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Background: Physical literacy (PL) is considered an important determinant of children's physical activity through which health benefits may be derived. The purpose of this study is to describe a sample of Canadian children's baseline levels of PL and movement behaviors, and explore whether the associations between PL and their mental wellbeing, if any, are mediated by moderate-to-vigorous physical activity (MVPA)., Methods: All grade two children in 14 elementary schools in the West Vancouver School District, Canada were invited to participate in a two-year longitudinal project. PL was assessed through PLAYfun and PLAYself tools. Physical activity was measured by wrist-worn accelerometers (GT3X + BT) for seven days. Children's mental well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ). A score of total difficulties was aggregated for internalizing and externalizing problems., Results: A total of 355 children aged 7-9 (183 boys, 166 girls, 6 non-binary) participated with 258 children providing valid accelerometer data. Children exhibited an average of 111.1 min of MVPA per day, with 97.3% meeting the physical activity guidelines. Approximately 43% (108/250) of participants were meeting the Canadian 24-h movement guidelines. Children were at an 'emerging' level of overall physical competence (45.8 ± 5.6) and reported a mean score of 68.9 (SD = 12.3) for self-perceived PL, with no significant differences between boys and girls. PL was significantly associated with MVPA (r = .27) and all SDQ variables (rs = -.26-.13) except for externalizing problems. Mediation analyses showed PL was negatively associated with internalizing problems and total difficulties when the association with MVPA was considered. However, the mediating role of MVPA was found only between PL and internalizing problems, β = -.06, 95%CI [-.12, -.01]., Conclusions: Although most of our sample was physically active and showed higher adherence to 24-H movement guidelines than comparable population data, the motor competence and self-perceived PL of our sample were similar to those of previous studies. PL has an independent association with children's internalizing problems and total difficulties. Ongoing assessment will investigate the relationships between PL and children's mental health from a longitudinal perspective., (© 2023. The Author(s).)

Food marketing is currently a multi-billion dollar industry. High levels of child-targeted food marketing, including on food packaging, suggests the need for media literacy skills to navigate persuasive techniques on food products. Evidence-based educational content on the topic of Media Literacy & Food Marketing (MLFM) was developed for children in Grades 3 to 9. This MLFM content has been taught to thousands of Canadian children across Canada, both in-person and virtually. This Practice Note highlights key strategies and lessons from implementing the program, and provides valuable insights into effective methods for empowering children's critical thinking around food promotion.

Indigenous families tend to move house more often, especially families with young children. However, little is known about the impact of high mobility on children's well-being and development. The aim of this systematic review was to examine the relationship between residential mobility and children's health, developmental, and educational outcomes for Australian, Canadian, and New Zealand Indigenous children (0-12 years). Four databases were investigated with pre-determined inclusion and exclusion criteria. The search identified 243 articles after independent screening by two authors. Eight studies assessing four child health outcomes were included, six quantitative and two qualitative. Child health outcomes were classified into four broad categories-physical health, social and emotional behavior, learning and development, and developmental risk. The review identified limited evidence; possible links were identified between high mobility and emotional and behavioral difficulties for younger children. One study identified evidence of a linear relationship between the number of houses a child has lived in since birth and developmental risk. Further research is needed to fully understand the impact of high residential mobility for Indigenous children at different developmental stages. Prioritizing the involvement, collaboration, and empowerment of Indigenous communities and leadership is critical for future research.

Foodbot Factory is a serious game developed to teach children about the 2019 Canada's Food Guide (CFG) healthy eating principles. Because no measurement tools existed to assess changes in children's knowledge of the CFG, the Nutrition Attitudes and Knowledge (NAK) questionnaire was developed for this purpose. The NAK is based on the 2019 CFG nutrition content and aligned with the Foodbot Factory modules (Drinks, Whole Grain foods, Vegetables and Fruit, Protein foods). Seven experts assessed face and content validity of the draft NAK questionnaire. Three sections were deemed valid, while the remaining 2 required minor revisions. The NAK was pilot tested for changes in nutrition attitudes and knowledge among children aged 9-10 years-old ( n  = 23), who answered the NAK questionnaire before and after using Foodbot Factory. Significant increases were found in overall nutrition knowledge, and knowledge of Whole Grain foods, Vegetables and Fruit and Protein foods. Knowledge of Drinks and nutrition attitudes remained unchanged. The NAK showed a moderate reliability when tested among a group of children ( n  = 23). While the NAK questionnaire is a promising tool for assessing changes nutrition knowledge related to the 2019 CFG guidelines in children, further research is required to test construct validity of this instrument. Novelty: The Nutrition Attitudes and Knowledge (NAK) questionnaire was developed by educators and dietitians. The NAK underwent face and content validity assessments and was pilot tested among children. The NAK questionnaire is a potential tool to detect changes in children's knowledge of the 2019 Canada's Food Guide.

