The Children’s Health Policy Centre has taken on a new research project to comprehensively estimate children’s mental health needs in BC and recommend how they can be met. The BC Ministry of Children and Family Development (MCFD) has requested this effort, to inform new services for children’s mental health.

This project will inform needs-based planning by:

• Reviewing the latest epidemiological data on the prevalence of the 10 most common childhood mental disorders
• Summarizing the best evidence on exemplary prevention and treatment interventions for young people
• Examining public datasets that can be used to track children’s mental health outcomes going forward, and
• Synthesizing prevalence, intervention and public data evidence to suggest a comprehensive plan for BC

Led by BC MCFD’s Child and Youth Mental Health Policy Branch, a cross-governmental policy advisory group for the project includes senior representatives from the:
• BC Ministry of Mental Health and Addictions (co-sponsor)
• BC Ministry of Health
• BC Ministry of Education
• First Nations Health Authority, and
• Métis Nation of BC
Other policy collaborators are also being consulted as needed.

The CHPC team is being led by Charlotte Waddell, Christine Schwartz and Nicole Catherine — together with Jen Barican, Donna Yung and Yufei Zheng. Additional scientific collaborators include Kathy Georgiades from McMaster University and Bohdan Nosyk and Emanuel Krebs from Simon Fraser University.

This project is being conducted from 2019 through 2021.

A significant percentage of very young mothers in BC are coping with low income, poor education and mental health challenges. These were the issues highlighted by Katie Hjertaas, Ange Cullen and Charlotte Waddell speaking at SFU Vancouver’s inaugural Lunch ‘n’ Learn event, Feb. 6,  on the topic Improving Children’s Lives Through Research.

This new series of lunch hour sessions showcases how SFU’s Vancouver research is making a positive difference in society.

Hjertaas, Cullen and Waddell came to their understanding of the challenges facing very young mothers in part through working on the BC Healthy Connections Project (BCHCP). This randomized controlled trial aims to assess Nurse-Family Partnership (NFP), an intensive, home-based nursing program for very young mothers and their children. NFP runs throughout pregnancy and the child’s first two years of life.

The talk showed that the 739 girls and young women in the study were coping with daunting challenges when they first enrolled:

• 83% were living on less than $20,000 per year
• Half were coping with not having grade 12 or equivalent, and those still in school had their education interrupted by pregnancy
• Many experienced housing instability
• 74% were coping with mental or physical health problems that affected their daily activities
• 56% reported experiencing maltreatment when they were children themselves.

Findings from this study are already informing public health policy locally, nationally and beyond — with more reports to come, particularly on how NFP can benefit children.

The Children’s Health Policy Centre marked the closure of research interviews for the BC Healthy Connections Project, its randomized controlled trial assessing the Nurse-Family Partnership program, with a celebration on Dec. 10.

The trial, which is sponsored by the BC government, involves 739 young mothers and their 744 children. Nurse-Family Partnership is a landmark public health program that begins even before children are born. It involves intensive home visits by nurses, which continue until children reach their second birthday. Program outcomes will be compared with BC’s existing health and social services to learn how we can better improve children’s mental health and development.

Above, CHPC director Charlotte Waddell is shown with SFU’s Dean of Health Sciences Tania Bubela, cutting a cake. Also attending was the Scientific Director and Co-Principal Investigator for the BC Healthy Connections Project (BCHCP) Nicole Catherine and many members of the BCHCP team from over the past eight years.

Guests of honour included BC’s former Provincial Health Officer, Perry Kendall, the Executive Director of BC’s Public Health Services, Kim Bruce and BC Ministry of Health Nurse-Family Partnership Provincial Coordinator Donna Jepsen.

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