Healthy Schools

We are busy preparing for the next whole network meeting of Child & Youth Health Network on May 27th at the University of Victoria.

We have an auditorium and 11 break-out rooms booked because we’re expecting a crowd!

Please save the date~.

For the first time, our whole network meeting will be hosted by one of the ‘constellations‘ (working groups) of the network: Healthy Schools.

The first Healthy Schools event took place on May 27th in 2015 and focused on Promoting the Mental Health of our Children & Youth.

Find the background materials from that event here:

Personal Recovery Outcome Measure

Measuring RecoveryLast week Dr Skye Barbic presented on the Personal Recovery Outcome Measure (PROM) at Island Community Mental Health.

The PROM questionnaire is designed for people who are recovering from mental illness. But it can be used by everyone.

The World Health Organization (WHO) defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

Clearly we don’t need to be recovering from a debilitating mental illness to be pursuing improved mental health. In fact, the WHO definition for mental health could be the definition for purpose in life.

How it Works

The questionnaire tells a story of recovery, from the very earliest stages of the process to total wellness.

That’s why all of us can use it: wellness is a goal we all share no matter where we are stating from.

This tool quantifies that which can otherwise feel amorphous. It enables a person to track their progress over time, and also enables comparison between people.

There are 30 multiple-choice questions in PROM and they are sequential.

The metaphor Dr Barbic uses to describe measurement of recovery using PROM is a 30-cm ruler. The whole ruler represents total wellness. For any of us.

Almost no one is at 30. All of us are somewhere on the ruler.


Each one of the questions, in order, represents another increment (a centimeter) on the ruler.

By completing the PROM questionnaire we end up with a score. Some number out of the highest possible total of 30.

This score enables you to track changes over time.

If you missed the link earlier in this post,  you can find the questionnaire here.

PROM questionsRecovery

After scoring, the questionnaire enables you to identify areas of strength as well as areas to work on.

Your score also refers you to an intervention opportunity as part of your story of recovery.

So, for example, a score of 16 refers you to statement #16 “I have new interests”.

You could choose to work on something else, but something around 16 might be a good place to start.

Dr Barbic suggested that we look at a range of options, three below and three above our score.

PROM questions 2Implications for Youth

I was curious about whether this questionnaire could be used with youth. Before I could put up my hand to ask, Dr Barbic told us that it can, but that a youth version is currently under development.

One example: Youth don’t care about sleep. But they care very much about intimate relationships. So those statements (#5 & #29) may need to be adjusted in a tool developed for youth.

She’ll have more information in April.

How Common are Behaviour Disorders?

Mental Health QuarterlyThe winter 2016 edition of the Children’s Mental Health Research Quarterly focuses on children’s conduct difficulties and behaviour problems and notes that “30% to 50% of referrals to children’s mental health services are for behaviour problems”

The following are quotes from this edition:

“According to rigorous epidemiological surveys, approximately 2.4% of children meet criteria for oppositional defiant disorder at any given time. Similarly, a review of nine high-quality surveys found that approximately 2.1% of young people meet diagnostic criteria for conduct disorder at any given time. Extrapolating from BC and Canadian population figures, an estimated 30,000 children and youth in BC and 240,000 in Canada are likely experiencing one or both of these conditions at any given time.”

“Policy-makers, practitioners and members of the public can make a difference for young people by enacting and supporting policies that address socio-economic disadvantage, including overall child poverty levels. For example, evaluations of income-supplement programs have suggested that increasing the incomes of poor families by just $5,000 a year for two or three years could produce large improvements in children’s behaviour. And, given that living in poverty poses multiple risks for child well-being, poverty reduction may also avert other risks. For example, family socio-economic disadvantage has also been linked to children having chronically activated stress pathways, with consequent effects on their immune systems.

The available causal evidence also suggests that practitioners may have an added role to play by directly helping parents — given that parenting appears to be another important modifiable factor in the development of children’s behavioural problems”

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.

School Connectedness

Research consistently shows that high levels of school connectedness are associated with better health outcomes for children and youth:


While the positive impacts of school connectedness are greatest on the students involved, here is a spill-over effect on our communities and society:


This information is available at BC Healthy Schools. Find the full report (& all the evidence) here.

A Child & Youth Mental Health Epidemic (& a solution~)

beach youth“According to the most recent information from the Mental Health Commission of Canada, more than one million, or 23 per cent of Canadians aged nine to 19, are living with a mental illness. And by some estimates, a staggering three out of four young people who have mental-health issues do not receive the help they need. At almost every turn, they encounter barriers to accessing timely and appropriate care, ranging from a lack of resources to their own reluctance to seek help due to shame, embarrassment or fear of prejudice.”

This quote from an article titled “To improve mental health, tackle problems early” from the Globe & Mail this week.

So what do we do?

A small group of youth age 15-17 who are partners in the Child & Youth Health Network have a vision…

A Youth Resource Hub

Their idea is simple: we come together create a place where youth can go & no matter what they are looking for, they can get support.

A one-stop shop.

From a professional standpoint we would frame this in terms of mental health services. The youth are fine with this, but they are clear that, for them, a resource hub would address the whole person: mind/body/spirit.

So whether a youth is

  • lonely;
  • worried about ‘a friend’s’ suicidal ideation;
  • needs help with creating a resume;
  • has a weird & embarrassing rash;
  • is getting bullied;
  • needs help with coming out;
  • doesn’t know where they will sleep that night;
  • is worried about their parent; or
  • needs time to build trust and relationships before sharing what they are grappling with…

there is a youth-friendly place they can go where youth-friendly people will not leave until the youth is safe & a plan is in place.

That is their vision.

Other features of the hub that are important to these youth:

  • A food garden where youth are welcome, can find fresh food to eat, learn how to grow food and can access indirect, low-pressure counselling from a counsellor~gardener.
  • All kinds of services onsite, including (perhaps) a branch of the youth clinic, a branch of the Victoria Regional Library (designed for youth), a café (where youth can get job & life skills + affordable healthy food), mental health/addictions/counselling services, & a place to offer workshops/groups.
  • Youth- & adult-led groups & workshops for youth on subjects that matter to youth: gender identity, sexuality, spirituality, etc.
  • That the hub be intentionally designed to be safe for all youth, including those that may be young/sheltered. Not just an emphasis on street involved/homeless youth.

Turns out, other communities have already embraced this model. The Globe & Mail article explains:

“Such a big problem requires big solutions, especially as more young people, freed from the discrimination of previous generations, speak out and seek help. While we’ve seen increased attention and funding from various levels of government (from community boards to federal agencies), we will be left with a patchwork of initiatives unless concrete steps are taken to improve access to diagnosis and provide funding for treatment nationwide. A few initiatives under way are worthy of national attention.

Dismantling silos

One of the boldest of these initiatives seeks to radically change how young people receive mental-health treatment with the ambitious goal of driving down waiting times. Modelled after Australia’s Headspace National Youth Mental Health Foundation, the ACCESS Canada project aims to provide one-stop hubs where youth can seek the various services they need.”

What about the cost of not finding a way to effectively support children & youth who are struggling with their mental health?

“Untreated, [children & youth] risk failing at school, floundering at work, getting into trouble with the law, facing homelessness, being repeatedly hospitalized or dying by suicide.

The Mental Health Commission reports the total cost of addressing mental-health problems and illnesses over the next 30 years is expected to exceed $2.5-trillion. Yet some of these costs could be prevented. An estimated 70 per cent of mental-health problems emerge in childhood or adolescence and evidence shows the earlier they’re tackled, the better the chances of positive outcomes.”