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OBJECTIVES: Investigate the direct and moderating effects of daytime parenting practices on the relationship between bedtime routines and pediatric sleep problems. METHODS: A community sample of 407 parents with children 2-10 years old completed measures of parenting practices (i.e., laxness and over-reactivity) and bedtime routines (i.e., consistency and reactivity to changes in routines). Sleep problems (i.e., severity and signaled night waking) were assessed by a parent-report questionnaire and sleep diaries. RESULTS: Higher parenting laxness (ß = .13) and less bedtime routine consistency (ß = -.34) significantly predicted sleep problem severity. Laxness moderated the relationship between bedtime reactivity and sleep problem severity: when bedtime reactivity was high, higher parental laxness was associated with more severe sleep problems. CONCLUSIONS: Daytime parenting practices are important to consider when children are reactive to changes in bedtime routines, as permissive or inconsistent daytime parenting practices were found to be associated with more severe sleep problems. Future research should examine the effects of parenting practices and bedtime routines on problematic signaled night waking in a clinical sample of children.
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Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Criança , Pré-Escolar , Humanos , Poder Familiar , Pais , Sono , Transtornos do Sono-Vigília/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders - require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research. MAIN BODY: In 2002 we developed a unique program to respond to these needs - Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC). The program's goals are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to aid them in tackling current and future challenges in PHC and in leading collaborative interdisciplinary research teams. Seven essential educational approaches employed by TUTOR-PHC are described, as well as the principles underlying the curriculum. This program is unique because of its pan-Canadian nature, longevity, and the multiplicity of disciplines represented. Program evaluation results indicate: 1) overall program experiences are very positive; 2) TUTOR-PHC increases trainee interdisciplinary research understanding and activity; and 3) this training assists in developing their interdisciplinary research careers. Taken together, the structure of the program, its content, educational approaches, and principles, represent a complex whole. This complexity parallels that of the PHC research context - a context that requires researchers who are able to respond to multiple challenges. CONCLUSION: We present this description of ways to teach and learn the advanced complex skills necessary for successful PHC researchers with a view to supporting the potential uptake of program components in other settings.
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Currículo , Pesquisadores , Canadá , Humanos , Aprendizagem , Atenção Primária à SaúdeRESUMO
OBJECTIVE: The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents' and children's needs to support sleep during the pandemic. METHODS: Eighty-five Canadian parents with children aged 4-14 years participated in this explanatory sequential, mixed-methods study using an online survey of children's and parents' sleep, with a subset of 16 parents, selected based on changes in their children's sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. RESULTS: While some parents perceived their child's sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child's sleep had worsened (40.0%, n = 34). Parents attributed children's worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children's and parents' sleep. CONCLUSIONS: The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children's sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.
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COVID-19 , Pandemias , Canadá , Criança , Humanos , Pais , SARS-CoV-2 , SonoRESUMO
The original version of this article was unfortunately published with an error in Table 2. The confidence intervals listed in Table 2 were published incorrectly. The correct version of confidence intervals in Table 2 should read as below.
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Dropout from children's mental health services has negative impacts on children, families and service providers. To target interventions aimed to reduce dropout, it is essential to predict individuals who drop out. This study compares predictors of dropout using a novel need-based definition, to existing definitions of dropout. Children (N = 650; 61% male) aged 5-13 attended five children's mental health agencies in Ontario. A mixed effects logistic regression was used to model binary outcome variables (i.e., dropout or treatment completion), for each definition of dropout. Using the need-based definition, older child age, lower child problem presentation, higher child risk behaviors, higher caregiver needs, and more child strengths predicted an increased likelihood of dropout. The need-based definition results in different predictors of dropout than existing definitions in the literature. High caregiver needs was the only predictor of dropout across all definitions. Caregiver needs represent a prospective target when distributing interventions aimed to reduce dropout.
