Children's Health Policy Centre

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The Children's Health Policy Centre is an interdisciplinary research group in the Faculty of Health Sciences at Simon Fraser University. It focuses on improving social and emotional wellbeing for all children, and on the public policies needed to reach these goals. Its work complements the mission of the Faculty of Health Sciences to advance the health of populations locally, nationally and globally.

Mental health treatment: Reaching more kids

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020
Abstract: 

Background: Nearly 70% of children who are in need of specialized mental health services do not access them. We set out to identify effective self-delivered interventions as a way to help bridge the gap between those in need and those being serviced.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating self-delivered treatments. After applying our rigorous inclusion criteria, we accepted five RCTs evaluating five treatment interventions.

Results: Three self-directed family interventions reduced anxiety diagnoses and symptoms for school age children. One self-directed parenting intervention reduced ADHD diagnoses for school age children. Additionally, one self-directed youth invention reduced depression symptoms for adolescents.

Conclusions: Strong research evidence supports the use of self-directed treatments to address three common childhood mental disorders. Greater use of these interventions can expand the number of children who are reached with effective treatments.

Prevention: Reaching more kids

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020
Abstract: 

Background: Effective prevention programs are particularly crucial to reduce the number of children in need of mental health treatment services. Yet despite growing research evidence on effective programs, prevention efforts remain modest in many jurisdictions.  Given the high levels of unmet needs, reaching more children is a priority. One approach is to identify prevention options that are more self-directed and less reliant on direct provision by practitioners, such as online programming and self-help tools.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating self-directed prevention interventions. Applying our inclusion criteria, we accepted eight RCTs evaluating seven prevention interventions.

Results: The seven self-directed interventions prevented or reduce symptoms of the five most common childhood mental concerns — anxiety, ADHD, problematic substance use, behaviour problems and depression. These interventions assisted children and youth across a range of ages, from the preschool years to the teens.

Conclusions: Strong research evidence supports the use of self-directed prevention interventions as part of the continuum of care for the most common childhood mental health concerns. Including these types of interventions in overall service planning can enable providers to reach many more children, youth and families, in turn potentially lowering the need for treatment. Comprehensive children’s mental health plans should therefore include these kinds of prevention programs.

Six decades of preventing and treating childhood anxiety disorders: A systematic review and meta-analysis to inform policy and practice

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019
Abstract: 

Question Anxiety disorders are the most prevalent childhood mental disorders. They also start early and persist, causing high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders?

Methods We sought randomised controlled trials (RCTs) evaluating interventions addressing anxiety problems in young people. We identified RCTs by searching CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science. Thirty-three RCTs met inclusion criteria—evaluating 8 prevention programmes, 12 psychosocial treatments and 7 pharmacological treatments. We then conducted meta-analyses by intervention type.

Findings For prevention, the cognitive-behavioural therapy (CBT) programme Coping and Promoting Strength stood out for reducing anxiety diagnoses. For psychosocial treatment, 9 CBT interventions also reduced diagnoses: Cool Kids; Cool Little Kids Plus Social Skills; Coping Cat; Coping Koala; One-Session Treatment; Parent Education Program; Skills for Academic and Social Success; Strongest Families and Timid to Tiger. Successful CBT interventions were used with children ranging from pre-schoolers to teens in homes, communities/schools and clinics. For pharmacological treatment, selective-serotonergic-reuptake-inhibitors (SSRIs) significantly improved symptoms. Fluoxetine stood out for also reducing post-test diagnoses, but caused adverse events. Meta-analyses indicated strongest effects for CBT (Log OR=0.95; 95% CI, 0.69 to 1.21) and SSRI treatments (1.57; 1.09 to 2.06).

Conclusions CBT is effective for preventing and treating childhood anxiety—across a range of ages and formats. Fluoxetine is also an effective treatment but side effects must be managed. CBT prevention and treatment interventions should be made widely available, adding fluoxetine in severe cases.

Fifty years of preventing and treating childhood behaviour disorders: A systematic review to inform policy and practice

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018
Abstract: 

Question Oppositional defiant and conduct disorders (ODD and CD) start early and persist, incurring high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders?

Study selection and analysis We sought randomised controlled trials (RCTs) evaluating interventions addressing the prevention or treatment of behaviour problems in individuals aged 18 years or younger. Our criteria were tailored to identify higher-quality RCTs that were also relevant to policy and practice. We searched the CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science databases, updating our initial searches in May 2017. Thirty- seven RCTs met inclusion criteria—evaluating 15 prevention programmes, 8 psychosocial treatments and 5 medications. We then conducted narrative synthesis.

Findings For prevention, 3 notable programmes reduced behavioural diagnoses: Classroom-Centered Intervention; Good Behavior Game; and Fast Track. Five other programmes reduced serious behaviour symptoms such as criminal activity. Prevention benefits were long term, up to 35 years. For psychosocial treatment, Incredible Years reduced behavioural diagnoses. Three other interventions reduced criminal activity. Psychosocial treatment benefits lasted from 1 to 8 years. While 4 medications reduced post-test symptoms, all caused important adverse events.

Conclusions Considerable RCT evidence favours prevention.

Clinical implications Effective prevention programmes should therefore be made widely available. Effective psychosocial treatments should also be provided for all children with ODD/CD. But medications should be a last resort given associated adverse events and given only short-term evidence of benefits. Policymakers and practitioners can help children and populations by acting on these findings.

Building children’s resilience

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2008
Abstract: 

Background: Parenting has a profound impact on children’s well-being. Positive parent-child relationships can promote children’s brain development, academic functioning, social competence, mental health and self-esteem. Responsive caregiving also buffers children from the negative impacts of adversity and stress. Given this, we set out to identify interventions that can promote positive parenting.    

