A paper by the BC Healthy Connections Project team has just been published in the prestigious journal BMC Public Health.

This “baseline” paper provides a profile of participants in a BC-based scientific evaluation of the Nurse Family Partnership (NFP) program when they first entered the study, in early pregnancy. The paper reveals a group of girls and young women coping with substantial adversities. In addition to low income, most also face single parenthood, limited education, housing instability, severe anxiety or depression and experiences of maltreatment themselves when they were younger.

“Despite Canada’s public programs,” the paper concludes, “these pregnant girls and young women were not being adequately reached by social services. Our study adds new data to inform early intervention planning, suggesting that unacceptably high levels of socioeconomic disadvantage exist for some young British Columbians.”

The paper suggests that greater health and social supports and services are warranted for the young mothers and children involved, as well as for populations like them. The authors note that most of the adversities they have depicted are avoidable — with NFP being the starting point for prevention programming that can better support young families.

BMC Public Health is an open access, peer-reviewed journal, publishing articles on the epidemiology of disease and the understanding of all aspects of public health. The journal has a special focus on the social determinants of health, the environmental, behavioural, and occupational correlates of health and disease, and the impact of health policies, practices and interventions on the community.

A full copy of the paper may be seen here.

The BC Healthy Connections Project is continuing to follow these girls and young women and their children. Future reports will cover prenatal findings and the impact of NFP on child development and mental health when children reach age two years.

The Children’s Health Policy Centre has completed two companion systematic reviews — on childhood behaviour disorders and on childhood anxiety. Published in the journal Evidence-Based Mental Health these reviews outline effective interventions, including medications, across the entire prevention-to-treatment continuum. The bottom line from both reviews is that there is strong research evidence that we can prevent both behaviour and anxiety disorders in childhood, thereby averting much avoidable adversity early in life. There is also strong evidence that we can treat these disorders effectively, particularly making use of psychosocial interventions such as cognitive-behavioural therapy.

National Child and Youth Mental Health Day is being marked in Canada on May 7.

In honour of the day, the Children’s Health Policy Centre has timed the release of the 50th issue of its Quarterly publication about children’s mental health research. This celebratory edition is titled Celebrating children’s mental health: 50 lessons learned.

The purpose of the issue is to present effective interventions and all the “good news” we know about how to safeguard children’s mental health.

National Child and Youth Mental Health Day was started in 2007 by the Vancouver-based Institute of Families for Child & Youth Mental Health. It is intended to create awareness and acknowledgement of the thousands of children, youth, and families needing mental health support and care across Canada.

A major new child health study has just been released — the first Canadian study in 30 years to measure the prevalence of childhood mental disorders and associated service use, as well as changes in disorders over time and the role of social determinants. The Ontario Child Health Study was led by Michael Boyle and Kathy Georgiades at McMaster University and included more than 10,000 Ontario children. Children’s Health Policy Centre researchers also participated. Findings apply across Canada, including in BC. Here are the summaries of some of the papers just released in the Canadian Journal of Psychiatry. See https://journals.sagepub.com/toc/cpab/current. All articles are open access.

2014 Ontario Child Health Study Findings: Policy Implications for Canada

• 2014 OCHS is a 30-year report card on children’s mental health, showing that in Canada we need to do better.
• The main findings are: 1) prevalence of childhood mental disorders remains high; 2) service reach remains low; 3) needs have increased over the past 30 years; and 4) exposure to avoidable adversities (such as income disparities and violence) influences children’s mental health.
• Governance of children’s mental health services in Canada resides within provinces/territories and often spans healthcare, schools, early childhood education and children’s mental health and related services — making central expert leadership and planning crucial for improving children’s mental health in the next 30 years.
• Next steps include: 1) ensuring coherent policy leadership in each province/territory; 2) making and sustaining comprehensive children’s mental health plans that address both prevention and treatment; 3) ensuring the use of effective interventions; 4) reaching all children with mental disorders with innovative service approaches; 5) addressing avoidable childhood adversities; and 6) ensuring adequate and dedicated children’s mental health budgets. See: 2014 Ontario Child Health Study Findings: Policy Implications for Canada

Corresponding author: Charlotte Waddell, MD, FRCPC, University Professor, Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC

 Six-Month Prevalence of Mental Disorders and Service Contacts among Children and Youth in Ontario: Evidence from the 2014 Ontario Child Health Study

• 18–22% of children aged 4–11 years had at least one mental disorder. Behaviour disorders were the most common in younger children and anxiety disorders most common in older children; for those with disorders, only 26–34% had had contact with a mental health provider; however, 60% had had contact with providers in other settings, most often schools.

