Comprehensive Children’s Mental Health Indicators

It’s a wonderful thing when you find a paper that proactively answers your specific research question!

Creating Comprehensive Children’s Mental Health Indicators for British Columbia is a paper like that.

Our Question

What data sources are available and what criteria should we use to select comprehensive indicators to track the mental health of young people in the capital region over time?

This Paper Answers:

The Data Sources used to select indicators for this study can be found on pages 16-18 and the indicators on pages 19-22.

But the whole paper is worth a read. Or two.

Here’s just a little of what this paper offers:

“Mental health—or social and emotional well-being—is fundamental to human development and essential for all children to flourish. Yet at any given time, an estimated 14% of children (or 800,000 in Canada) experience mental disorders causing significant symptoms and impairment, exacerbating matters, clinical treatment services still reach fewer than 25% of these children despite substantial public investments in health care. Meanwhile, there are almost no investments in programs that could address determinants and prevent problems. Consequently, mental disorders unnecessarily persist throughout the lifespan, with adverse outcomes ranging from reduced educational and occupational chances to increased mortality. The associated economic burden is now estimated to exceed $51 billion in Canada annually, urgently underscoring the need to better address mental health starting in childhood. To address children’s mental health adequately, a new comprehensive population health approach is needed—promoting healthy development for all children and preventing disorders in children at risk, in addition to providing effective treatment for children with established problems and disorders.”

“Canada urgently requires a population health approach to children’s mental health—promoting health and preventing disorders, in addition to providing treatment. Underpinning this approach, indicators could enable population monitoring, thereby informing ongoing public investments.”

“Strategically, monitoring could also raise public awareness about the importance of children’s mental health—understanding that ‘what gets counted, counts.'”

“A population health approach for children’s mental health—promoting health and preventing disorders, in addition to providing treatment—requires a correspondingly broad framework encompassing concepts central to the social and emotional well-being of the entire population of children. Therefore we propose a comprehensive framework that covers: major developmental stages; determinants and contexts; mental health status and related developmental domains; and a wide range of intervention approaches.”

Population Health Framework for Children's Mental Health
Gratitude to Charlotte Waddell, Cody A. Shepherd, and Alice Chen from Simon Fraser and Michael H. Boyle from McMaster for all the work that went into this project and for reporting the results so we could learn from them.

Nurturing Early Childhood Development in Times of Austerity

dad16According to a paper titled Nurturing early childhood development in times of austerity in BC, “Canada has the weakest public funding for early childhood development among wealthy countries. The consequences of this lack of investment can be seen in the state of early childhood development in British Columbia.”
This paper describes the findings of  study that identified communities with higher levels of vulnerability on the Early Development Instrument (EDI) that managed to change the trend of vulnerability.

According to this analysis, the following elements enable this change:

  • The federal and provincial government must take a strong leadership role in creating policies and funding for employment, income, housing, parental leave and child care. This sets a well-furnished stage for the work of local agencies and individuals.
  • Initiatives to improve early childhood development outcomes must be broad-based and not simply targeted at low-income or high-risk families. Research shows that vulnerability occurs across all income levels, and that universal approaches are most effective.
  • Government must provide leadership with policies and funding, but must also partner with local agencies and individuals. This type of partnership harnesses the power of active and engaged community members.
  • Local committees that include representatives from all levels of government, schools and community agencies, are an ideal way to support improvements to early childhood development. Communities with this type of committee tend to have lower levels of developmental vulnerability.

What is poverty costing us in BC?

Alberta is comfortable with an economic argument. That may be the reason they are leaving BC in the dust when it comes to Early Childhood intervention.

The Royal College of Physicians and Surgeons of Canada published it’s first position statement on Early Childhood this year. It made 15 recommendations:

Recommendation #7:  A pan-Canadian poverty reduction strategy, including the eradication of child poverty, with clear accountability and measurable targets.

We can be motivated by justice or by economics. Either way, the math is the same.

