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



May 2008

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Fighting stigma and discrimination through research and awareness

Children, youth, parents and caregivers struggling with mental health issues often face the added burden of stigma and discrimination – making a difficult situation even tougher to address. The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO (the Centre) speaks out against stigma and discrimination through many of its activities – including innovative partnerships, youth engagement, public awareness and research. Eliminating the harmful forces of stigma and discrimination will play an essential role in our collective effort to build an effective and responsive mental health system for Ontario children and youth. The Centre is doing its part by funding research activities on stigma through its grants and awards program, conducting internal research, facilitating international dialogue and developing awareness resources for youth, teachers and service providers.

The Centre defines mental health stigma as labelling or discriminating against an individual or group of individuals on the basis of observed or presumed mental health difficulties. The experience of stigma can take many forms and can come from a number of sources such as individuals, groups or institutions.

Children and youth who suffer from mental health difficulties, along with their families and caregivers, often face discrimination because of it. Discrimination prevents them from getting the help and support they need to cope and feel better. It also interferes with their ability to function at school and in their communities. For families and caregivers, it can decrease productivity and increase absenteeism in the workplace.

Despite the best efforts of well-meaning individuals and organizations, many people remain uncomfortable discussing mental health issues. This taboo is compounded for our youngest citizens whose parents and caregivers also feel the stress and impact of stigma and discrimination. Stereotypes, labels and discriminatory attitudes or behaviours can prevent people from seeking help, incite feelings of shame and stand in the way of successful treatment of mental health issues. Simply put, stigma interferes with the right to thrive that every child and youth should enjoy.

The Centre’s concern for the often-devastating effects of stigma and discrimination is shared with many others. We are involved in a number of collaborative activities that will ultimately reduce the compounded suffering of children, youth, parents and caregivers. Among our partners is the new Mental Health Commission of Canada, which has identified stigma and discrimination as a key priority area for its early activities.

In 2007, the Centre completed a systematic review of the scientific evidence surrounding school-based interventions meant to reduce or eliminate stigma and discrimination. The results of the review prompted a follow-up workshop bringing together researchers, educators, advocates, youth, and service providers from around the globe. The aim was to develop a framework and form an international working group of committed people to guide the development, implementation and evaluation of school-based programs designed to eliminate and prevent the stigmatization of individuals with mental health difficulties. This collaboration has recommended the need to build on the work already initiated by others and to ensure that a methodologically sound research lens is brought to evaluating the outcomes of such efforts.

The Centre’s commitment to reduce stigma is also evident in our youth engagement activities. Our efforts to partner with youth have helped to inform projects such as the international stigma workshop. Other activities have tackled mental health awareness and stigma among youth themselves. Project Postcard, an art project in partnership with the Canadian Mental Health Association, the Centre for Addiction and Mental Health, the Ottawa School of Art and the Community Foundation of Ottawa, provided youth with the opportunity to learn about the importance of mental health and to express themselves through paintings. Students from across Ottawa participated in this classroom-based project that aims to normalize the conversation about mental health.

Mental health difficulties touch the lives of the majority of people living in our society, either directly or indirectly. It is therefore reasonable to suggest that addressing the wrong of stigma and discrimination on the basis of mental health difficulties is everyone’s responsibility.

Do you have a topic to suggest for Focal Point? Send it to

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York region partners tackle stigma in new community mobilization project

York region is one of the fastest-growing and most diverse communities in Canada with a booming South Asian population. As the population growth continues, it has become evident that agencies and organizations serving children, youth, parents and caregivers cannot respond to the challenges alone and that stigma represents a significant barrier to accessing care. They recognize that a collaborative and community-based approach will be the most effective way to address the needs of the South Asian community.

In York, Kinark Child and Family Services has partnered with the Social Services Network to build ongoing partnerships with a wide range of community stakeholders. Together they will look for collaborative ways to increase access to mainstream children’s mental health services by the South Asian community and reduce the stigma associated with mental health difficulties within this growing population.