Corresponding author: Kathy Georgiades, PhD, Associate Professor, Offord Centre, Faculty of Health Sciences, McMaster University, Hamilton, ON

Changes in the Prevalence of Child and Youth Mental Disorders and Perceived Need for Professional Help between 1983 and 2014: Evidence from the Ontario Child Health Study

• The perceived need for professional help increased from 7% to 19% for 4–16-year-olds over the past 30 years — with increases in attention-deficit/hyperactivity for younger boys and in depression and anxiety for older boys and girls, but decreases in conduct disorder for older boys and girls.

Corresponding author: Jinette Comeau, PhD, Assistant Professor, Department of Sociology, Western University, London, ON

 Poverty, Neighbourhood Antisocial Behaviour and Child Mental Health Problems: Findings from the 2014 Ontario Child Health Study

• When children experience high levels of neighbourhood antisocial behaviour, those living below the poverty line are at much higher risk for behavioural problems; these children are also at higher risk for emotional and behavioural problems when they live in areas with greater socioeconomic inequities.
  Corresponding author: Michael Boyle, PhD, Professor Emeritus, McMaster University

You are invited to attend the Innovations in Research event hosted by SFU Public Square on April 10.

Innovations in Research is an evening event showcasing SFU researchers and innovators who are designing solutions to confront the disinformation age.

There will be a presentation showing how the Children’s Health Policy Centre prepares its Quarterly publication using systematic review and synthesis methods. This publication, which is produced in partnership with policy-makers from the BC Ministry of Children and Family Development, confronts disinformation to improve children’s mental health.

Innovations in Research will take place on Wednesday, April 10 from 7 to 9 pm at SFU Segal Graduate School of Business, 500 Granville Street, Vancouver, B.C.

Anyone wanting more information, is invited to visit the event website.

A recent video conference, focusing on an academic publication by the Children’s Health Policy Centre, ended up highlighting a unique partnership in B.C.

“I think it’s remarkable that you have such an integrated group of people who implement policy, who advocate for policy and who research policy,” said moderator Michael Ostacher, associate professor of psychiatry and behavioural sciences at Stanford University and digital content editor for the journal Evidence-Based Mental Health.

The one-hour discussion brought together the BC Ministry of Children and Family Development, represented by Rob Lampard, the BC division of the Canadian Mental Health Association, represented by Bev Gutray and the CHPC research team, led by Charlotte Waddell. She was joined by Christine Schwartz and Jen Barican from the CHPC.

Although the impetus for the event was publication of a systematic review of prevention and treatment of childhood behaviour disorders, the wide-ranging discussion touched on much broader issues and concerns.

Highlighted was the unique relationship between the CHPC research group and the BC government. “There’s been a relationship between [the CHPC and] the policy branch that goes way back to the early 2000s,” said BC Child and Youth Mental Health Policy Executive Director Rob Lampard. “The team has had a big influence on the public policy landscape. Their excellent work is part of a large fabric that’s been woven over many years.”

His positive views were echoed by BC division Canadian Mental Health Association CEO Bev Gutray. “It’s a great privilege to be part of this team,” she said, noting that she was particularly happy with her own group’s ability to launch an intervention called Confident Parents/Thriving Kids. An adaptation of evidence-based parent training developed in Oregon, the built-in-BC program is able to provide support to parents via the phone in evenings and on weekends. “We couldn’t have done this without the CHPC team,” Gutray said. “And the Ministry has been alongside us every step of the way,” she adds.

While emphasizing the value of systematic review work, CHPC director Charlotte Waddell also stressed the importance of being pragmatic. “It’s really important to avoid what some people have called systemic review nihilism,” she said. “We need to give policy makers something practical that will allow them to respond to kids’ needs.”

Anyone wishing to view the video conference can see it here.

You are invited to attend a Google Hangout on preventing and treating childhood behaviour disorders, Sept. 5 at 8 am Pacific time.

Attending the event will be a team of people from the Children’s Health Policy Centre, including the director and child psychiatrist, Charlotte Waddell, clinical psychologist and scientific writer Christine Schwartz and research manager Jen Barican. The CHPC has authored a publication for the journal Evidence-Based Mental Health, which is the organizer of the hangout.

Also attending the event will be representatives of the Canadian Mental Health Association, the BC government, Oxford University and Stanford University.

