Improving the mental health of BC’s children in care

Children in government care face extraordinary challenges. Some of them may have entered  care because they have experienced maltreatment. Then once in the care system, many continue to experience avoidable adversities, such as multiple changes of placement.

This situation can lead to inconsistent caring relationships, school disruptions and cultural disconnections. These children also face higher rates of mental disorders, lower rates of high-school graduation and more conflicts with the law.

Compounding these issues are the unfair burdens faced by Indigenous children who often experience overinvolvement of the child welfare system, an ongoing legacy of colonialism.

How to reduce the need for care — or manage it better when it’s necessary —  was the subject of a report recently prepared by the Children’s Health Policy Centre at the request of the office of the BC Representative for Children and Youth.

The report identifies:

  • Successful programs for preventing child maltreatment
  • Numbers on the burden of mental disorders for children in care, with prevalence approximately four times higher than in the general population of children
  • Successful prevention and treatment programs for addressing mental well-being specifically for children in government care

These findings can inform efforts to improve the well-being of some of British Columbia’s most disadvantaged children.

For more information and to review the entire report, see here.

 

Dealing with the overdose crisis means starting with children

How can the province of BC better address the current opioid crisis?

That was the subject of a 60-minute Zoom-based talk by the Children’s Health Policy Centre on Aug. 3/22 to the Select Standing Committee on Health for the BC Legislature.

Roughly 10 MLAs and their staff attended to hear a presentation prepared by Charlotte Waddell, Christine Schwartz, Nicole Catherine, Jen Barican and Donna Young.

The CHPC team urged the province to tackle the toxic drug supply problem in a new way — by addressing social inequities that contribute to substance use problems for young people and by providing effective prevention and treatment programs for them. 

“We need to start early in life — not waiting until problems are entrenched in adolescence or adulthood,” said director of the Centre, Charlotte Waddell. “We also need to address the underlying social inequities that are driving the problem.”

The group suggested that the province needs to double its investments in child and youth mental health and work to ensure that services are better coordinated across the multiple ministries and health authorities currently involved.

 

Celebrating BC’s Nurse-Family Partnership nurses

What are the next steps for the Nurse-Family Partnership (NFP) program in BC?

That was the subject of a 45-minute talk to the Fraser Health Authority NFP nursing team on June 1/22. Nicole Catherine, Mowafaghian University Research Associate with the Children’s Health Policy Centre had been invited to provide a celebratory update to the nursing team.

A primary prevention program for young, first-time moms, Nurse-Family Partnership, has been the subject of a scientific evaluation, the BC Healthy Connections Project led by the Children’s Health Policy Centre in collaboration with Fraser Health Authority, the BC government and three other health authorities.  “The NFP nursing team’s dedication and commitment was tremendous,” Catherine told the group. “The trial is now providing rigorous evidence on how NFP works in BC.”

She also commented on the special challenges presented by Covid. “I’ve heard from the NFP nurses how life has become even more difficult for these children and families since the onset of the pandemic,” she said. “But we feel united by our desire to see all children flourish.”

Many of the nurses currently delivering the program were involved in the original trial and they said they have been impressed by the knowledge being generated by the study – and they hope it will inform new policies and programs to better support underserved children.

Engaging students in child health research and policy

How can we prevent maltreatment and ensure all children flourish?

That was the subject of a 30-minute talk to a group of undergraduates, graduate students and faculty at an SFU Faulty of Health Sciences student conference held May 3/22. Nicole Catherine, Mowafaghian University Research Associate with the Children’s Health Policy Centre was the person addressing the group.

Speaking on the results of the BC Healthy Connections Project, an evaluation of a primary prevention program for young, first-time moms, Nurse-Family Partnership, Catherine said the results of the research had been moving. “We were honoured that more than 700 girls and young women and their children had shared their experiences with us,” she said. The research group conducted some 3,700 research interviews for the project.

“We’ve learned that prevention needs to start early in pregnancy before children are born,” Catherine said. “Adversities such as family socioeconomic disadvantage and child maltreatment are socially produced and are therefore preventable.”

Students expressed curiosity about how policymakers are interpreting the trial findings, whether the program is continuing in BC and whether other provinces will explore this intervention. They also noticed that the majority of the research was conducted in English which will have excluded children and families from other cultural backgrounds representative of BC.

The importance of knowing what needs fixing

Could better monitoring of children’s mental health conditions lead to better outcomes for BC’s children?

That was the subject of a 60-minute virtual talk to graduate students in UBC’s school of population and public health on March 17, 2022, by Charlotte Waddell, director of the Children’s Health Policy Centre.

Speaking on the serious mental health service shortfalls for BC youth and children before Covid-19, Waddell said there is an urgent need to for better measurement now.

“If we measure it, we can start to shift the public conversation,” she said. “This is crucial because until it is their child, people just do not know and so, do not ask policymakers to pay attention.”

The 60-minute talk included enthusiastic discussion of case studies.

Evaluating the impact of COVID-19 on child health in Canada

A McMaster University team is leading Canada’s first comprehensive investigation of the impact of the COVID-19 pandemic on child health, with a team from the Children’s Health Policy Centre as Co-Principal Investigators.

