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In a new study from Lawson Health Research Institute and Western University, researchers partnered with youth receiving care at the First Episode Mood and Anxiety Program (FEMAP) at London Health Sciences Centre (LHSC) to better understand personal perspectives on care and treatment outcomes. The study found that patients experienced lasting improvements in managing their symptoms and improvements in academics, work performance and relationships, and they reported that these benefits involved being empowered by feelings of self-acceptance.
The study included 22 patients from FEMAP, a novel outpatient mental health program at LHSC that provides treatment to 'emerging adults,' ages 16 to 25, with emotional concerns that fall into the categories of mood and anxiety symptoms. Treatment at FEMAP takes a patient-centred approach and the research involved looking at what is meaningful and valuable to patients during their care journey.
"The transition from adolescence to adulthood is challenging. FEMAP employs an innovative model of care tailored to the needs of this complex population," said Dr. Elizabeth Osuch, a clinician-scientist at Lawson, associate professor at Western University's Schulich School of Medicine & Dentistry and medical director at FEMAP. "By engaging patients in a reflection of their experience, we can learn how effective the program is from the patient perspective."
Participants shared their experiences through open-ended interviews with Dr. Osuch's research team. Interview transcripts were collected and analyzed to determine common themes around treatment and outcomes. These themes were then presented back to the research participants for validation.
The study found that treatment led to development of coping strategies to better manage symptoms. Research participants credited these strategies for better functioning in academics, careers and personal relationships. Challenges in these areas are common among emerging adults and are often stressors that lead to youth seeking mental health care.
Participants characterized their treatment at FEMAP as an important investment in their mental health and wellbeing, and credited a collaborative partnership with their care provider for keeping them engaged in treatment. They appreciated the ease of accessing treatment at FEMAP where they could receive care from a psychiatrist, social worker, addictions counsellor, family counsellor and a psychologist, depending on their needs.
The research found that the complexities of treatment were initially frustrating to patients as they were seeking an "easy fix" to their mental health concerns, but they ultimately appreciated that mental health recovery is a journey. They valued that care providers partnered with them to set long-term treatment goals, choose the best treatment options and provide support both during and between appointments.
"Patients may prefer FEMAP over other mental health services because the care is tailored to emerging adults," said Justin Arcaro, first author on the study and a former MSc candidate at Schulich Medicine & Dentistry and research associate at FEMAP. "There's an important balance between recognizing emerging adults' personal autonomy and their need for comprehensive support."
Study results demonstrated that through treatment at FEMAP, patients realized they are not alone in their mental health journey which led to improved self-acceptance and self-compassion. Participants reported feeling empowered to create meaningful changes in their lives.
Participants also discussed the decision to seek mental health care in the first place. Many struggled with the decision of whether or not treatment was needed. "This shows a need for targeted campaigns to help emerging adults distinguish between normative feelings and those that indicate a need for help," said Dr. Osuch.
This study also aligns with other research projects at FEMAP that suggest a need for targeted education campaigns about mental health care as a process with solutions that are not necessarily quick or easy. The research team highlights the importance of these findings in informing future funding decisions and policy around mental health care for emerging adults. The findings emphasize the need for quick engagement with a trusted care provider and an integrated treatment team that can partner with patients to support them while enhancing independent growth and self-acceptance.
The study, "Emerging adults' evaluation of their treatment in an outpatient mood and anxiety disorders program," is published in Emerging Adulthood.
11 July 2018
Source: Lawson Health Research Institiute
A new study finds that severe childhood trauma and stresses early in parents' lives are linked to higher rates of behavioral health problems in their own children.
The types of childhood hardships included divorce or separation of parents, death of or estrangement from a parent, emotional, physical or sexual abuse, witnessing violence in the home, exposure to substance abuse in the household or parental mental illness.
