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.”

Funding for childhood mental health in BC should increase three-fold to reach all children with mental disorders. That was one of the key messages from child psychiatrist and CHPC director Charlotte Waddell, in speaking at B4Stage4 event in Victoria, November 29.

Sponsored by the Canadian Mental Health Association, B4Stage4 is a campaign highlighting the difference between cancer and mental health care in Canada. “We don’t wait until stage 4 to intervene for cancer, so why do we wait to treat mental illness and addiction,” the website reads.

In her plenary talk, Waddell delineated the numbers for BC:

• Some 84,000 children ages four to 17 — or nearly 13% of children — are estimated to have mental disorders at any given time

• But only 30 % receive the specialized treatment they need

•This means that some 70% — about 58,000 — are not being treated

Waddell emphasized that it is unthinkable that we would ask 70% of BC children with cancer to go without treatment. So we can no longer allow this to continue for children with mental health problems.

Waddell also pointed out that five of the most common mental-health conditions in children and adolescents — anxiety disorders, attention-deficit/hyperactivity disorder, substance misuse, conduct disorder and depression — are also preventable. More information about Waddell’s talk is available in an article in the Times-Colonist.

In marking the May 15 United Nations International Day of Families, the Simon Fraser University website presented a profile of the Children’s Health Policy Centre and its director, Charlotte Waddell.
The story began…
The theme for this year’s International Day of Families on May 15th is “Families, healthy lives and sustainable future,” with a special emphasis on the most vulnerable members of society: children.
At SFU’s Children’s Health Policy Centre, every day is devoted to enhancing children’s social and emotional wellbeing. Its work is guided by the central question, “What are the most effective ways to ensure that every child can flourish and participate?” 
Dr. Charlotte Waddell, the Centre’s director, believes passionately that society should invest in providing all children with the best possible start in life. Mental health problems are like the tip of an iceberg…. (see more)

“For the One and the Many,” is the title of talk given by Children’s Health Policy director, Charlotte Waddell.

Delivered in March 2016 to practitioners at BC Children’s Hospital and in April 2016 to managers at the BC Ministry for Children and Family Development, the talk focuses on the mental health challenges facing many young people in British Columbia today.

In addition to examining the prevalence of various disorders — ranging from anxiety to substance misuse to autism — the talk also tracks health spending in Canada, showing how children’s mental health programs are languishing, even as overall health spending rises. As well, the talk explores effective prevention programs and new alternatives for children such as the Nurse-Family Partnership program.

A complete slide show for the talk may be viewed here.

Nurse-Family Partnership (NFP) — a program aimed at improving the health and development of disadvantaged children — has shown an impressive record in the US for more than 30 years.

In long-term studies in Elmira, New York, Memphis, Tennessee and Denver, Colorado, it improved parenting, improved children’s behaviour and learning, and helped mothers achieve economic self-sufficiency, among other benefits.

Now NFP is being tested in other countries and the results are starting to appear. Results in BC — where NFP is being tested for the first time in Canada — won’t be available for several years. But meanwhile, researchers in the Netherlands have also had positive findings.

As reported in three peer-reviewed journal articles in Midwifery and PLOS ONE, the program has been shown to reduce prenatal smoking, increase breastfeeding, and improve child and family safety.

As the Dutch authors observed: “The results of this randomized controlled trial…corroborate the positive effects of this type of intervention that have been shown in NFP trials conducted in the US.”

In England, on the other hand, NFP has not shown the same impact.  In fact, the Lancet has just published an article outlining limited benefits for children and families who received Family-Nurse Partnership (the UK-adapted version of NFP) compared with existing services.  There, researchers studied prenatal nicotine use, subsequent pregnancies at 24 months postpartum, infant birth weight and child emergency room encounters for all causes. The Lancet has also included a commentary on the English findings by David Olds, NFP’s founder.

Charlotte Waddell, who is the co-principal investigator for BC’s NFP evaluation, says, “Every country is different.  For example, public health spending and other kinds of social supports vary a lot, which can influence how effective a new intervention may appear to be.”

“But this is exactly why we’re conducting a trial in BC — to learn how well NFP works in BC and Canada,” Waddell says.

As to whether the effort and expense of this kind of evaluation is worth it, Waddell has no doubts. “Our aim is to improve the lives of children in BC.  This trial is the best way to find out if NFP should be an important part of this.”

To read the three articles on the Dutch trial results please see the following:
Science Direct
Plos One: 2015
Plos One: 2013

To read the article on the English trial results please see the Lancet.

To read David Olds’ commentary on the English trial results please see his article in the Lancet.

The English Family-Nurse Partnership Unit has also posted a response on their website.

The Children’s Health Policy Centre has just finished a national qualitative study looking at the singular influence of parents of children with autism on the policy process in Canada – and the lessons to be learned in improving services for children with other kinds of mental health and developmental difficulties. Full text of this article is available here.

Dr. Nicole Catherine has been appointed Mowafaghian University Research Associate with SFU’s Children’s Health Policy Centre. She is also Scientific Director for the BC Healthy Connections Project and Adjunct Professor in the Faculty of Health Sciences at SFU.

Dr. Catherine completed her BSc in pharmacology at Dundee University, Scotland, followed by an MSc in nutritional sciences at the University of Toronto. She received her PhD in educational psychology at UBC, studying the neurobiology of social support and child behaviour. Before joining the Children’s Health Policy Centre, she was a post-doctoral fellow in psychology at SFU, studying the neurobiology of adolescent development. She has more than 10 years of experience leading randomized controlled trials.

Funding for this University Research Associate position is made possible by the generous support of the Mowafaghian Foundation, which aims to better the lives of children through health and education.