What is poverty costing us in BC?

Alberta Government Policy on Early Childhood

BC & AlbertaBritish Columbia is lagging.

Our neighbour, Alberta, has well-developed early childhood policy. In fact, The Government of Alberta has made the strategic decision to focus specifically on early childhood development.

These Alberta Government documents are eloquent on the subject:

The Government of Alberta is comfortable with an economic argument when it comes to early childhood, and it seems to be working. Alberta knows that when children thrive, they become adults who contribute to the collective well-being of the entire province.

Perhaps it’s time British Columbia embraced an economic argument as a way to engage all sectors (including business & government decision-makers) in creating population-level change for children, youth & families?

The following are direct quotes pulled from these two Alberta Government policy documents:

Investment in early childhood is one of the
greatest opportunities we have to enhance
the health and well-being of all Albertans.

Not only will it make a difference to individuals and communities, it will position our province for greater economic growth and leadership in a knowledge based society, now and in the future. As Albertans, we take great pride in ingenuity. We have established an international reputation for innovation in areas as diverse as biomedical research, nanotechnology and industrial processes. We also take pride in our communities and understand that “we’re all in this together!” Imagine if we could harness both our ingenuity and our community spirit to drive a whole new commitment to early childhood development in Alberta.

Recognition of the early childhood years is growing in Alberta. The Premier’s Council for Economic Strategy, for one, has linked the importance of early childhood experiences to economic growth and development. A new Early Learning Branch of Alberta Education is making the connection between school readiness and what happens in the first years of life. The Norlien Foundation’s Early Brain and Biologic Development Symposium is bringing together decision-makers and researchers to find ways to improve outcomes for young children. The Early Childhood Development Mapping Initiative is highlighting the factors that may be affecting early child development in Alberta. At the same time, the Alberta Centre for Child Family and Community Research is creating new knowledge to support greater investment in this pivotal time of life.

What we know… the science of early childhood development

We are currently on the leading edge of a revolution in the science of early childhood development. A growing body of evidence from cell biology, neuroscience and birth cohort studies has greatly expanded what we know about the early years and offers opportunities we did not appreciate even as recently as a decade ago.

This evolving science has given us a much better understanding of human brain development and the interconnectedness between a child’s environment and his experiences as a result of that environment, from conception onwards. It is showing us the strong connection between the early childhood years and a person’s life-long health, well-being, learning and behavior. We are learning that what happens in a child’s early years has a long reach forward.

Simply put, the quality of a child’s earliest environment and exposure to positive experiences at the right stages of development has a strong influence on the course of their life path. Ensuring the right conditions in the early years is more effective and far less costly than correcting problems later.

In Canada, fewer than five per cent of children at every socio-economic level are born with known limits to their development. By school age, more than 25 per cent of children are behind where they should be in their physical, social, language or cognitive development.

In other words almost all children are born with a strong potential to grow, learn and thrive but by school age many, approximately one in five, have lost ground.

Image from http://www.worldbank.org/
Image from http://www.worldbank.org/

Early intervention is cost effective; in other words, we can pay now or we can pay more later. The return for investing in the early years of our children is significant. Healthy children are more likely to become hard-working, creative adults who contribute to a strong economy and the quality of our communities and our society overall.

Research shows that intervening earlier rather than later increases the positive impact on brain development and life course outcomes.

Economic analyses suggest that a dollar invested in early childhood is 3 times more cost effective than one invested later.

All governments in Canada, including Alberta, make significant investments in their children; however, traditionally more has been focused on children after they enter the school system than before and our investments are primarily targeted to children deemed to be from high-risk families.

The public conversation about early childhood development often focuses solely on family responsibilities without factoring in our collective responsibility.