Together, we are building on Statistics Canada’s uniquely-positioned 2019 Canadian Health Survey of Children and Youth — conducted just prior to the start of the pandemic. In re-interviewing this representative, population-based sample of 45,000 young people and their families, we will be able to measure the impact not only of COVID-19 but also of pandemic responses on mental health, physical health, learning and social inequities.

This project is funded by the Canadian Institutes of Health Research (CIHR) and Statistics Canada, with additional supports from Children’s Healthcare Canada, the Public Health Agency of Canada, McMaster University, BC MCFD and donors. Initial results are anticipated in 2023–2024.

Centre members are also providing supports for an associated study of the impact of the pandemic on Ontario children, funded by the province of Ontario. Results are anticipated in 2022. Beyond this, we contributed to a Royal Society of Canada volume outlining safe ways for children to return to school during the COVID-19 pandemic.

Working to end child maltreatment

How can child maltreatment be prevented?

That was the subject of a 60-minute virtual talk, on February 22, 2022, by Nicole Catherine, scientific director for the BC Healthy Connections Project and Christine Schwartz, adjunct professor with the Children’s Health Policy Centre.

They were speaking with just over 200 practitioners attending a virtual conference titled “A multidisciplinary approach to child maltreatment — a path to healing,” sponsored by the Vancouver-based Sophie’s Place Child & Youth Advocacy Centre.

Speaking on the prevalence, risks and outcomes of child maltreatment, Schwartz told the group that one in three Canadians has experienced some form of maltreatment in childhood and that the COVID pandemic has only increased the risk. “Families being isolated in their homes, especially during periods in which schools have been closed, have come at a great cost to children,” she said.

Schwartz also discussed a systematic review of maltreatment prevention programs, citing strong evidence that child maltreatment can be prevented. She also noted that, home-visiting programs, like Nurse-Family Partnership, “provide needed supports to address family socioeconomic disadvantage, promote parenting skills and help children flourish.”

Nicole Catherine then summarized the early results of a recent BC-based scientific evaluation of the Nurse-Family Partnership. Findings of the BC Healthy Connections Project have shown that Health Authorities successfully reached the population that the program is designed to benefit and that it helped reduce prenatal substance use. Findings on child maltreatment and developmental outcomes, as well as maternal life course are anticipated later in 2022.

“To prevent child maltreatment, we must invest in programs that start early, in pregnancy and ensure that we reach underserved children and families who can benefit the most,” Catherine said.

Preventing the pain of childhood mental disorders

What are the most effective interventions for preventing mental disorders in children?

That was the subject of a  30-minute Zoom talk, Oct. 2/21,  by Christine Schwartz, adjunct professor with the Children’s Health Policy Centre. She was speaking with 60 members of the Health Officers Council of BC — a group of public health physicians who are either practicing in or closely allied with public health.

Schwartz told the group that roughly 12 percent of children experience mental disorders but that only 44% of this group, less than half, receive any treatment. “One of the key ways of addressing this service shortfall is to reduce the number of children needing treatment by having a greater emphasis on prevention,” she said.  “There are effective prevention programs for eight of the most common childhood mental disorders.”

Schwartz also discussed two success stories centred on delivering prevention programs in BC.  This includes Preventure, a program that can prevent problematic substance use and Confident Parents Thriving Kids, a coaching program that helps prevent child behaviour problems and reduces anxiety.

Children’s mental health services need to substantially increase

An estimated one in eight children in high-income countries have mental disorders at any given time, causing symptoms and impairment, therefore requiring treatment. Yet even in countries such as Canada, most children with mental disorders are not receiving services for these conditions.

These were the conclusions of a systematic review and meta-analysis by the Children’s Health Policy Centre recently published in the journal Evidence-Based Mental Health.

The team looked at high-quality studies on 12 of the most common childhood mental health conditions. Overall prevalence of any childhood mental disorder — before the pandemic — was 12.7% with anxiety, ADHD, oppositional defiant disorder, substance use, conduct disorder and depression being the most common. Among children with mental disorders, only 44.2% received any services for these conditions.

The paper discusses the implications of these findings, particularly the need to substantially increase public investments in children’s mental health services. Most important is ensuring that all children with mental health conditions can access effective interventions — when they need them. The needs are likely even more urgent during the COVID-19 pandemic. But addressing the pre-pandemic levels of need is a crucial starting point.

The entire paper is available here.

Making research more useful for policymakers

What’s the role for research in terms of children’s mental health policy?

That was the subject of a recent 40-minute Zoom talk by Children’s Health Policy Centre director Charlotte Waddell on May 31. She was speaking with 25 doctoral and post-doctoral mentees and their supervisors from across Canada as part of a Pathways in Autism longitudinal study.

Waddell’s key message was that to effectively influence policy, researchers must first appreciate the policy process. “As researchers, we are faced with very different concerns than the ones that policy leaders must grapple with,” she said. “So, learning about the policy process is a crucial first step for researchers who want their work to be useful for policymakers.”

Waddell also discussed how policy engagement by parents of children with autism has acted as a constructive example — showing the way forward to significantly improve services for children.

Following her talk, Waddell also led a 20-minute session working through policy-research case studies and encouraging conversation.