Schwartz, C., Yung, D., Barican, J., & Waddell, C. (2020). Preventing and Treating Childhood Mental Disorders: Effective Interventions. Vancouver, BC: Children’s Health Policy Centre, Simon Fraser University.
Author Archives: Daphne Gray-Grant
Nov. 20 marks Universal Children’s Day
This is a good time to remember that reducing inequality in society has been shown to reduce maltreatment of children. In particular, policies that redistribute wealth to ensure that more children have their basic needs met can contribute to reducing important problems such as child maltreatment. For more information on preventing and treating child maltreatment, see Vol. 3, No. 2 of the Children’s Mental Health Research Quarterly.
Increased mental health struggles will result from COVID-19
COVID-19 will have significant mental health consequences for B.C. children and youth, according to a report authored by the Children’s Health Policy Centre and released Nov. 12/20.
The report concludes that the pandemic creates a critical need for government to invest in B.C.’s over-stretched and underfunded child and youth mental health services system.
Sponsored by the BC Office of the Representative for Children and Youth, the report reviews several studies on mental health outcomes for children and youth after earlier pandemics and natural disasters. This research identifies the mental health challenges children and youth can be expected to experience during and after COVID-19, including anxiety, post-traumatic stress, depression and behavioural problems.
The report indicates that because untreated mental health problems can persist, even extending into adulthood if left untreated, supports for children and youth will significantly reduce future costs.
The report also finds that some children and youth may be disproportionately affected, including those with neuro-diverse needs, pre-existing mental health conditions, youth in foster care and those affected by adversities such as socioeconomic disadvantage and racism. It also finds that COVID-19 may particularly affect Indigenous peoples, who disproportionately experience harms related to colonialism such as unsafe housing, lack of access to clean water and extreme food insecurity – conditions that the report recognizes as putting children’s mental health at risk.
“This report underlines the importance of addressing mental health issues in the early stages,” says Representative for Children and Youth Jennifer Charlesworth. “The data indicates that children do well when their communities have more socioeconomic resources… Clearly, community and family health play significant roles in child and youth mental health, and that is what we need to be supporting.”
Families who were in more precarious economic situations before COVID-19 are now facing many added difficulties, according to Charlotte Waddell, director of the Children’s Health Policy Centre and the lead author of the report.
“We found that children who experience socioeconomic inequalities are much more likely to develop emotional and behavioural concerns,” says Waddell. “The pandemic has the potential to amplify inequalities – in turn putting less advantaged children at even greater risk for mental health concerns.”
The full report may be found here.
COVID-19 and the Impact on Children’s Mental Health
Waddell C, Schwartz C, Barican J, Yung D, Gray-Grant D. COVID-19 and the Impact on Children’s Mental Health. Vancouver, BC: Children’s Health Policy Centre, Simon Fraser University, 2020.
Start with psychosocial treatments
When a child has depression, families should have easy access to effective psychosocial treatments such as Cognitive-Behavioural Therapy. Interpersonal Therapy can also be effective. Then, if medication is needed, fluoxetine is the first choice, given robust research evidence supporting its use. For more information, see Vol. 11, No. 4 of the Children’s Mental Health Research Quarterly.
Let’s ban spanking
Spanking can harm children, for example, leading to physical injuries as well as emotional and behavioural problems. Spanking is also ineffective at changing children’s behaviour. Spanking and other forms of physical punishment should therefore not be used. For more information, see Vol. 9, No. 1 of the Children’s Mental Health Research Quarterly.
Study shows drop in cannabis and cigarette use during pregnancy for young, first-time mothers
Findings from a scientific study by Simon Fraser University give encouraging clues on how to reduce cannabis and cigarette use during pregnancy for young, first-time mothers -to-be.
The BC Healthy Connections Project, which is being led by SFU’s Children’s Health Policy Centre, in collaboration with researchers at McMaster University, is a randomized controlled trial examining an intensive nurse-home visiting program, called Nurse-Family Partnership (NFP). Findings suggest that NFP may help in reducing some types of prenatal substance use in girls and young women experiencing socioeconomic disadvantage.
Findings were recently published in a peer-reviewed academic journal, Canadian Medical Association Journal Open. The paper may be seen here.
Prenatal exposure to alcohol, cigarettes/nicotine, cannabis, and street drugs all place children at risk for poor health outcomes including being born too early, having a low birth weight, and having later learning and behaviour problems.
Girls and young women who received NFP (compared with regular prenatal services) showed a statistically-significant drop in prenatal cannabis use. As well, those who were smokers and received NFP showed a statistically significant drop in daily number of cigarettes smoked — which is important, given that even low-level cigarette smoking is harmful to a fetus.
Prevention is by far the best approach to such issues, according to Children’s Health Policy Centre director Charlotte Waddell. “These findings are good news in that they show we can prevent or reduce substance use during pregnancy,” she says. Study scientific director Nicole Catherine agrees. “It’s exciting to see these positive results during pregnancy, which is a crucial window for promoting children’s health and wellbeing.”
NFP is a prevention program involving public health nursing home visits 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 parents facing socioeconomic disadvantage. While NFP trials in the United States have shown many short- and long-term benefits for both children and mothers—including the program more than paying for itself—NFP has never before been tested in Canada.
For this study, the team is following 739 mothers and 737 children across BC. The BC Ministry of Health is sponsoring the trial, with support from the BC Ministries of Children and Family Development and Mental Health and Addictions—in collaboration with Fraser, Interior, Island and Vancouver Coastal Health Authorities.
Nurse home visiting and prenatal substance use in a socioeconomically disadvantaged population in BC
- Catherine, N.L.A., Boyle, M., Zheng, Y., McCandless, L., Xie, H., Lever, R., Sheehan, D., Gonzalez, A., Jack, S.M., Gafni, A., Tonmyr, L., Marcellus, L., Varcoe, C., Cullen, A., Hjertaas, K., Riebe, C., Rikert, N., Sunthoram, A., Barr, R.G., MacMillan, H., Waddell, C. (2020). Nurse home visiting and prenatal substance use in a socioeconomically disadvantaged population in British Columbia: Analysis of a prenatal secondary outcomes in an ongoing randomized controlled trial. Canadian Medical Association Journal Open, 8, E667–E675. https://doi.org/10.9778/cmajo.20200063
Flexibility, maintaining connection and texting all helped sustain participation rates
How do you persuade busy young mothers to participate in a scientific trial that’s going to last more than two years? The BC Healthy Connections Project achieved this goal by using a number of strategies. These included:
- Offering to perform research interviews on weekends and evenings.
- Changing the type of contact to suit the needs of participants who were aged 14–24 years.
- Making texting the preferred style of contact.
- Personalizing the connection by showing appreciation and conveying genuine interest.
Many of the 739 participants said they enjoyed contributing to research and having their voices heard, through the survey data. They especially appreciated being able to feel that someone was listening and was interested in their lives.
The trial, which started in 2011, was designed as a scientific evaluation of 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.
For more information on how the BC Healthy Connections Project maintained its impressive participation rates, see the team’s paper recently published in Trials.
Medications can help with ADHD
In October, which is ADHD Awareness Month in Canada and around the world, it’s worth remembering the many young people who are frequently labeled as “problem children” rather than children with a medical problem. Research evidence supports the use of three medications — methylphenidate, dextroamphetamine and atomoxetine — for children with ADHD. Careful use of these medications can reduce children’s symptoms and improve their quality of life. For more information, see Vol. 11, No. 1 of the Children’s Mental Health Research Quarterly.