RESEARCH IN MIND

BY ELIZABETH CHORNEY-BOOTH

Giving kids in backyards across Alberta the highest quality of evidence-based care calls for constant innovation. Since 2007, the Stollery Children’s Hospital Foundation has invested more than $6 million in 99 pediatric mental health research projects through the Women and Children’s Health Research Institute (WCHRI) at the University of Alberta. Here are stories about two Foundation-funded researchers who are breaking new ground in their approaches to providing the best possible mental health support for children and youth.

Many of us look at the prospect of relocating from one country to another as a potentially stressful experience. But can the act of immigrating and living in a new culture affect the mental health of a child? That’s the question that Dr. Bukola Salami, an associate professor in the faculty of nursing at the University of Alberta, has set out to answer — with the help of some funding from the Stollery Children’s Hospital Foundation in the form of two different grants.

The first of Salami’s two Foundation-funded projects through WCHRI, for which she received $40,000, was a pilot run of a “conversation café” initiative, in which parents who have immigrated to Canada from Africa engaged with each other to discuss their children’s transitions and any struggles they may face in parenting in a new cultural environment. Running in late 2018 and early 2019, the pilot project consisted of nine sessions, held at the Edmonton Intercultural Centre and the Edmonton Immigrant Services Association. The series of cafés was co-facilitated by African immigrants, health-care professionals and pediatric residents from the University of Alberta so that participants would get a balance of medical advice and cultural understanding. Salami’s hope is that, through these events, parents received a foundation that could help them to navigate the cultural differences between their old and new home countries and, by extension, provide the best-possible support to their children as they struggle with the typical stresses that come with childhood and adolescence, without creating any stigma.

“We decided to look at well-being in general rather than using the words ‘mental health’,” Salami says. “We talked about nutrition, we talked about sleep, we talked about managing behaviours — things that are symptomatic of mental health issues or are factors that would affect a child’s mental health.”

The second project, which received $50,000 from the Stollery Children’s Hospital Foundation through WCHRI, is a research study in which Salami and her team delved into data from the Canadian Health Measures Survey conducted by Statistics Canada. Salami found that when kids are on an even playing field, immigrant children experience equal or even better mental health than non-immigrant children.

“We also did interviews of immigrant parents to identify the factors they think contribute to the mental well-being of their children,” Salami says. “Some of the barriers they mentioned were limited access to physical activity programs, lack of information about the Canadian health-care system, and being unable to navigate the system and understanding how the system works. For some there was racism and discrimination and they factored that into mental health, as well as language barriers and not feeling listened to by health service providers.”

Despite the findings that suggest immigration itself isn’t a detriment, immigrant children often do face different circumstances than

non-immigrant kids and need some extra support. While immigrant children whose families are coming to Canada by choice are from relatively stable backgrounds by default (otherwise they would not be accepted by Canada’s immigration program), African immigrants are more likely than many other immigrant groups to be refugees or to have family members who have been involved in gun violence, both of which can cause significant mental trauma. Salami’s research will continue to look at ways that sub-groups of immigrant youth experience mental health issues and how the Canadian system can properly support them.

All of what Salami is studying falls into the Stollery Children’s Hospital Foundation’s mandate of helping to

ensure that all kids, regardless of their background, are properly supported by the mental health care system.

“New research initiatives like this are incredible in terms of advancing how we understand the needs and care for children and youth,” says Katherine Captain, the Foundation’s director of development & mental health campaign. “Supporting Dr. Salami’s research in this area is part of our greater long-term, ongoing commitment to child and youth mental health care in Alberta.”

Since 2007, the Stollery Children's Hospital Foundation has provided over $6M for 99 pediatric mental health projects, including:

Developing a clinical care model to help children and families deal with fetal alcohol spectrum disorder symptoms

Assessing the attention control and emotional regulation capacities of children with autism spectrum disorder in hopes of developing earlier methods for diagnosis

Developing an app to help adolescents manage anxiety

Studying how children’s social and emotional behaviors change during preschool and kindergarten

Mindfulness-based stress reduction for youth with mental health concerns

For many families, the pediatric emergency department at either the Stollery Children’s Hospital in Edmonton or the Alberta Children’s Hospital in Calgary is often the first point of contact for mental health care. Too frequently, families just don’t know where else to go or find themselves in such a state of crisis, making a trip to the emergency their only option.

Recognizing that emergency departments can be frightening and uncomfortable, especially to a young person in a state of extreme mental distress, researchers funded in part by the Stollery Children’s Hospital Foundation are bringing together more than 50 health-care managers, health-care providers and parents from around the province to improve the standards of care for pediatric patients who find themselves accessing mental health or addiction care in an emergency setting.

The team is co-led by Dr. Amanda Newton, a professor of pediatrics at the University of Alberta and member of WCHRI. Newton works closely with the emergency departments in both Calgary and Edmonton, as well as clinic staff, program managers, and parents in both cities.

“The idea [with this team] is to bring together all the best available evidence that we know has been shown to lead to improvements in mental health care,” Newton says. “We want to [unite] some of the efforts that all these other people have been leading so that we can be a synergistic force in moving forward.”

The team has been meeting for over two years to come up with a “bundle” of tools and recommendations. Two important aspects of the bundle for emergency department care are evidence-based assessment tools to identify the main concerns for families in the emergency department and improved communication during the visit. A key aspect of the bundle for post-emergency department care, meanwhile, is ensuring families are active participants in identifying preferences for subsequent outpatient care. This approach to shared decision-making is generally known as the Choice and Partnership Approach (CAPA). The bundle also includes protocols to streamline care so that patients aren’t forced to repeatedly tell their stories to multiple care providers.

Team participant Christine Mummery, who is Alberta Health Services’ director for Children, Youth and Families – Addiction and Mental Health Services for the Edmonton region, says the project will provide options for families who find themselves in the emergency department during a child’s mental health crisis. “The CAPA approach is going to encourage our clinical providers to talk to families in a more structured way so that they can listen to the options and then agree to the plan that best suits them,” Mummery says. “That’s the attraction from our perspective: getting a more consistent structured approach so that we know that families have been given all the options.”

Giving families those options and, ultimately, the best care possible is also the goal of the Stollery Children’s Hospital Foundation, which has committed a total of $150,000 to the project through WCHRI, to be distributed over two years.

“We hear from families that it’s difficult to find acute mental health care for kids when it’s needed,” says Katherine Captain, the Foundation’s mental health campaign director. “We’re excited to invest in important research by people like Amanda and her team to help improve mental health for children, youth and their families.”

The initiative is unique in that a research study, headed by Newton and Stephen Freedman at the Alberta Children’s Hospital, is happening in conjunction with the real-time implementation of the bundle of new practices. In February 2020, the researchers began collecting data on patient feedback regarding satisfaction and well-being (as well as more objective measures) to understand the impact of the current state of care. After 12 months of that, the new practices will be introduced and Newton will continue to collect data to compare the bundle’s impact on families.

Newton is excited that the project involves implementing and assessing the new approach simultaneously and is hopeful that all of the stakeholders will continue with the new practices beyond the period of data collection.

“My goal would be to set up an evaluative framework that is embedded within AHS systems and resources,” Newton says. “While we may finish after the period that we’re funded for, there will be something left there afterwards that builds capacity in terms of performance measurement, evaluation, and quality improvement. So not only are we using the money that we’ve been given wisely, but it will have an ongoing impact moving forward.”