Did You Know?

There are three effective interventions for reducing self-harm in young people: Dialectical Behaviour Therapy (DBT) and Mentalization-Based Treatment (MBT) as stand-alone programs, and Resourceful Adolescent Parent Program (RAP-P) as a supplementary program. For communities that have yet to adopt programs for youth who self-harm, DBT may be a particularly helpful place to start. But if effective treatments are already on offer, it may be helpful to supplement them with RAP-P. For more information, see Vol. 13, No. 3 of the Children’s Mental Health Research Quarterly.

Self-harm in young people has been correlated with a number of situations or conditions. Being female is a particularly strong correlate. In one systematic review, girls were noted to be 1.7 times more likely than boys to harm themselves. Another survey has found even more pronounced gender differences, with girls harming themselves at triple the rate of boys (24% vs. 8%). Other correlates of youth self-harm include:

• low socio-economic status,
• parenting problems,
• adverse childhood experiences (including child maltreatment),
• exposure to others harming themselves,
• concerns about sexual orientation,
• limited problem-solving skills, and
• mental health problems (including depression, anxiety and substance misuse).

In particular, researchers have found that being victimized is a particularly strong risk factor for self-harm — including being maltreated by parents, peers or siblings, and being a victim of cyberbullying or a crime. For more information, see Vol. 13, No. 3 of the Children’s Mental Health Research Quarterly.

May 3 marks the beginning of the 70th Annual Canadian Mental Health week and May 7 is National Child & Youth Mental Health day. The Children’s Health Policy Centre celebrates these important events and reminds all readers that research should be used to assist parents.  Behaviour problems, for example, account for as many as half of all referrals to children’s mental health services. So practitioners need effective approaches for addressing these problems. Parenting programs, such as Incredible Years, have strong evidence of success and should be readily available to families in need. For more information, see Vol. 10, No. 1 of the Children’s Mental Health Research Quarterly.

The name of the committee was a mouthful: The Regional Evaluation Advisory Committee. It’s abbreviated as REAC (and pronounced: ree-ack).

But its work was essential to the successful completion of a recent scientific evaluation of the Nurse-Family Partnership program (NFP) through the British Columbia Healthy Connections Project.

NFP is a program developed nearly 40 years ago in the US, but never before scientifically evaluated in Canada. The program helps girls and young women and their children who are facing disadvantages such as low income — aiming to reduce child maltreatment while also improving child mental health and development. 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.

REAC was the group of roughly 18 high-level public health managers — from the Fraser, Interior, Island and Vancouver Coastal Health Authorities — helping launch and implement the project in a “real-world” effectiveness trial. Other members included representatives from the BC Ministries of Health and Children and Family Development and the Children’s Health Policy Centre.

“We met every two weeks for many years,” recalls Dr. Nicole Catherine, the scientific director for the study. “It was a fantastic group of dedicated people helping trouble-shoot and overcome all the various project challenges we faced.”

The first challenge, back in 2012, was developing participant eligibility criteria for the study of NFP – criteria that were appropriate and efficient for nurses to use in screening potential participants over the phone. Criteria included, for example, young age or first-time pregnancy.

But challenges emerged early in the study when the Health Authorities had a hard time reaching and referring participants to the study. “When it launched we had slow recruitment as the prenatal referral systems were new,” Catherine says. “REAC worked to develop active recruitment strategies to reach those who could benefit from the NFP. The nurses would visit physician offices and schools. We fondly called it ‘pounding the pavement’.”

When research data collection wrapped up in 2019, REAC had achieved its goal and the group disbanded. Prenatal findings showing that NFP has positive effects on reducing substance use are already published. Additional main outcome results showing how NFP works in BC are expected in 2021/2022. Meanwhile, senior health authority officials are continuing to be involved in the study via the project’s Provincial Advisory Committee.

Self-harm affects a surprising number of young people. According to studies in representative samples, 11 to 28% of adolescents have reported harming themselves. As well, two BC studies provide information about local rates. A survey of nearly 40,000 youth from 58 school districts in this province have found that 17% reported engaging in self-harm in the past year. Similarly, a population-based survey of nearly 600 Victoria youth found that 17% reported harming themselves. For more information, see Vol. 13, No. 3 of the Children’s Mental Health Research Quarterly

Eating disorders can be prevented. In particular, young people can learn how to combat messages promoting thin ideals, improve their body image and stop unhealthy weight control practices such as dieting. These approaches in turn can reduce eating disorder symptoms. For more information, see Vol. 9, No. 2 of the Children’s Mental Health Research Quarterly

Even though bipolar disorder is a long-term condition, it can be managed. Once a careful diagnosis is made, there are two effective approaches for young people. One is medications. Aripiprazole and lithium reduce symptoms and improve overall functioning, although both cause side effects. The other approach is psychosocial. Three new family-focused programs, used together with medications, also reduce symptoms and improve functioning. For more information, see Vol. 13, No. 1 of the Children’s Mental Health Research Quarterly.

Created by the United Nations General Assembly, World Autism Awareness Day occurs on April 2 every year. Autism spectrum disorder refers to a group of complex neurodevelopment disorders. They are characterized by repetitive patterns of behaviour and difficulties with social communication and interaction. The symptoms are present from early childhood. Recently, Children’s Health Policy Centre director Charlotte Waddell, has been co-author of a new study on Autism Spectrum Disorder.  See full text of the article and a link to the study here.

At the launch of the BC Healthy Connections Project in 2011, a Provincial Advisory Committee was immediately set up.

Why? The purpose of this important group of roughly 50 people was to gain expert practice and policy advice to help guide the scientific study — examining the effectiveness of the Nurse-Family Partnership (NFP) program. Later, another purpose of the group was to provide an effective and efficient way of communicating trial updates and findings. And, today, this same group helps to guide the ongoing delivery of NFP, while awaiting trial results on exactly ‘how’ NFP works in BC (expected in 2021/2022).

“This group really gives us a sustained, active and reciprocal way to collaborate,” scientific director Nicole Catherine says noting that the team includes senior policymakers from BC government ministries such as Health, Children and Family Development, and Mental Health and Addictions as well as managers and directors from each of the four regional health authorities involved in the trial: Fraser, Interior, Island and Vancouver Coastal.

Other members in the group include representatives from the First Nations Health Authority, Métis Nation of BC, the Public Health Agency of Canada, the Provincial Health Services Authority, Perinatal Services BC, Child Health BC, and the BC Midwives Association.

While the group meets quarterly and has often gathered by phone (an especially useful principle during COVID), they held an in-person meeting in June 2015 where members gathered for what they called a “pre-mortem.”

“The idea was to make sure we could sustain the program and to boost its chances of success,” Catherine says. The object of the pre-mortem was to consider potential obstacles to the project and then develop ways to prevent them from occurring.

“Although the idea of a ‘pre-mortem’ might sound negative,” Catherine says, “it was actually the opposite. When you’re so focussed on succeeding, it’s easy to overlook small but important roadblocks. This exercise helped us avoid doing that.”

“For this, and for all the other work the committee has contributed, we are very grateful for the many people who have been so generous with their time to help ensure the success of this project,” Catherine says.

Researchers have uncovered some troubling trends in prescribing practices with young people. In BC and Manitoba, antipsychotics have commonly been prescribed for conditions such as ADHD — where these medications lack both research evidence and regulatory approval. To better support young people, antipsychotic prescribing should be limited to conditions for which there is good research evidence and regulatory approval, such as schizophrenia and bipolar disorder. For more information, see Vol. 7, No. 4 of the Children’s Mental Health Research Quarterly