For many years, CAMH clinician scientist Dr. Joanna Henderson was puzzled by why the same issues kept coming up among youth dealing with both mental health and substance abuse issues.
“These kids seem to fare very poorly in life. Even if they are identified early on, they tend to be at higher risk of committing suicide, becoming homeless or being victimized,” explained Dr. Henderson. “All this led me to question ‘why?’”
With other colleagues at CAMH, Dr. Henderson started a program of research, called Research and Action for Teens (RAFT), aimed at improving knowledge, screening tools and treatment for youth coping with concurrent substance use and mental health challenges.
The team is also researching new interventions for families and identifying how support services can be improved. A number of CAMH researchers, including Drs. Joe Beitchman, Shelley McMain, Brian Rush, David Wolfe and E.B. Brownlie are also lead investigators for this project, funded by a Canadian Institutes of Health Research (CIHR) team grant.
Talking to Kids: Identifying the Issues
In one part of the project, researchers are following more than 700 Ontario students in grades seven and eight over three years. By tracking mental health issues and drug use in these kids, CAMH scientists hope to get a clearer picture of how to help youth who are coping with or are at risk of developing concurrent disorders.
“We want to know more about how the situation looks over time — who’s at highest risk of developing concurrent mental health and substance use problems, and what are some of the things that mitigate risk,” said Dr. Henderson, who is beginning to analyze the first round of data.
She also hopes to track, in a similar manner, approximately 100 youth who have already been diagnosed with concurrent disorders.
Treating the Disorders: Breaking New Ground
In another arm of the study, led by CAMH Clinician Scientist Dr. Shelley McMain, the effectiveness of two interventions — motivational interviewing and dialectical behaviour therapy skills training — is being measured.
“We’re breaking ground by exploring whether new treatment approaches will help these kids,” said Dr. McMain. “Currently, there is lack of empirically-derived knowledge to guide treatment of youth with concurrent mental health and substance problems."
Through motivational interviewing, participants will examine their substance use, and consider the pros and cons of their behaviours and set goals. Through dialectical behaviour therapy (DBT) skills training, they will learn skills designed to help them manage substance urges, tolerate negative emotions, and improve coping skills in difficult situations.
The research team is also studying skills training derived from dialectical behaviour therapy for families of youth with concurrent disorders. Treatment consists of 12-week family skills training led by trained professionals and peer facilitators.
Right now, researchers are currently recruiting families and kids in Toronto. Later this year, a similar study group will begin in Thunder Bay and Ottawa. At all three sites, the team will monitor progress made by kids and families.
“The goal is to see whether teaching kids how to regulate their emotions and behaviours will improve their coping,” explains Dr. McMain. “Hopefully, we’ll also relieve some of the burden on parents.”
Opening Communication: Knowledge Translation & Exchange
The needs of youth, and potential areas for service improvements, will be outlined in a report by Dr. Henderson and Gloria Chaim, Deputy Clinical Director of Child, Youth and Family Services.
The report is the outcome of their work in screening youth for mental health and substance use issues in various Ontario communities, and collaborating with child and family-focused organizations across sectors, such as mental health, education and youth justice.
Currently, the team is working with agencies on incorporating a common screening tool, called the GAIN Short Screener, so that kids don’t have to be reassessed each time they start a new service. Ultimately, the collaborators are working towards strengthening overall communication and referral processes between different service providers, so that kids don’t get lost in the system.
“We know there are some gaps between what youth need and what they are offered. But is there anything we can do differently?” said Dr. Henderson. “Our hope is that kids get identified and they get the support they need from the community.”