Objectives: Children's mental health and wellbeing declined during the first COVID-19 lockdown (Spring 2020), particularly among those from disadvantaged settings. We compared mental health and wellbeing of school-aged children observed pre-pandemic in 2018 and after the first lockdown was lifted and schools reopened in Fall 2020. Methods: In 2018, we surveyed 476 grade 4-6 students (9-12 years old) from 11 schools in socioeconomically disadvantaged communities in Northern Canada that participate in a school-based health promotion program targeting healthy lifestyle behaviours and mental wellbeing. In November-December 2020, we surveyed 467 grade 4-6 students in the same schools. The 12 questions in the mental health and wellbeing domain were grouped based on correlation and examined using multivariable logistic regression. Results: There were no notable changes pre-pandemic vs. post-lockdown in responses to each of the 12 questions or any of the sub-groupings. Conclusion: Supporting schools to implement health promotion programs may help mitigate the impact of the pandemic on children's mental health and wellbeing. The findings align with recent calls for schools to remain open as long as possible during the pandemic response., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dabravolskaj, Khan, Veugelers and Maximova.)

This study aimed to obtain consensus on physical activity (PA) and sedentary behaviour (SB) policy items for use in Canadian childcare settings. Purposeful sampling of Canadian experts in PA/SB (n = 19) and Early Childhood Education (ECE; n = 20) was used to form two distinct (i.e., PA/SB and ECE) panels for a 3-round Delphi study. In round 1, the PA/SB experts suggested their top 10 items for a Canadian childcare PA/SB policy. Policy items were then pooled to generate a list of 24 unique items. In round 2, experts in both panels rated the importance of the 24 policy items using a 7-point Likert scale (i.e., 1 = "Not at all important" to 7 = "Extremely important"). The ECE panel was also asked to report on the feasibility of the policy items using a 4-point Likert scale (i.e., 1 = "Not at all feasible" to 4 = "Very feasible"). Policy items that received an interquartile deviation (IQD) score of [less than or equal to] 1 (indicating consensus) and a median score of [greater than or equal to] 6 (indicating importance) in both panels were considered shared priorities. In round 3, members of both panels re-rated the importance of the policy items that did not achieve consensus among their respective panel in round 2 and were asked to order items based on importance. Descriptive statistics were used to assess feasibility of policy items, and differences in panel ratings were quantified using Mann Whitney U tests. Consensus was achieved for 23 policy items in the PA/SB panel and 17 items in the ECE panel. Overall, 15 shared priorities were identified (e.g., provide 120 min of outdoor time per day, sedentary behaviour should not be used as a punishment), and six policy items exhibited a statistical difference in ratings across panels. Members of the ECE panel indicated that the policy item, "children should be permitted to go outside whenever they want, for as long as they want" (M = 1.78; SD = 0.65) was lowest in terms of feasibility, and the policy item, "children should receive opportunities to engage in both unstructured and structured physical activity opportunities daily" (M = 3.89; SD = 0.32) was the most feasible for daily implementation. Findings from this study can inform the development of an expert-generated and feasibility-informed institutional PA/SB policy for use in Canadian childcare settings.

The marketing of unhealthy foods and beverages contributes to childhood obesity. In Canada and the United States, these promotions are self-regulated by industry. However, these regulations do not apply to movie theatres, which are frequently visited by children. This pilot study examined the frequency and healthfulness of food advertising in movie theatres in the United States and Canada. A convenience sample of seven movie theatres in both Virginia (US) and Ontario (Canada) were visited once per month for a four-month period. Each month, ads in the movie theatre environment and before the screening of children's movies were assessed. Food ads were categorized as permissible or not permissible for marketing to children using the World Health Organization's European Nutrient Profile Model. There were 1999 food ads in the movie theatre environment in Ontario and 43 food ads identified in the movie theatre environment in Virginia. On average, 8.6 (SD = 3.3) and 2.2 (SD = 0.9) food ads were displayed before children's movies in Ontario and Virginia, respectively. Most or all (97%-100%) food ads identified in Virginia and Ontario were considered not permissible for marketing to children. The results suggest that movie theatre environments should be considered for inclusion in statutory food marketing restrictions in order to protect children's health., Competing Interests: In 2018, EP received a small honorarium from the Stop Marketing to Kids Coalition, a group of non-profit health organizations, for providing expert advice.

