Author Archives: Daphne Gray-Grant

Mental health education can start as early as kindergarten

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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.

Opportunities to help kids during COVID

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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.

Director named to McMaster University Alumni Gallery

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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.

 

What public data sources can help us monitor children’s mental health in BC?

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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:

  1. 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
  2. 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

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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.

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BCHCP Methodology Manuals now available for researchers

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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

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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:

  1. anxiety disorders
  2. attention-deficit/hyperactivity disorder (ADHD)
  3. oppositional defiant disorder
  4. conduct disorders
  5. substance use disorders (SUDs)
  6. depression
  7. autism spectrum disorder
  8. obsessive-compulsive disorder (OCD)
  9. bipolar disorder
  10. eating disorders
  11. posttraumatic stress disorder (PTSD), and
  12. 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.

 

Increased mental health struggles will result from COVID-19

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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.