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

CHECKPOINT


CHECKPOINT

September 2007


In this issue:
FOCAL POINT
 .  GRANTS AND AWARDS  .  PARTNERSHIPS  .  EXCELLENCE IN THE FIELD  .  CENTRE NEWS


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

 


FOCAL POINT

Child and Youth Mental Health Services in Ontario - A Service Provider’s Viewpoint

Cherry Murray is executive director of Crossroads Children's Centre, a children’s mental health centre in Ottawa. In commenting on the status of the child and youth mental health system in Ontario, Ms. Murray asks and answers the questions, What Do We Know?, What Do We Do?, and Where Do We Stand? She shares her understanding of the burden, what works to address it and reiterates that service providers do make a significant difference despite the challenges they face. Ultimately, Ms. Murray wonders whether we are at the edge of a precipice or filled with hope for better times ahead.

What do we know?
Our common starting point is clear when we ask ourselves what we know - we know the toll : Mental health problems in children and youth in Ontario exact a terrible cost, not just on the person struggling with the problems but also on their families, friends, communities, and society. We all know the discouraging statistics.

We know what works
We have learned much with an explosion of better understanding over the past decade. Service providers are committed to both stay on top of an ever-changing knowledge base and to do only what works. Evidence-based practices are the watchwords that guide us all. Centres of excellence that have come into existence over the past few years guide us to research, disseminate knowledge, and exchange tools and practices as never before. It is an exciting time in the field.

We know we make a difference
It takes over $100,000 to keep a youth in custody for a year but for as little as $2,500 we can turn a whole life around.

We know the challenges
Far and away the biggest challenge we have faced in Ontario over the past 15 years is our eroding funding base. The lack of even cost-of-living increases for all but two of these years has left us with fewer services, fewer trained and experienced staff, decimated programs, and long wait times.

Adding to the equation is the fact that services in other sectors are experiencing increased pressures as well. Education has seen special services diminish. In youth justice, police and prosecutors are now specifically required to consider community referrals to help address the underlying causes behind crime. Child welfare finds that maltreatment is substantiated more often for children with behavioural and emotional concerns. These trends exacerbate pressures on our already overtaxed mental health system.

Service providers will tell you they are not only seeing the numbers of referrals rising, but the complexity of needs and ensuing crises are escalating as well. It is critical that our skills and knowledge base are of the highest quality and both must be constantly honed and upgraded - another challenge when combined with diminishing resources.

Taken together, these issues have created for us a sense of sadness and frustration: sadness when we see children and youth we know we could help who instead have to wait until their pain is deep and their problems are entrenched; and, frustration when we see our ability to reach those that need us unnecessarily blocked.

A different health issue of this magnitude with these costs in both dollars and human suffering would create a public outcry that would make addressing it a driving goal of our province. Why has it not? The answer, simply put, is that the stigma attached to these problems is as crippling as the problems themselves. Kinark Child and Family Services Centre and Léger Marketing in Ontario just completed a survey that found 38% of Canadians are embarrassed to admit their children suffer from anxiety or depression and 58% said they would not tell anyone their child had attempted suicide.

What do service providers do?
We do all the things you think we do: We assess needs, we provide treatment, we teach parenting skills, social skills and anger management. We seek to constantly upgrade our own skills and knowledge base. We measure our outcomes and we strive to embrace new technology that will allow us to reach more people in need more effectively.

And we do much more: One important fact that has been emphasized in the past decade is that mental health issues do not exist in a vacuum. The children, youth and families that are struggling with them are often also struggling with an array of problems - any one of which has the power to be devastating. Addressing a mental health issue often leads us to help people find housing, flee abuse, deal with crises, and find warm clothing. We “wrap around” the individual with a blanket of treatment and services.

Perhaps the greatest thing we have learned over the past decade has been that we can only lift up those who need us by standing on each other’s shoulders. Across the province you will find coalitions, partnerships, collaborations, networks and cross-sectoral initiatives the likes of which have never before existed.

