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The Facts About CYMH

Child and Youth Mental Health: the Realities Dr. Simon Davidson Chair, Child & Youth Advisory Committee, Mental Health Commission of Canada; Chief Strategic Planning Executive, Centre of Excellence for Child & Youth Mental Health at CHEO Toronto, Ontario November 6, 2009. The Facts About CYMH.

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The Facts About CYMH

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  1. Child and Youth Mental Health:the Realities Dr. Simon DavidsonChair, Child & Youth Advisory Committee,Mental Health Commission of Canada;Chief Strategic Planning Executive,Centre of Excellence for Child & Youth Mental Health atCHEOToronto, Ontario November 6, 2009

  2. The Facts About CYMH • High prevalence of psychiatric disorder (13-22%). • High demand for service, limited access, long wait lists (only 1 in 6 of those needing help (16%) had accessed services in the previous 6 months). • More than 70% of adults with mental illnesses onset in childhood/adolescence. • Est $51B lost per year –workplace absenteeism due to mental illness * It all begins with children and youth!

  3. Mental Health Commission of Canada • The History • The Structure • The Priorities www.mentalhealthcommission.ca

  4. Key Initiatives National Mental Health Strategy Anti-stigma Campaign Knowledge Exchange Centre Homelessness/Mental Health Research Projects Partners for Mental Health Campaign and Foundation

  5. Child and Youth Advisory Committee (CYAC) of MHCC ‘The orphan of the orphan’ ….NO LONGER! • 16 member Committee • Across the age spectrum to age 25 • *family & youth centredness • *maternal & family health

  6. MHCC – CYAC Funded Initiatives* • National Mental Health Strategy • Evergreen Document • School-based mental health programs -evidence -demonstration projects Youth Reference Group • Anti-stigma, Anti-discrimination Campaign Youth Focus Youth Reference Group Family Self Stigma • Knowledge Exchange Centre cymh component *collaboration and engagement across Canada encouraged whenever possible (exploring national prevalence & surveillance study)

  7. The Many Faces of Child Abuse & Neglect • Prevention -the name of the game • If not, then early identification and early intervention

  8. The Many Faces of Child Abuse and Neglect • Iatrogenic abuse & neglect? • Does system inadequacy or failure constitute abuse or neglect? • What about the Rights of the Child and Youth?

  9. ‘Our children are a living message to a time we will not see’ Sir Al Aynsley Green Children’s Commissioner for England

  10. Conclusion Great Program Stimulating day ahead Thank you for your attention!

  11. Understanding the Developmental Determinants & Changing the Life Scripts of Abused & Neglected ChildrenDeborah Goodman, MSW, RSW, PhD.Manager of Research & Program Evaluation,Child Welfare Institute, Children’s Aid Society of Toronto The Many Faces of Child Abuse and Neglect Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect Friday, November 6, 2009•Design Exchange, Toronto, Ontario

  12. Canadian Child Welfare Context

  13. Child and Welfare vs. Child Protection Systems • Child Protection Systems (CPS) • Canada, United States, United Kingdom, Australia • Emphasis: individual rights & responsibilities; Mandate: “stand-a-lone” authority • Family Service Systems (FSS) • France, Germany, Sweden, Netherlands • Emphasis: consensual agreement; Mandate: child & family welfare systems; • Focus: support parent-child relationships & care of children • Community Caring Systems (CCS) • Canada’s Aboriginal Peoples, New Zealand Maori • Emphasis: consultations with parents, extended family, local community • Focus: keeping children within their family/community; respect traditional values

  14. Canadian Child Protection System Characteristics • Provincial authority – model • Residual system • Focus is on risk & safety • Focus is on protecting children from harm in their own home • Mandatory reporting • 1-point entry system • Reliance on court to convey authority • Viewed as stigmatizing • Division between services for family support & child protection • Service is to vulnerable / at risk youth via a patchwork of services delivered by different ministries (e.g. child welfare, youth justice, children’s mental health…)

  15. The social construction of “child maltreatment”… a moving target 1900-2000 1900’s Physical Neglect / Abandonment 1960’s Physical harm / Medical Neglect 1980’s Sexual harm 1990’s Neglect / Inadequate Supervision/ Inappropriate Child Care 1990’s Emotional harm /Exposure to adult conflict 2000- 2100… Deleterious effects of 2nd-hand smoke is well established in literature and law Parental right vs. child abuse? Unintentional injury (UI) is the leading cause of death for children age 1-11; half UI’s are transportation accidents Poor parenting decision vs. neglect? Parental alienation Family dysfunction vs. emotional harm?

