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.

Helping children overcome trauma

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2011
Abstract: 

Background: After being exposed to trauma, some children will develop emotional and behavioural symptoms. Consequently, we set out to identify which interventions can support children to recovery from these experiences and their sequalae.       

Methods: We used systematic review methods to identify interventions aimed at addressing childhood trauma. Applying our inclusion criteria, we accepted one systematic review that reviewed 21 randomized controlled trials (RCTs). 

Results: Among the 21 RCTs, 12 evaluated cognitive-behavioural interventions (CBT). Ten CBT interventions resulted in statistically significant improvements for children, including reduced depressive, behavioural and posttraumatic stress symptoms. As well, eye movement desensitization and reprocessing also reduced posttraumatic stress symptoms according to two RCTs. Overall, however, CBT produced a larger effect size than all other interventions.  

Conclusions: CBT is the most effective psychotherapy for traumatized children. By providing CBT to children in need, recovery from trauma is both possible and probable. 

Preventing prenatal alcohol exposure

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2011
Abstract: 

Background: It is well recognized that alcohol impairs fetal development. Both binge drinking and moderate to heavy drinking during pregnancy puts children at risk for lifelong developmental disabilities.       

Methods: We used systematic review methods to identify interventions aimed at reducing alcohol consumption in pregnancy. Applying our inclusion criteria, we accepted four randomized controlled trials.

Results: All four programs were brief, consisting of a single 10- to 60-minute session. Three of the interventions – Brief Intervention, Brief Intervention with Partners, and Motivational Interviewing – led to positive outcomes among specific subgroups of women. Among women who had committed to being abstinent during pregnancy, those assigned to Brief Intervention were significantly more likely to remain abstinent than those in the control group. Women with higher levels of alcohol use before enrolling in Brief Intervention with Partners were significantly more likely to reduce the frequency of their drinking compared to women in the control group. Similarly, women with the highest pre-intervention intoxication levels had lower peak blood alcohol concentration levels two months after completing Motivational Intervention relative to women in the control group. 

Conclusions: For women drinking at low or moderate levels during pregnancy, participating in short-term interventions may be beneficial.

Nurse-Family Partnership and Children’s Mental Health

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2011
Abstract: 

Background: Nurse-Family Partnership (NFP) is a targeted prevention program that aims to improve the lives of vulnerable first-time mothers and their children.  The program involves nurses visiting young mothers in their homes, starting prenatally and continuing until children reach age two.

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of NFP. Applying our inclusion criteria, we accepted three RCTs.

Results: All three RCTs found substantial benefits. For children, these included fewer hospital visits for injuries, less reported and substantiated maltreatment, fewer behaviour problems, and fewer symptoms of anxiety and depression. NFP also produced very significant long term gains for children including less alcohol and cannabis use at age 12 as well as fewer arrests and convictions at age 15 and 19. As well, NFP advanced mothers’ parenting including improving competency and sensitivity. 

Conclusions: Three rigorous RCTs have documented NFP’s ability to help vulnerable young mothers and their children achieve positive outcomes. The duration of the benefits was striking, lasting up to 17 years after the program ended. As well, the program has been found to be cost-effective.  

How can foster care help vulnerable children?

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2012
Abstract: 

Background: Children who enter foster care often face significant obstacles beyond not being able to reside with their parents. These include higher rates of mental disorders, such as conduct disorder, as well as a reduced likelihood of completing high school.      

Methods: We used systematic review methods to identify studies evaluating treatment foster care, where children are cared for by foster parents who have specialized training and extra support, to determine if this type of care improved children’s outcomes relative to typical foster care.  Applying our inclusion criteria, we accepted five randomized controlled trials. 

Results: Most forms of Treatment Foster Care produced statistically significant benefits. Multidimensional Treatment Foster Care proved to be effective for adolescents with behaviour problems. A less intensive version of this intervention for younger children resulted in greater placement stability. Fostering Individualized Assistance Program also resulted in fewer behaviour problems among youth.

Conclusions: Treatment Foster Care is a promising intervention for children and youth experiencing emotional and behavioural problems and in need of protective care.  

Intervening after intimate partner violence

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2012
Abstract: 

Background: Many children witness their parents or caregivers experiencing physical and emotional violence by an intimate partner. Exposure to IPV harms children, including leading to emotional and behavioural problems.

Methods: We used systematic review methods to identify interventions aimed at helping children exposed to IPV. Applying our inclusion criteria, we accepted five randomized controlled trials evaluating four programs.

Results: Three programs — Advocacy, Child-Parent Psychotherapy and Project Support — all produced at least one beneficial outcome for children. Advocacy reduced children’s contact with the perpetrator of the abuse and also increased children’s self-confidence. Child-Parent Psychotherapy significantly reduced children’s behaviour problems. Project Support reduced diagnoses of oppositional defiant and conduct disorders, behaviour problems and  emotional problems. As well, it reduced mother’s perpetration of physical abuse. In contrast, Nurse Case Management did not improve children’s outcomes.

Conclusions: This review finds that much can be done to help women help their children after they have experienced IPV. The three successful programs achieved positive outcomes for children by helping their mothers access needed resources, by providing mother with parenting education and by providing children with direct support. 

