Did You Know?

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

When problematic substance use is prevented, the benefits extend beyond helping young people and their families. Society also benefits, including financially. In particular, net benefits for effective skill-based programs were an estimated $160 to $1,850 dollars per youth. For more information, see Vol. 4, No. 2 of the Children’s Mental Health Research Quarterly

Eating disorders can be effectively treated. For youth with anorexia, Family Therapy is the first choice. For those with bulimia, both Family Therapy and Cognitive-Behavioural Therapy (CBT) show positive results. And for those with binge-eating disorder, CBT is also highly effective. All young people with eating disorders should be easily able to receive these effective treatments. For more information, see Vol. 9, No. 3 of the Children’s Mental Health Research Quarterly

The original anti-bullying day was established in Canada in 2007 when two Nova Scotia teens bought and distributed 50 pink shirts after a male ninth grade student was bullied for wearing a pink shirt during the first day of school. The last Wednesday in February — this year, Feb. 24 — is now the national anti-bullying day in the country. A focus on self-regulation — including paying attention and inhibiting impulsivity — is crucial for healthy child development and a step in reducing bullying. Parents can promote this skill by being responsive to their children, providing positive feedback during challenging tasks, and supporting older children and teens to be more autonomous. For more information, see Vol. 10, No. 4 of the Children’s Mental Health Research Quarterly

When the BC Healthy Connections Project announced its first results, via a paper in the Canadian Medical Association Journal Open, researchers were pleased.

The study had shown that the program being examined — Nurse-Family Partnership — reduced the number of cigarettes used by smokers during pregnancy and reduced prenatal cannabis use for all participants.

But, then, a nurse spoke to a member of the BCHCP steering committee. “Is this a good news story?” she asked.

“At first, this question took me aback,” says Nicole Catherine, Scientific Director of the project. “We knew it was a good news story — a positive result — but then we realized that the tone required by academic journal publication is so low key, that our communications needed to be refined for sharing with our policy and practitioner partners.”

Catherine says she was grateful to get this feedback thanks to the group’s steering committee, a seven-member board established in 2012 and involving a sustained and reciprocal research-policy-practice partnership.

Members include senior policymakers from the BC Ministry of Health, the Ministry of Children and Family Development and the Ministry of Mental Health and Addictions, as well as senior scientific team trial leaders.

At the start, the committee met every two weeks (via teleconference) addressing crucial issues such as study design, eligibility criteria and the interpretation of mixed trial findings from the Netherlands and England.

As the trial continued, meetings dropped to once monthly, providing advice on recruitment closing, data collection completion and communicating the positive prenatal trial findings.

Now, the group meets every two months, continuing to provide valuable advice and feedback as the scientific team continues with the primary outcome analysis, relating to reducing childhood injuries.

“We are very grateful to all members of the steering committee for their continued involvement in this important project,” Catherine says.

Most LGBTQ+ youth successfully navigate adolescence and thrive as adults. Yet everyone around these young people can help create conditions that further ensure they flourish. For instance, schools can use gender-neutral language, model acceptance, be aware of LGBTQ+ issues and create positive environments. For more information, see Vol. 11, No. 2 of the Children’s Mental Health Research Quarterly.

Most children spend more than a third of their waking hours in school. So, beyond academics, schools as a venue have tremendous mental health potential. For example, students in schools with safe environments, including high levels of peer and teacher support, have a lower risk for depression. For more information, see Vol. 8, No. 4 of the Children’s Mental Health Research Quarterly

The COVID-19 pandemic has killed more than two million people worldwide, put extraordinary pressure on mental health (especially that of children), and affected the financial wellbeing of frontline workers — cleaners, grocery store clerks and other essential services.

But it also has an impact on other areas, including that of researchers. The BC Healthy Connections Project (BCHCP) — a scientific evaluation of the Nurse-Family Partnership program (NFP) — has been fortunate that the pandemic has resulted in only minimal effects.

“We are lucky that all of our in-person work was finished before the first lockdown, says BCHCP Scientific Director Dr. Nicole Catherine, referring to the order by Dr. Bonnie Henry in March 2020. “If this pandemic had occurred before we’d been able to complete our in-person research interviews with children, our data would have been seriously affected.”

While some of the visits to study participants could have been conducted by phone, observing the cognitive skills of children would have been close to impossible.

The study — a randomized controlled trial — was launched in October 2013. The study team followed 739 families until all 737 children had reached their second birthday, by November 2019.

The aim of the study is to determine how NFP, an intense nurse-visiting program for young, disadvantaged families, compares with existing health and social services in British Columbia.

Upon notice of the first lockdown, researchers at Simon Fraser University began working from home. Similar to other researchers around the world, they met via Zoom or telephone. Team members could get access to some protected data only by going into their offices and they received special permission to do that, from time to time.

Since the start of the pandemic, the team has published a paper in the Canadian Medical Association Journal Open, showing that delivery of NFP led to a reduced prenatal use of cannabis and, a modest reduction in cigarette use by smokers.

The team is continuing to analyze the data, currently looking at whether NFP has reduced childhood injuries, as well as improving child mental health and development by age two years. “We will know the results later this year,” Dr. Catherine says.