Aim: This review considers prominent risk factors and mitigation strategies of influenza among Indigenous children., Methods: Seven electronic databases were searched from the period of 2004-2017 to locate articles discussing influenza among Indigenous children in the developed circumpolar nations of Australia, Canada, United States, and New Zealand. Articles selected for inclusion discussed influenza among Indigenous children as either individuals or as a part of a community. Ancestry searches of articles meeting the review criteria were also undertaken to discern seminal research in this topic area., Results: From the 39 primary research studies included, marked risk factors and mitigation strategies of influenza among Indigenous children were identified using inductive analysis. Notable risk factors included age under 2 years, cigarette smoke exposure, presence of a chronic illness, and crowded living conditions. Successful mitigation of influenza for Indigenous children included strategies to improve vaccine coverage, provision of health education, and policy change., Conclusion: In the past, the impact of influenza upon Indigenous communities has been devastating for both children and their families. By utilizing existing public health infrastructure and collaborating with culturally unique Indigenous groups, preventive action for Indigenous children at significant risk of contracting influenza can be realized.

Adequate calcium intake and supply of vitamin D during childhood play important roles in ensuring adequate bone mass gain to achieve optimal peak bone mass. The Healthy Immigrant Children study employed a mixed-method cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3-13 years who had been in Canada for less than 5 years. This paper presents bone mineral content and vitamin D status data along with qualitative data that deepen the understanding of newcomer bone health status. A significantly higher percentage of refugee children (72.3%) had insufficient (<50 nmol/L) or deficient (<30 nmol/L) serum vitamin D compared with immigrants (53.2%). Vitamin D deficiency was most common among ethnic minority girls. Newcomer children with higher intakes of vitamin D, younger newcomer children, and those from western Europe or the United States had higher serum vitamin D levels. Immigrants had significantly higher mean total body bone mineral content compared with refugees. Total body fat, serum vitamin D, calcium intake, height, height by calcium intake, total body fat by calcium intake, and total body fat by height predicted total body bone mineral content levels. Vitamin D deficiency among newcomer children may be related to lack of knowledge regarding children's vitamin D requirements in the Canadian environment, dietary habits established in country of origin, low income that limits healthy dietary choices, and lifestyle habits that limit exposure to sunlight. Results suggest a need to screen newcomer children and pregnant women for vitamin D deficiency and support early intervention.

There are knowledge gaps in our understanding of the development of chronic disease risks in children, especially with regard to the risk differentials experienced by immigrants and refugees. The Healthy Immigrant Children study employed a mixed-methods cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3-13 years who had been in Canada for less than 5 years. Quantitative data regarding socioeconomic status, food security, physical activity, diet, and bone and body composition and anthropometric measurements were collected. Qualitative data regarding their experiences with accessing health care and their family lifestyle habits were gathered through in-depth interviews with the parents of newcomer children. Many newcomers spoke about their struggles to attain their desired standard of living. Regarding health outcomes, significantly more refugees (23%) had stunted growth when compared with immigrants (5%). Older children, those with better-educated parents, and those who consumed a poorer-quality diet were at a higher risk of being overweight or obese. Sixty percent of refugees and 42% of immigrants had high blood cholesterol. Significant health concerns for refugee children include stunting and high blood cholesterol levels, and emerging trends indicate that older immigrant children from privileged backgrounds in low-income countries may be more at risk of overweight and obesity. A variety of pathways related to their families' conceptualization of life in Canada and the social structures that limit progress to meeting their goals likely influence the development of health inequity among refugee and immigrant children. Public health initiatives should address these health inequities among newcomer families.