According to Together We Raise Tomorrow, success will be achieved when:

  1. More women experience healthy pregnancies. Measure: Improved measures of infant and child health.
  2. More children are realizing their developmental potential in the first years of life. Measure: Reduced per cent of children in Alberta who are reported to be experiencing great difficulty in one or more of the areas of development.
  3. Alberta parents are more confident in their parenting role and how their child
    is developing. Measure: Increased percent of parents who report using effective parenting practices to support their child’s development.
  4. Communities are working together to increase access to the right services, at the right time to meet the needs of families. Measure:  Increased percent of parents who understand where and how to access Early Childhood Development (ECD) information and supports.

Early Childhood: Royal College Position Statement

The Royal College of Physicians and Surgeons of Canada published it’s first position statement on Early Childhood this year.

Find the full statement here.

OLYMPUS DIGITAL CAMERAExecutive Summary

Early childhood or ‘the early years’ is the most important developmental phase of life in which
crucial advancements in physical, social, cognitive, emotional and language domains take place. Experiences during this time – and even before birth – influence health, education and economic prospects throughout life.

Experiences in the first six years can become biologically embedded and influence outcomes throughout the life course in a positive way but also in a negative way. Disruptions during this period can significantly impact behavior and learning as well as adult health outcomes.

Fortunately, intervening early and often can have a tremendous influence to promote
positive outcomes and minimize or mitigate the impact of adverse childhood experiences and
events.

Research clearly shows that health promotion and disease prevention programs targeted at
adults would be more effective if investments were also made early in life on the origins of those
diseases and behaviours.

Early childhood development interventions (such as education and care, parenting support, and poverty reduction) yield benefits throughout life that are worth many times the original investment.

Recommendations

  1. The federal government, in collaboration with the provinces and territories, implement an early child development system with supports for families including but not limited to
    supports during pregnancy; early childhood learning opportunities; and high quality,
    universal, accessible and developmentally appropriate child care, including for Indigenous children living both on and off reserve.
  2. The federal government commit to increasing funding for early childhood development to 1% of GDP to bring Canada in line with other OECD countries.
  3. Evidence based home visiting programs such as the Nurse Family Partnership be made
    available to all vulnerable families in Canada.
  4. Governments support the expansion of community resources for parents and caregivers
    which provide parenting programs and family supports, creating a system where all families have access.
  5. Governments increase public awareness and support to optimize health and reduce potential remediable risk factors for pregnancy and before conception.
  6. Governments increase accessible prenatal care, educational programs and parental supports.
  7. The federal government work with provinces and territories to implement a pan-Canadian poverty reduction strategy, including the eradication of child poverty, with clear accountability and measurable targets.
  8. The federal government work with the provinces and territories to create a robust collection, monitoring and reporting system on early childhood to ensure proper monitoring of development and effectiveness of interventions including:
    ~the identification of data gaps related to disadvantaged populations and Indigenous
    children including Métis
    ~ongoing implementation of the Early Development Instrument (EDI) in all jurisdictions
    ~a similar tool for 18 months and middle childhood.
  9. Curriculum on early brain, biological development and early learning be incorporated,
    including education on the developmental origins of adult health and disease and the impact of the determinants of health specific to Indigenous children such as colonization and racism into all Canadian medical schools and residency programs.
  10. Continuing medical education on early brain, biological development and early learning be available to all care providers, particularly but not limited to those in primary care.
  11. All provinces and territories implement an enhanced 18-month well-baby visit strategy with appropriate compensation, access to tools, adequate electronic medical records and resource pathways to community supports.
  12. Physicians and other primary care providers integrate the enhanced 18-month visit into their regular clinical practice.
  13. Comprehensive resources be developed for primary-care providers to identify community supports and services to facilitate referral for expecting parents, parents, and children.
  14. Physicians be educated about the evidence base for the impact of early family literacy and the importance of discussing and recommending literacy promotion in routine clinical encounters with children of all ages.
  15. National and Provincial/Territorial Medical Associations work with governments and the
    non-profit sector to explore the development of a clinically based child literacy program for Canada working in collaboration with community literacy efforts .