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.

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No, item is not peer reviewed.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No, item is not peer reviewed.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

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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.

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.