The education system has a long and rich history in providing service to children and youth. There is, however, an increasing complexity of student need that is challenging the parameters of the current system. The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO put together this high level perspective based on the input of members of our Service Providers Reference Group, among others, who work in the education system.
While mental health services are not mandated within the Education Act, and proper training in child and youth mental health is not part of the curriculum for educators, the school environment is often where mental illness is most obvious and first identified. When mental illness is acknowledged, there is inconsistency in how individual school boards address resource needs, coordination of services, and reduction of stigma. These are pressing concerns, but we cannot expect the responsibility for finding solutions to rest solely on the schools.
For children or youth with special needs, a timely response can effectively capitalize on their developmental trajectory, often preventing more serious manifestation of their illness and/or the compounding of secondary problems (e.g., learning, socialization). Parents expect schools to provide speedy assessment and support. But the demand for service from school boards and staff can seldom be met in ways that respond to the actual needs of individual students in a timely and cohesive way. Today’s assessments are more lengthy and comprehensive than in the past, and the existing system is overburdened due to the volume of requests and understaffing in special services. In addition, there is a reliance on testing over prevention programs. Parents and caregivers must navigate large bureaucratic systems to get their child assessed and put a plan in place to meet their needs. Families who pay for outside assessment will have their child’s needs met more quickly, but this alternative puts considerable financial strain on some families and is simply not an option for many more.
Overall funding constraints and the stretching of existing resources to respond to new directions further limits the ability of school boards and staff to address the long waiting lists. In addition, mental health professionals having to work in education’s ‘test and place’ model face employment issues. “We are finding it harder to recruit and retain new staff because they don't want to spend all their time just doing tests and being asked to work faster” says Dr. Lean.
Greater coordination between community services and the education system is increasingly recognized as a promising direction to address the needs of children and youth. Some key issues however must be resolved before this can be accomplished in the best interest of the student. The tension between educational and community settings needs to be further explored so that children and youth can be better supported as holistic beings in the context of their lifestyles as students. The adult mental health sector is increasingly addressing workforce re-integration issues. A parallel process for children and youth must involve the education setting. This also means that teachers need support and training so that any systemic changes can be integrated right to the classroom level. This coordination between the education system and community services might also address some of the current problems in at least three key areas: the duplication of services funded by different Ministries; the inconsistency of access and quality of these services across schools, school boards and communities, and; the support for families who can’t necessarily access recommended services or are on very long waiting lists in schools or the community.
Another challenge for school boards lies in developing a more proactive response to mental illness. According to Dr. Lean, “School-based special service professionals have the training but little or no opportunity to provide prevention activities.” A key part of prevention is stigma reduction, and school is the ideal place for stigma reduction programs for all students. Destigmatizing mental illness and normalizing access to mental health services could address both students’ and schools’ reluctance to reach out for help. Currently, identified students are vulnerable to potential stigma as they navigate the system.
Increasingly the need for more knowledge and capacity is being recognized. There are more alternative programs for students and more training and cross training between mental health and education professionals. Many school boards and organizations across the province are working together in various ways to improve the child and youth mental health of the students of their communities.
One such example is the partnership that has been developed in Southwestern Ontario between the Bluewater and Bruce Grey Catholic District school boards and Keystone Child, Youth and Family Services. In this district, school boards and service agencies are working together to develop and implement models and programs to build teacher capacity and develop a community response to meet the needs of students. “We really do believe that in building futures together we are able to define not only what our goal/mandate is but also how we seek to deliver these services IN PARTNERSHIP,” says Dennis Boyle, Executive Director of Keystone Child, Youth and Family Services.
As the successes start accumulating we have opportunities to learn from each other and to build an evidence base that supports the continued development of these programs. Ultimately we will better serve children and youth for the long term.
TeachADHD:Taking Cognitive Neuroscience to the Classroom
Attention Deficit Hyperactivity Disorder (ADHD) has high prevalence occurring in 5 to 12% of children worldwide. By this measure, Ontario has between 107,000 and 256,800 students with ADHD in our publicly and privately funded schools. Very few of the teachers who work with these children and youth will have received adequate training about ADHD. Presence of the disorder in a student increases the risk for poor academic outcomes and eventual high school drop out.
TeachADHD is a set of integrated multimedia tools that have been developed by the Hospital for Sick Children1 (SickKids) specifically for education professionals to bridge the gap between the neurocognitve understanding of ADHD and classroom practice.
ADHD has not been recognized by the education system as a special needs category despite the recognition of it as a valid mental health disorder. As a result, there is little attention to ADHD in teacher training programs. This means that every year all teachers have to try to accommodate and teach an average of one or two students with ADHD without any comprehensive training in the nature or educational implications of the disorder.