Strategies that may be built in to the York action plan include: increasing the influence of the South Asian community at local planning tables, improving the cultural competence of mainstream service providers, and reaching out to South Asian community members through a comprehensive and culturally appropriate communications campaign.

York region is one of three Ontario communities benefiting from the Centre’s new Community Mobilization Award – a pilot program launched in January 2008. Other pilot communities include Thunder Bay and Nipissing First Nation. Over the next two years, these communities will forge strong partnerships that will allow them to develop sustainable solutions for pressing child and youth mental health issues.

Watch for information on the launch of our first full competition of the Community Mobilization Awards on our website later this summer.

Upcoming deadlines for the grants and awards program …

  • Evaluation Capacity Building Grants – June 2, 2008
  • Evaluation Implementation Grants – June 2, 2008
  • Expertise Mobilization Awards – July 2, 2008
  • Individual and Group Professional Development Awards - Submit anytime (Open)

For more information on grants and awards, please visit our Web site at

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Effects of School-based Interventions on Mental Health Stigmatization: A Systematic Review

All too often, Canada’s children and youth face discrimination based on their mental health status, and stigmatizing beliefs and behaviours can appear early among school-aged children. In order to respond appropriately to this growing concern, an examination of the current state of the evidence on this topic was required. The Centre has completed a systematic review on the effects of school-based interventions on the stigma surrounding mental health difficulties. The aim of the project was to determine the potential benefits or harms of a variety of interventions so as to identify those that are most effective in preventing or eliminating mental health discrimination.

A systematic review is regarded as the gold standard in research when informing the organization and delivery of front-line practice. It involves rigorous and systematic processes to identify, appraise and synthesize relevant scientific evidence. Dr. Howard Schachter is a research scientist at the Centre who specializes in systematic reviews and led this stigma project. He explains that a systematic review minimizes the bias that typically exists when dealing with evidence.

“Findings generated from systematic reviews are often considered essential when responding to important issues such as the stigma surrounding mental health” he says.

Dr. Schachter and his team completed a qualitative analysis of 40 studies that evaluated school-based stigma interventions implemented for populations 18 years or younger. Based on the literature, the team identified three categories of stigma related interventions that are most commonly used in schools. The first involves traditional education- and information-based activities. The second gives students an opportunity to interact with those who have first-hand experience with mental health difficulties either as consumers or service providers. The third type of intervention involves a combination of these educational and contact components.

Upon completing a synthesis of study findings, the team was unable to recommend any single intervention type. The evidence failed to identify whether any of the specific interventions could successfully and reliably prevent or eliminate stigma. A number of barriers to drawing such conclusions were identified, most of which involved inconsistencies and inadequacies in study methodology. The team proposed that an international workshop be held, facilitating the collaboration of stakeholders and expertise as a next step in responding to the gaps in evidence and knowledge.

Conclusions from the systematic review and the workshop have been incorporated into a set of recommendations for future research, including an emphasis on the importance of sound evaluation. Publication of the systematic review is pending and a detailed account of these conclusions will be available on the Centre’s website upon its release.

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Opening the Doors to Stigma and Discrimination Reduction Opportunities

In response to the results of the systematic review, the Centre hosted an international workshop to begin filling research gaps related to school-based strategies to eliminate or reduce mental health discrimination. In preparation for the workshop, the Centre teamed up with YouthNet/RéseauAdo to gather youth perspectives on how to effectively reduce stigma and discrimination. Incorporating the voices of youth into our work provided us with a richer understanding on the reality of their experiences with stigma. These perspectives also bring home the importance of the shared responsibility we all have in addressing stigma and discrimination. The Centre continues to post their valuable perspectives on our website.

