Children's Health Policy Centre

Receive updates for this collection

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.

Fighting racism

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2021
Abstract: 

Background: Racism has a profound impact on children well-being. In fact, researchers have found links between experiencing racial discrimination and mental health concerns, including depression, anxiety and conduct problems. We therefore set out to identify effective interventions for reducing racism in children.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating interventions to reduce racism. After applying our rigorous inclusion criteria, we accepted five RCTs evaluating 11 interventions.

Results: Two interventions showed promising outcomes. Books that recounted close friendships between non-refugee and refugee children resulted in children having more positive attitudes towards refugees.  As well, history lessons focused on Black American’s contributions to society and their experiences of racism resulted in children having more positive attitudes towards Black people and increased their valuing of racial fairness. 

Conclusions: Two brief interventions had a positive impact on children’s attitudes towards people of colour. They offer a helpful starting point for ongoing efforts to create more equitable experiences for all children. 

File(s): 

COVID-19 and the Impact on Children's Mental Health

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No, item is not peer reviewed.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

The COVID-19 public health crisis has created significant challenges for children in British Columbia. These challenges have included most children facing restrictions in their contacts with family members and friends, as well as temporary school closures. Many children are also part of families that have experienced economic hardships. Beyond the social, educational and economic costs, there will also be mental health consequences. This rapid review therefore aimed to determine how the pandemic and its associated challenges may affect the mental health of BC’s children, including those who may be disproportionately harmed. The overarching goal was to inform and assist policymakers to support all children in BC during COVID-19 — and beyond.

Our systematic review identified one relevant original study on the mental health consequences of previous pandemics and five systematic reviews on the mental health consequences of natural disasters for children. The findings showed dramatic increases in rates of anxiety, posttraumatic stress, depression and behavioural challenges compared to rates typically found in the general population of children. Other literature suggests that some groups may also be disproportionately affected, including children from socioeconomically disadvantaged families and those who have faced extreme or cumulative adversities. Racism may contribute to Asian-Canadian children facing added hardships. Indigenous children may also be particularly disadvantaged given the cumulative adversities associated with the legacies of colonialism. As well, children with neuro-diverse special needs such as autism spectrum disorder, fetal alcohol spectrum disorder, developmental delays or other disabilities may have greater mental health needs during the pandemic.

On balance, the available research evidence suggests that BC’s response to the COVID-19 pandemic must make children’s mental health a high priority — ensuring that children do not experience additional avoidable adversities due to either the pandemic or the public health responses. Central to these objectives will be: providing additional necessary prevention and treatment services; ensuring that public investments go towards effective interventions; preventing avoidable childhood adversities including reducing socioeconomic disparities; and tracking child outcomes so that all British Columbians can see the progress. Failing to address children’s mental health now will lead to greater costs in the future, if mental health problems are allowed to persist into adulthood. COVID-19 is an unprecedented public health crisis. Yet it also presents an unprecedented opportunity — to make BC a place where the social and emotional wellbeing of all children is highly valued and where children are the focus of sustained collective efforts to ensure their healthy development.

Document type: 
Report

Prevalence of childhood mental disorders in high-income countries: A systematic review and meta-analysis to inform policymaking

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021
Abstract: 

Question Mental disorders typically start in childhood and persist, causing high individual and collective burdens. To inform policymaking to address children’s mental health in high-income countries we aimed to identify updated data on disorder prevalence.

Methods We identified epidemiological studies reporting mental disorder prevalence in representative samples of children aged 18 years or younger—including a range of disorders and ages and assessing impairment (searching January 1990 through February 2021). We extracted associated service-use data where studies assessed this. We conducted meta-analyses using a random effects logistic model (using R metafor package). 

Findings Fourteen studies in 11 countries met inclusion criteria, published from 2003 to 2020 with a pooled sample of 61 545 children aged 4–18 years, including eight reporting service use. (All data were collected pre-COVID-19.) Overall prevalence of any childhood mental disorder was 12.7% (95% CI 10.1% to 15.9%; I2=99.1%). Significant heterogeneity pertained to diagnostic measurement and study location. Anxiety (5.2%), attention-deficit/hyperactivity (3.7%), oppositional defiant (3.3%), substance use (2.3%), conduct (1.3%) and depressive (1.3%) disorders were the most common. Among children with mental disorders, only 44.2% (95% CI 37.6% to 50.9%) received any services for these conditions.

Conclusions An estimated 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. We discuss the implications, particularly the need to substantially increase public investments in effective interventions. We also discuss the policy urgency, given the emerging increases in childhood mental health problems since the onset of the COVID-19 pandemic (PROSPERO CRD42020157262).

Document type: 
Article
File(s): 

Supporting Children — By Supporting Practitioners and Families During COVID-19 and Beyond

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

Background: The COVID-19 pandemic has introduced new and urgent mental health challenges for children. This public health crisis has also caused novel challenges in the delivery of services to children in need. 

Methods: We conducted a rapid research review detailing safe, effective and efficient ways of delivering mental health services to children experiencing anxiety, the most common mental health concern faced by young people. 

