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.

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.

Charlotte Waddell and Nicole Catherine both gave brief talks May 4, 2021, at the first student-organized research conference for SFU public health and health sciences students.

The aim of the three-day conference was to give students the opportunity to present their own research, and to hear about the research of others in the Faculty of Health Sciences.

Waddell spoke about improving social and emotional wellbeing for all children, and on the public policies needed to reach these goals. And Catherine spoke about her work with the BC Healthy Connections Project and its examination of the Nurse-Family Partnership program.

What interventions can best help children facing mental health concerns in BC right now?

That was the topic Christine Schwartz addressed on a March 30, 2021  Zoom presentation to more than 100 senior leaders and clinicians from the BC Ministry of Children and Family Development.

An Adjunct Professor with the Children’s Health Policy Centre and lead writer for the Children’s Mental Health Research Quarterly, Schwartz was also co-author of a paper on these interventions published in October 2020.

As a clinical psychologist, Schwartz told the group that there are numerous effective interventions for both preventing and treating the most common mental disorders experienced in childhood.

“Every child who needs an effective intervention should be able to get one that works,” she told the group. But she added, “there are a lot of children who aren’t being addressed or they’re being given ineffective interventions.”

Starting with the most commonly experienced mental health disorder, anxiety, Schwartz said there is excellent evidence that cognitive behavioural therapy (CBT) is effective at both prevention and treatment. CBT is also effective at both prevention and treatment for depression. And for behaviour disorders — such as conduct disorder or oppositional defiant disorder — parent training programs are effective for both prevention and treatment.

The full presentation can be viewed here.

Recommendations for public health surveillance relating to children’s mental health was the topic for Charlotte Waddell, the director of the Children’s Health Policy Centre, in speaking to students at the UBC School of Population and Public Health.

In her one-hour March 24, 2021 presentation, Waddell addressed the huge value of high-quality epidemiological studies, which give the most robust data on how well children are doing. These studies are robust because they tell us about all children, not just those who obtain services, or who sign up for studies.

What policymakers may do in the absence of such data, Waddell said, is rely on administrative data, such as records of physician visits. “The problem,” Waddell said, “is that most children with mental health problems don’t get any services at all so their needs are essentially unknown.” As well, families with greater economic means, may end up seeing private practitioners such as psychologists, but those data are not captured either.

The workshop suggested approaches for identifying and using high-quality epidemiological data to measure children’s mental health, worked through some case studies and included a lively question and answer session.

A longitudinal study of children with autism spectrum disorder from across Canada has shown that “doing well” is possible — even in the context of continuing to meet diagnostic criteria for the disorder. The Pathways study has been following children since they were first diagnosed — known as an inception cohort — and now is tracking children into their teens.

“These results support a strengths-based approach to treatment planning that should include robust support for children and youth and families to increase the likelihood of doing well,” the study concluded.

The paper was published March 29/21 in the Journal of the American Medical Association Open. Peter Szatmari from the University of Toronto is lead author. Charlotte Waddell, director of the Children’s Health Policy Centre, is also an author. She is a longstanding co-investigator with the team.

The paper can be viewed here.

Recently invited to deliver an international seminar about the British Columbia Healthy Connections Project, scientific director Dr. Nicole Catherine spoke to a group of researchers, policymakers and practitioners from around the world. Catherine began by describing the sustained research-policy-practitioner collaborations that support the 10-year Canadian scientific study of the Nurse Family Partnership (NFP) that is being conducted in BC in four Regional Health Authorities.

NFP was developed nearly 40 years ago by Dr. David Olds and colleagues in the United States, to help girls and young women and their children who are facing disadvantages such as low income. The program starts early — in pregnancy, before children are even born — and involves intensive home visits by public health nurses, continuing until children reach their second birthday.

The study is what Catherine described as a “robust” size, with 739 participants and their 727 children, with 200 of these mothers identifying as Indigenous. An analysis of participant characteristics at study entry, in early pregnancy, was published in 2019 showing that the trial reached pregnant girls and young women experiencing socioeconomic disadvantage (i.e., young age, preparing to parent while single, having limited income, having limited education).

Many (47–56%) had associated health and social adversities including unstable housing, a history of childhood maltreatment, or severe anxiety or depression. In fact, 90% were experiencing three or more adversities. “Our data show unacceptable rates of socioeconomic disadvantage for some BC girls and young women who are preparing to parent for the first time,” Catherine told the group. “NFP was designed to support these children and these young mothers.”

While the research interviews were completed in November 2019, analysis is continuing. Main outcome results showing how well NFP works in BC are expected to be announced in 2021/2022. In the meantime, two findings have already been identified.

• Prenatal findings published in the academic journal, Canadian Medical Association Journal Open suggest that NFP reduced the number of cigarettes smoked, for pregnant smokers — which is important, given that even low-level cigarette smoking is harmful to a fetus. NFP also reduced prenatal cannabis use, an emerging public health problem.
• The BC Healthy Connections Project achieved an outstanding participant retention rate (83%–91%) for the six research interviews conducted with each family starting in pregnancy and through until children reached aged two years. The study team successfully completed 4,000 in-person and telephone interviews over six years. This was especially encouraging, Catherine said, because girls and young women experiencing considerable disadvantage are often considered “hard-to-reach” by researchers and practitioners. The study team’s development and use of a standardized retention protocol helped them engage and retain this underserved population. “The onus is on us,” says Catherine. “It’s not that these families are ‘hard-to-reach’— it’s that we ‘need-to-reach’ them.”

The seminar was followed by a conversation with researchers, policymakers and practitioners in various countries around the globe currently considering, evaluating or implementing NFP. This list included Australia, Bulgaria, England, Northern Ireland, United States, Norway and Scotland. Videos from all presenters may be viewed here; Catherine’s presentation is third on the list.