Setting: This paper chronicles the transformational process through which a national intersectoral collaboration, the Canadian Partnership for Children's Health and Environment (CPCHE), came to embrace a more upstream, equity-based focus in its mandate to advance children's environmental health., Intervention: After 15 years of working within a conventional, evidence-informed approach to health promotion and policy advocacy, in 2010-2013, CPCHE had the opportunity to collaborate on the development of equity-focused knowledge translation (EqKT). EqKT is a relational approach to knowledge practices that challenges intersectoral actors to work to uncover biases and limitations within their own institutional paradigms and professional practices that constrain their capacity to address population health inequities., Outcome: The ensuing transformation towards equity-focused intersectoral practice led CPCHE to create an intersectoral initiative called RentSafe. Conceptually and operationally, RentSafe provides an intersectoral space within which the grounded expertise of people with experience of unhealthy and undignified housing provides a roadmap for public health and other practitioners to critically explore professional and institutional blind spots and barriers. With RentSafe as its watershed moment, CPCHE is shifting from a top-down "for whom" orientation to an authentically engaged "with whom" approach that seeks to work integrally with community partners to expose and challenge systemic roots of health inequity., Implications: The transformational story of CPCHE underscores the competencies needed for public health professionals to acknowledge the sources of our own biases and limitations as a necessary first step in equity-focused intersectoral practice (EquIP). It also affirms the value of working in partnership with those who experience the environmental health inequities that such efforts seek to address.

Children with intellectual disability experience a higher prevalence of dental disease, obesity, challenging behaviours, and mental health disorders compared to children without intellectual disability. Children with intellectual disability concurrently face health and social service navigational barriers that are associated with unresolved health needs and hospital admissions, and parent burnout and employment interruptions. In this study, we explored the knowledge gap of how carers and governmental agencies, providing services, understand intellectual disability using discourse analysis, and a theoretical framework applying Deleuze and Guattari's concepts of the rhizome and stratification. We found that children with intellectual disability were stratified into eligible or ineligible service recipients through the diagnostic process that prioritized specified characteristics. Carers did not perceive that their children's unique characteristics and needs were accounted for within the diagnostic process and expressed feelings of being dismissed by clinicians and providers in decision-making about priority needs and services.

Developmental research during COVID-19 suggests that pandemic-related disruptions in family relationships are associated with children's mental health. Most of this research has focused on 1 child per family, thereby obfuscating patterns that are differentially operative at the family-wide (i.e., between-family) versus child-specific (i.e., within-family) levels of analysis. Thus, the current study evaluates multilevel, longitudinal associations between COVID-19 disruption, family relationships, and caregiver/child mental health using a sibling comparison methodology. Caregivers (N = 549 families with 1098 children between 5 and 18 years old) were recruited from the Prolific research panel (73% White-European; 68% female; 76% United Kingdom, 19% U.S.A.; median 2019 income $50,000-$74,999). Caregiver reports of COVID-19 disruption, psychological distress, family functioning, parenting, and child mental health (for 2 children per family) were provided during May (time 1) and July (time 2) 2020. A Bayesian multilevel path analysis with random effects revealed: (a) families were experiencing difficulties across domains when COVID-19 disruption was high; (b) COVID-19 disruption corresponded to greater sibling differences in mental health; and (c) the sibling with poorer mental health received lower quality parenting over time, especially in families who reported higher levels of differential parenting. Findings suggest that understanding children's mental health difficulties during COVID-19 requires a family system lens due to the multiple ways these consequences permeate across the family unit. Comprehensive interventions for children's mental health during this time will likely require an examination of caregiver, sibling, and whole-family dynamics in the context of evidence-based telehealth practice.

Background: Considering the amount of time children spend sitting in school, concerns about the consequences of an improper sitting position have been raised.Purpose: Evaluate the outcome of an occupational therapy intervention implemented to reduce child-furniture incompatibility.Methods: Repeated-measures design utilizing a within-subject comparison. Teachers' competence in promoting children's positioning (N = 14 teachers) and child-furniture incompatibility (N = 171 children) was measured.Findings: A statistically significant increase in teachers' competence was measured, as well as a decrease in desk-height incompatibility. Seat-height incompatibility remained unchanged.Implications: Evaluating the impact of workshops remains essential to ascertain the effectiveness of our interventions.

The introduction of a NEW physical education (PE) program at Ancaster Senior Public School had, at its root, the desire to make physical activity an inclusive domain for both athletic students and those not so inclined. With the growing concerns over the rapid and consistent rise in childhood obesity rates it was evident that the current model of competitive sport skill-related programs was not meeting the needs of many students. In an effort to address these concerns, it was necessary to look for ways to engage students that would meet their needs and interests. To accomplish this end, it was determined that many of the goals the school was attempting to meet could be addressed through the use of a climbing wall. The climbing wall was seen as a legitimate educational activity that would encourage the physical, mental, social and emotional growth of each participant. This article describes how a climbing wall became an integral part of Ancaster Senior's NEW PE program. The integration of a permanent climbing wall in the school as part of its NEW PE program has provided students with an invitation to revisit their childhood and "climb" the new challenges presented in the "new curriculum" of the 21st century.

