Intimate relationships should be meaningful and enjoyable, not dangerous. Yet about one in 10 young people experience violence in their dating relationships. This form of violence can be prevented, however, setting the stage for healthy and respectful relationships in early adulthood and beyond. Two programs stand out — Fourth R and Youth Relationships — for having proven success in teaching positive relationship skills to Canadian teens. For more information, see Vol. 7, No 1 of the Children’s Mental Health Research Quarterly.
Author Archives: Daphne Gray-Grant
Director named to McMaster University Alumni Gallery
Charlotte Waddell, the director of the Children’s Health Policy Centre, has been honoured as a member of McMaster University’s Alumni Gallery.
The Gallery currently includes the biographies and photographs of 427 interesting McMaster graduates who have made significant contributions to society on a local, national or global level. Members of the Gallery include the former Lieutenant Governor of Ontario Honourable Lincoln Alexander, actor Martin Short, and astronaut Roberta Bondar.
Waddell earned her MD from McMaster where she completed residencies in Family Medicine and Psychiatry. She also undertook a research fellowship at McMaster’s Offord Centre for Child Studies before becoming an assistant professor with the Centre. From there she moved to UBC for six years until she was recruited by SFU to take up the Canada Research Chair in Children’s Health Policy, Tier 2, and to launch the Children’s Health Policy Centre in 2006.
Her story can be seen on the McMaster website.
There is value in making lots of contact
In conducting a scientific evaluation of a program designed to help young first-time mothers, a research team from the BC Healthy Connections Project went to extra effort to make connections. The team was prepared to contact each participant five or more times to schedule interviews. This ‘extra effort’ was deemed important in reaching participants who were often struggling with issues such as insecure housing and mental or physical health challenges. The scientific evaluation, which started in 2011, looked at the Nurse-Family Partnership, a landmark US program focusing on children born to girls and young women who are facing disadvantages such as low income. The program starts early — in pregnancy, before children are even born — and involves intensive home visits from public health nurses. In Canada and elsewhere, policy-makers and practitioners have traditionally struggled to reach, engage and maintain connections with populations who are facing socioeconomic disadvantage. The BC Healthy Connections Project team has provided a detailed case example, offering strategies for how to make better connections, that last. The team hopes that their paper, which can be seen in the journal, Trials, will inform a shift for researchers, policy-makers and practitioners alike—from seeing disadvantaged populations as “hard-to-reach” to viewing them as “need-to-reach.”
What public data sources can help us monitor children’s mental health in BC?
Improving the mental health of children in BC requires monitoring across all age groups — from infancy through late adolescence — to assess public investments aimed at better meeting children’s needs.
How to achieve this goal comprehensively was the subject of a report prepared by the Children’s Health Policy Centre (CHPC) at the request of the Child and Youth Mental Health Policy Branch of the BC Ministry of Children and Family Development. The BC Ministry of Mental Health and Addictions cosponsored the project.
The CHPC conducted an audit of possible data sources with potential application in BC, applying a population health framework to ensure comprehensiveness. The report examined 25 sources, identifying two types that — if used in aggregate —offer potential for ongoing monitoring. They are:
- For assessing determinants and status: Canada Census and BC Education data (determinants; covering all ages); Early and Middle Years Development Instruments (status; covering younger and middle school-age children only); and Canadian Community Health, Health Behaviour in School-Age Children and McCreary Adolescent Health Surveys (status; covering adolescents only); and
- For assessing interventions and services: MCFD’s Brief Child and Family Phone Interview (BCFPI) combined with BC Medical Services Plan (MSP) diagnoses from fee-for-service practitioners (mental healthcare encounters; covering all ages).
Yet each of these sources has limitations. For example, the BCFPI and MSP only cover those children who access services. And we know from high-quality epidemiological studies that the majority (56%) of children with mental disorders do not receive any services for these conditions.
So it is crucial to use population-based public data sources (such as #1 above) in combination with “clinical” sources (such as #2 above). And most importantly, public data sources should always be normed against epidemiological studies — which give the most accurate depiction of how many children need assistance.
For more information and to review the entire report, see here.
Public Data Sources for Monitoring Children’s Mental Health: What We Have and What We Still Need in British Columbia
Waddell, C., Catherine, N., Krebs, E., Nosyk, B., Cullen, A., Hjertaas, K., Lever. R., MacKenzie, D., Yung, D., Barican, J., Schwartz, C. (2020) Public data sources for monitoring children’s mental health: What we have and what we still need in British Columbia. Vancouver, British Columbia: Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University.
Pro-social behaviour should be promoted
Parents are crucial in promoting children’s positive behaviours. Parents can do this by interacting in ways that are sensitive and warm, being highly connected to children and setting effective limits. For more information, see Vol. 9, No. 4 of the Children’s Mental Health Research Quarterly.
