Presenter: Janet McCrimmon

Intensive treatment services in Ontario focus on reducing the severity of remedying the mental health problems of children/youth that are psychological, emotional, social and behaviour related. In this presentation, Strides Toronto and Capitalize for Kids will share key learnings from a comprehensive review of the current state of Toronto’s ICYMH services and recommendations to move to a future state system.

Presenter: Allison Kennedy

Aim: Suicide is the second leading cause of death in adolescents. Prompt service response for adolescents with suicidal thoughts – also called suicidal ideation (SI) – is challenged by increasing demand and an overburdened mental health (MH) system. Providing early treatment for adolescent SI and including caregiver support may prevent symptom escalation and need for more intensive MH services. Building Resilience and Attachment in Vulnerable Adolescents (BRAVA) is a 6-week intervention with separate adolescent and caregiver modules developed to fill a gap in a stepped care model. Rolling entry permits prompt access. Manualized content and ability to deliver in-person or virtually facilitates implementation in diverse settings and lessens barriers to service.

Methods: BRAVA treatment efficacy and participant satisfaction were recently evaluated in a virtual clinical trial, which included 99 youth with mild-to-moderate SI and their caregivers recruited from hospital and community settings. In 2023, BRAVA youth modules were implemented and evaluated in a live-in treatment centre for youth with complex MH issues. More recently, the caregiver modules were implemented at a pediatric hospital for caregivers of youth admitted to a psychiatric inpatient unit and evaluation is ongoing.

Results: In the clinical trial, BRAVA treatment was associated with moderately high participant satisfaction and greater improvement in adolescent SI, depression/anxiety, perceived stress, and caregiver stress relative to a comparison group. BRAVA participants presented to the Emergency Department (ED) for MH-related concerns significantly less than the comparison group during their study participation. For the live-in treatment center implementation, following training and temporary support, staff expressed an increased comfort in group facilitation and interest in continuing BRAVA groups. Facilitators (BRAVA’s structure and resources) and barriers (time constraints) were identified. The modules are still in use one-year post-implementation.

Implications: Our recent findings demonstrate that BRAVA’s adaptability and flexibility can translate to being delivered promptly in hospital and community settings – fitting well into the stepped care model. We believe BRAVA is an example of how a research-based MH intervention can be incorporated within clinical services. BRAVA participation was associated with improved adolescent SI, mood and stress, and fewer ED visits and reduced caregiver stress. Its structure facilitates quick access to services and reducing the risk of escalating SI, potentially mitigating the need for intensive services. Its standardized format, virtual/in-person delivery methods, and co-facilitator model lend itself to enhancing the capacity of clinicians with varied MH backgrounds and the intervention is easily adapted to diverse settings.

Presenter: Amanda Ragazzon

We walk alongside caregivers as they courageously learn about themselves and begin a new relationship with their child. Reinforced through evaluation, we reflect on how this Parallel Process is crucial in youth therapy. When a youth engages with Pine River Institute (PRI) for treatment of mental health and addictive symptoms, we consider the whole family. Often, youth tell us that they feel they are the “problem”. We encourage caregivers to reflect on their life experiences and their impact on relationships and parenting approach. PRI begins the parallel process from first point of contact, through outpatient, live-in treatment and aftercare supports. We assist caregivers in fostering boundaries and a differentiated sense of self, supporting their child’s journey towards maturity and independence. In this presentation, we share lessons learned about family engagement and tools utilized to help caregivers walk alongside their youth in a journey of personal growth and family reconnection.

Presenter: Gloria Lee

Aim: To examine the effectiveness of the Circle of Security Parenting (COS-P) intervention, as implemented and integrated within a comprehensive community-based program for mothers with substance use problems and their young children aged 0-6 years.