Oppositional defiant and conduct disorders start early and persist, incurring high individual and collective costs. The panel of experts will discuss the best available research evidence on preventing and treating these disorders, following their recent systematic review. The review will provide a starting point for wide ranging discussion and debate, including consideration of the implications of the evidence for policy and practice.

To join the event go to YouTube at https://bit.ly/2wmos51.

Representatives from the Children’s Health Policy Centre were proud to address the 50th Annual Banff International Conference on Behavioural Science, March 18 to 21, 2018. The theme was, “What are Ideal Children’s Mental Health Services?”

CHPC director Charlotte Waddell (adjacent), delivered the closing plenary address on the topic, “Improving Children’s Mental Health: The Policy Opportunities in Canada.” In her 50-minute presentation, Waddell covered a host of topics for the broad-ranging audience that included everyone from well-known academics to graduate students.

Waddell’s key messages included five points:

• It’s important not to focus on one age group at the expense of others. The responsibility facing children’s mental health policymakers encompasses all young people from before birth to early adulthood.

• There are considerable challenges in providing services for all ages and all disorders. “We are currently reaching only 30% of children with mental health disorders,” Waddell said, citing a recent systematic review the CHPC prepared.

• We shouldn’t fall for the argument that there’s not enough money. “Canada spends a lot on healthcare, but if we look at current Canadian spending, most of it is going towards older Canadians,” Waddell said. “We need to have a public conversation about that.”

• It is possible to change spending patterns. This has been demonstrated by spending on autism where funding has increased tenfold over the last 10 years. “It’s a terrific success story for one mental disorder,” Waddell says, adding, “We can learn from that.”

• We need to triple spending on children’s mental health. “That goal is entirely reasonable,” according to Waddell. She adds that new spending should cover both prevention and treatment, and should go towards effective or proven interventions.

Earlier in the conference, the CHPC team also delivered a three-hour workshop titled, “Research-policy partnerships in children’s mental health: Lessons from British Columbia.” In it, Nicole Catherine spoke about her experience as Scientific Director and Co-Principal Investigator of the BC Healthy Connections Project, the first Canadian randomized controlled trial evaluating the Nurse-Family Partnership (NFP) program.

Developed nearly 40 years ago by David Olds and colleagues in the US, NFP starts in early pregnancy, before children are born, and involves intensive home visits continuing until children reach their second birthday. The program particularly focuses on girls and young women and their children who are facing disadvantages such as low income.

The BC Healthy Connections Project trial involves close collaborations with BC policymakers in the Ministries of Health and Children and Family Development and in four participating regional Health Authorities. Some 744 children are being reached through the trial, with final results expected in 2020–2021.

In the same workshop, Christine Schwartz spoke about the Children’s Mental Health Research Quarterly, describing a longstanding research-policy-practice partnership with BC’s Ministry of Children and Family Development. She highlighted the methods used to convey research evidence to policymakers, as well as to practitioners and families.

These methods include preparing systematic reviews of evidence on prevention and treatment interventions across a wide array of childhood mental health problems. Evidence is then prepared in user-friendly formats, published free on line, in the Quarterly. Topics are chosen in consultation with policy partners and each issue is accompanied by talks.

The BC child and youth mental health budget should be tripled to ensure help for the estimated 70 per cent of young people with mental disorders who currently receive no effective treatment, according to Charlotte Waddell, director of SFU’s Children’s Health Policy Centre.

Waddell shared her views in an article published recently in the Vancouver Sun.

The system needs more interdisciplinary teams, including psychologists, nurses and social workers, to be available in communities where children live, according to Waddell. But instead, budgets for these services, which are provided for all BC children through the Ministry of Children and Family Development’s Child and Youth Mental Health Branch, have been steadily eroded over the years.

Waddell also said that some common childhood disorders — such as anxiety, behaviour problems, substance misuse and depression — could be avoided if society invested in more preventive programs. There are many such programs that are effective and that can be delivered, in family homes and in schools. (For examples, please see the Centre’s recent publication on preventing childhood depression as well as one on preventing anxiety in children.)

Waddell noted that budgets for autism in both B.C. and Ontario have increased 10-fold over the last decade, mostly due to effective lobbying by parents of autistic children. The same has not been true for budgets for other childhood mental disorders, she said. But these increases for children with autism show that increases are possible.

The story, which ran under the headline “Not enough services for mentally ill kids, says family of struggling boy,” was published in the Dec. 1/17 issue of the Vancouver Sun. A follow-up story appeared on Dec. 4/17 under the headline, ” A mother’s plea: Save unique Richmond school that helped her 7-year-old mentally ill son.”