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Serviços de Saúde da Criança , Necessidades e Demandas de Serviços de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental , Pacientes Desistentes do Tratamento , Adolescente , Cuidadores/psicologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Estudos ProspectivosRESUMO
There is limited empirical evidence documenting the magnitude and correlates of area-level variability in unmet need for children's mental health services. Research is needed that identifies area-level characteristics that can inform strategies for reducing unmet need in the population. The study purpose is to: (1) estimate area-level variation in children's unmet need for mental health services (using Service Areas as defined by the Ontario Ministry of Children and Youth Services), and (2) identify area-level service arrangements, and geographic and population characteristics associated with unmet need. Using individual-level general population data, area-level government administrative data and Census data from Ontario, Canada, we use multilevel regression models to analyze unmet need for mental health services among children (level 1) nested within Service Areas (level 2). The study finds that 1.64% of the reliable variance in unmet need for mental health services is attributable to between-area differences. Across areas, we find that Service Areas with more agencies had a lower likelihood of unmet need for mental health services. Compared to other Service Areas, Toronto had much lower likelihood of unmet need compared to the rest of Ontario. Rural areas, areas with unsatisfactory public transport, and areas with higher levels of socio-economic disadvantage had a higher likelihood of unmet need for mental health services. These findings identify challenges in service provision that researchers, policymakers and administrators in children's mental health services need to better understand. Policy implications and potential Service Area strategies that could address equitable access to mental health services are discussed.
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Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Ontário , Análise de Regressão , Características de Residência , Fatores SocioeconômicosRESUMO
BACKGROUND: Some children with mental health (MH) problems have been found to receive ongoing care, either continuously or episodically. We sought to replicate patterns of MH service use over extended time periods, and test predictors of these patterns. METHODS: Latent class analyses were applied to 4 years of visit data from five MH agencies and nearly 6000 children, 4- to 13-years-old at their first visit. RESULTS: Five patterns of service use were identified, replicating previous findings. Overall, 14% of cases had two or more episodes of care and 23% were involved for more than 2 years. Most children (53%) were seen for just a few visits within a few months. Two patterns represented cases with two or more episodes of care spanning multiple years. In the two remaining patterns, children tended to have just one episode of care, but the number of sessions and length of involvement varied. Using discriminant function analyses, we were able to predict with just over 50% accuracy children's pattern of service use. Severe externalizing behaviors, high impairment, and high family burden predicted service use patterns with long durations of involvement and frequent visits. CONCLUSIONS: Optimal treatment approaches for children seen for repeated episodes of care or for care lasting multiple years need to be developed. Children with the highest level of need (severe pathology, impairment, and burden) are probably best served by providing high intensity services at the start of care.
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Serviços de Saúde da Criança/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
PURPOSE: Many youth who receive specialized children's mental health treatment might require additional treatment as young adults. Little is known about how to prepare these youth for transitions to adult care. DESIGN AND METHODS: This study gained perspectives from children's mental health providers (nâ¯=â¯10) about the process of caring for younger adolescents (aged 12-15) with mental health problems (e.g., depression, anxiety), who might require mental health services after age 18. Providers were asked about their clients' future mental health needs and the possibility of transition to adult care. RESULTS: Using Grounded Theory analysis, an over-arching theme was providers' reluctance to consider the transition process for their younger clients (<16â¯years old). This stemmed from uncertainty among providers about: (1) who [which youth] will need adult mental health services; (2) when this discussion would be appropriate; and (3) what adult services would be available. CONCLUSIONS AND PRACTICE IMPLICATIONS: Findings indicate a lack of treatment capacity within children's mental health to routinely monitor youth as they approach the age of transfer (18â¯years old). In the absence of routine monitoring (post-treatment), it may be difficult to predict who will need adult care. A comprehensive evaluation of existing follow-up practices, in children's mental health and beyond, is needed to identify strategies for ensuring adolescents with recurring conditions receive optimal transition care.
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Pessoal de Saúde/psicologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Melhoria de Qualidade , Transição para Assistência do Adulto/organização & administração , Adolescente , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Canadá , Criança , Tomada de Decisão Clínica/métodos , Depressão/diagnóstico , Depressão/terapia , Teoria Fundamentada , Humanos , Masculino , Transtornos Mentais/diagnóstico , Saúde Mental , Monitorização Fisiológica/métodos , Pesquisa Qualitativa , Medição de Risco , Adulto JovemRESUMO
Children's mental health (CMH) problems can be long-lasting. Even among children and youth who receive specialized CMH treatment, recurrence of problems is common. It is unknown whether youth and their parents view the possibility of future mental health problems. This has important implications for how CMH services should be delivered. This grounded theory study gained perspectives from youth (aged 12-15 years) who received CMH treatment ( n = 10) and their parents ( n = 10) about the expected course of CMH problems. Three disorder trajectories emerged: (a) not chronic, (b) chronic and persistent, and (c) chronic and remitting, with the majority of youth falling in the third trajectory. A gap in available services between CMH and adult care was perceived by parents, leaving them either help hopeful or help hungry about their child's future care. Improving care for youth with ongoing mental health problems is needed to minimize costs to families and the system.