Procedure/Method: The COS-P was delivered once a week for 8 weeks, with each session lasting approximately 90 minutes. In all, the intervention was delivered 5 times. The study used a mixed-methods approach. Quantitatively, a satisfaction questionnaire (5 items rated on a 6-point Likert scale) was administered to 19 mothers at the final session of each group. Qualitatively, two focus groups with six mothers each were conducted, exploring their experiences with COS-P through open-ended reflective questions.

Findings/Results: Findings indicated a high level of satisfaction among mothers with the COS-P intervention; mothers noted that the supportive environment facilitated the application of learned concepts in daily life. Qualitative analysis identified several themes: 1) recognition of changes in mothers’ own internal processes, 2) recognition of changes in mothers’ own external behaviour, 3) changes in the child’s behaviour, family situation, or mother-child relationship, and 4) specific application of COS-P concepts outside of the program delivery. Findings highlighted that the integration of COS-P within a community-based program strengthened the therapeutic alliance between facilitators and participants via an interactive and active learning model. Furthermore, frequent exposure of the COS-P principles helped the mothers establish secure and healthy relationships with their young children, as well as with others (e.g., partners, older children), while also enhancing their understanding of others’ perspectives. The COS-P implementation setting noticeably enhanced three domains of mothers’ internal and external processes, including the self, child, and mother-child relationship.

Implications/Applications: Embedding COS-P within existing services can promote positive outcomes in mother-child attachment and should include ongoing support to reinforce learning and application of parenting concepts. Service providers interested in enhancing mother-child relationships could benefit from integrating COS-P into their programs.

Presenter: Alisha Haseeb

Aim: The purpose of this study is to systematically review and synthesize existing studies on how neighborhood context influences mental health care-seeking behaviors among adolescents in North America. By examining the interplay of socioeconomic status, cultural norms, and available resources within neighborhoods, this study aims to address a critical gap in understanding the barriers and facilitators to mental health care for young people.

Procedure/Method: This study adhered to PRISMA and Cochrane guidelines and involved a systematic search of four major databases: PsycINFO APA, PubMed, Web of Science, and Scopus. The search focused on studies published between 2013 and 2023 that utilized randomized controlled trials (RCTs) and both quantitative and qualitative methodologies. Two independent reviewers screened 888 studies for inclusion, followed by data extraction and quality assessments to ensure rigor and unbiased results.

Findings/Results: The review found that adolescents from lower socioeconomic neighborhoods reported higher perceptions of environmental hazards, such as crime and violence, which correlated with increased mental health issues. Cultural stigmas and limited access to healthcare resources were significant barriers to seeking mental health care in certain neighborhoods. The results highlight the complex interplay between adolescents’ living environments and their mental health care-seeking behaviors, emphasizing the importance of context-aware strategies in mental health services.

Implications/Applications: The findings from this study are crucial for people involved in policy-making, mental health service provision, and community planning. By understanding the determinants of mental health care-seeking behaviors, stakeholders can develop tailored approaches to improving mental health services for adolescents. This research emphasizes the need for comprehensive and flexible strategies that consider each neighborhood’s unique characteristics to promote better mental health outcomes for young people and their families.

Presenter: Cailin Scott

Aim: Decrease the number of inappropriate referrals to hospital mental health services in the KFL&A region through a centralized triage process that ensures clients get access to the right service at the right time.

Procedure/Method: Participating family health teams in KFL&A send all child and youth mental health referrals to Maltby Centre to be triaged. Maltby Centre clinicians determine if the referral is best served through hospital services (i.e. psychiatry), Maltby Centre services (i.e. core CYMH services in community), or both.

Findings/Results: The centralized triage process decreases the number of inappropriate services to hospital and prevents children and youth from sitting on a wait list for the wrong service. It also gives children, youth, and families access to services that may be helpful while they wait for more intensive services. For example, a family may choose to access workshops at Maltby Centre related to parenting your anxious child while awaiting psychiatry consult on medications from the hospital. Please note that data analysis on this process is still underway, but concrete findings will be presented at the conference.

