Did You Know?

While there are effective self-delivered treatment options for some of the most common childhood mental disorders, they are used by a relatively small number of children. These findings suggest four implications for practice and policy.

1. Expand the number of children being reached by self-delivered treatments. Some children can greatly benefit from self-delivered interventions, even becoming disorder free. Greater use of these interventions can expand the number of children who are reached with effective treatments.
2. Provide more support to those with greater needs. Some children and families have needs that cannot be met by self-delivered interventions, such as youth who are suicidal. As well, the ability of children and families to implement interventions without the support of a practitioner will vary. Families who are more disadvantaged may require extra supports, such as telephone coaching, to fully benefit from self-delivered interventions.
3. Increase the availability of other effective self-delivered treatments. Beyond the successful self- delivered interventions described above, there are others that are not yet available in Canada. Consequently, additional investments in getting effective self-delivered interventions into the hands of Canadian children may increase treatment options.
4. Build on the research to create new self-delivered treatments. We did not find any effective self- delivered treatments for two of the five most common childhood mental disorders — substance use and conduct disorders. Creating new and effective treatments for these disorders too could benefit many young people and their families.

Research evidence supports using self-delivered treatments as part of the continuum of care for childhood mental disorders. Including these interventions in service planning can make it possible to reach more young people in need. For more information, see Vol. 14, No. 2 of the Children’s Mental Health Research Quarterly.

April 2 marks the twelfth annual World Autism Awareness Day. Hundreds of thousands of landmarks, buildings, homes and communities around the world will shine with blue light in recognition of people living with autism.

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. Children’s Health Policy Centre director Charlotte Waddell, has been co-author of a study on Autism Spectrum Disorder.  See full text of the article and a link to the study here.

Leap, now called BreathingRoom, focused on teens aged 13 to 18 with depression. The program used mindfulness techniques, including increasing forgiveness, gratitude and compassion while also reducing negative thinking, loneliness and boredom. Teens completed the eight internet-based modules within two months.

The Leap study assessed depression severity at the end of treatment. For intervention youth, severity of depression was significantly reduced compared to controls. Even so, the average depression severity score for Leap youth was still within the range of scores typically experienced by depressed young people. So some young people may still need the support of a practitioner even after trying a self-directed intervention. For more information, see Vol. 14, No. 2 of the Children’s Mental Health Research Quarterly.

Parenting the Active Child, now called Parents Empowering Kids, focused on children aged eight to 12 with ADHD. This program aimed to help parents notice and reward good behaviour; ignore challenging behaviours (such as whining and complaining); use time outs effectively; prepare children for transitions; and collaborate with schools. Parents were given a handbook, a video and a behaviour chart, which were supplemented with weekly telephone sessions with a coach. Parents completed the program in slightly less than seven months.

The Parenting the Active Child led to benefits for children. Approximately 65% of intervention children were diagnosis free at 5 1⁄4-month follow-up, compared to 40% of controls. The high remission rate for controls may have been due, in part, to these children receiving mental health treatments outside of the study — such as behavioural interventions — at significantly higher rates than intervention children. Despite this, intervention children still had more than 2.7 times the odds of not having an ADHD diagnosis by final follow-up. For more information, see Vol. 14, No. 2 of the Children’s Mental Health Research Quarterly.

The last Wednesday in February — this year, Feb. 23 — signifies a national stand against bullying. The theme of this year’s celebration is Lift Each Other Up — showing acceptance, respect, and inclusion for everyone. Helping children learn to self-regulate — by paying attention and inhibiting impulsivity — is an important 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.

Three interventions using Cognitive Behavioural Therapy (CBT) delivered by audio, workbooks or a book, have been shown to significantly reduce anxiety disorder diagnoses: Turnaround, Chase Worries Away and Helping Your Anxious Child.

For Turnaround children, more than half no longer met diagnostic criteria for their primary anxiety disorder at the end of treatment, compared to only 16.7% of controls. Intervention children also had fewer overall anxiety diagnoses by the end of treatment compared to controls (1.5 vs. 2.3), as well as less severe anxiety and fewer anxiety symptoms.

Chase Worries Away also produced impressive outcomes. Approximately 75% of intervention children no longer met criteria for an anxiety disorder compared to approximately 55% of controls by 5 1⁄2-month follow-up.

Helping Your Anxious Child similarly reduced anxiety disorder diagnoses. For intervention children, 17.8% no longer had an anxiety disorder by the end of treatment, compared to 5.7% of controls. Intervention children also experienced less severe anxiety. For more information, see Vol. 14, No. 2 of the Children’s Mental Health Research Quarterly.

Increasing the number of mental health professionals who can provide effective one-on-one treatments in clinic settings is one way to reach more children. Yet given the population affected, this approach is highly unlikely to reach all those in need. Instead, more comprehensive approaches that include novel delivery methods are also needed. Effective treatments — not requiring face-to-face contact with practitioners — may be an innovative way to improve capacity.

Self-delivered treatments accessed online, by text or telephone, or by book have several advantages. They can be provided on a larger scale and at lower costs than in-person therapies. They are accessible in convenient locations, such as people’s homes, and at the times of people’s choosing. These treatments can also reach more families in remote areas. As well, they may be more palatable to families who would not ordinarily pursue or receive treatment for their children. For more information, see Vol. 14, No. 2 of the Children’s Mental Health Research Quarterly.

Many common childhood mental disorders can be prevented. A review conducted by the CHPC identified seven effective self-directed interventions for preventing or reducing symptoms of the five most common childhood mental concerns — anxiety, ADHD, problematic substance use, behaviour problems and depression. The results suggest the following five implications for practice and policy.

• Reach more children, youth and families with self-directed prevention programs. Encouraging prevention will allow more children, youth and families to be reached, in turn reducing the burden of mental health problems in the population.
• Provide extra support when needed. Extra supports should be added to self-directed programs according to need.
• Ensure everyone can participate. Self-directed programs can come with specific barriers to participation for some families such as those lacking online access or mobile phones. As well, some self- directed programs can come with costs for families. Consequently, some families will need support to access these interventions.
• Recognize the role of culture. Some programs may require adaptations to ensure cultural fit and relevance, especially those that target parenting practices.
• Use mental health practitioners wisely. Investments in prevention can help reduce the need for specialized mental health practitioners who are in high demand. This will leave them free to care for more children and youth with the highest levels of need.

Including self-directed interventions in overall service planning can enable providers to reach many more children, youth and families, in turn potentially lowering the need for treatment. For more information see Vol. 14, No. 1 of the Children’s Mental Health Research Quarterly.

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.