  16. Child maltreatment by context…differs USA 2007vs.Britain 2005 vs. Canada 2003 vs. Toronto 2003 Population 302M 61M 32M 2.5M Neglect 60% 44% 30% 46% Phys. Abuse 11% 15% 24% 28% Sexual Abuse 8% 9% 3% 5% Emotional Abuse 4% 20%* 15% 1% Exposure to DV ~ ~ 28% 20% Mixed 13% 12% ~ ~ Other 4% ~ ~ ~ TOTAL 100% 100% 100% 100% * Britain includes DV Over 1.8millionOver 214,000 Over 12,000 investigations investigations investigations

  17. Canadian Incidence Study (CIS 2003) 5 categories 20+ maltreatment forms Categories Physical abuse Sexual abuse Neglect Emotional maltreatment Exposure to domestic violence

  18. Substantiated by child age: CIS 2003 CIS 2003 Age Incidence/ % Group per 1000 Substantiated <1 28.22 7% 1-3 19.93 15% 4-7 21.35 24% 8-11 23.21 29% 12-15 20.40 25% Total 21.71 100%

  19. Reason for service at an Ontario CAS Ontario Eligibility Spectrum  PROTECTION SECTIONS 1-5 Section 1 – Physical/Sexual Harm by Commission Section 2 –Harm by Omission / Neglect Section 3 – Emotional Harm/ Exposure to Partner Conflict Section 4 –Abandonment/ Separation Section 5 –Parental Capacity

  20. Children 5 & under No Court Involvement N=2,245 Section 1-Physical Harm 29% Section 3-Emot Harm/DV 28.5% Section 5- Parental Capacity 27% Total 84-85% Children 5 & under Court Involvement N=50 22% 12% 48% 82% Top 3 Ontario Eligibility Codes –Children 0-5 for 2008 @ 1 CAS in GTA

  21. Eligibility Code –Top Section & Top ScaleChildren 0-5: 2006-2008 Top Section/Scale: 5-3 Caregiver with a Problem NO – court involvement YES - court involvement 2006 286 35 2007 341 19 2008 433 14 Sub total 5-3 1060 68 Total all sections 5620 187 % 5-3 accounts for All Reasons of Service 18.9% 36.4%

  22. About a Canadian public health issue – children at risk

  23. About the areas of concern for thePublic Health Agency of Canada AREAS 1- Poverty / low SES 2- Child abuse and neglect 3- Prenatal 4- Children’s mental health 5- Obesity 6- Unintentional injuries APPROACH 1- Prevention 2- Promotion 3- Protection 4 -Treatment

  24. About the development of brain growth: newborn to 6 months Wotherspoon newborn 1 month 3 months 6 months

  25. These statistics are not direct comparisons as they are not based on controlled sampling within single research projects. a Total Canadian population b Of the 30% of former Crown wards who became pregnant at an early age, 60% became re-involved in the child welfare system as parents. MCYS

  26. Early developmental determinants of risk and resilience

  27. Risk and protective factors Risk Personal/Internal factors Exist within the individual e.g. genetic, disabilities Environmental factors Exist within a social context e.g. family, school, community, country NOTE: The #of risk factors is more important than the type of risks Protective Personal/ Internal factors Exist within the individual e.g. personality, autonomy External factors Exist within a social context e.g. family, school, community, country NOTE: Protective factors reduce risk of harm, improve resistance to risk, contribute to positive outcomes

  28. About the effects of physical discipline/harm on child development… About the effects of line on child development… 10/11 meta analyses found parental corporal punishment is associated with the following behaviours & outcomes: Decrease in Increase in - Child’s moral internalization - Child delinquency - Quality of relationship: parent to child - Child anti-social behaviour - Child mental health - Likelihood of being a victim phys. abuse - Adult mental health - Adult aggression - Adult criminal/anti-social behaviour - Likelihood of abusing own child/spouse Short-term effect + Immediate child compliance

  29. * *2 =5.9, p<.04

  30. About the effects of domestic violence on child development… The effects of domestic violence on infants and toddlers place these children at increased risk of abuse by their mothers and/or the abusive adult in the home. Child abuse occurs in 30-60% of spousal violence cases. 21% Canadian women are abused by their partners during pregnancy. 40% of those women who were abused during pregnancy reported that the abuse began when they were pregnant. 11% of the women stated the violence occurred before their current pregnancy 64% of the women indicated the abuse escalated during the pregnancy

  31. Still Face Experiment http://www.youtube.com/watch?v=7AGJFg6twjg&feature=related

  32. About the effects of neglect on child’s developing brain… no neglect neglect

  33. About the effects of sexual abuse on the developing brain…

  34. About the effects of alcohol on the developing fetus… Direct Effects of Alcohol on Fetus: Neuronal cell damage/cell death Inhibited protein and DNA synthesis in the placenta, fetal liver and brain = fewer cells, decreased growth and differentiation = smaller organs Effected the hippocampus, amygdala, cerebellum -all appear particularly sensitive to effects of alcohol Smaller skeleton, greater cartilage and less skeletal bone creation (e.g. craniofacial anomalies due to effects of cell death & reduced neural crest cell numbers) Indirect Effects of Alcohol on Fetus Nutritional deprivation/malnutrition Calcium abnormalities Structure and function of the placenta was altered Circulatory changes = decreased fetal blood flow Interference with growth factors and other cell signaling mechanisms Fetal overexposure to stress hormones (brain areas involved in a) the stress response, b) depression, and c) addiction overlap