Armed with valuable input from the youth focus group participants, the Centre invited researchers, educators, advocates, youth, service providers and policymakers from around the world to participate in a three-day workshop called Transcending the Stigma Surrounding Mental Health Difficulties: An International Research Collaboration to Empower Children and Youth.

In March 2007, 38 respected leaders in stigma prevention gathered in Toronto to discuss the global challenge of mental health discrimination and begin the process of developing an international research collective in efforts to identify effective school-based interventions to address it. Participants came from across Canada, as well as from Austria, the United Kingdom, United States and Australia.

Workshop participants discussed a wide range of components and characteristics that may contribute to an intervention’s ability to sustainably prevent or eliminate discrimination. Important points raised include: the duration, timing and format of the intervention, its supplementary educational material, the way in which it is delivered and by whom.

Interventions that involve direct contact with other human beings took centre stage during these discussions. Participants agreed that a series of experiential engagements with other people are a necessary component of any curriculum-based intervention intended to foster empathy and social inclusion among students.

The collaborative determined that these personal interactions may be most powerful when they are introduced early and sustained across the curriculum. Young children may benefit most from a generic intervention such as Roots of Empathy, which connects classrooms with a parent and infant for one school year. As students get older, the interventions could evolve in an age-appropriate way to address topics more specific to mental health discrimination. For example, older children could be introduced to individuals who have experienced mental health difficulties.

The systematic review also highlighted an immediate need to bring increased consistency and rigor to the research surrounding school-based interventions to eliminate and prevent mental health discrimination. Workshop participants discussed ways to ensure new research in this area makes a meaningful contribution to our understanding of effective school-based stigma interventions.

Transcending the Stigma was co-sponsored by the Centre, the Canadian Council on Learning, and the Centres of Excellence for Children’s Well-Being. A report on the workshop can be found at

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Generating Awareness through Project Postcard: a Pilot Project

Project Postcard engages youth in a creative process and demonstrates how art can be used for advocacy.

If a picture is worth a thousand words, then Project Postcard has the potential to get a lot of people talking. Armed only with art supplies, boundless creativity and a little help from the Ottawa School or Art, dozens of elementary school students created a series of paintings that represent their unique perspective on mental health.

Project Postcard has received rave reviews from students and teachers alike. Student participants gained an appreciation for the importance of mental health saying, "I like that we are promoting a very important cause, but we get to make it fun by painting."

When teachers were asked to describe what they liked most about Project Postcard, one teacher responded by saying the "reinforcement of ideas through the art project", suggesting that the group artwork was seen as a very important component of the project's success.

The project paintings have been reproduced as postcards for broad distribution. This art-based mental health awareness project was developed by the Centre, in partnership with the Canadian Mental Health Association-Ottawa and the Centre for Addiction and Mental Health, with funding from the Community Foundation of Ottawa.

For more information or post-cards contact the Centre at

Project Postcard 1 Project Postcard 2 Project Postcard 3

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Minister Matthews’ Visit to the Centre

Hon. Deb Matthews, Ontario’s new Minister of Children and Youth Services, met with the Centre and representatives from its Consumer and Advocates Network (CAN) in Ottawa earlier this year. It was a very positive meeting and the Centre is looking forward to continuing these interesting discussions and further exploring some of the opportunities that were identified in the meeting.

During the meeting, Minister Matthews confirmed her interest in shifting away from an emphasis on systemic outcomes to a more direct emphasis on individual outcomes for children and youth. She also expressed a specific interest in the indicators initiative that the Centre is currently undertaking with the Ministry in an effort to evaluate Ontario’s progress with respect to its policy framework for child and youth mental health. This project speaks directly to the evidence-informed and methodologically sound manner way in which the Centre approaches all of its projects. In addition, Minister Matthews expressed her admiration for the emphasis we place on partnerships that are facilitating and accelerating system-wide change.

Centre staff shared with Minister Matthews their strategy of approaching the upcoming evaluation. It was quite clear from the conversation that this process will be undertaken in a spirit of cooperation and collaboration with the Ministry. There was a commitment to ongoing dialogue and partnership with the Minister and her Ministry on this and other Centre-related issues.

