Reprinted from "CBT" issue of Visions Journal, 2009, 6 (1), p. 21
About one in seven—that’s 140,000—children and youth in BC have a mental health problem serious enough to affect their relationships with family and friends and their performance in school. There is also a gap between the need and the availability of mental health services.1 The Ontario Child Health Study in 1997 determined that only one in six children and youth with mental disorders receive some form of specialized services.2
The Children and Youth Mental Health Plan
The Child and Youth Mental Health Plan for BC (CYMH Plan) was introduced by the provincial government in February 2003. The five-year CYMH Plan (2003-2008) presented a new approach to services and supports for children and youth with mental health problems and their families. Instead of focusing only on children and youth with the most serious mental disorders, the CYMH Plan focused on helping young people earlier, to prevent or reduce their risk for developing mental health problems. Additionally, the plan provided direction for the types of therapy that would be most likely to help children, youth and their families. Before the CYMH Plan, clinical services were a mixture of whatever approaches staff clinicians had to offer.
In developing the CYMH Plan, the Ministry of Children and Family Development (MCFD) committed to using research evidence to make sure the most effective prevention and treatment approaches would be used.
In 2001 to 2002, the Children’s Health Policy Centre at Simon Fraser University reviewed the research literature on behalf of MCFD. MCFD also formed expert advisory groups to recommend the best approaches for some particular mental health problems. These included depression, anxiety, behaviour problems and eating disorders. Advisory groups also addressed co-occurring issues of mental health and substance use, and mental health and developmental disabilities.
Recommendations led to training initiatives as part of the CYMH Plan, focusing on cognitive-behavioural therapy, interpersonal psychotherapy, dialectical behavioural therapy, suicide and dual diagnosis.
Cognitive-behavioural therapy (CBT) was recommended as the most effective for anxiety and depression. Anxiety is the most common mental health problem in children and youth, affecting about 6.5% of young people. Depression affects 2.1% of children and youth.1
Some things you may do as part of CBT are:
The CBT approach
CBT is a counselling approach that requires the active participation of the client. It helps you understand the connections between your thoughts, feelings and behaviours that might contribute to anxiety and depression.
Feelings of anxiety are learned, so fortunately they can also be unlearned. These feelings are often reinforced through direct and indirect experiences. For instance, growing up with a parent who is overprotective or having fearful experiences like being bit by a dog may reinforce the notion that the world is a scary place.
A question a clinician might ask to help you look at some of your anxious thoughts or beliefs could be: Do you notice that when you think that bad things are going to happen, they almost never do? When people with anxiety experience physical sensations like a racing heart or sweaty hands, they often fear they might faint or have a heart attack. These physical sensations, however, are seen by mental health professionals as normal reactions to scary situations. They are not dangerous and often last for only a very short time, then go away. The clinician’s task is to help you realize this and devise strategies for managing your reactions to these sensations.
Similarly, in the case of depression, a clinician might ask: Have you felt this way at another time in your life, and did those feelings go away? One would expect to feel sad or depressed for a short period following a loss or disappointment. But if it lasts several months, a mental health professional can help you learn ways to deal with these feelings.
Parents have a very important role to play in helping their children deal with anxiety or depression. Parents can help by supporting their children to try new behaviours, gently questioning unhelpful beliefs, supervising the charting of tasks and modelling positive behaviour.
Cognitive-behavioural therapy has primarily been used for children and youth ages eight and older, but programs using the principles of CBT have been shown to be effective with younger children as well. FUN FRIENDS, an anxiety prevention program for children aged four to seven, is being piloted this fall in BC. It’s an adaptation of the original FRIENDS program that MCFD and school districts have implemented in grades four, five and seven in BC. Another MCFD project based on CBT principles is the self-help depression manual for youth titled Dealing With Depression: Antidepressant Skills for Teens. You can find all these programs on the MCFD website (see sidebar).
Where to find the resources in this article
Expanding CBT services in the province
By 2005, MCFD had begun training CYMH clinical staff in CBT to ensure they could use the most effective approaches for helping children and youth with anxiety problems and depression.
MCFD works with CBT Connections,3 a BC company that provides training. They offer a two-day foundational CBT workshop on the principles of CBT as treatment for anxiety disorders, including generalized anxiety, obsessive-compulsive behaviour, phobias, separation anxiety, panic, social anxiety and post-traumatic stress.
The goal is to have all MCFD clinicians in the province take the two-day workshop. Registration for each training session is based on population and socio-economic factors to ensure there are trained clinicians province-wide. There are approximately 500 clinicians in BC, and at present, about three-quarters have done this training.
Clinicians can complete a certification program through CBT Connections and AnxietyBC. In addition to the two-day workshop, they learn in more depth how to use CBT with children and youth who have more complex anxiety disorders. This latter part of the program involves Web-based learning modules and tests, developing case treatment plans and making audio recordings of client sessions for feedback by trainers.
Almost half of all CYMH clinicians have completed the CBT certification for anxiety disorders. There isn’t a requirement for all clinicians to complete the certification, though all are encouraged to do so. Some clinicians, however, choose to focus additional training on one of the other approaches recommended in the plan instead.
Some CYMH clinicians have also received additional training in CBT for depression (by Dr. Chris Wilkes, Head, Child and Adolescent Psychiatry in the Calgary Health Region), though there are no plans for further training at this time. The principles, however, are similar to those applied to anxiety disorders.
A small group of CYMH clinicians have received training in Trauma-Focused CBT delivered by the Harborview Center for Sexual Assault and Traumatic Stress4 in Seattle. They will be better able to help children and youth who have experienced trauma in their lives. There are plans for further training in this area of CBT.
MCFD offers free counselling, including CBT, to children and youth with mental health problems and their families. You can access CBT by accessing counselling services through MCFD.
If you have concerns and would like to speak to a mental health clinician, check the MCFD website (see sidebar) for the Child and Youth Mental Health office closest to you. You can also find office locations in the provincial services section of your telephone directory blue pages.
About the authorGayle is the Senior Mental Health Consultant on the Child and Youth Mental Health Policy Team, Ministry of Children and Family Development. She has worked in mental health for 26 years as a clinician, supervisor, manager and consultant. Gayle and her colleagues developed and implemented the Child and Youth Mental Health Plan for BC.
Waddell, C. & Shepherd, C. (2002). Prevalence of mental disorders in children and youth: A research update prepared for the British Columbia Ministry of Children and Family Development. Vancouver: University of British Columbia, Mental Health Evaluation & Community Consultation Unit. www.mcf.gov.bc.ca/mental_health/mh_publications/02a_cymh.pdf.
Offord, D.R., Boyle, M.H., Szatmari, P. et al. (1987). Ontario child health study: Six-month prevalence of disorder and rates of service utilization. Archives of General Psychiatry, 44(9), 832-836.
CBT Connections: www.cbtconnections.com.
Harborview Centre for Sexual Assault & Traumatic Stress: http://depts.washington.edu/hcsats/about_us.html.