"Previous research has looked at childhood trauma as a risk factor for later physical and mental health problems in adulthood, but this is the first research to show that the long-term behavioral health harms of childhood adversity extend across generations from parent to child," said the study's lead author, Dr. Adam Schickedanz. He is a pediatrician and health services researcher and assistant professor in the department of pediatrics at the David Geffen School of Medicine at UCLA.
The study showed that the children of parents who themselves had four or more adverse childhood experiences were at double the risk of having attention deficit hyperactivity disorder and were four time more likely to have mental health problems.
A mother's childhood experiences had a stronger adverse effect on a child's behavioral health than the father's experiences, the study found.
Parents who lived through adverse childhood experiences were more likely to report higher levels of aggravation as parents and to experience mental health problems, the researchers found. However, these mental health and attitude factors only explained about a quarter of the association to their child's elevated behavioral health risks. The remainder of how the parent's adverse childhood experiences are transmitted to their child's behavior deserves further study.
The findings add to the evidence supporting standardized assessment of parents for adverse childhood experiences during their child's pediatric health visits.
"If we can identify these children who are at a higher risk, we can connect them to services that might reduce their risk or prevent behavioral health problems," Schickedanz said.
The researchers used information from a national survey containing information from four generations of American families, including information from parents about whether they were abused, neglected or exposed to other family stressors or maltreatment while growing up, and information on their children's behavior problems and medical diagnoses of attention deficit disorder.
With this data, they were able to find strong associations between the parents' adversity histories and their children's behavioral health problems, while controlling for factors such as family poverty and education level.
The next step for researchers is to look at how resilience factors, such as the support of mentors or teachers, could offset the harms of childhood traumas, Schickedanz said.
The study was published in the journal Pediatrics.
9 July 2018
A new study published in Pediatrics found that young adults who had a parent incarcerated during their childhood are more likely to skip needed healthcare, smoke cigarettes, engage in risky sexual behaviors, and abuse alcohol, prescription and illicit drugs. These findings have potentially broad impact, as over five million U.S. children have had a parent in jail or prison.
Strikingly, incarceration of a mother during childhood, as opposed to a father, doubled the likelihood of young adults using the emergency department instead of a primary care setting for medical care.
Young adults whose mothers had been incarcerated also were twice as likely to have sex in exchange for money, while those with histories of father incarceration were 2.5 times more likely to use intravenous drugs.
"The United States has the highest incarceration rates in the world. With the climbing number of parents, especially mothers, who are incarcerated, our study calls attention to the invisible victims – their children," says lead author Nia Heard-Garris, MD, MSc, a pediatrician at Ann & Robert H. Lurie Children's Hospital of Chicago and Instructor of Pediatrics at Northwestern University Feinberg School of Medicine. "We shed light on how much the incarceration of a mother versus father influences the health behaviors of children into adulthood."
Dr. Heard-Garris and colleagues analyzed national survey data from over 13,000 young adults (ages 24-32), finding that 10 percent have had a parent incarcerated during their childhood. Participants were on average 10 years old the first time their parent was incarcerated.
Additionally, young Black adults had a much higher prevalence of parental incarceration. While Black participants represented less than 15 percent of the young adults surveyed, they accounted for roughly 34 percent of those with history of an incarcerated mother and 23 percent with history of an incarcerated father.
"The systemic differences in the arrest, prosecution, conviction, and sentencing of people of color impact the future health of their children," says Dr. Heard-Garris.
Previous research shows that individuals with a history of parental incarceration have higher rates of asthma, HIV/AIDS, learning delays, depression, anxiety and post-traumatic stress disorder.
"It's possible that because these young adults are more likely to forgo medical care and engage in unhealthy behaviors, they are at higher risk to develop these physical and mental health conditions," says Dr. Heard-Garris. "By pinpointing the specific health-harming behaviors that these young adults demonstrate, this study may be a stepping stone towards seeking more precise ways to mitigate the health risks these young adults face. Hopefully, future studies will teach us how to prevent, screen for, and target negative health behaviors prior to adulthood."