Promoting healthy dating relationships

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2013
Abstract: 

Background: Abuse in adolescent dating relationships is a far too common experience with approximately 10% of youth reporting being a victim of dating violence. Rates of emotional abuse are even higher with 29% of youth describing being insulted, swore at, or threatened with violence. These figures suggest the need for interventions aimed at preventing adolescent dating violence.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions designed to prevent adolescent dating violence. Applying our inclusion criteria, we accepted four RCTs.

Results: The three programs — Fourth R, Safe Dates and Youth Relationships — led to significantly less violence perpetration. Safe Dates also resulted in less physical violence victimization while Youth Relationship led to less emotional abuse victimization.  Only Ending Violence failed to reduce dating violence.

Conclusions: Prevention programs can significantly reduce adolescent dating violence. Among them, the classroom-based programs, Fourth R, Safe Dates and Youth Relationships, stand out.

Addressing acute mental health crises

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2013
Abstract: 

Background: Mental health crises can involve a number of circumstances, including suicidality and aggression to others. Such crises often result in young people and their families turning to hospital emergency rooms for support. 

Methods: We used systematic review methods to identify studies evaluating alternatives to inpatient mental health care for children in crises.  Applying our inclusion criteria, we accepted two randomized controlled trials.  

Results: Both Home-Based Crisis Intervention and Multisystemic Therapy (MST) aimed to avert hospitalization for young people in crisis by providing intensive community-based treatments. Both programs were associated with important gains. Home-Based Crisis Intervention reduced children’s emotional problems and overall problems at post-test. MST reduced days in hospital and behavioural problems at post-test. As well, a one year follow-up, MST youth also had significantly fewer suicide attempts.

Conclusions: Community based treatments, such as MST and Home-Based Crisis Intervention, can effectively treat young people experiencing mental health crises. These treatments can also result in better short-term outcomes than hospitalization.

Troubling trends in prescribing for children

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2013
Abstract: 

Background: Off-label prescribing occurs when a practitioners prescribes a medication for either a condition or a population for which a regulatory body has not granted approval. Off-label prescribing can come with unintended negative consequences, such as safety concerns.

Methods: We used systematic review methods to identify psychotropics being prescribed for young people in Canada. We then compared how these prescription practices align with the best available research evidence regarding the use of psychotropics in children and youth.

Results: The data revealed striking increases in the number of antipsychotic prescriptions written and dispensed for young people with risperidone, quetiapine and olanzapine being prescribed most frequently. We also found that these medications were often prescribed for conditions, such as depression and anxiety disorders, for which there was neither regulatory approval nor high quality research evidence to support their use.

Conclusions: Off-label psychiatric prescribing comes with many risks. To help remedy this situation, more high-quality pediatric medication trials and more robust monitoring of drug safety are required. 

Addressing parental substance misuse

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2014
Abstract: 

Background: Approximately one in 10 children under the age of 12 lives with a parent with a substance use disorder. When parents misuse substances, children often suffer harmful consequences. For this reason, interventions for parents with substance use disorders also need to focus on helping children.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions aimed at treating parents with substance use disorders.  Applying our inclusion criteria to the studies identified from our searches, we accepted four RCTs evaluating three different programs.

Results: All three programs — Focus on Families, Parent Skills Training and Relational Psychotherapy Mothers’ Group  — produced some benefits. Focus on Families resulted in reduced drug use among parents as well as fewer alcohol and marijuana use disorders among their sons 12 to 15 years after the program ended. Parent Skills training reduced children’s anxiety and depression symptoms but had no effect on parent substance use.  Finally, Relational Psychotherapy Mothers’ Group had no impact on children’s mental health but did reduce parent substance use in the first RCT. In the second RCT, the program reduced children’s depression symptoms but only in the short-term and had no impact on parent substance use.

Conclusions: Much can be done to help families when parents have substance use problems. Comprehensive programs such as Focus on Families can produce long-term benefits including reduced parental substance misuse, better care for children and the prevention of substance use disorders in children.

Treating childhood obsessive-compulsive disorder

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2014
Abstract: 

Background: Approximately 0.4% of children meet diagnostic criteria for OCD. These young people need effective treatment in order to reach their full potential.   

Methods: We used systematic review methods to identify studies evaluating OCD treatments. Applying our inclusion criteria, we accepted one systematic review which included 13 randomized controlled trials (RCTs).  We also identified three RCTs published since the systematic review that met inclusion criteria.

Results: Our review found strong evidence supporting a form of Cognitive-Behavioural Therapy (CBT) — Exposure and Response Prevention — for treating OCD. This therapy produced large treatment effects which persisted months after treatment ended. There was also evidence supporting the effectiveness of the medications clomipramine, fluoxetine, fluvoxamine, paroxetine and sertraline. While all medications were associated with side effects, clomipramine all resulted in serious adverse events.

Conclusions: Treatment for childhood OCD should begin with CBT.  Then, if needed, fluoxetine or sertraline should be considered. If medications are used, they should be carefully monitoring for both benefits and side effects.