The general purpose of this study was to examine the proportions of children and adolescents identified with behavioral, emotional and cognitive clinical findings and disabilities. Data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) were used in this study. Participants in this study included 7672 children aged 0 to 15 years who were reported for maltreatment and investigated by child welfare services across Canada. It was found that behaviour problem was the most common clinical finding in all age levels and psychiatric disorder was among the least common across all ages. Significant relationships were found among age levels and each clinical finding. A significant relationship was also found among age levels and having at least one clinical finding. Generally, the proportions of children for each clinical finding increased with age. Developmental delay was the most common disability at all age levels. Significant relationships among age levels were revealed for other health conditions, physical or developmental disability, and having at least one disability. The proportions of children identified for each disability generally decreased as age increased. The results suggest the use of a developmental approach to address the assessment, prevention, and intervention needs of these children and adolescents. (Contains 2 tables.)

All around the world, partnerships among schools and other youth-serving systems are promoting more comprehensive school-based mental health services. This article describes the development of international networks for school mental health (SMH) including the International Alliance for Child and Adolescent Mental Health and Schools (INTERCAMHS) and the more recent School Mental Health International Leadership Exchange (SMHILE). In conjunction with World Conferences on Mental Health Promotion, SMHILE has held pre-conference and planning meetings and has identified five critical themes for the advancement of global SMH: 1) Cross-sector collaboration in building systems of care; 2) meaningful youth and family engagement; 3) workforce development and mental health literacy; 4) implementation of evidence-based practices; and 5) ongoing monitoring and quality assurance. In this article we provide general background on SMH in four nations, two showing strong progress (the United States and Canada), one showing moderate progress (Norway), and one beginning the work (Liberia). Following general background for each country, actions in relation to the SMHILE themes are reviewed. The article concludes with plans and ideas for future global collaboration towards advancement of the SMH field.

Background: Little information exists on health of children with developmental disabilities (DDs) in the Canadian province of Manitoba. Method: The present authors linked 12 years of administrative data and compared health status, changes in health and access to health and social services between children with (n = 1877) and without (n = 5661) DDs living in the province, matched by age, sex and region of residence. Results: Children with DDs were significantly more likely than children in the matched comparison group to die before the age of 17 and have a history of respiratory illness, diabetes and injury-related hospitalizations. Children with DD also had significantly higher average number of ambulatory physician visits and higher rate of continuity of care. Conclusions: Children with DDs had poorer health status than the matched comparison group. The health disparities experienced by children with DDs persisted over time. Further population-based longitudinal research is needed in this area.

Children and youth with autism spectrum disorder presenting in emergency departments face potential cognitive, sensory, and behavioral challenges, and it is crucial for providers to be aware of their unique needs. However, disclosure of a child's autism spectrum disorder can be complex for parental caregivers and is not well understood. This qualitative study utilized a grounded theory approach and analyzed data from 28 parents and 16 health care providers related to autism spectrum disorder disclosure within two Canadian pediatric emergency departments. Study results indicated that participants identified benefits and risks of disclosure. Encouraging understanding, expediting service, and preparing health care providers for working with children with autism spectrum disorder were identified as benefits of disclosure. Risks related to disclosure included potential negative attributions toward the children and parental discomfort in disclosing a diagnosis in front of the children. Parents discussed the health care encounters they experienced following disclosure and provided recommendations for improving the disclosure process in the emergency department. It is recommended that future research explore the experiences of parents who choose not to disclose their child's autism spectrum disorder. Greater awareness of the disclosure experience and the development of resources and tools to support communication between parents and health care providers are also recommended.