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Transtornos Mentais/psicologia , Pais/psicologia , Adolescente , Atitude Frente a Saúde , Criança , Doença Crônica/psicologia , Feminino , Teoria Fundamentada , Humanos , Entrevistas como Assunto , Masculino , Saúde Mental , Transição para Assistência do AdultoRESUMO
Using a discrete choice conjoint experiment, we explored the design of parenting programs as an interim strategy for families waiting for children's mental health treatment. Latent class analysis yielded 4 segments with different design preferences. Simulations predicted the Fast-Paced Personal Contact segment, 22.1% of the sample, would prefer weekly therapist-led parenting groups. The Moderate-Paced Personal Contact segment (24.7%) preferred twice-monthly therapist-led parenting groups with twice-monthly lessons. The Moderate-Paced E-Contact segment (36.3%), preferred weekly to twice-monthly contacts, e-mail networking, and a program combining therapist-led sessions with the support of a computerized telephone e-coach. The Slow-Paced E-Contact segment (16.9%) preferred an approach combining monthly therapist-led sessions, e-coaching, and e-mail networking with other parents. Simulations predicted 45.3% of parents would utilize an option combining 5 therapist coaching calls with 5 e-coaching calls, a model that could reduce costs and extend the availability of interim services. Although 41.0% preferred weekly pacing, 58% were predicted to choose an interim parenting service conducted at a twice-monthly to monthly pace. The results of this study suggest that developing interim services reflecting parental preferences requires a choice of formats that includes parenting groups, telephone-coached distance programs, and e-coaching options conducted at a flexible pace.
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Transtornos Mentais/psicologia , Serviços de Saúde Mental , Poder Familiar/psicologia , Pais/educação , Pais/psicologia , Listas de Espera , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Psicoterapia de Grupo/métodos , Inquéritos e QuestionáriosRESUMO
Continuity of care, how individuals experience care over time as coherent and linked, is considered an ethical principle of care. While continuity has been examined extensively in the adult health literature, there is a paucity of studies examining continuity in children's mental health care. Using qualitative semi-structured interviews with parents, youth, and service providers, the current study found themes and issues unique to this healthcare context, such as coordination across sectors; risks to discontinuity, such as transitions; and consequences of discontinuity, such as parents acting as liaisons. Implications of these findings are discussed.
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Continuidade da Assistência ao Paciente , Serviços de Saúde Mental , Adolescente , Adulto , Administração de Caso , Criança , Proteção da Criança , Pré-Escolar , Humanos , Entrevistas como Assunto , Transtornos Mentais/terapia , Ontário , Pais/psicologiaAssuntos
Saúde do Adolescente/estatística & dados numéricos , Saúde da Criança/estatística & dados numéricos , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Sistemas de Informação , Saúde Mental/estatística & dados numéricos , Adolescente , Criança , Humanos , Ontário/epidemiologiaRESUMO
Little is known about behaviors displayed by preschoolers during night-waking. Mothers (N = 203) of community preschoolers completed the Children's Night-waking Behavior Scale and measures of night-waking, co-sleeping, and daytime behavior. Approximately 1/2 of wakings involved calling out, getting out of bed, and requests for comfort; 1/4 involved activity, fear, or instrumental requests. Specific associations between night-waking behaviors, night-waking, and bedtime and daytime behaviors were observed; associations were not consistent across child gender and age. For example, comfort requests were associated with mothers' perceptions of sleep as problematic in 4- and 5-year-old children only (ρ = .42); activity requests were associated with hyperactivity for boys only (r = .36). Understanding night-waking requires consideration of factors beyond parenting, such as children's behavior, age, and gender.
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Comportamento Infantil , Distúrbios do Início e da Manutenção do Sono/psicologia , Fatores Etários , Pré-Escolar , Feminino , Humanos , Masculino , Mães , Poder Familiar , Fatores Sexuais , Sono/fisiologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Inquéritos e QuestionáriosRESUMO
A new measure, Continuity of Care in Children's Mental Health (C3MH), is presented. The study involved item generation, pre-testing, pilot testing, and validation. The C3MH was administered to 364 parents recruited from 13 children's mental health agencies in Ontario, Canada. The measure includes five scales supported by confirmatory factor analysis. Scale validity was supported through analyses of relationships with established measures of satisfaction, problem severity, and therapeutic alliance, as well as through known-group differences. The results of a pilot youth-report version (N = 57) are presented. The C3MH will be a useful tool for assessing improvements in system integration.