The authors also stress that more research is needed to identify specific barriers to healthcare, targeting this population's under-utilization of care.
"We need to consider how to help youth of incarcerated parents receive timely healthcare," says senior author Matthew Davis, MD, MAPP, Senior Vice-President and Chief of Community Health Transformation at Lurie Children's and Professor of Pediatrics, Medicine, Medical Social Sciences and Preventive Medicine at Northwestern University Feinberg School of Medicine.
"We must intervene if we are going to change the health trajectories for these kids."
9 July 2018
Source: Ann and Robert H. Lurie Children's Hospital of Chicago
Children typically begin lying in the preschool years, between two and
four years of age. These intentional attempts at deception may worry
parents, who fear their child will become a pint-sized social deviant.
But from a developmental perspective, lying in young children is rarely cause for concern. In fact, lying is often one of the first signs a young child has developed a "theory of mind", which is the awareness that others may have different desires, feelings, and beliefs to oneself. When a child misleadingly claims "Daddy said I could have an ice cream", they're using this awareness of others' minds to plant false knowledge.
While lying itself may not be socially desirable, the ability to know what others are thinking and feeling is an important social skill. It's related to empathy, cooperation, and care for others when they're feeling upset.
How lying changes with age
Young children's first lies are often more humorous than effective.
Imagine the child who claims not to have eaten any cake while her mouth is
still full, or who blames the family dog for drawing on the wall. Young
children may know they can deceive others, but they don't yet have the
sophistication to do so well.
Before age eight, children frequently give themselves away when lying. In one study, children aged three to seven were asked not to peek at a mystery toy (Barney) that had been placed behind them. Nearly all did, and nearly all lied about it later (increasing with age).
But across the group, children also had trouble maintaining the lie. Liars aged three to five were surprisingly good at keeping a straight face but typically gave themselves away by describing the Barney toy by name. Liars aged six and seven had mixed success, with half feigning ignorance and half accidentally saying Barney's name.
As children get older and their perspective-taking ability develops, they're increasingly able to understand the kinds of lies that will be believable to others. They also become better at maintaining the lie over time.
Moral development also kicks in. Younger children are more likely to lie for personal gain, while older children increasingly anticipate feeling bad about themselves if they lie.
Older children and teens are also more likely to draw distinctions between different kinds of lies. White lies, to them, are considered more appropriate than harmful or antisocial lies.
While studies that estimate the frequency of lying among children and teens are rare, teenagers are especially likely to lie to parents and teachers about things they consider their own personal business.
One study found 82 per cent of US teenagers reported lying to their parents about money, alcohol, drugs, friends, dating, parties, or sex in the past year. They were most likely to lie about their friends (67 per cent) and alcohol/drug use (65 per cent). Perhaps surprisingly, they were least likely to lie about sex (32 per cent).
When reading short scenarios in which the protagonist lied to his or her parents, the teens were also likely to consider the lying acceptable if it was to help somebody or keep a personal secret, but not if it was to harm or hurt someone.
Is lying a cause for concern?
Despite its prevalence, lying among children is rarely cause for concern. It's important to remember many adults also lie — sometimes for good, as in the case of white lies that protect someone's feelings, and sometimes for ill. While estimates vary, a study found about 40 per cent of US adults reported telling a lie in the past 24 hours.
In some instances, chronic lying can become a concern if it occurs alongside a cluster of other behaviours that are maladaptive. For example, deceitfulness through lying is often present in conduct and oppositional defiant disorders (ODD).
Young people with conduct disorders or ODD cause considerable disruptions in the home or at school through persistent aggression and harm to others or property. But to meet diagnoses, lying would have to occur with a cluster of other symptoms such as refusal to comply with authority figures, persistent violations of rules, and failure to take responsibility for their actions.
