Look to the Children

by Mind Over Matter V 13:

Early Intervention for Youth Mental Health & Development 

Dr. Teresa Bennett’s views of children’s mental health were informed by a period in 2013 when she worked in the mental health emergency room at McMaster Children’s Hospital in Hamilton, Ontario and noticed some familiar patterns to the stories she heard from teenagers and their families. 

As a psychiatrist who specializes in working with children and adolescents, she spoke with many teenagers who indicated that they struggled with their emotions at a young age, commencing in the sixth and seventh grade. Their stories were reinforced by their parents, who noted that their families often endured multiple challenges (including financial hardships and mental health problems with the mothers and/or fathers) and that, in retrospect, their children exhibited early signs of emotional distress.  

“The ER is so important to help stabilize children and youth in crisis, but for too many kids, signs and worries had gone unnoticed until they reached that crisis level,” Dr. Bennett told Mind Over Matter®. “It became clear to me that we needed to do something earlier. Working in the mental health ER really got me thinking about prevention. If we can identify them earlier, we can not only reduce mental health risks but also make their learning and lives better.”

Dr. Bennett is a core member of the Offord Centre for Child Studies and an Associate Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, and holds the Jack Laidlaw Endowed Chair in Patient-Centred Care. The benefits of early intervention are at the heart of her latest research project, which is being funded by Brain Canada and the RBC Foundation. 

RESEARCH HAS SHOWN THAT EMOTIONAL AND BEHAVIOURAL PROBLEMS (EBPS) SUCH AS DEPRESSION, ANXIETY, AND AGGRESSION OCCUR AT DISTURBING RATES AMONG YOUNG CHILDREN: RANGING FROM APPROXIMATELY 12% TO 26% FOR THOSE UNDER THE AGE OF SIX. 

Dr. Bennett and her team are evaluating the use of an intervention program called the Family Check-up™ (FCU), which was first developed more than 20 years ago by the late Dr. Thomas Dishion and colleagues, Dr. Beth Stormshak and Dr. Daniel Shaw at the University of Oregon and the University of Pittsburgh.   

The family-centered program targets known risk and protective factors for child well-being, with a focus on early intervention for youth at high risk of severe and chronic mental health problems. Children are deeply affected by their everyday environment and the influence of their parents, and experiences early in life (both positive and negative) can have lasting consequences. 

The FCU focuses on partnering with parents to build on the strengths of their children and families, achieve their own positive parenting goals, and connect them to community and healthcare supports. The actual interventions are relatively brief (two or three sessions), but the program has demonstrated robust and sustained effects across child and family mental health outcomes in several U.S. studies.

The FCU model had never been implemented in Canada and given the differences in culture and health care systems, a clinical study was needed in order to evaluate its efficacy within a Canadian setting.  

Dr. Bennett’s team conducted a randomized control trial involving 206 families from the Hamilton area, all with children between the ages of two and four who were displaying behaviours that concerned their parents. Clinicians interviewed each family to get an understanding of their challenges, and then would film the participants interacting with each other as they might at home, dealing with basic household issues.

The clinicians, who have training in motivational techniques, played back the video recordings for the adult participants and gave them positive feedback on their parental abilities. 

“Parents sometimes don’t see where they do well,” said Dr. Bennett. “We showed them the videos to help them recognize their strengths, which they can use to set new goals.”

PROBLEMS SUCH AS DEPRESSION, ANXIETY, AND AGGRESSION IN OUR YOUTH ARE CONSIDERED SOME OF THE LARGEST PREDICTORS OF MENTAL ILLNESS LATER IN LIFE. EVIDENCE SUGGESTS THAT EARLY INTERVENTIONS COULD MAKE A DIFFERENCE IN PREVENTING THEIR ONSET. 

The clinicians also examined what is known as the “executive function” of the child participants – more specifically, their ability to regulate their emotions, manage their impulses, and to easily switch from one task to another.  

“It’s a thinking skill that’s linked to better performance. Kids who can regulate their emotions and put the brakes on impulses are less likely to have emotional and behavioural problems, both now and down the road,” she said. 

“We like the term ‘ecological assessment.’ The aim is to support the child’s emotional well-being but does so by addressing parenting within the broader context of the family.”

One of the advantages of the FCU is that it is uniquely tailored for each family and is offered in an accessible and convenient setting. Far too often, the families who require the most assistance stop attending parenting programs because they are too generic and do not address their particular needs.  

Dr. Bennett hopes to publish the results of their study within the next year. Although she is cautious about discussing their findings before the peer review process is completed, she indicated that the families participating in the FCU appear to be experiencing significant improvements in child behaviour.  

“It looks like it’s demonstrating some long-term benefits. We’re really optimistic that this is a positive tool to identify kids and families in need of support earlier in a way that’s meaningful for kids and families that need help the most,” she said. 

Sex and gender aspects play a key role in her research. There are an equal number of girls and boys participating in the FCU, and the researchers will be examining whether the effectiveness of the program is the same for each.

Dr. Bennett called the study “Making the Race Fair,” inspired by one of Canada’s best-known child psychiatrists, the late Dr. David “Dan” Offord, under whom she studied.

“Dan used to talk about how growing up in Canada is like a race, and early mental health problems make the race unfair for kids. We hope to level the playing field.” 

She is grateful that an institution like Brain Canada recognized the value of this kind of work and provided crucial support. 

“We know that to change kids brains in healthy ways, we need to address their environments and support their families. It takes a lot of wisdom to fund programs that may influence brains indirectly but in important ways.” 

“This kind of work gives me a lot of hope,” Dr. Bennett continued. “I love it because I feel like I’m doing some meaningful innovation. Focusing on prevention is more than ever where we need to be thinking. For me personally and professionally, it’s really rewarding and exciting, and fun.” 

The project has been made possible with the financial support of Health Canada, through the Canada Brain Research Fund, an innovative partnership between the Government of Canada (through Health Canada) and Brain Canada, and RBC..