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Serviços de Saúde da Criança/normas , Continuidade da Assistência ao Paciente/normas , Serviços de Saúde Mental/normas , Adolescente , Adulto , Idoso , Criança , Serviços de Saúde da Criança/organização & administração , Pré-Escolar , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Análise Fatorial , Feminino , Humanos , Masculino , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Pais/psicologia , Satisfação do Paciente/estatística & dados numéricos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVES: Most children stop napping between 2 and 5years old. We tested the association of early nap cessation (ie, children who stopped before their third birthday) and language, cognition functioning and psychosocial outcomes. METHODS: Data were from a national, longitudinal sample of Canadian children, with three timepoints. Children were 0-to-1 year old at T1, 2-to-3 years old at T2, and 4-to-5 years old at T3. Early nap cessation was tested as a correlate of children's psychosocial functioning (cross-sectionally and longitudinally), cognitive function (longitudinally), and language skills (longitudinally). There were 4923 children (50.9% male; 90.0% White) and their parents in this study who were included in the main analyses. Parents reported on demographics, perinatal and developmental variables, child functioning, and child sleep. Children completed direct assessments of receptive language and cognitive ability. Nap cessation, demographic, and developmental-control variables were tested as correlates of cross-sectional and longitudinal outcomes using linear regression (with a model-building approach). RESULTS: Early nap cessation correlated with higher receptive language ability (ß = 0.059 ± 0.028) and lower anxiety (ß = -0.039 ± 0.028) at T3, after controlling for known correlates of nap cessation, nighttime sleep, and other sociodemographic correlates of the outcomes. Cognitive ability, hyperactivity-inattention, and aggression were not correlated with nap cessation. CONCLUSIONS: Early nap cessation is related to specific benefits (ie, better receptive language and lower anxiety symptoms). These findings align with previous research. Future research should investigate differences associated with late nap cessation and in nap-encouraging cultures, and by ethnicity.
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Sono , Humanos , Canadá , Feminino , Masculino , Pré-Escolar , Lactente , Estudos Longitudinais , Estudos Transversais , Fatores de Tempo , Cognição , Funcionamento Psicossocial , Recém-NascidoRESUMO
OBJECTIVES: Sleep health inequities likely contribute to disparities in health outcomes. Our objective was to identify social determinants of sleep health among middle-aged/older adults in Canada, where prior evidence is limited. METHODS: We analyzed cross-sectional data from the Canadian Longitudinal Study on Aging, a survey of over 30,000 community-dwelling adults aged 45-85years. Self-reported measures included sleep duration, sleep satisfaction, and sleep efficiency. We explored associations between sleep measures and social determinants of health. We used modified Poisson regression to estimate prevalence ratios for sleep satisfaction and sleep efficiency, and linear regression for sleep duration. Estimates were adjusted for all social, lifestyle, and clinical covariates. We explored effect modification by sex. RESULTS: Of the 11 social determinants explored, all were significantly associated with at least one domain of sleep health. These associations were reduced to 9 variables with adjustment for all social variables, and 7 with further adjustment for lifestyle and clinical covariates, including differences by sex, age, education, marital status, employment, race/ethnicity, and sexual orientation. Better sleep health in >1 domain was observed among males, older age groups (65 and older), higher income groups, the retired group, and homeowners with adjustment for social variables, and only in males and older age groups with additional adjustment for lifestyle and clinical variables. Only sleep duration associations were modified by sex. CONCLUSIONS: Sleep health disparities among Canadian adults exist across socioeconomic gradients and racial/ethnic minority groups. Poor sleep health among disadvantaged groups warrants increased attention as a public health problem in Canada.