Another cause for parental concern is if lying serves to mask other mental health problems due to fear or shame. For example, a child or adolescent suffering from severe anxiety may lie chronically to avoid confronting situations that make them afraid (for example, school, parties, germs).
They may also lie to avoid the stigma of mental health disorders. In these instances, consulting your doctor or a mental health professional (such as a psychologist or psychiatrist) will help clarify whether lying is indicative of a mental health concern.
Parents and teachers make a difference
While lying is developmentally normal, parents and teachers can support
children's truth-telling in three ways.
First, avoid excessive or over-the-top punishments. In a study comparing a West African school that used punitive punishments (such as hitting with a stick, slapping, and pinching) and a school that used non-punitive reprimands (such as time outs or scolding), students at the school with punitive punishments were more likely to be effective liars.
Children from families that place a strong emphasis on following the rules and not open dialogue also report lying more frequently.
Second, discuss emotional and moral scenarios with children. This "emotion coaching" supports children's understanding of when lies are most harmful, how they affect others, and how they themselves might feel when they lie. Children increasingly anticipate pride for telling the truth, and parents can emphasise these positive aspects of truth-telling.
Third, ensure the lie really is a lie. Very young children are prone to blend real life and imagination, while older children and adults frequently remember arguments differently to one another. If a child reports physical or sexual abuse, these allegations must always be investigated. By distinguishing whether or not there is a deliberate attempt at deception, parents and teachers can target their response effectively.
Lying in children is developmentally normal
Lying is developmentally normal and an important sign other cognitive
skills are also developing.
If lying is persistent and is impairing the child's ability to function effectively in everyday life, it's worth consulting a mental health expert or your doctor. But in other situations, remember that lying is just one way children learn to navigate the social world. Open and warm discussions about telling the truth should eventually help to reduce children's lies as they develop.
By Penny Van Bergen and Carol Newall
Penny Van Bergen is a senior lecturer in educational psychology and Carol Newall is a senior lecturer in early childhood at Macquarie University, Australia
Training professionals with virtual reality technology can help them to be better at spotting signs of child abuse, academics have found.
A three-year study by University College London and Goldsmiths examined the potential for using a virtual reality simulation of an encounter with a child and parent to train professionals to spot subtle signs of potential abuse that are hard to teach in a classroom-type environment.
The virtual reality simulation used in the study recreated an encounter with a parent with a complex medical condition and their young child, both of whom were recreated using video game-style computer graphics based on the motions of real actors. The visual cues and dialogue were adjusted to make the signs of abuse more overt, or subtle.
The researchers asked 64 general practitioners to experience the simulation while wearing virtual reality headsets and then write up their notes, which the researchers then analysed to see how well they picked up on the signs of potential abuse.
The aim of the study was to determine whether a GP's experience and personality affected their ability to spot signs of child abuse. The researchers found that experienced GPs were no more likely to spot the more subtle warning signs of abuse in the simulation than their more junior counterparts. It also found that GPs that were "less neurotic" and "more extrovert" were most likely to flag up their concerns.
They concluded that similar virtual reality simulations have "considerable potential" as a tool for training professionals to spot abuse, especially as using real-life child actors in role-plays about spotting abuse is problematic.
Dr Caroline Fertlman, the study's medical lead and a paediatrician with child safeguarding expertise, said: "For ethical reasons it would be impossible to recreate this kind of sensitive scenario using child actors. What we have shown, for the first time, is that we can create virtual reality characters of abused children and their parents that doctors believe in and interact with in a realistic way, enabling them to learn how to spot the subtle warning signs of abuse."
"An advantage of our approach is that, unlike with actors, we have absolute control over our virtual characters," added Dr Sylvia Xueni Pan, who led on the study's virtual reality work.
"This means we can subtly alter the behaviour and responses of these virtual patients. Our results show that medical doctors responded to this, as those given less obvious behavioural cues were not as effective as those given more obvious cues."
The study, published in the journal Frontiers in Robotics and AI, also found that GPs who were less stressed and more extroverted tend to be better at raising child protection concerns in their notes.
