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.

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.

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.