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Etnicidade , Determinantes Sociais da Saúde , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Idoso , Estudos Longitudinais , Estudos Transversais , Canadá/epidemiologia , Grupos Minoritários , Envelhecimento , SonoRESUMO
OBJECTIVE: Many parents of preschool-age children have concerns about how to discipline their child but few receive help. We examined the effects of a brief treatment along with usual care, compared with receiving usual care alone. Patients. Parents (N = 178) with concerns about their 2- to 5-year olds' discipline were recruited when they visited their family physician at 1 of 24 practices. METHODS: After completing mailed baseline measures, parents were randomly assigned to receive usual care or the Parenting Matters intervention along with usual care. Parenting Matters combined a self-help booklet with two calls from a telephone coach during a 6-week treatment period. Follow-up assessments were completed at 7 weeks post-randomization, and 3 and 6 months later. RESULTS: Behaviour problems (Eyberg Child Behaviour Inventory) decreased significantly more in the Parenting Matters condition compared with Usual Care alone, based on a significant time by treatment group effect in intent-to-treat, growth curve analyses (P = 0.033). The Parenting Matters group also demonstrated greater and more rapid improvement than in usual care alone in terms of overall psychopathology (Child Behaviour Checklist, P = 0.02), but there were no group differences in parenting. The overall magnitude of group differences was small (d = 0.15 or less). CONCLUSION: A brief early intervention combining a self-help booklet and telephone coaching is an effective way to treat mild behaviour problems among young children. This minimal-contact approach addresses the need for interventions in primary health care settings and may be a useful component in step-care models of mental health.
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Comportamento Infantil , Medicina de Família e Comunidade , Poder Familiar , Pais/educação , Consulta Remota , Adulto , Pré-Escolar , Educação , Feminino , Humanos , Análise de Intenção de Tratamento , Masculino , Folhetos , Satisfação do PacienteRESUMO
OBJECTIVES: Despite the high prevalence of mental disorders among youth (age 12 to 17) and emerging adults (age 18 to 24), few receive mental health (MH) services. Using a cross-sectional study design, we examined population characteristics associated with MH service use in this age group from 2011 to 2016. METHODS: Data were from six cycles of the Canadian Community Health Survey (2011-2016). Population characteristics associated with service use were analyzed using logistic regression models for each year. Changes in odds ratios over time were used to examine trends. RESULTS: Presence of a mood or anxiety disorder had the largest magnitude of association on MH service use in every year. Trends suggested an increased association size between self-rated MH status and service use; lower self-rated MH was associated with a 62% increase in odds of service use in 2011 and an 83% increase in 2016. Being female was associated with increased odds of MH service use (range: 59-107%). Compared with white respondents, individuals who were East and Southeast Asian or South Asian had decreased odds of MH service use. While the association size varied for South Asians, there was a trend toward decreasing likelihood of accessing care (55% decreased odds in 2011, 74% in 2016) for East and Southeast Asians. CONCLUSION: Trends suggest changes in population characteristics associated with access to MH care (e.g., self-rated MH status) as well as persistent inequity in MH service use in Canada for males and individuals from Asian ethnic groups.
RéSUMé: OBJECTIFS: Les jeunes (12 à 17 ans) et les adultes émergents (18 à 24 ans) sont peu nombreux à recevoir des services de santé mentale (SSM) malgré la prévalence élevée des troubles mentaux dans ces deux groupes d'âge. À l'aide d'une étude transversale, nous avons examiné les caractéristiques démographiques associées à l'utilisation des SSM dans ces groupes d'âge entre 2011 et 2016. MéTHODE: Les données provenaient des six cycles de l'Enquête sur la santé dans les collectivités canadiennes (20112016). Les caractéristiques démographiques associées à l'utilisation des services ont été analysées à l'aide de modèles de régression logistique pour chaque année étudiée. Les changements dans les rapports de cotes au fil du temps ont servi à analyser les tendances. RéSULTATS: Pour chaque année, c'était la présence d'un trouble de l'humeur ou d'un trouble anxieux qui était la plus largement associée à l'utilisation des SSM. Les tendances ont indiqué une association accrue entre l'état de santé mentale autoévalué et l'utilisation des services; une moins bonne santé mentale autoévaluée était associée à une hausse de 62 % de la probabilité d'utilisation des services en 2011 et à une hausse de 83 % en 2016. Le sexe féminin était associé à une probabilité accrue d'utilisation des SSM (intervalle : 59107 %). Comparativement aux répondants blancs, les personnes originaires de l'Asie de l'Est, du Sud-Est ou du Sud présentaient une probabilité réduite d'utilisation des SSM. Malgré la variabilité de l'ampleur de l'association chez les Asiatiques du Sud, nous avons observé une tendance à la baisse dans la probabilité d'avoir accédé aux soins (probabilité réduite de 55 % en 2011 et de 74 % en 2016) chez les Asiatiques de l'Est et du Sud-Est. CONCLUSION: Ces tendances indiquent des changements dans les caractéristiques démographiques associées à l'accès aux SSM (p. ex. l'état de santé mentale autoévalué), ainsi qu'une iniquité persistante dans l'utilisation des SSM au Canada chez les hommes et les personnes appartenant aux groupes ethniques asiatiques.