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Introduction: The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. Methods: A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Results: Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Discussion: Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Conclusion: Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families. [ABSTRACT FROM AUTHOR]

Objective: Canadian governments produced 64 reports containing data about the mental health of children but no reports could adequately be called monitoring reports. Surveys sought to clarify definitions, challenges and processes that could help lead to regular reports. Method: (Details in Part I). The 2006 survey clarified government current data use and future need, challenges to producing reports and the role of NGOs. The 2008 survey clarified the definition of reports, governments' most desired indicators, and national factors. Results: Governments wanted the data for policy making, program construction, priority setting and resource allocation. The most challenging difficulties were governments themselves: coordinating among departments, lack of funding, lack of an agency and lowered priority. Governments most wanted indicators of child functioning, population health and early identification. Reports needed to meet specific criteria for contents, indicator qualities, population characteristics and regularity. Conclusions: Governments wanted a national strategy, national framework and agreement on a measuring agency. Good general agreement existed about reporting criteria. A partnership model may lead to quicker results given the difficulties within governments. NGOs and others need to continue collaborative advocacy. Monitoring is one of two steps that could help turn collections of services into selfregulating systems. [ABSTRACT FROM AUTHOR]

Objective: Canadian governments spend billions of dollars yearly on programmatic interventions, intended to improve the mental health of children, without recommended monitoring of children's mental health. The Canadian Academy of Child and Adolescent Psychiatry monitored governments' progress in producing reports. Method: Five evolving surveys were done during 2002, 2004, 2005, 2006 and 2008. Initially, progress was monitored then later surveys examined challenges that inhibited monitoring, the need for a national strategy, an indicator framework and an agency to do the monitoring and the role of non-government organizations. The 2008 survey requested the three most important indicators governments desired, and created clarity in the definition of monitoring reports in contents, criteria, qualities of indicators and potential names. For comparison purposes, a Partnership Model to survey populations was evaluated. Results: Over five surveys, 13 of 14 governments affirmed the desire for monitoring and 64 publications were reviewed and categorized. No reports met criteria for 'monitoring reports'. The Partnership Model was used successfully in 11 Provincial-Territorial governments. Conclusions: It was reassuring that governments supported monitoring and were producing reports. The Partnership Model may offer a suitable alternative for governments. Results of 2006 and 2008, discussion, conclusions and references are in Part II. [ABSTRACT FROM AUTHOR]

Objectives: To review the evidence for efficacy and metabolic effects of atypical antipsychotics (AAPs), and to propose a metabolic monitoring protocol for AAP use in children and adolescents. Methods: A PubMed search was performed to obtain all studies related to efficacy, metabolic side-effects, and monitoring in those less than 18 years of age. Results: There are no approved indications for AAP use in children and adolescents in Canada. Based on US Food and Drug Administration approvals and a review of randomized controlled trials, we identified 7 indications for AAP use that target specific symptoms in youth including schizophrenia, bipolar I disorder, autism, pervasive developmental disorder, disruptive behaviour disorders (including conduct disorder and ADHD), developmental disabilities and Tourette Syndrome. A wide range of metabolic effects including weight gain, increased waist circumference, dysglycemia, dyslipidemia, hypertension, elevated hepatic transaminases and prolactin levels have been reported. We have developed a proposal for metabolic monitoring that includes anthropometric measurements and laboratory testing at baseline and appropriate intervals thereafter. Conclusion: There is an urgent need for national clinical practice guidelines that provide, not only appropriate treatment algorithms for AAP use based on evidence, but also address metabolic monitoring and subsequent management of complications in this vulnerable population. [ABSTRACT FROM AUTHOR]