Purpose: Patterns of physical activity (PA) and sedentary time, including volume of bouted activity, are important health indicators. However, the effect of accelerometer epoch length on measurement of these patterns and associations with health outcomes in children remain unknown. Method: We measured activity patterns in 308 children (52% girls, age range = 8-11 years) using ActiGraph GT1M accelerometers with 15-s epochs and reintegrated to 60-s epochs. We calculated the volume (minutes per day) of moderate-to-vigorous PA (MVPA), sedentary time, light, moderate, and vigorous PA, as well as bouted MVPA and sedentary time (0-5 min, 5-10 min, 10-20 min, and > 20 min). Results: The difference between 15-s and 60-s epochs was statistically significant for all outcomes; however, effect sizes were small or negligible in 30% of comparisons. Bias ranged from 1.9 min/day (total MVPA) to 102.7 min/day (0-5 min sedentary bouts). Regression-based estimates of bias and 95% limits of agreement illustrated that the magnitude, and in some cases, the direction, of between-epoch differences varied with activity level. Correlations with body mass index and cardiovascular fitness were similar for 15-s (r = - 0.19 to 0.20) and 60-s (r = - 0.16 to 0.29) epochs. Estimated 15-s data (predicted from 60-s) were similar to measured data and had similar relationships with health outcomes. Conclusion: Epoch length influences measurement of PA and sedentary patterns and the effect is modified by activity level. However, associations with health outcomes were similar and epoch differences can be adjusted. Future research should clarify the accuracy of different epoch lengths for measuring bouted activity and evaluate whether epoch length alters relationships with additional health outcomes.

It is now recognized that there is a very high prevalence of psychological disorders among children and adolescents and relatively few receive psychological treatment. In the current article, we present the argument that levels of distress and dysfunction among young people are substantially underestimated and the prevalence of psychological problems is higher than realized because of a variety of factors. In particular, it is suggested that psychological problems are underestimated due, in part, to the presence of subthreshold conditions that do not meet diagnostic criteria yet involve substantial distress and impairment. In addition, we focus on a subset of children and adolescents who experience profound distress yet keep it hidden or disguised because of a personality style characterized by self-concealment and a tendency to engage in perfectionistic self-presentation. The characteristics of these students who are "flying under the radar" are described with a discussion of associated familial, cultural, and school factors that reduce the likelihood of these students ever seeking help. Given our premise that psychological problems are substantially underestimated, it is apparent that schools have a vitally important role in mental health promotion in terms of the need for proactive system-wide preventive interventions led by school mental health counsellors. Broad programs are needed to bolster levels of resilience and the willingness to seek help among all children and adolescents but especially among those students who would otherwise not be on anyone's radar screen.

Introduction: Compared to typically developing peers, children with disabilities due to neurodevelopmental disorders and disabilities (NDD/D) and to chronic medical conditions (CMC) have reduced participation in activities. The extent to which these two groups of children have different levels of participation is unknown and was examined in this study. Methods: The 2006 Participation and Activity Limitation Survey children dataset collected by Statistics Canada was analyzed. Children with disabilities due to NDD/D and CMC were identified following review and classification of all ICD-10 codes in the dataset by two pediatricians. Dependent variables were parent-reported child participation in supervised and unsupervised physical activities within and outside of school, educational activities, and social/recreational activities. Logistic regression analyses, with relevant covariates (child and familial characteristics), were used to analyze the data. Results: Children with NDD/D were significantly more likely to take part in supervised and unsupervised physical activity at school than children with CMC (p less than 0.001). A similar trend was observed for participation in school outings, although the effect was not significant at p less than 0.01. Finally, a trend in the opposite direction was observed for educational activities, as children with NDD/D were less likely to take part in these activities than children with CMC. Discussion: Finding decreased participation among children with CMC compared with NDD/D was not predicted a priori but has potential implications for their mental and physical health. Conclusions: Gaining a better understanding of the barriers to participation in physical activity may contribute to improving the overall health status of children with CMC. (Contains 3 tables.)

Research Findings: The purpose of this study was to investigate how neighborhoods and neighborhood socioeconomic disadvantage impact school readiness over time. School readiness was measured using the Early Development Instrument (EDI) for 3 populations of kindergartners in 2001, 2003, and 2005 in Saskatoon, Saskatchewan, Canada. EDI results revealed that mean scores for the EDI domains of (a) physical health and well-being and (b) communication and general knowledge have been decreasing over time, although this varied according to neighborhood. A derived summary measure of socioeconomic disadvantage at the neighborhood level was significantly associated with declining scores in the EDI domain of physical health and well-being. Practice or Policy: These findings suggest a need for policy and programs that address the underlying determinants of poor school readiness scores, such as socioeconomic disadvantage at the neighborhood level. (Contains 8 tables, 4 footnotes, and 4 figures.)

