Did You Know?

The art of saying “thank you” may be more usually associated with social interactions but for Nicole Catherine and her colleagues with the BC Healthy Connections Project, it’s an important part of science as well.

Catherine and senior research coordinators Katie Hjertaas and Ange Cullen are soon to begin contacting all 739 participants in the multi-year study to let them know what an extraordinary contribution they have made.

The scientific study is examining whether an intensive nurse home-visiting program for young first-time moms can improve child health and development. Pregnant girls and young women living across four regional BC Health Authorities generously agreed to participate in six research interviews during pregnancy and through until their child’s second birthday. In total, families contributed to an impressive total of 4,000 research interviews involving eight million data points on mothers’ life experiences and the experiences of their children.

Their voices, as heard through the survey data, are informing new policies and efforts to support similar girls and young women and their children. “They demonstrated strength and resilience in connecting with public health early in their pregnancy, and in agreeing to participate in a long-term research study,” Catherine says. “What’s even more remarkable is that they did this while coping with other issues in their lives,” she added. Some 91% of participants were preparing to parent while single and 49% were adolescents.

In making this outreach, the study team will share some positive prenatal findings and let families know that they will be contacted in the near future to be invited to participate in a longer-term follow up across childhood and adolescence.

Recent news from a similar study in England has shown positive results in a follow-up study conducted when children were age 7. Children of nurse-visited mothers in that country showed better school readiness at age 5 and better reading achievement at age 7.

BC is proclaiming May 23 to 29, 2021, as Anti-Racism Awareness Week – a chance for British Columbians to celebrate and learn about B.C.’s diverse culture, reflect on biases and stand together against racism.

“We stand alongside every person who has faced, or continues to face, racism in our province,” said Attorney General David Eby. “This week is a chance for all British Columbians to think about how we can be anti-racist, challenge our own biases and build a stronger province on a foundation of diversity and mutual respect.”

The dates were chosen because the anniversaries of the Komagata Maru, the murder of George Floyd and Asian Heritage Month are all this week.

Co-incidentally, the next issue of the Children Health Policy Centre’s Quarterly publication will focus on the topic of anti-racism interventions. It is scheduled to be released July 21/21.

For some young people, self-harming behaviours may come to an end when treatment does. For others, however, these behaviours may re-emerge in the future. It may be helpful for practitioners to reconnect with youth after treatment ends to determine whether follow-up support is needed. For more information, see Vol. 13, No. 3 of the Children’s Mental Health Research Quarterly.

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.