Implications/Applications: Hospital services are among the most intensive treatment options for young people with mental health concerns, and also among the most costly. A centralized triage process ensures that clients are flowing through a stepped-care model and clinicians with a systems-level understanding are able to direct the referral in the best interest of the client. This model may be beneficial to be replicated in other communities who are experiencing pressure on hospital-level mental health services.

Presenter: Jordana Rovet

Aim: Recovery colleges (RCs), one of the fastest-growing global mental health initiatives, take an innovative approach to mental health education and position people with lived/living experience(PWLLE) of mental health challenges as experts and leaders, who collaborate with individuals with academic/professional expertise to develop educational courses and workshops. The Collaborative Learning College (CLC) at the Centre for Addiction and Mental Health (CAMH) is a nonclinical recovery-oriented education program that is based on the RC model.

Procedure Method: At the CLC, we move beyond tokenistic and ad-hoc forms of engagement by meaningfully involving PWLLE throughout all aspects of our program, including program development, implementation, evaluation, and research. Through this process, power dynamics and hierarchies are challenged and traditional forms of mental health education are re-imagined.

Findings: Through this innovative approach to recovery-oriented education, we have garnered insights into the value of meaningful and effective lived experience engagement and leadership. These insights have furthered the conversation related to the ways in which PWLLE are involved in matters related to their care and treatment.

Implications: The CLC offers an invitation to think more broadly about mental healthcare and education through the shift from students as passive recipients of knowledge to active participants and knowledge holders, placing emphasis on self-determination, collaboration, and autonomy. During this presentation, attendees will be invited to reflect on traditional models of mental health service delivery and education, as well as, envision the possibilities that may arise if the voices of children, youth and families were centred. We will share the transformative nature of RCs and the approaches we’ve taken to support individual, institutional, and systemic growth.

Presenter: Christine Polihronis

Aim: Few tools administered by direct service workers identify both mental health and developmental (MHD) needs in children under 6 years old. From a review of milestone tools and in consultation with healthcare providers, the HEADS-ED Under 6 was developed as a MHD screening and triage tool that helps direct service workers identify and communicate areas of need and recommended services. The tool screens and flags functional impairment and intensity of need in seven domains. We aimed to examine the HEADS-ED Under 6 tool’s implementation feasibility in community and hospital settings, utility to assist with clinical decision-making, and validity against a comprehensive assessment.

Procedure/Method: We conducted two validation and implementation studies to examine the uptake and use of the tool at two sites. For our initial validation study, we piloted the tool at Children First between November 2019-March 2021 (N=566). For our cross-validation study, we examined how the tool was implemented within 1Call1Click.ca between June 2021-August 2023 (N=589).

Findings/Results: For our initial validation study, the HEADS-ED Under 6 was widely used by intake workers (95%, N=539/566). The tool showed good concordance with the InterRAI Early Years assessment in similar domains requiring no action (61.1-81.6%), action but not immediately (49.2-88.0%), and immediate action (66.7-100%) for children under 4 years old (p<.001). Three domains (Eating & sleeping, Development/speech/language/motor, and Emotions & behaviours) independently predicted an urgent care recommendation (p<.001). For our cross-validation study, the tool was used during all intake appointments, and 96.4% (N=568/589) documented level of need. HEADS-ED Under 6 domains (.24 to .38) and total scores (.52) were significantly correlated with level of need (p<.001). Higher HEADS-ED Under 6 total scores were associated with more intense services based on level of need (p<.001). ROC analyses (AUC=.807, SE=.022, 68.5% sensitivity, 79.5% specificity) confirmed a total score of ≥6 helped triage to more targeted and intense services.

Implications/Applications: The HEADS-ED Under 6 is a brief and straightforward screening and triage tool that can be used by direct service workers to guide their interview in several areas of MHD, communicate the severity of children’s needs, and assist with determining level of need for services. When a HEADS-ED Under 6 total score reaches ≥6, more intensive services should be advocated for when making referrals. The HEADS-ED Under 6 can support better MHD outcomes for infants and children by helping direct service workers efficiently guide families to the appropriate care.