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Consumer and Advocates Network Presents Petition to Minister

Also during her January visit, Minister Matthews met with members of the Centre’s Consumer and Advocates Network (CAN). The representatives of CAN handed over 9,500 signatures from last year’s petition circulated to encourage the implementation of the government’s Child and Youth Mental Health Policy Framework – A Shared Responsibility.

Minister Matthews with members of the Centre's Consumer and Advocates Network (CAN)

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The Centre Streamlines its Management Structure

The Centre is formalizing its operational practices with a more clearly defined management structure.

Ian Manion, Executive Director

Ian Manion continues as Executive Director of the Centre, a role he now holds exclusively. Ian’s expanded role includes his previous responsibilities as ED of Operations and acknowledges the significant role he plays beyond the day-to-day business of the Centre in terms of establishing and implementing partnerships and providing leadership within the Centre and beyond.

Simon Davidson, Chief Strategic Planning Executive

Simon Davidson carries on his leadership with the Centre as our key strategist in developing external partnerships, a champion for the Centre’s profile provincially, nationally and internationally and our steadfast link to the new Mental Health Commission of Canada. While maintaining the same level of commitment to the Centre, Simon will now have more flexibility to focus on current and emerging strategic opportunities.

Amy Boudreau, Director, Strategic Planning and Operations

Amy Boudreau’s role has gradually increased to include responsibility for most of the administrative management of the Centre – including strategic planning, operational direction, staff supervision and budget management. The majority of the Centre’s team now reports to Amy and will continue to do so. The expansion in her responsibilities warrants the acknowledgement that this adjustment in title brings to her position.

The Centre is growing and evolving. With this realignment within our management structure, the organization will continue to increase its effectiveness in working towards building a child and youth mental health system that better meets existing and future needs.

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Med Ed Pilot Training Program

The Centre, in collaboration with Dr. Stan Kutcher of Dalhousie University, has developed a plain-language resource designed to assist non-physicians in managing the use of psychotropic medications to treat child and youth mental health problems. This exciting initiative is now moving into its first training phase.

The Med Ed reference guide was designed to provide youth, parents and caregivers, front-line health workers and teachers with reliable and practical information about the use, effects and side effects of medications involved in treating mental health problems in children and youth. It also includes a passport tool that allows youth to track their medications and related symptoms and activities. The intent is to empower youth and their families to make informed decisions and improve their treatment outcomes.

May 6th and 7th will mark the launch of a Med Ed pilot training program for the implementation of this resource with Ontario service providers. While the resource itself is designed to facilitate knowledge exchange and support collaboration among partners in care, it has been paired with a training component to ensure the optimal use of this tool in communities across the province. The two-day pilot training program in Ottawa will follow a train-the-trainer approach to facilitate ongoing dissemination among service providers and their colleagues.

For more information on the Med Ed project or the pilot training program, contact the Centre at

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Made in Ontario: A showcase of leading practices in child and youth mental health

Made in Ontario

Made in Ontario

The Centre, in partnership with five leading Ontario-based child and youth mental health organizations, is hosting an event designated exclusively for service providers in May. Made in Ontario: A showcase of leading practices in child and youth mental health was born during an important discussion among colleagues about the lack of opportunity for service providers to learn from one another in a true ‘community of practice’ setting. This event is a first for service providers; it will provide them with a unique opportunity to share leading practices and network with their peers and neighbours about made-in-Ontario solutions and strategies to address mental health difficulties. This one-day event is scheduled during Canada’s National Mental Health Awareness Week in Mississauga, ON. Stay tuned for an update on the outcomes of this event.

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Annual Report

The Centre will be distributing our 2007-2008 annual report in May. If you would like to receive a copy either electronically or by mail please let us know by filling out this online request form.

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