Results: We outline the delivery cognitive-behavioural therapy, the most effective prevention intervention and treatment for childhood anxiety, using both virtual and self-directed formats. We also identify an effective pharmaceutical, fluoxetine, for children who require medication. 

Conclusions: COVID-19 has caused significant disruption in the lives of children, including increased anxiety for many. Our findings detail a path forward for helping children with anxiety during COVID-19 and beyond.

Preventing and Treating Childhood Mental Disorders: Effective Interventions

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

Background: Social and emotional wellbeing is a crucial resource for all children. Yet high-quality epidemiological studies suggest that 12.7% of children will experience a mental disorder. 

Methods: We used systematic review methods to identify 113 randomized controlled trials and six systematic reviews on effective interventions for preventing and treating the most common childhood mental disorders. 

Results: We found effective prevention interventions for anxiety disorders, attention-deficit/hyperactivity disorder, oppositional defiant and conduct disorders, depression, eating disorder and posttraumatic stress disorder. In addition to identifying useful treatments for all of these disorders, we also found effective treatments for autism spectrum, obsessive-compulsive and bipolar disorders as well as schizophrenia. 

Conclusions: Mental disorders, which typically start in childhood, cause significant distress and impairment for children. Beyond the hardships they cause for children and families, there are also significant avoidable costs for society as a whole. By implementing effective prevention interventions and treatments for these concerns, it is possible to avert unnecessary hardships for young people, their families and their communities.

Treating posttraumatic stress disorder in children

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2021
Abstract: 

Background: Posttraumatic stress disorder (PTSD) affects approximately 0.1% of children who have been exposed to serious adversities. We therefore set out to identify effective interventions for treating childhood PTSD.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating treatment interventions for children who had diagnosed with PTSD. After applying our rigorous inclusion criteria, we accepted five RCTs – evaluating three psychosocial interventions and one medication.

Results: Prolonged Exposure for Adolescents and KIDNET, both based on cognitive-behavioural therapy (CBT), showed significant benefits for children, including reduction of PTSD diagnoses, symptoms, and overall functioning compared to controls. In contrast, D-cycloserine failed to show benefit for children compared to controls. In a head-to-head trial, Eye Movement Desensitization and Reprocessing (EMDR) and CBT both reduced PTSD diagnoses and symptoms, with EMDR outperforming CBT in reducing diagnoses by parent-report at one-year follow-up.

Conclusions: Preventing childhood adversities is priority. But when a child develops PTSD, access to effective treatment is crucial. CBT was effective in reducing diagnoses and/or symptoms across four RCTs in our systematic review. 

File(s): 

Helping children cope with trauma

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2021
Abstract: 

Background: Experiencing adverse experiences during childhood can lead to the development of mental disorders. We therefore set out to identify that effectively help children who have experienced trauma.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating prevention interventions for children after serious adverse experiences. After applying our rigorous inclusion criteria, we accepted five RCTs – evaluating three psychosocial interventions delivered to children who had been maltreated, and one medication for children who had sustained physical injuries.

Results: It’s My Turn Now, Fostering Healthy Futures, and Multisystemic Therapy showed benefits for children who had a history of maltreatment, including reducing symptoms of mental disorders. In contrast, Propranolol failed to show benefit for children who had sustained injuries.

Conclusions: Preventing childhood adversities wherever possible is crucial and recognizes children’s rights to safety. Yet it is possible to prevent mental health symptoms from developing even after children have experienced serious adversity.

Helping young people with psychosis

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

Background: Psychotic disorders are associated with a high degree of impairment making early intervention crucial for youth. We therefore set out to identify effective psychosis interventions for young people.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating treatment interventions. After applying our rigorous inclusion criteria, we accepted eight RCTs – evaluating five different medications and three psychosocial interventions.

Results: Aripiprazole and olanzapine showed benefits in two trials each, although both led to adverse events that require close monitoring. Cognitive Remediation Therapy, Computer-Assisted Cognitive Remediation and the Think Program showed secondary benefits of improved cognitive skills and reduced emergency room visits which can be helpful when used along with antipsychotic medications.

Conclusions: Antipsychotics should be used prudently, after careful assessment and diagnosis, and psychosocial interventions should be offered as well. Further research is needed on early interventions to help young people with psychosis.

Psychosis: Is prevention possible?

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

Background: Controversy persists about whether or not it is possible to prevent psychotic disorders. We set out to identify if there were any effective interventions that prevent psychosis among youth.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating prevention interventions. After applying our rigorous inclusion criteria, we accepted three RCTs –  evaluating one supplement and two psychosocial interventions with youth found to be at high-risk for psychosis.

Results: Omega-3 polyunsaturated fatty acid (PUFA) supplements reduced psychosis diagnoses and symptoms use and improved overall functioning over six years follow-up. Two other interventions – Auditory Cognitive Training and Family-Focused Treatment – did not produce significant benefits post-intervention.

Conclusions: More studies are needed to replicate results for PUFAs. As well, additional research is needed to develop psychosocial interventions that may help high-risk youth. Given the high burdens and costs associated with psychosis, prevention remains an important goal for youth and families.

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.