Presenter: Imogen Sloss

Aim: Families play an influential role in promoting youth resilience, which has led to the development of family-based therapeutic approaches, such as Emotion-Focused Family Therapy (EFFT). A two-day caregiver group EFFT intervention has been designed to increase the accessibility of this service. This brief EFFT intervention is associated with positive changes in child psychopathology and parental self-efficacy over 12 months (Foroughe et al., 2023). The current study aimed to expand on this research by investigating whether similar patterns are observed in relation to trait resilience–an individual’s ability to cope well with challenges.

Procedure/Method: Participants included 155 caregivers who participated in a virtual two-day caregiver group EFFT intervention. Caregivers completed self- and parent-report measures reporting on themselves and their children (up to four per family) at six time points from baseline to 12-months follow-up. The present study employed three-level multilevel modelling to investigate (1) the extent to which trait resilience is a characteristic of families, individuals, and change over time, (2) trajectories of trait resilience, (3) child and caregiver differences, and (4) family-level predictors of trait resilience.

Results: In the current sample, a significant proportion of trait resilience was explained by family-level factors, individual characteristics, and change over time. Participants (children and caregivers) exhibited an increase in trait resilience over 12 months. Caregivers had higher initial levels of trait resilience compared to children, and improved at a slower rate. Finally, participants in families with higher social support and family functioning had higher baseline trait resilience; however, these variables did not predict change.

Implications/Applications: Findings reveal that characteristics of families, individuals, and change over time explained variance in trait resilience. Therefore, in order to comprehensively support youth and families, researchers and service providers must consider youth’s growth and development, individual experiences, and family context. Finally, family-level factors (social support and family functioning) were associated with trait resilience, further emphasizing the relevance of including families in interventions and treatment.

Presenter: Jennifer Paul

Aim: The purpose of our support is to improve mental health outcomes for children and families by empowering parents to understand and enhance their own mental health and wellbeing. Our approach shifts the focus from traditional child-centered interventions to parent-focused strategies, creating a supportive home environment that fosters positive mental health for the entire family.

Procedure/Method: Our methodology involves a self-directed online learning platform where parents engage in educational courses designed to help them understand their brain, body, stress responses, and overall mental health. These courses encompass Acceptance and Commitment Therapy (ACT), compassionate self-inquiry, neuro-education, and mindfulness techniques. The modules cover stress coping techniques, mindfulness, meditation, self-care, and emotional regulation. To support parents in integrating this knowledge, we offer parent coaching consultations. These one-on-one sessions with our experienced coach provide personalized guidance and strategies to ensure successful application of the concepts learned online. Additionally, we host workshops to facilitate community connections, allowing parents to share experiences, support each other, and build a network of like-minded individuals committed to improving their families’ mental health.

Findings/Results: Our approach has shown significant positive impacts on families who have participated in our program. Parents report improved understanding of their mental health, better stress management, and increased ability to model and teach positive mental health strategies to their children. Families have experienced enhanced communication, stronger emotional connections, and a more nurturing and empathetic home environment. These outcomes demonstrate the effectiveness of our model in promoting long-term mental health resilience in children by first empowering their parents.

Implications/Applications: The results of our research highlight the importance of parent-focused interventions in achieving better mental health outcomes for children and families. By reviewing our presentation, conference participants will gain valuable insights into how self-directed learning, combined with coaching and community support, can be effectively implemented in their own practices. Our model can serve as a blueprint for organizations and practitioners looking to enhance mental health support for families, ultimately contributing to a healthier, more resilient future for children. Our presentation embodies the theme “Together for Tomorrow” by emphasizing the critical role of parental involvement in fostering positive mental health and wellbeing for the next generation. We are excited to share our vision and contribute to the ongoing conversation about innovative strategies for improving mental health outcomes for children, youth, and families.