Did You Know?

It is always crucial to reach and support children and families who are coping with multiple adversities — those we “need-to-reach”. Yet many are defined by researchers, policymakers and providers as “hard-to-reach” and therefore are underserved.

A new report by the Children’s Health Policy Centre — funded by the BC Representative for Children and Youth — addresses the issue of reaching underserved children and families. This report arises out of work conducting the Canadian randomized controlled trial evaluation of the Nurse-Family Partnership in preventing child maltreatment and improving healthy child development.

The Centre’s study team found that investing resources in  sustained respectful engagement helped more families to participate in the six planned research interviews. Participants showed the team that making frequent contacts and using texting were the most effective approach for reaching young families. As well, the team invested in significant training and support for its researcher staff. These strategies helped the Children’s Health Policy Centre achieve its goal of having more than 80% of families complete the study interviews after 2.5 years of their participation.

Full text of the report is available here.

In order to help mitigate the mental health consequences of COVID-19, BC should invest in increased prevention and treatment for children in the early years (prenatal to age three years) according to a report authored by the Children’s Health Policy Centre.

Sponsored by the BC Office of the Representative for Children and Youth, the report cites high-quality research evidence on effective psychosocial interventions for preventing and treating three of the most common mental health conditions that start in early childhood:

• anxiety
• attention-deficit/hyperactivity disorder (ADHD)
• and behaviour disorders

The report found strong evidence supporting cognitive behavioural therapy for anxiety. It also found strong evidence supporting parent training for child behaviour problems and ADHD.

Says the report: “There is ample evidence to act on — starting with early childhood anxiety and behaviour programs, where the research evidence is strongest. Prevention, in particular, is also cost-effective. For example, preventing just one case of a severe childhood behaviour disorder can save millions of dollars in averted lifetime costs. Investments in effective prevention programs in early childhood can therefore benefit not only children and families, but also society.”

The full report and details on all the programs cited may be found here.

Families seeking help for children with substance use issues may benefit from a program called Substance Use Prevention for Girls. The program made a substantial impact, showing positive outcomes on all relevant measures. Specifically, intervention girls used less alcohol, less cannabis and fewer medications for non-medical purposes at one-year follow-up compared to controls. The success of the program may be linked to the fact that nearly 100% of all mother-daughter pairs completed all nine program modules. Another program, MobileCoach Alcohol, significantly reduced binge drink among youth by the end of the three-month follow-up. Specifically, the odds of not engaging in risky alcohol use were 1.6 times higher for youth who received MobileCoach Alcohol compared to controls. For more information see Vol. 14, No. 1 of the Children’s Mental Health Research Quarterly.

The book Feeling Good details cognitive-behavioural strategies for reducing depressive symptoms. Written at a high-school reading level, the book guides readers to challenge unrealistic negative thinking and to increase their positive and productive activities. A study showed the book effectively prevented the development of depressive episodes for youth at two-year follow-up. In fact, youth who had been randomly assigned to read the book had eight times lower odds for developing depression compared with controls. For more information see Vol. 14, No. 1 of the Children’s Mental Health Research Quarterly.

Addressing childhood anxiety does not always involve working with a mental health practitioner. In fact, a video game called MindLight successfully helped children manage anxiety by using deep breathing and positive self-talk.  A randomized controlled trial found that MindLight was as effective as in-person group cognitive-behavioural therapy, according to child and parent ratings of children’s anxiety at six-month follow-up. For more information see Vol. 14, No. 1 of the Children’s Mental Health Research Quarterly.

Families seeking help for children with behaviour problems may benefit from a program known as Triple P Online with Telephone Support. A rigorous evaluation found this program led to improvements in child behaviour and reduced frequency of child disruptive behaviours. These findings were not only statistically significant, but also clinically meaningful. Parent satisfaction was also significantly higher with telephone support than without it. For more information see Vol. 14, No. 1 of the Children’s Mental Health Research Quarterly.

Beyond underfunding for children’s mental health services, additional barriers impede prevention efforts from reaching all those in need. These include:

• Lack of individuals in rural communities with experience delivering prevention programs.
• In Indigenous communities: staff shortages, high staff turnover, and interventions that fail to incorporate Indigenous perspectives and approaches.
• Prevention services delivered in inconvenient settings or at inconvenient times.
• Fear of stigmatization.

When children and families do enrol in prevention programs, other barriers can prevent them from fully benefiting. Studies have found that up to 80% of children and families do not complete mental health interventions. This issue is most likely to occur with children from families in low-income neighbourhoods. For more information see Vol. 14, No. 1 of the Children’s Mental Health Research Quarterly.

The United Nations’ Universal Children’s Day, which was established in 1954, is celebrated on November 20 each year to promote international togetherness and awareness among children worldwide. UNICEF, the United Nations Children’s Fund, promotes and coordinates this special day, which also works towards improving children’s welfare.

The original text promoting this special day reads:

• The child must be given the means requisite for its normal development, both materially and spiritually
• The child that is hungry must be fed, the child that is sick must be nursed, the child that is backward must be helped, the delinquent child must be reclaimed, and the orphan and the waif must be sheltered and succored.
• The child must be the first to receive relief in times of distress.
• The child must be put in a position to earn a livelihood and must be protected against every form of exploitation.
• The child must be brought up in the consciousness that its talents must be devoted to the service of its fellow human beings.

But in a report published earlier this year in the journal Evidence-Based Mental Health,  the Children’s Health Policy Centre estimated that one in eight children have mental disorders at any given time, causing symptoms and impairment, therefore requiring treatment. Yet even in high-income countries, most children with mental disorders are not receiving services for these conditions. The report discusses the implications for this situation, particularly the need to substantially increase public investments in effective interventions. It also discusses the policy urgency, given the emerging increases in childhood mental health problems since the onset of the COVID-19 pandemic.

Readers can get access to the report, here.

Effective prevention programs are particularly crucial to reduce the number of children in Canada needing mental health treatment services. Yet despite growing research evidence on effective programs, prevention efforts remain modest in many jurisdictions. This is not necessarily due to a lack of resources. Overall, between the government, insurance and individual citizens, Canadians spend an estimated $254 billion on health annually, or about $6,800 per person. But less than 6% of this spending goes toward public health, including prevention — with even less going toward the prevention of childhood mental disorders. For more information see Vol. 14, No. 1 of the Children’s Mental Health Research Quarterly.

An estimated 13% of children and youth in Canada have mental disorders at any given time, and most do not receive mental health care. Therefore, many more young people need to be reached. Taking a comprehensive public health approach is the best strategy for meeting these needs. Such a strategy involves addressing social determinants of mental health, including avoidable adverse childhood experiences; promoting healthy development for all children; preventing mental disorders in children at risk; providing treatment for all children with mental disorders; and monitoring outcomes. For more information see Vol. 14, No. 1 of the Children’s Mental Health Research Quarterly.