around the world, they met via Zoom or telephone. Team members could get access to some protected data only by going into their offices and they received special permission to do that, from time to time.

Since the start of the pandemic, the team has published a paper in the Canadian Medical Association Journal Open, showing that delivery of NFP led to a reduced prenatal use of cannabis and, a modest reduction in cigarette use by smokers.

The team is continuing to analyze the data, currently looking at whether NFP has reduced childhood injuries, as well as improving child mental health and development by age two years. “We will know the results later this year,” Dr. Catherine says.

Early childhood programs lead to many gains

Early child development programs can improve school readiness. Yet they can also do much more. For example, the Perry Preschool program, which was delivered to disadvantaged three- to four-year-olds, resulted in significant benefits up to 35 years after the program ended. These benefits included significantly less criminal involvement and less cannabis and heroin use. For more information, see Vol. 5, No. 4 of the Children’s Mental Health Research Quarterly.

Support foster parents and kids

When children have to enter foster care they often face significant new challenges, such as repeatedly changing foster homes. Specialized training and increased supports for foster parents can help — and have been shown to improve children’s behavioural well-being, school functioning and residential stability. For more information, see Vol. 6, No. 3 of the Children’s Mental Health Research Quarterly.