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The Provincial Centre of Excellence for Child and Youth Mental Heath at CHEO

CHECKPOINT


CHECKPOINT

June 2006


In this issue:
FOCAL POINT
. KNOWLEDGE EXCHANGE . GRANTS AND AWARDS . CONSULTING SERVICES . PROFILE . CENTRE NEWS


Contact Us: http://www.excellenceforchildandyouth.ca/contact-us
Web Site: http://www.excellenceforchildandyouth.ca


FOCAL POINT

YOUTH JUSTICE AND CHILDREN’S MENTAL HEALTH:
A Call for Better Integration and More Resources

Terry Henry There is a longstanding concern that the youth justice system is inappropriately used to deal with social problems that go well beyond criminality. Mental illness and substance abuse disorders present a huge challenge for youth justice, complicating efforts to address underpinning criminogenic factors. Many youths would be more appropriately dealt with in the child welfare or children’s mental health systems, to access resources they desperately need for support, protection or control.  Both the Young Offender’s Act and the new Youth Criminal Justice Act have conscientiously addressed this concern by instituting legislative safeguards in this area.

The youth justice system exists to provide three social goods, namely, to:

  • Rehabilitate youths that are in conflict with the law;
  • Educate such youths on personal accountability & responsibility; and
  • Ensure public safety & security. 

It is usually not possible to address rehabilitation and accountability needs without simultaneously addressing mental illness and substance abuse.  These areas have a tendency to reinforce each other and to work against the efforts of counsellors.  To properly help youths, we need resources, expertise, and strategies that support a comprehensive and coordinated intervention.  Being part of an integrated children’s service environment like MCYS is, hopefully, a major step in this direction.

More services are slowly being made available to meet the child welfare and mental health needs in our communities.  In particular, the government’s recent announcement of $22.5 million for

  • New Youth Mental Health Court Workers,
  • More intensive case management, planning, & coordination of services,
  • Crisis response & outreach,
  • Crisis support beds, and
  • Long-term supportive housing.

It is fair to say that today the vast majority of youths entering the youth justice system have genuine criminogenic needs and legitimate reasons for being dealt with by the kind of programming and interventions unique to our sector.  Youth justice is no longer a direct substitute for other social resources.

The number of youths in our system with mental health problems however far exceeds that of the general youth population.  This establishes youth justice as an indirect substitution for other supports and resources.  Consistent estimates of such needs are hard to determine because of variation in methodology, instrumentation, and definitions of what constitutes a mental illness. 

  • Conservatively, between 20% and one-third have a mental disorder that meet the diagnostic criteria of the DSM-IV. 
  • Between 50% and 75% have a mental health problem serious enough to interfere with normal functioning. 
  • Close to 100% may meet the diagnostic criteria for Conduct Disorder. 
  • Between half and three-quarters of our youths with mental health problems also have a co-occurring substance abuse disorder. 
  • The exact extent of FAS/FAE/FASD in this population is not known.  Some studies put the figure as high as 23%, while prevalence in the general population is less than 2%.

Another overlap between the youth justice and mental health systems is the issue of stigma.  It has a direct impact on youth justice because many youths would rather be seen as “delinquent” than as “mentally ill” – consequently, they work hard to criminalize their behaviour.  In effect, with a large number of children and youth, probation and incarceration become the “treatment of choice”.  CMHO identifies the need to reduce the stigma of mental illness as one of the top priorities for a Mental Health Policy.  Joint efforts between the two systems to understand this dynamic and to diminish the stigma of mental illness could have a significant impact on further reducing the number of youths entering the youth justice system.

As we come together in an integrated service environment, youth justice has much to learn from children’s mental health.  I’ll mention just two lessons I see as incredibly important: one related to service need, the other, to policy development.

Regarding service need:  One in five children has a diagnosable mental illness before their 19th birthday yet only one in every six of these children receive help from the treatment system1.  Similarly, nearly 20% of all youths in Ontario will be referred to a criminal court for an offence before their 18th birthday, where 13% will be convicted and sentenced2.  No one knows exactly, however, how many children are involved in criminal activity that goes unapprehended or unreported.  Most self-reported offence surveys place the number around 40%3 and some go as high as 75%, again depending on definitions and instrumentation.  Consequently, our children’s youth justice needs, like their mental health needs, are vastly under-recognized and under-served in this province.  We need a youth justice system that parallels and coordinates with children’s mental health efforts to provide a more realistic level of service.  We need a youth justice system that reaches out to these children with appropriate criminogenic assessment, prevention, early intervention, and treatment services.