  35. Prenatal alcohol exposure delays skeletal development in fetal rats Alcohol Pair-fed control Ad-lib fed control Weinberg

  36. About the impact of emotional trauma on the developing brain… # /frequency/duration/chronicity of stress episodes is important e.g. infant feels unsafe with caregiver (physical harm), &/or is in an unsafe situation (DV), &/or has unpredictable/no response from caregiver with infant’s distress cues (parent capacity re substance use/mental health, neglect) STRESS SITUATION Activates infant’s stress response system Large amounts of cortisol flood the infant’s developing brain Cortisol floods can be toxic to the brain/ may change brain structure

  37. About the effects of poverty on a child’s development Low-income families are over-represented in child welfare involved families (both in care and out of care) USA National Incidence Studies (NIS1,23) found a strong inverse correlation with income and child maltreatment cases Child maltreatment report rates are greatest in communities with high poverty rates and high unemployment rates Strong correlation between welfare assistance and child protection caseloads

  38. Changing life scripts

  39. Reducing maltreatment is about protective factors & prevention strategies Five Protective Factors to Reduce Child Maltreatment Nurturing & attachment between family members Knowledge of parenting/ child development Parental emotional resilience Social connections for parents Concrete supports – adequate food, clothing, housing Prevention Strategies Universal/Primary – “before the fact” Targeted /Secondary– “before the fact” Indicated / Tertiary – “after the fact”

  40. Preventing child maltreatment – Evidence-based to promising practices Evidence-based interventions Primary prevention programs e.g. “Back to Sleep” - reduced SIDS A caring, committed caregiver & stable placement Healthy Babies/Healthy Children; Head Start Emerging evidence-based interventions Triple P Parenting Trauma treatment e.g. CBT FASD training for professionals and respite services for children with FASD Family Group Conferencing Early diagnosis / meconium testing Promising practices Home visiting/targeted parenting programs Quality preschool/family support Improve and repair brain function e.g. exercise, pharmacology Targeted education to children e.g. prevent sexual abuse, dating violence

  41. Key practice & learning areas

  42. Future Research Areas Gene and brain research Impact of substance use on fetus & child Infant mental health Stronger links -poverty to child maltreatment Link affordable, high quality early learning & child care programs to maltreatment prevention Impact of greater collaboration across sectors

  43. Combating child maltreatment -professionals Common focus, consistent message Comprehensive approach by all levels of government Consolidate knowledge, especially Canadian Consistent collaboration – practice & policy & research & across-sectors & across-disciplines Coordinate on evidence based practices Capabilities to identify expanded Collect data, analyze outcomes

  44. Combating child maltreatment- Canadian society Stronger prevention focus Much earlier intervention with infants/young children Improve understanding of infant developmental needs Better education on risks of maternal alcohol use Provision of quality child care Eliminate corporal punishment of children

  45. THANK YOU! Child Welfare Institute, CAS-Toronto Developing evidence-based knowledge today...so we can be more effective tomorrow Deborah Goodman, PhD Manager of Research & Program Evaluation, dgoodman@torontocas.ca 416 -924-4640 x 2792

  46. Working Towards WinningThe Collaboration of Children’s Aid Societies, Parents and the Courts

  47. Howard Hurwitz, M.S.W., R.S.W.Director of Children’s ServicesJewish Familyand Child Service of Greater TorontoMODERATOR The Many Faces of Child Abuse and Neglect Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect Friday, November 6, 2009•Design Exchange, Toronto, Ontario

  48. Paramount Concern is Early Permanency Planning for Children Although a large percentage of cases are settled out of court, there are still too many legal battles Issues related to Family Courts are laden with emotion rather than complex legal theory We need to work more effectively with other professional groups, understand one another’s roles, and forge multidisciplinary approaches The goal is early resolution of litigation and early decisions to give children permanent homes.

  49. Kristina ReitmeierChildren’s Aid Society (CAS) The Many Faces of Child Abuse and Neglect Ontario’s First Multidisciplinary Conference on Child Abuse and Neglect Friday, November 6, 2009•Design Exchange, Toronto, Ontario

  50. CAS Mandate Child and Family Services Act investigate allegations and information that a child is in need of protection provide assistance to parents to prevent need for protection and to protect where required when no less restrictive alternatives available, must intervene through court Dual role of CAS worker

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