Good relationships prevent anxiety
Positive relationships can protect children from problematic anxiety. For example, young people who feel accepted and respected by their parents and cared for by their friends are less likely to develop anxiety problems.For more information, see Vol. 10, No. 2 of the Children’s Mental Health Research Quarterly.
BCHCP Methodology Manuals now available for researchers
The study team for the BC Healthy Connections Project (BCHCP) has recently released a series of scientific methodology manuals. Their aim is to inform health researchers, research trainees and students conducting similar long-term research, in particular with populations experiencing socioeconomic disadvantage.
This body of work highlights the team’s knowledge and expertise collected over eight years in conducting 4,000 in-person and telephone research interviews with 739 girls and young women and their 737 children who were experiencing socioeconomic disadvantage upon entry into the trial.
The team collected survey and observational data from this cohort at six interview timepoints, starting in early pregnancy and continuing until children reached age two years (2.5. years duration per family). Retention results were encouraging (>83%) given that many participants were experiencing considerable disadvantage including residential instability, low income and intermittent cell phone access.
These methodology manuals highlight key aspects of the Field Interviewer role including:
- intensive training over four weeks with ongoing support and mentorship over many years
- rigorous questionnaire administration and data quality
- participant-centered retention efforts
- safety awareness and risk mitigation during in-person interviews
The manuals provide resources, practical guidance, and troubleshooting for situations that a Field Interviewer may encounter. The team has also published its planned, theory-and evidence-based BCHCP retention protocol.
The Nurse-Family Partnership program (NFP) is a primary prevention program involving intensive home visiting by public health nurses starting early in pregnancy and continuing until children reach age two years. It aims to improve child and maternal wellbeing, focusing on young, first-time mothers experiencing socioeconomic disadvantage. While findings from three NFP randomized controlled trials in the United States have shown many short- and long-term benefits for both children and mothers — including the program paying for itself — this trial is the first scientific evaluation of NFP in Canada.
Conducting such a large-scale, public health randomized controlled trial involved intensive resources and rigorous scientific oversight. The manuals represent lessons learned from designing and implementing the trial. The scientific field interviewers were unaware of families’ group assignment (i.e., NFP or comparison) to ensure unbiased data collection, hence this work has implications for all health research studies and not just randomized controlled trials.
“Our goal is to inform health researchers and service providers committed to reaching and sustaining engagement with populations experiencing disadvantage who we describe as “need-to-reach,” rather than “hard-to-reach,” according to study Scientific Director Nicole Catherine.
Recent findings show that NFP reduces cannabis use in all participants and the number of cigarettes used (by smokers) during pregnancy, which is a crucial window for healthy child development. Reports on other outcomes of interest including NFP’s effect on child maltreatment, child cognition, language and mental health, as well as maternal life-course, are expected in 2021 and 2022.
The study manuals may be viewed here (scroll to end of page).
Report suggests interventions for childhood mental disorders
Mental health, or social and emotional wellbeing, is crucial for all children. But in BC, high-quality epidemiological studies show that nearly 95,000 children aged four to 18 years— or an estimated 12.7% — will experience mental disorders.
All children with mental disorders require effective treatments, and many additional children would benefit from effective prevention programs. To inform policymakers about how to address these needs, the Children’s Health Policy Centre has prepared a research report for the BC Ministry of Children and Family Development.
This report summarizes the best available research evidence on effective interventions for preventing and treating 12 of the most common mental disorders (or groups of disorders) affecting children. These include:
- anxiety disorders
- attention-deficit/hyperactivity disorder (ADHD)
- oppositional defiant disorder
- conduct disorders
- substance use disorders (SUDs)
- depression
- autism spectrum disorder
- obsessive-compulsive disorder (OCD)
- bipolar disorder
- eating disorders
- posttraumatic stress disorder (PTSD), and
- schizophrenia
The report identifies effective prevention interventions for eight of these disorders and effective treatments for all 12.
To view the entire report, please see here.
Early intervention delivers long-term benefits
The Nurse-Family Partnership (NFP) program is a leading example of how intervening very early in life can bring many long-term benefits. This intensive home-visiting program focuses on young first-time mothers-to-be who are coping with socio-economic disadvantage. It begins in early pregnancy and continues until children reach age two, and can produce life-changing benefits. A recent paper — by researchers from the Children’s Health Policy Centre and published in the Canadian Medical Association Journal OPEN — suggests some encouraging results. In a randomized controlled trial in BC, NFP led to reduced prenatal cannabis use, and in smokers it led to modest reductions in cigarette use. As a result, it is thought that NFP may hold promise for reducing some types of prenatal substance use in disadvantaged populations.