Teachers can play a critical role in the outcomes for students with ADHD because we know that instructional quality is a key determinant of academic, affective and behavioural outcomes at school. There are currently many existing resources available for teachers to learn about ADHD. Unfortunately, most of these resources conceptualize ADHD as a behavioural disorder and do not provide educators with a clear rationale for developing and implementing instructional strategies to facilitate academic success. Recent evidence has changed our perspective.
Very few of the province’s teachers will have received information about ADHD in their pre-service training programs, or have access to specialized workshops on how best to support these students. New methods are needed to provide the necessary professional development, since traditional workshop approaches are labour intensive and costly. Many teachers are unable to take advantage of educational workshops in universities because of our vast geography. At the same time, the cost of presenting regional workshops is prohibitive for school boards, teaching institutions and private partners.
The TeachADHD materials consist of a 3-part DVD, an accompanying teachers’ manual, and a Web site. The DVD presents three 20-minute programs
These programs provide teachers with an accessible and engaging overview of the key research evidence about ADHD as well as providing them with opportunities to systematically observe students with ADHD and behavioral management techniques in a classroom context.
The Web site (www.teachadhd.ca) provides information, updates, and resources about ADHD, as well as a password protected discussion board for teachers. The Web site provides the vital link between researchers and educators, because it transfer new knowledge about ADHD to the educational sector and it enables educators to dialogue with each other and the mental health researchers at SickKids.
The TeachADHD materials are designed primarily for use by elementary classroom teachers, special education teachers or teacher consultants. The materials could also be used in teacher pre-service training. While they were designed as an independent study program, they may be used as the focus of a series of short workshops on ADHD.
According to SickKids’ Dr. Bruce Ferguson, “The solution for successful knowledge transfer requires innovative models that blend both traditional interventions and new distance education technologies. The TeachADHD materials represent a first attempt at such innovation.”
The Community Health Systems Resource Group at SickKids is working to develop a series of professional development tools for education professionals titled Teach for Success. They are currently evaluating the roll out and teacher uptake of the TeachADHD materials. The goal is to take the knowledge and experience gained forward to the production of several more such packages.
1 TeachADHD was conceived by the Community Health Systems Resource Group at SickKids and developed from the research work of Dr. Rosemary Tannock. The DVD was developed and produced in partnership with TVOntario. The Teachers Resource Manual was authored by Rhonda Martinnussen and Rosemary Tannock with Alison McInnes and Peter Chaban. The project was supported by funding by Shire Biochem Inc. (an unrestricted educational grant) and grants from the National Institutes of Health and the Canadian Institutes of Health Research.
The Centre supports mental health awareness and stigma reduction among youth through its Dare to Dream Program. It provides an opportunity for youth (18 years of age and under) to get involved in innovative projects on mental health awareness and stigma reduction. Our next competition is quickly approaching – October 31, 2006; so make sure to pass this information along to all of the youth in your networks… They can get more information and application forms from http://www.daretodreamprogram.ca/. We will give them up to $1000 to make their creative ideas come true. There are plenty of examples… Snap-Pey Pals, a youth developed comic book about bullying is one.
Dare to Dream Program
From Snap-Pey Pals
We have recently moved to online applications to provide for you a more convenient way of applying for Centre funding. Guidelines for the online application process will be available on our site, under the Grants and Awards section. They will assist you as you prepare for the application and as you move through the process. Please remember to review the guidelines prior to beginning the online form.
TAKE NOTE OF THESE DATES
The Centre will be posting new criteria/conditions on September 15, 2006 for its second Program Evaluation Grant competition. This year, a limited number of grants of up to $20,000 each will be made available to Ontario-based mental health service provider organizations. Applicants MUST apply, before November 1, 2006, by using our online application form available on our Web site. Award decisions and announcements will be made by December 1, 2006. Successful recipients will have approximately four months to complete their evaluation activities, ending on March 31st, 2006. Please apply by visiting our Web site anytime between September 15, 2006 and November 1, 2006.
These Grants aim to:
For more information on Program Evaluation Grants and other Grants and Awards, please visit our Web site at www.excellenceforchildandyouth.ca.
Joel Shapiro is an undergraduate student at the University of Western Ontario
with big plans for his career as a child and youth mental health professional. The landscape of the field during his career will be different than it is today. Fostering this change is the basis for the activities of the Centre and in particular the Grants and Awards Program geared to students1 . With the financial help of the Centre, mental health professionals of today, like Joel’s mentor2 Dr. Margaret Steele, are investing in students to improve child and youth mental health in the long run.