Regarding policy development:  The Ontario Child and Youth Mental Health Policy Framework is an excellent model for all child-serving sectors.  Youth Justice Ontario is currently taking a leadership role in advocating for a similar framework process for our sector – an Ontario Youth Justice Policy Framework.  The children, families, and communities of Ontario are best served when the stakeholders of each service sector work together in an open and transparent process.  Whether they are government officials, service providers, academic institutions, researchers, professional associations, supportive professions, or consumers of services, we need to determine what directions and what priorities are best for the sector and for the children and communities it serves.

And I suppose it should be noted as well that we would love to see the establishment of a Provincial Centre of Excellence for Youth Justice.

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1CMHO
2Carrington, Matarazzo, & deSouza, 2005
3Wikström, 2003

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KNOWLEDGE EXCHANGE

The online versions of the first two in a series of toolkits designed to support you in your work are now available.

To have the greatest impact in the child and youth mental health sector in Ontario, we must work together to forge new partnerships, new knowledge and new ways to get things done.  These toolkits, while geared to applicants to the Grants and Awards program, are based on the best available evidence and in keeping with a broad focus on child and youth mental health. 

Doing More With What You Know
Supports the planning of knowledge exchange activities beyond publication in peer-reviewed journals and presentations at conferences.  The toolkit offers practical tools including a checklist, emerging concepts, scenarios, vehicles, a glossary and suggested readings for further ideas and information.

Doing More in Partnership
Supports the development of authentic partnerships between community-based and university- or academic health science centre-based researchers.  This toolkit supports the development of collaborative projects by providing a roadmap, information on emerging concepts and models, a glossary of terms and suggested readings for further ideas and information.

Annotated Bibliographies

Clinical Practice Guidelines
Clinical practice guidelines are statements intended to assist clinicians in making decisions about appropriate assessment, diagnosis and/or treatment for specific conditions. They are systematically developed based on research evidence and/or expert consensus.

An annotated bibliography of clinical practice guidelines relating to child and youth mental health is now available on the Centre’s Web site. Organized by topic, it includes overview information, such as the purpose, intended audience and target population, as well as directions on where to locate the full text. 

Systematic Reviews
A systematic review is the gold standard strategy to investigate a health or health care question using the existing body of relevant research.  The two strengths of systematic reviews are

  1. Comprehensiveness and
  2. Scientific rigor of the methods used to define, search for, retrieve, process, synthesize, critically appraise, interpret, and represent the findings relating to the empirical evidence addressing a meaningful research question.

An annotated bibliography of systematic reviews relating to child and youth mental health, organized by topic, is now available on the Centre’s Web site.

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GRANTS AND AWARDS

What a great first year we had in 2005-2006, distributing over $2.1 million to help increase research capacity in child and youth mental health across Ontario.  For a complete list of the grants and awards distributed in the last fiscal year, please visit the funding recipients listing on our Web site.

Taking Action
As we continue into 2006-2007, many more targeted opportunities are available.  Check out the list of grants and awards now open and the tools we have created to assist you in the application process.

Expertise Mobilization Awards
Do you have expertise in research or education and an interest in pursuing a related project but lack the time in your work week to do it?  Expertise Mobilization (backfill) Awards offer individual service providers and service provider agencies protected time to work on a specific research or educational project that addresses the child and youth mental health mandate. These awards are offered twice a year. Submit an application by July 4, 2006.

Research Grants
The Centre will be accepting applications until September 1, 2006 for Phase I (Letter of Intent) of the 2006-2007 research grant competition.  Research calls encourage and support research of direct relevance to child and youth mental health in the targeted areas of

  • Awareness and stigma,
  • Evidence-based practice and its uptake,
  • Increasing capacity (service provision perspective),
  • Knowledge exchange,
  • Youth justice,
  • Child welfare and
  • Mental health in schools. 

