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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No, item is not peer reviewed.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No, item is not peer reviewed.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. 

Early childhood development and mental health

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No, item is not peer reviewed.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

Background: The overarching aim of most early childhood development (ECD) programs is to improve children’s school readiness. Over 50 years of research evidence has found that these programs lead to fewer developmental delays, better language capabilities and better school readiness for disadvantaged children. Researchers have also begun to examine the impact of ECD programs on children’s emotional wellbeing.        

Methods: We used systematic review methods to identify ECD interventions that assessed children’s social and emotional outcomes. Applying our inclusion criteria, we reported on four ECD programs found in one systematic review.  

Results: All four programs resulted in some benefits for children, all of whom were living in socio-economically disadvantaged communities. Better Beginnings, Better Futures resulted in children having fewer anxiety symptoms and better self-control when children were eight years old.  Chicago Child Parent Centre led to participants having fewer arrests at age 20 and fewer depressive symptoms between the ages of 22 and 24.  Children who participated in Perry Preschool engaged in more positive classroom behaviours at age 15 and were less likely to have tried marijuana or heroin at age 40. Finally, an ECD program delivered to children in Mauritius resulted in participants having fewer symptoms of conduct disorder and psychosis.    

Conclusions: There is a strong body of evidence supporting ECD programs for disadvantaged children to support their overall development and their mental health.  

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.