Given today's climate of economic uncertainty and fiscal restraint, organizations providing child and youth mental health services are required to do so with limited resources. Within this context, service providers face added pressure to deliver evidence-based programs and demonstrate program effectiveness. The Ontario Centre of Excellence for Child and Youth Mental Health works with organizations to meet these demands by building capacity in program evaluation. While personal instruction and mentoring are important ways of providing support, face-to-face consultations are not always cost-effective. In this article we describe the use of interactive technology and computer-based learning as an alternative and/or complementary (to face-to-face) means of delivering evaluation information and training. We discuss the process of developing these tools and share findings from our preliminary evaluation of their effectiveness in enhancing the evaluation-related supports we offer to providers of child and youth mental health services. (Contains 5 notes.)

Background: Previous research on psychiatric and health disparities according to level of cognitive functioning has focused on adults within an American healthcare context. The current study compares children with and without cognitive and developmental delays in Quebec, Canada, using physician billing data from a longitudinal study of low-income, francophone families. Canada is an ideal context for studying medical billing data as its equal access healthcare system removes many socioeconomic biases. Methods: A large sample (n = 1050) of children is used to describe psychiatric and health disparities, as well as differences in Ambulatory Care Sensitive (ACS) conditions and primary healthcare, between children with (n = 107) and without (n = 943) diagnoses in their billing history indicative of delays. Results: The findings demonstrated a relatively high level of psychiatric diagnoses for children with delays. However, no difference was found between children with and without delays in regard to emergency room visits and hospitalizations for ACS conditions and primary healthcare. Conclusions: The findings suggest that, within a universal healthcare system, disparities in primary healthcare may not emerge until adulthood in individuals with delay status.

Background: This study examines the use of the Brief Child and Family Phone Interview (BCFPI) to screen for childhood psychiatric disorder based on Diagnostic Interview Schedule for Children Version IV (DISC-IV) classifications of attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety (SAD), generalized anxiety (GAD) and major depression (MDD). Methods: Data for analysis come from a sample of 399 children and adolescents aged 5-17 years old referred to child mental health outpatient services in three Ontario cities. Mothers were administered the BCFPI on three occasions: baseline, 2 and 13 months; and the DISC-IV on two occasions: 1 and 12 months. Results: Based on kappa, test-retest reliability for disorders classified by the BCFPI exceeded 0.50 for all conditions except MDD (0.45). In receiver operating characteristic (ROC) analysis, area-under-the-curve (AUC) estimates for BCFPI scale score associations with DISC-IV classifications of disorder exceeded 0.80 for CD, ODD, ADHD and SAD; and were lower for GAD (0.76) and MDD (0.75). In stratified analyses, there were no statistically significant differences in AUC estimates for boys versus girls and 5 to 11 versus 12 to 17-year-olds. Conclusions: Classifications of childhood disorder derived from the BCFPI provided a reasonable approximation to disorders classified by the DISC-IV administered by lay interviewers.

Background: This study describes the development of the Brief Child and Family Phone Interview (BCFPI)--a computer-assisted telephone interview which adapts the revised Ontario Child Health Study's (OCHS-R) parent, teacher, and youth self-report scales for administration as intake screening and treatment outcome measures in children's mental health services. It focuses on the factor structure of the BCFPI's hypothesized parent-reported child mental health scales describing attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and major depression (MDD). Methods: Data for the analysis come from an OCHS-R measurement study that included two groups of children and adolescents selected from the same urban area: a general population sample (n = 1,712) and a clinic-referred sample (n = 1,512); and a third sample that was enlisted in a province-wide implementation study of clinic-referred 6- to 18-year-olds (n = 56,825). We used confirmatory factor analysis to assess the factor structure of the BCFPI scales in different populations and to test measurement equivalence across selected groups. Results: Despite the strong constraints imposed on the measurement models, estimates of model fit across the three samples were comparable in magnitude and approached the cut-offs suggested for the GFI and CFI (greater than 0.9) and RMSEA (less than 0.05). Measurement equivalence was demonstrated between the OCHS-R clinic and provincial implementation samples. Within the implementation sample, the factor structure of the BCFPI scales was equivalent for boys versus girls and for 6- to 12- versus 13- to 18-year-olds. A companion paper examines the test-retest reliability, sensitivity, specificity, and validity of these BCFPI scales when used for screening. Conclusion: This project supports the feasibility and acceptability of a computer-assisted telephone interview for assessing emotional-behavioral problems of children and adolescents referred to children's mental health services.