Mr. Shapiro, with Dr. Steele’s mentorship, will launch a survey in three representative communities. By sampling a combination of rural, urban and mixed communities, Mr. Shapiro expects to document a better understanding of how primary care providers refer mentally ill youth across the province. With Dr. Steele’s mentorship, the information will then be used to develop a set of guidelines to help primary care physicians refer children and youth to psychiatrists and mental health agencies more efficiently. In addition, the information could be used by children's mental health agencies to help them determine whether they are effectively communicating with physicians.
Dr. Steele is Physician Lead of the Child and Adolescent Mental Health Care Program at the London Health Sciences Centre and the Chair of the Division of Child and Adolescent Psychiatry at the Schulich School of Medicine and Dentistry at the University of Western Ontario. As a mentor, she has committed to overseeing Mr. Shapiro and ensuring that the standard of his work will make for a reliable resource for others. In addition, her connection ensures that his award is managed through an established research institution.
The Centre provided Joel with a $2500 award to work on this project. The outcome of this study will not only help in furthering the development of the child and youth mental health in Ontario, it will contribute to the development of a future child and youth mental health professional in the field.
1 The Undergraduate Awards aim to encourage students to pursue a child and youth (0-18 years of age) mental health project in order to increase their knowledge in this area, to develop and deliver a project that will impact child and youth (0-18 years of age) mental health and potentially attract the candidate to this field of study and work. This award is not restricted to any one discipline of mental health training or sector of mental health practice.
2 Mentors must hold an academic appointment at an accredited university or community college within the Province of Ontario. He or she must be engaged in areas of teaching or investigation directly related to child and youth mental health and that meet the mission and strategic directions of the Centre. The mentor is expected to assist with the intellectual content of the application submitted and will be identified as the individual supervising the training program/project for the applicant.
Working on Stigma-Perennial Roadblock to Well-being
Dealing with the stigma associated with mental health difficulties is a key action area for the Centre. We recently completed a state-of-the-art systematic review1 of school-based interventions, for children and youth, to reduce the stigma related to mental health difficulties.
Stigma adds unnecessarily to the suffering from mental health difficulties. It refers to thoughts, feelings or behaviours that discriminate against others like hateful language, fear of people, rejection from a social group, or hiring discrimination. Stigma can reduce people’s willingness to seek, comply with or complete care. It lowers quality of life and self-esteem, thereby increasing withdrawal, curtailing social involvement, and increasing self-harm or harm directed at others. It not only affects people with mental health difficulties, but parents, siblings, spouses and friends can also feel the burden. For children and youth, this makes getting help even harder as they are often dependent on these others. The systematic review asked what kinds of interventions there are and whether they work to reduce stigma.
The Centre is preparing a manuscript for publication about our research on stigma. Our work highlighted the need for a small, intensive workshop to plan a high quality, multi-site, international study to investigate the effectiveness of school-based interventions, for children and youth, to reduce the stigma associated with mental health difficulties. The Centre is proceeding with this next step, organizing a small workshop for experts in stigma research as well as other key partners or stakeholders in the spring of 2007.
The ultimate goal of this work is to use the findings from the formal study, which our workshop will afford, to guide the implementation and evaluation of the best school-based intervention(s) in Ontario. “Best” refers to interventions that maximize the reduction of stigma and minimize any adverse effects on participants.
Other organizations are working on the issue of stigma. For example, the Mood Disorders Society of Canada is hosting a workshop in October 2006 to develop a research agenda that addresses the stigma associated with mental health difficulties across the life cycle. Researchers from the Centre will attend the workshop to ensure that its agenda is inclusive of child and youth issues. The Centre is also supporting youth representatives to attend the workshop.
1 A systematic review employs high quality scientific methods to bring together all available information on a specific topic.
The Centre recently welcomed Dr Darcy Santor as our new Senior Child and Youth Mental Health Research Scientist. Dr. Santor is a clinical psychologist specializing in adolescent mental health and in the assessment and treatment of mood disorders. He has an undergraduate degree in Philosophy and Psychology from the University of Western Ontario, and a doctoral degree from McGill University. Dr. Santor has expertise in school based mental health programming and has pioneered the use of Internet based applications to facilitate help seeking and the early detection of illness. His primary research interests include vulnerability factors influencing adolescent mental health and mood disorders, as well as measurement and applications of item response theory and hierarchical linear modeling.
Dr. Santor was director of the IWK Grace Health Centre's Interpersonal Therapy Program where he was actively involved in clinical research and treatment. In coming to Ottawa, Dr. Santor also accepted the position of Full Professor at the School of Psychology at the University of Ottawa. He has been generously funded by CIHR and SSHRC.