Where do we stand?
Today, we see hopeful signs. Ontario’s Ministry of Children and Youth Services released a policy framework for child and youth mental health intended to transform the current system of prevention, support and treatment services.  In April the Hon. Mary Anne Chambers announced a funding increase of $24.5 million annually for the children’s mental health sector bringing 5% back into our depleted budgets, on top of 2% in 2004. Nationally, The Mental Health Commission of Canada was created with the goals of promoting the development of a national strategy, launching an anti-stigma campaign, and creating a knowledge exchange centre. A children and youth advisory committee will be included in this initiative.

We also stand at the edge of a precipice. Our next steps are precarious without additional investment and support. With such support bridges can be built and the children, youth, and families who so desperately need our help can be reached.

Cherry E. Murray, MSW, RSW
Executive Director
Crossroads Children's Centre
cherry@crossroadschildren.ca
www.crossroadschildren.ca

Do you have a topic to suggest for Focal Point? Send it to centre@cheo.on.ca.

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GRANTS AND AWARDS

Profile

Measuring the return on investments in child and youth mental health

It’s not always easy to make a case for ramping up investments in child and youth mental health care. While mounting evidence suggests prevention and early intervention services can help struggling families take control of their situations, there is a dearth of information about the financial impact of those services on the broader Ontario community and the provincial pocketbook.

“Both funders and donors are asking us to demonstrate how the work we do with families is having an economic impact on our community,” says Laura Dunlop Dibbs, a special projects manager at the Merrymount Children’s Centre. “However until recently, no measurement model existed.”

A new approach developed by researchers at McMaster University’s System-Linked Research Unit, coupled with a program evaluation grant from the Centre, has given Merrymount just the opportunity they were looking for. The $10,000 award allowed Merrymount to develop a powerful plan to determine if investments in community-based prevention and early intervention services produce both clinical benefits for families and economic benefits for the communities in which they live. The research project was launched in November 2006.

The System Service Utilization Model lays out a standard method to measure the cost of the full spectrum of Ontario social services a family uses, which may include income supports and emergency or crisis services. The Merrymount project is using the model to compare the overall cost of serving two randomly-assigned groups of at-risk families referred to the centre by the local Children’s Aid Society. The first group is receiving basic services, including one suitable support program and scheduled respite or flexi-care at specific intervals. The second group is receiving intensive interventions, which can include any combination of Merrymount services, but should include at least one from each of the agency’s four service categories: support and wellness, psycho-educational groups, family and child care and groups for school aged children. Recruitment for the three-year study is ongoing - the agency expects between 300 and 400 families to participate.

The goal of the evaluation is to determine if prevention and early intervention services produce positive outcomes for families and a net economic benefit for society as a whole. The cost effectiveness of the basic and intensive treatment approaches are being compared by adding up the total cost of social services used by each family and adjusting for the precise cost of the Merrymount services they received. By presenting the clinical impact of basic and intensive services alongside their economic effects, this approach will determine if bigger investments in more intensive prevention and early intervention services will result in proportionally greater economic benefits for the province.

According to Dunlop Dibbs, the results of the Merrymount study will likely have impact far beyond the London service area.

“We know that the economic impact study will have national benefits,” she said. “Having the clinical data to measure against the economic model will be both helpful and newsworthy for the social service and children’s mental health sectors.”

Opportunities

September means back-to-school and the Centre’s grants and awards program is in-sync with what is an important time of year for many people. The spectrum of education awards offered by the Centre ranges from those geared to all levels of college and university study, to those for the professional development of service providers and others working in the child and youth mental health and related fields.

In addition, the Dare to Dream Program provides funding for youth projects geared to raising awareness about mental health with their peers or in their communities. Although not exclusively a school-based program, many previously funded projects have taken place in schools. Dare to Dream applicants need mentors - and that could be you.

Upcoming deadlines for the grants and awards program …

  • Dare to Dream Program - October 31, 2007
  • Undergraduate Awards - December 3, 2007
  • Graduate Awards - December 3, 2007
  • Post-Doctorate and Fellowship Awards - December 3, 2007
  • Individual and Group Professional Development Awards - Submit anytime (Open)

For more information on 2007-2008 grants and awards, please visit our Web site at www.excellenceforchildandyouth.ca.