In an effort to strengthen the links between researchers and practitioners, a condition of collaborative partnership (co-principal applicants) has been applied to these grants for academic- and community-based agencies.  For more information on how to build and maintain a successful collaborative partnership, download the pdf of the “Doing More in Partnership” toolkit and roadmap…

Education and Training Awards

Professional Development Awards
Are you interested in building your knowledge or skills in an area relevant to child and youth mental health?  The Centre offers service providers and academics the opportunity to pursue a re-training, enhanced training, and/or re-tooling activity. The knowledge gained is then shared with others in your organization or agency. This is an open opportunity.  We invite you to submit an application at your convenience.

Student Training Awards
Investing in students interested in child and youth mental health today will help to build capacity for the future.  The Centre’s education awards are available to students from all disciplines of mental health training.  The next deadlines for applications are:

  • Undergraduate Awards - November 1, 2006
  • Graduate and Post-Doctorate/Fellowship Awards - December 1, 2006

Please visit our Web site for more information on our Grants and Awards

Dare to Dream Program
Youth learn best from other youth - this is the underlying philosophy of the Dare to Dream program. The Centre is encouraging youth to stretch their imaginations to help get people talking about mental health. Through this program, the Centre offers $1000 to cover the costs of mental health awareness projects by youth 18 years and under across Ontario. If you know of any creative/innovative youth in your community who may be interested, information on how to apply is available at www.daretodreamprogram.ca or by calling toll free 1-866-282-7601. If you are interested in being a mentor to a youth interested in this program, please contact us and we will help get you connected. The Dare to Dream Review Team reviews applications twice a year – October and March.  The next deadline for applications is October 31, 2006. 

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CONSULTING SERVICES

mindyourmind.ca strengthens its research toolkit

mindyourmind.caSince its inception in early 2005, the Centre's research consultation office has assisted over 40 clients in Ontario.  Services rendered ranged from help putting together grant applications to assisting in the formulation of research questions to the teaching of basic research methods and program evaluation skills.  One such client is the innovative Web site, mindyourmind.ca.  Founded by Sharron Zweig and Maria Luisa Contursi in London, Ontario, mindyourmind.ca is a very popular and impressive educational portal for children and youth to access experiences, information and strategies for dealing with stress, mental illness or just tough times -- either their own or someone else's.

Increasingly, donor-funded health endeavours, like mindyourmind.ca, are feeling the need to engage in self-evaluation practices, both to satisfy donors and to help tweak services to maximize their impact and influence.  While the site's staff do outreach work within their local community, allowing them to gauge mindyourmind.ca's influence and impact qualitatively, the global nature of the Internet makes it problematic to measure the site's actual reach, scope and usefulness.  Determining the effectiveness and uptake of their unique intervention is a special challenge not typically encountered in traditional program evaluation models.  Like so many projects in Ontario, mindyourmind.ca is mostly volunteer run with a skeletal budget and limited resources for engaging in comprehensive evaluation.

In response to this challenge, Dr. Ray Deonandan of the Centre's research consultation office provided the staff of mindyourmind.ca with an on-site educational workshop to explain the basic concepts underlying the art and science of program evaluation.  He then made specific recommendations for how the Web site could set up its own automated data collection system, cheaply and quickly, using embedded online surveys which collect usage, demographic and evaluative data from each visitor.

Within days, mindyourmind.ca had set up their surveys, which Dr. Deonandan vetted for scientific rigour, and had their data collection system up and running.  Some months later, mindyourmind.ca successfully competed for the Centre's inaugural program evaluation grant, receiving much needed funds to expand their evaluation practices and make their analyses more complex and useful.  The new data will no doubt help the site better target some of its programs and leverage new funding.

With new expertise and confidence, mindyourmind.ca was a finalist at this year's Stockholm Challenge, the world’s leading Internet prize for Information and Communication Technology.  In the words of Sharron Zweig, “It was nice to be able to respond in an intelligent way to the topic of impact evaluation. Of course, without your help and the Centre's financial support,  I would have been at a loss to respond at all.  So, your help & training has made a difference in our participation in international forums, making Canada look good.”

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PROFILE

David Pare
David Paré is an Ottawa psychologist and Counselling professor at the University of Ottawa who serves as the group facilitator for a Collaborative Community Practice Group.  This community-based team of counsellors, sponsored by the Youth Services Bureau of Ottawa, comes together to form “reflecting teams”, that expand the conversations with young people and families facing difficulties. 