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of parenting interventions for high-risk families. Applying our inclusion criteria, we accepted four RCTs.

Results: All four programs produced some beneficial outcomes. Familias Unidas reduced child behaviour problems and increased parent involvement. Family Check-Up similarly increased maternal involvement. Nurse Home Visitation improved children’s language development and executive functioning among particularly high-risk families. SAFEChildren improved parental involvement in children’s education as well as children’s reading skills.  

Conclusions: Programs that encourage warm and consistent parenting can improve the lives of children and families, especially among those facing significant adversities.  

Addressing bullying behaviour in children

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2008
Abstract: 

Background: When bullying occurs, children pay a significant price. Those who are bullied are at risk for impaired social developmental, mental and physical illnesses and school absenteeism. Children who bully others frequently suffer from high rates of mental disorder and from learning problems. To help avoid these detrimental outcomes, interventions that can prevent bullying are greatly needed.

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of anti-bullying interventions. Applying our inclusion criteria, we accepted eight RCTs evaluating seven programs.

Results: Four programs were successful in reducing bullying: Brief Strategic Family Therapy, Integrative Family Therapy, Bullies and Dolls, and Steps to Respect. The first two programs were targeted to children who were engaging in bullying  and were delivered to families in clinics. In addition to reducing bullying, they also reduced children’s anger and engagement in risky behaviours. The latter two interventions were universal preventative interventions delivered within schools.

Conclusions: These results find that adults can intervene to help end bullying by ensuring that effective interventions are employed so children’s environments are free from the fear and intimidation that bullying creates. 

The economics of children’s mental health

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

Background: There is an increasing push towards policy-makers approving interventions for childhood mental disorders based on clinical effectiveness and cost considerations. To this end, high-quality economic evaluations of these interventions are starting to accumulate. Consequently, we set out to review the available data to help determine which prevention programs constitute the wisest use of limited public funds.

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of mental disorder prevention programs that also had an economic evaluation. Applying our inclusion criteria, we accepted four RCTs.

Results: Coping With Stress resulted in significantly more depression-free days for participants with an average incremental cost-effectiveness ratio of id="mce_marker"0 per depression-free day.  Fast Track significantly lowered the incidence of conduct disorder but only among the high-risk children. However, the cost per averted case of conduct disorder was still more than $752,000 for this group of children. Nurse Home Visitation resulted in significantly fewer serious behavioural problems many years after the program ended, including fewer criminal convictions. It also resulted in a net saving among the highest risk families by reducing other service use. Finally, Perry Preschool similarly resulted in less criminal activity as well as higher educational achievement and employment earning years after the program ended. It also produced a net savings.

Conclusions: Prevention programs can not only avert needless suffering for children and families, they can also produce cost-savings for society. 

Understanding and treating psychosis in young people

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

Background: Medications are a key treatment for young people with psychosis. In fact, up to 80% of individuals will experience a remission of psychotic symptoms within their first year of treatment with antipsychotic medication. Given the array of antipsychotics available, we set to determine which of these medications provide the best outcomes for youth considering both effectiveness and side effect profiles.  

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of interventions for psychosis. Applying our inclusion criteria, we accepted seven RCTs evaluating 6 medications.

Results: The medications clozapine, haloperidol, olanzapine and risperidone proved successful in treating psychosis in young people. However, due to clozapine’s side effect profile, it is typically reserved for youth who have not responded to at least two other antipsychotics. When price is a consideration, older antipsychotic have the benefit of costing less while having similar effectiveness to newer medications. 

Conclusions: With careful management, antipsychotic medications can dramatically improve functioning and reduce suffering for youth with psychosis.

Preventing suicide in children and youth

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

Background: Suicide is a leading cause of death among young people. Interventions to reduce youth suicide include both primary prevention programs as well as targeted treatments. We set out to evaluate the effectiveness of both types of interventions.

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of interventions designed to prevent or treat suicidal thoughts or attempts among young people. Applying our inclusion criteria, we accepted four RCTs.

Results: The one primary prevention program, Signs of Suicide (SOS), resulted in significantly fewer suicide attempts among high school students. One treatment program, Multisystemic Therapy (MST), was also effective in reducing suicide attempts. 

Conclusions: There is solid evidence that suicide rates among young people can be significantly reduced with effective prevention programs like SOS. MST may be particularly effective for high-risk youth. 

Addressing parental depression

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2010
Abstract: 

Background: When parents suffer from depression, children can be substantially impacted. These offspring can have an increased risks for social problems, cognitive delays and mental disorders. Consequently, we set out to determine if addressing parental depression can improve children’s outcomes.

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of interventions aimed at supporting children of depressed parents. Applying our inclusion criteria, we accepted six RCTs.

Results: While the six interventions were highly diverse, ranging a home visiting program for mothers of infants to a group cognitive-behavioural therapy (CBT) family intervention, most interventions involved both parents and children. Among interventions for young children and their mothers, Clinician Home Visiting improved many aspects of the mother-child relationship, including maternal sensitivity and infant responsiveness. Psychodynamic Therapy and Non-Directive Counselling also both reduced behaviour problems in very young children. Among the interventions for school-age children and their parents, a group CBT family intervention and a group cognitive therapy (CT) program for youth both reduced depressive symptoms. The former also reduced parental depression symptoms and child anxiety symptoms while the latter reduced youth suicidality and improved youth’s overall functioning.  

Conclusions: There are a range of options for helping families when a parent experiences depression. For mothers of young children, it is helpful to focus on parenting skills and healthier ways of viewing themselves as parents. For older children and families, CBT and BT interventions can support children’s mental wellbeing.