Law and ethics professor Sylvie Delacroix, who was also involved in running the study, said this was an important finding.
"Our results show that GPs who are less stressed, less neurotic, more agreeable and extroverted tend to be better at raising potential child abuse issues in their notes. These results not only indicate the considerable potential of virtual reality as a training tool – they also highlight fruitful avenues for further research and potential strategies to support GPs in their dealing with highly sensitive, emotionally charged situations."
By Tristan Donovan
2 July 2018
Homelessness is growing faster in NSW than anywhere else in Australia and despite more than $100 million of funding to help homeless youth, 5000 children arrived alone to seek help or shelter last year.
In the decade to 2016 the number of people aged between 12 and 24, estimated to be homeless increased 82 per cent in NSW while all homelessness rose by more than one-third in just five years.
But these numbers may underestimate the problem with new data showing in 2016-17 there were 19,000 people aged between 15 and 24 who were helped by homelessness services in NSW. Research shows young people leaving out-of-home care suffer high levels of homelessness.
In 2016 the NSW government promised to spend $55 million each year on more than 100 specialist homelessness programs for young people through to 2020, adding to a 2015 promise of $40 million over four years, under the Premier’s Youth Initiative to address youth homelessness more broadly. And in April an extra $13.9 million to increase the availability of 24/7 crisis beds and support was added.
Despite these investments, neither the NSW Department of Family and Community Services (FACS) nor the homelessness sector was able to provide answers to a "number of critical questions" asked by the NSW Ombudsman because "basic data is either not being captured or is unreliable".
For more than a decade the NSW Ombudsman has been raising concerns about the system that's meant to protect homeless children in NSW and last week he reported on "unresolved legal, policy and service gaps" including a "lack of decision-making authority" within the sector.
Many children seeking support from homelessness services have suffered some form of trauma or abuse, may be disengaged from school and/or caught up in the criminal justice system, NSW Ombudsman Michael Barnes' report said.
"Our inquiry has put a spotlight on the need for FACS to finally settle effective operational arrangements with homelessness services that clearly spell out the roles and responsibilities of FACS and services in supporting
"We should start with the basics – that a young person has secure accommodation and making sure that we know where they are and getting the services that they need, but because the system is so stretched it's failing to be able to provide that.
"Finding these young people accommodation in the marketplace is almost impossible so the only options they have are these services or friends and family... they are locked into a cycle of homelessness because they cycle through the system and can't get rental properties."
The NSW government has been talking about increasing affordable housing options – social or affordable housing – "but we haven't really seen those targets being met yet" and by not making housing more affordable, more people are pushed into homelessness, Ms Acheson said.
"We have to create safe and secure housing stock for under 16-year-olds, so that they can maintain their schooling or get a job or progress in their life.. most of the housing stock that is available is not going to young people," she said.
NSW Minister for Family and Community Services Pru Goward said the government will do more to address the issues in the report and directed her department to start to implement the ombudsman's recommendations.
"We need to do more to work with children, their families, communities, non-government agencies and across government departments to address this," Ms Goward said. "As an immediate response, the government will invest $4.3 million over three years to introduce nine non-government therapeutic caseworkers to work with unaccompanied children who present to homelessness services."
A spokesman for the minister said more than 25,000 social housing dwellings will be built by 2026 to help provide permanent shelter and the Premier has set a target of more than 34 per cent of young people to move from specialist homelessness services to long-term accommodation by 2019.
Labor's family and community services spokeswoman Tania Mihailuk said the government had been "throwing money away" on programs it wasn't assessing and settling for "temporary fixes that put people in motels, caravan parks and pubs".
"There are large numbers of kids ending up in motels and transitional housing that they shouldn't be in," she said. "Why should anyone 12 to 16 have to suffer moving from one transition housing arrangement to another?"
By Nigel Gladstone
28 June 2018