This is one of the creative ideas the Youth Services Bureau (YSB) has come up with to help counsellors to stay connected while providing innovative services to the young people who consult the agency.  The Collaborative Community Practice Group (CCPG) includes a number of YSB staff and counsellors from several Ottawa agencies and from private practice.  The 12-member group meets every couple of weeks to review articles, share their work, and engage in skill development. 

Norwegian physician and family therapist Tom Andersen developed the reflecting team as a way to include the perspectives of a number of practitioners in a counselling conversation.  A team of about four counsellors observes a session and shares their observations with each other while the primary counsellor and the consumer witness the exchange.  Instead of honing in, detective-like, on one particular “answer”, reflecting team members strive to be respectful and compassionate witnesses to the challenges that people face.  Their open-ended reflections typically generate a range of creative ideas that feed later counselling conversations.  Members of the CCPG regularly invite each other to counselling sessions as a way to practice collaboratively while providing “added value” to certain therapeutic conversations. 

Reflecting teams are a relatively new innovation and the early research on them indicates they’re a helpful addition to more traditional counselling work.  The YSB reflecting team practices are the focus of an action research project centred on the CCPG.  Dr. Paré and his colleagues Dr. Nick Gazzola and James Galipeau from the University of Ottawa are coordinating the research project funded through the YSB Program Evaluation Award from the Provincial Centre of Excellence for Child and Youth Mental Health at CHEO

Preliminary analysis from the counsellor interviews shows that reflecting processes have significant benefits for the counsellors themselves.  It is clear that reflecting teams are a venue for practitioners to actually work side by side.  It provides the opportunity for practitioners to witness each other’s styles and to try out innovative ideas together so that they can debrief and refine their practice as time goes on.  Reflecting on a team with clients present is a form of live, collaborative service delivery.  This has quite a different dynamic than case conferences, which talk about the work.  Preliminary data from the clients of these services indicates that they find the experience powerfully acknowledging and useful to them as they continue with their counsellors.

The counsellors interviewed for the YSB study consistently referred to the sense of support that comes with working in a community of practice.  Based on the interviews analyzed so far, it seems that by “going public” with their practices, the counsellors actually become more confident.  They spoke of how the work gets demystified through the mutual collaboration.  Counsellors said the extra eyes and ears are like a safety net—they come to feel more comfortable sharing both their clumsy and their brilliant moments.

In late April, the CCPG widened the conversation and reached out to other community-based practitioners by hosting an all-day conference entitled Working Together: Sharing Collaborative Practice.  It included about fifty practitioners from more than ten sites in Ottawa, Haliburton, Smith Falls, and Brockville, involving youth counsellors, mental health workers, nurses, and social workers.  The gathering featured a range of exercises devoted to collaborative counselling ideas and practices, a demonstration of reflecting teamwork, and a play written and performed by members of the CCPG. 

The Collaborative Community Practice Group is also busy planning further initiatives to sustain their innovative practices and to share their work with other practitioners.  Among the projects underway, they recently had a group discussion with counselling colleagues at Family Services of Haliburton County using a live Internet connection.  There are also plans for more knowledge sharing between academia and the community. The Faculty of Education at the University of Ottawa is developing a Web site, which will feature streaming video of counselling sessions and role-plays for professional development purposes.  The site will also provide a venue for the many skilled practitioners in the community to share their work with graduate students who are developing their counselling practices.  The Youth Services Bureau of Ottawa is also planning to start up a second similar group in September.

For more information on the Collaborative Community Practice Group, contact Don Baker at dbaker@ysb.on.ca or follow the links at www.glebeinstitute.com.  David Paré is at dpare@uottawa.ca

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CENTRE NEWS

The Centre’s Inaugural Report: Collaboration in Motion will be distributed soon.  Look for this update on the activities, highlights and available resources from the Centre’s first year.  If you have not yet requested your print copy, you can still do so…

As part of the Safeguards spring training program, Peter Levesque and Jane Tallim delivered three full-day workshops on Meeting the Challenges in Implementing Evidence-Based Practices and Treatments to over 150 service providers in Brockville, Stratford and Toronto. These workshops explored the challenges encountered by service providers in implementing evidence-based interventions and therapies in daily practice and provided strategies and tools for overcoming these challenges.

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