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PARTNERSHIPS

Coalition for Child and Youth Mental Health Information

Nine out of 10 parents of children with a mental health problem say they want more information to help them understand what is happening, and how to provide help and support effectively. Most don’t know where to find it. Many turn to their local library or the Internet, where they face an overwhelming array of information, little of it research-based and much of it conflicting. Information needs to be reliable, up-to-date and based on the best available evidence. A new partnership is looking to pool efforts to make sure resources are available to address these issues.

In early 2007, the Centre was instrumental in bringing together a number of partners, including the Offord Centre for Child Studies, Children’s Mental Health Ontario and ementalhealth.ca, to disseminate high quality information about child and youth mental health. Through this coalition, we look forward to pooling our expertise and minimizing duplication, to ensure that the information available to youth, parents, caregivers, service providers and others is accessible and of the highest quality.

“At Children's Mental Health Ontario, we're committed to ensuring that children and youth with mental health needs receive services and supports that are known to be effective. The shift to an evidence-based child and youth mental health system will require commitment and collaboration by many players, from researchers to frontline clinicians. We're excited to be at the leading edge of this very important transformation, working alongside our partners in the Coalition for Child and Youth Mental Health Information."
Gordon Floyd,
Executive Director & CEO, Children's Mental Health Ontario

"eMentalHealth.ca, an initiative of the Crossroads Children’s Centre, is delighted to be part of the Coalition. Our online mental health resource directory helps connect children and youth to local mental health resources. Through the Coalition, families and professionals anywhere in Ontario will be able to access quality mental health information about issues such as suicide and depression, and also be able to find out where in their local community they can get help."
Cherry Murray,
Executive Director, Crossroads Children’s Centre
Michael Cheng and Amy Martin,
Co-founders, eMentalHealth.ca

“The Coalition represents an exciting new framework for driving the process of knowledge mobilization. By partnering and combining our various strengths in knowledge creation, in service delivery and in advocacy, we will be positioned to influence decision-making at every level, from the choices made by consumers to clinical practice to provincial policy. The result will be to shorten the time it takes to turn knowledge into practice for the benefit of all children and youth.”
Peter Szatmari,
Director, Offord Centre for Child Studies

“The Centre is focused on building partnerships, sharing information and working towards a child and youth mental health system that makes more sense for children, youth, parents and caregivers, as well service providers. This Coalition is an example of how we can work together to put our priorities into action.”
Ian Manion,
Executive Director, Operations, The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO

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EXCELLENCE IN THE FIELD

Roots of Empathy

Roots of Empathy, is an evidence-based classroom program that builds children’s social and emotional competence, increases empathy and reduces levels of aggression and violence. Mary Gordon founded Roots of Empathy in 1996. Since then, this heartwarming program has been delivered in classrooms across Canada, including urban, rural, remote and Aboriginal communities (on and off reserve). It is also being piloted in Australia, New Zealand, and the United States.

Roots of Empathy

Roots of Empathy’s mission is to build caring, peaceful, and civil societies through the development of empathy in children and adults. The program’s goals are:

  • To foster the development of empathy
  • To develop emotional literacy
  • To reduce levels of bullying, aggression and violence, and promote children’s pro-social behaviours
  • To increase knowledge of human development, learning, and infant safety
  • To prepare students for responsible citizenship and responsive parenting

The program focuses on a neighbourhood infant and parent who visit the same classroom every three weeks over one school year. Participating classrooms range from kindergarten to grade 8. A trained Roots of Empathy instructor coaches the students to observe the baby’s development and label the baby’s feelings. The instructor also visits the classroom before and after each family visit to prepare and reinforce teachings using a specialized curriculum with a lesson plan for each visit. There is a 639-page curriculum divided into nine themes, with three classroom visits supporting each theme for a total of 27 visits. Each theme is further broken down into four age ranges. The training and curriculum ensure that each classroom receives the same quality learning experience.