According to the annual United Nations declarations based on the Human Development Index (HDI), Canada remains one of the best places in the world in which to live. Ironically, this declaration of socio-economic superiority does not extend to the young people in the society. Although post-industrial societies like Canada and the United States may be outstanding in terms of human development, they may also be violating the human rights of their children and youth by neglecting their basic needs. In this article, the author discusses how society and the government allow mass media to portray a dim political/cultural view of youth. These dim views of youth have multiple specific consequences. Instead of working to solve the sources of youth and child suffering, society and the government remain punishing and parochial in their objectives for and care of children. The authors suggest that a new paradigm shift of education that is committed to enfranchising children and youth is needed. This new policy should situate itself at the heart of all advocacy for children--one that teaches children the value of their voices. (Contains 15 notes.)

Context: There is insufficient literature documenting the mental health experiences and needs of rural communities, and a lack of focus on children in particular. This is of concern given that up to 20% of children and youth suffer from a diagnosable mental health problem. Purpose: This study examines issues of access to mental health care for children and youth in rural communities from the family perspective. Methods: In-depth interviews were conducted in rural Ontario, Canada, with 30 parents of children aged 3-17 who had been diagnosed with emotional and behavioral disorders. Findings: Interview data indicate 3 overall thematic areas that describe the main barriers and facilitators to care. These include personal, systemic, and environmental factors. Family members are constantly negotiating ongoing tension, struggle, and contradiction vis-a-vis their attempts to access and provide mental health care. Most factors identified as barriers are also, under different circumstances, facilitators. Analysis clustered around the contrasts, contradictions, and paradoxes present throughout the interviews. Conclusions: The route to mental health care for children in rural communities is complex, dynamic, and nonlinear, with multiple roadblocks. Although faced with multiple roadblocks, there are also several factors that help minimize these barriers.

In Calgary, Alberta, Canada, cooperation between families, agencies and health care providers has resulted in services that improve the health and quality of life for individuals with Down syndrome. One of these is the multidisciplinary Down syndrome team at the Alberta Children's Hospital, which provides assessment, treatment and support based on established the Down Syndrome Medical Guidelines (Cohen, 1999) to children with Down syndrome. Originally established to provide services to children from birth to six years of age, the clinic now sees children until the age of 18 years. This change in clinic mandate has enriched and changed the practice of the team. They have an increased awareness of how issues develop over time and impact the child's functioning and quality of life and have developed approaches to prevent and minimise these challenges. This article describes the Down syndrome team's evolution and the benefits of a multidisciplinary/coordinated approach for individuals with Down syndrome. (Contains 3 figures.)

A process-oriented approach to parental divorce locates the experience within the social and developmental context of children's lives, providing greater insight into how parental divorce produces vulnerability in some children and resiliency in others. The current study involves prospectively tracking a nationally representative sample of Canadian children of ages 4-7 and living with two biological parents at initial interview in 1994 (N = 2,819), and comparing the mental health trajectories of children whose parents remain married with those whose parents divorce by 1998. Results from growth curve models confirm that, even before marital breakup, children whose parents later divorce exhibit higher levels of anxiety/depression and antisocial behavior than children whose parents remain married. There is a further increase in child anxiety/depression but not antisocial behavior associated with the event of parental divorce itself. Controlling for predivorce parental socioeconomic and psychosocial resources fully accounts for poorer child mental health at initial interview among children whose parents later divorce, but does not explain the divorce-specific increase in anxiety/depression. Finally, a significant interaction between parental divorce and predivorce levels of family dysfunction suggests that child antisocial behavior decreases when marriages in highly dysfunctional families are dissolved.

Examines the influence of a home-based asthma health education program on parental coping and quality of life. Families (N=40) with children under 11 received either health education sessions or a booklet representing the traditional approach to care. Results suggest the use of a one-time, home-based intervention to assist families caring for children with asthma appears effective. (Author/JDM)

Discusses the development of Canuck Place, North America's first free-standing pediatric hospice of its kind, opened in British Columbia, Canada, in 1995. Discusses the process of assessing the need for Canuck Place. Data from traditional quantitative and less-traditional qualitative sources were used to document and develop an argument in support of developing this children's hospice program. (KW)

Argues for a child-centered approach to thinking about child cycling accidents. Helmets instill a false sense of safety in children and adults, while a profound change in the habits of adults is the only strategy that can protect children from accidents. Suggests steps for local analysis of the problem of cycling accidents. (MOK)