Updates

“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.

Tens of thousands of BC’s young people are experiencing mental health problems every year but fewer than a third of them actually receive treatment. That was the stark message from the Director of SFU’s Children’s Health Policy Centre to the Members of the Legislative Assembly of BC on the Select Standing Committee on Children and Youth.

“About 13 percent of kids are experiencing one or more mental disorders,” said Charlotte Waddell, who also holds the Canada Research Chair in Children’s Health Policy. “That means the total population affected is about 84,000 in BC at any given time, and about 678,000 in Canada. And we’re serving fewer than one-third of them,” she said. That translates to about 26,000 children and youth in BC and 212,000 in Canada.

Waddell presented her evidence to the committee June 11, 2014, when it was meeting in Vancouver as part of a special project examining youth mental health.  Part of the committee’s mandate is to foster greater awareness and understanding of the BC child and youth service system.

In presenting her report, Waddell emphasized that most mental health problems start well before adulthood and, in fact, many start well before adolescence.

In the very early years, autism, anxiety, disruptive behaviours and attention-deficit/hyperactivity disorder emerge. In the middle years, seven to 12, anxiety, depression and conduct disorder begin to appear. Then, in the teen years, substance use, bipolar disorder, eating disorders and schizophrenia can take hold, Waddell said.

“Unspeakable losses and unspeakable severity are what we’re talking about,” she said. “If we don’t intervene and if we don’t intervene effectively these disorders persist, and they carry on throughout adulthood.”

As a result, young people may not finish school and may not even be able to participate in the workforce. They also have increased physical health problems, and “early mortality is significantly increased in people with mental health problems,” she said. The impact on society is also very serious, with costs exceeding $50 billion annually in Canada.

A large part of the problem, Waddell said is that Canada may spend $200 billion annually on health — but little of that goes to children and youth.

“I cannot imagine anyone saying that it was acceptable to have only 30 percent of kids with cancer receiving treatment when we had a host of effective treatments,” Waddell said. “But that’s what we’re doing with mental health problems.”

Waddell concluded by making five recommendations to the committee:

• Acknowledge that mental disorders start at the beginning of life and provide a comprehensive range of evidence-based interventions at each stage of development, starting in early childhood.
• Triple investments in evidence-based treatment services to reduce symptoms and impairment among all children and youth with established mental disorders.
• Make equivalent investments in evidence-based prevention programs to reduce both prevalence and the need for treatment services over time, starting with the four most common preventable disorders (anxiety, substance use, conduct and depressive disorders).
• Evaluate all treatment services and prevention programs to ensure they are effective.
• Invest in new data collection to monitor the prevalence of child and youth mental disorders over time.

“Investments in the mental health of young people are among the most important investments that any of us can make,” she told the committee.

A copy of Waddell’s slide show can be seen here. A copy of the report she tabled is available here.