The program has reached more than 156,000 students across the country since it began in 1996. During the last school year, Roots of Empathy reached more than 18,000 children in 735 classrooms here in Ontario.

Results of independent research demonstrate the effectiveness of the program:

  • Five studies have been conducted at the University of British Columbia starting in 2000. Results from all studies show a significant decrease in aggression and bullying, and an increase in pro-social behaviours among children who participated in the Roots of Empathy program compared to children who did not.
  • In a 2004-2007 follow-up study, the Government of Manitoba not only found significant improvements in behaviours in Roots of Empathy children immediately after the program, but also that improvements were maintained three years later.
  • Research in Australia and New Zealand in 2005 also found increases in pro-social behaviour and decreases in aggressive behaviour in Roots of Empathy children.
  • In 2005, researchers at the Ontario Institute for Studies in Education at the University of Toronto undertook a program evaluation of Roots of Empathy and concluded that it is an effective program for developing social and emotional learning, based on scientific research on child development and the personal and professional experience of leading educators and health practitioners.

More information about Roots of Empathy is available on the Web site at www.rootsofempathy.org. The organization recently launched a program for preschool children called Seeds of Empathy. More information about that program is available at www.seedsofempathy.org.

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CENTRE NEWS

Dr. Simon Davidson to Head National Advisory Committee

Dr. Simon Davidson

On August 28th, Prime Minister Stephen Harper announced that Dr. Simon Davidson will chair the Children and Youth Advisory Committee for the Mental Health Commission of Canada. Dr. Davidson is executive director of Planning and Development at the Centre. Among the many other positions that Dr. Davidson holds, he is also Chair of the Division of Child and Adolescent Psychiatry in the Department of Psychiatry at the University of Ottawa.

According to Dr. Davidson, “Canada and its children and youth deserve a mental health system that allows them the best possible life trajectory. It must be built on solid evidence and address the full continuum of care, including mental health promotion and prevention, early identification, intervention, recovery, rehabilitation and continued care. The opportunities for improvement to our mental health services abound. Additional funding is required, but not to provide services in the same old way. I look forward to working with the many leaders across Canada to ensure that the mental health needs of our children and youth are given the attention they deserve.”

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Introducing Tammy Youssef, the Centre’s Grants and Awards Coordinator

 Tammy Youssef 

With 15 years administrative experience in health care, Tammy Youssef is a welcome addition to the Centre’s team. As the grants and awards coordinator, she is responsible for receiving applications submitted to the Centre, coordinating the peer-review process and administering the grants and awards to agencies across the province. Tammy also collects outcomes reports generated by the work funded by the Centre and ensures that deadlines are met. Overall, she works closely with the Centre’s grants and awards administrator to ensure that the system runs smoothly for applicants, recipients as well as for the Centre.

Tammy is available to answer your questions at 613-737-2297 or by email at grantsandawards@cheo.on.ca.

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International Initiative for Mental Health Leadership

The Centre recently hosted meetings of youth, service providers and parents and advocates from around the world leading up to the International Initiative for Mental Health Leadership (IIMHL) conference in Ottawa. With representatives from the United States, Australia, New Zealand, Scotland, Ireland and Canada, the meetings focused on an exchange of knowledge and best practices in child and youth mental health. This was the first time this group invited youth and parents to be involved and only the second time child and youth mental health issues were explored. Opportunities for partnership and ongoing learning are likely to follow.

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Youth Art in Action

The Centre teamed up once again this summer with a group of young art students to produce a mural about child and youth mental health. Nine young people had a guided discussion about mental health and painted their rendition of some of the issues as part of a mural course with the Ottawa School of Art. This year's mural entitled "Soar to New Heights" was officially launched as part of the IIMHL conference.

2007 Mural Project
"Soar to New Heights" - 2007 Mural Project

This has proven to be a winning partnership for the young artists and the Centre. The artists have a permanent installation of their work and the Centre has a constant image that reflects the vision of and for youth.

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