Physical Activity in Early Childhood: Centre Hospitalier Universitaire Sainte-Justine, Centre of Excellence for Early Childhood Development (2010)

"I think this is a wonderful website that provides lots of information in a really clear, concise way that is easy to incorporate in programming I do with parents and children. It gets the key messages across and breaks it down in a way that is easy to understand and makes sense. I appreciate using these resources or recommending that parents check out the website as well when they have questions regarding the latest information on early childhood development. Great job!"

-Website user 

Since its inception in 2001, the Centre of Excellence for Early Childhood Development (CEECD) has worked relentlessly to pursue its mission of providing parents, practitioners, service planners and policy makers with the most relevant, high quality, scientifically-based information on early childhood development. In a little over a decade, the CEECD has published in its online Encyclopedia on Early Childhood Development close to 400 papers on 47 different topics, while always insuring that the information was available in various formats and literacy levels to meet the needs of a variety of readers.  

With its priority to address topics that are relevant to its readers and to organizations that support its work, the CEECD was enthusiastic when The Lawson Foundation proposed and agreed to financially support the development of a new entry in the Encyclopedia focusing on physical activity in young children (0-5 years).

While there are increasing concerns over the rising prevalence of overweight, obesity and lack of physical activity among adults, adolescents and school children in Canada, there is a real dearth of knowledge concerning preschool children. In response to this worrying situation, and to provide the best scientific information, CEECD gathered and synthesized the latest international research on physical activity to inform and better equip parents, practitioners, service planners and policy makers with the most up-to-date information available.

With the support of The Lawson Foundation and a grant of $41,000, the CEECD was able to develop a high quality entry on physical activity in young children, release related resources and disseminate them to a variety of audiences.

Over a twelve-month period, using a thorough and rigorous process to identify the best international experts in the field, the CEECD published in its Encyclopedia six original papers on physical activity —all short syntheses of the most recent research— covering the most important aspects of the topic using a life-cycle approach to capture both the development and service perspectives. From these six experts’ papers, a three-page journalistic synthesis was written, answering three fundamental questions: How important is physical activity for young children? What do we know about it? And what can be done in term of services and policies to enhance and promote physical activity in young children? A bulletin and two leaflets, one for parents and practitioners and one for Aboriginal communities, were also developed, published and widely disseminated during the course of the project.

The process used to gather the best scientific information allowed us to capture the actual scientific consensus (importance, effects and guidelines) and to identify additional research activities that still need to be done in this area.

This project has had many positive outcomes for CEECD. Since the launch of this topic, readers have been providing very positive feedback and have already asked for numerous printed copies of the resources. Requests have come from child care and early years centres, schools and school health networks, family resources programs, Regional Health Units, pediatricians, federal and provincial governments, midwives associations, Band Councils from many provinces and Aboriginal centres and associations.

Material gathered throughout this project has also offered the CEECD new opportunities to share its knowledge with groups of experts who are providing recommendations and guidance on public policies related to screen time for young children.

This project has helped to raise awareness and respond to a need for reliable information on the topic of physical activity in early childhood. CEECD believes that parents and those working closely with young children should have access to relevant and high quality information and we will continue to promote and share this knowledge with those who need it most.

Why Weight: BC Children's Hospital Foundation (2008-2009)

“There’s so much info in this book- I love each and every section as it takes an individual’s overall health into consideration with wonderful educational and inspiring information”

-Recipient of the Healthy Living Toolkit for Professionals

Fifteen percent of British Columbia’s (BC) youth suffer from psychiatric disorders, and many of these youth will be treated with second-generation (atypical) antipsychotics (SGAs). Over the past few years, prescription of SGAs to youth has increased substantially. In British Columbia between 1996 and 2010, a 4.5-fold increase in SGA prescriptions was observed for boys aged 13 to 18 years, accompanied by a similar 3.5-fold increase for females aged 13 to 18 years. Serious adverse metabolic side effects, including weight gain, diabetes, hyperlipidemia, hypertension and metabolic syndrome have been reported in adults taking SGA medications. In recent reports, these metabolic effects have also been found in adolescents, with some studies suggesting that adolescents may be at a higher risk than adults for developing SGA-related metabolic side effects. These findings highlight the need for education, guidelines and tools for health care providers prescribing SGAs, and educational resources for youth taking SGAs. 

The Why Weight research team worked collaboratively with mental health professionals and other community-based partners across BC, as well as with youth with mental health conditions and their parents/guardians/caregivers, to evaluate the metabolic risks of SGA medications and develop guidelines, tools, and educational resources to mitigate the potential metabolic impacts associated with SGA use among children and youth. The research team implemented an innovative, community-based participatory research methodology among community mental health teams throughout BC as part of a naturalistic prospective study. This research informed the development of tools and resources that promote awareness about the potential risks associated with SGA use in youth, provide standardized clinical assessment, monitoring and management guidelines, and link to healthy living resources that reflect the unique needs of youth with mental health conditions.

A number of relevant and evidence-based tools, resources and guidelines have been developed for health care providers and educational resources for youth and their families. Members of the research team co-led the development of the first Canadian clinical practice guidelines for metabolic monitoring (i.e. the CAMESA guidelines), and developed the Metabolic Assessment, Screening & Monitoring Tool. In addition, resources were created to provide health professionals and youth taking SGA medications with strategies to prevent and mitigate SGA-related metabolic side effects. For example, the Healthy Living, Healthy Minds Toolkits for health professionals and families provide healthy living (e.g.,healthy eating, physical activity) resources for children and youth taking SGA medications, and have been disseminated across the province to health professionals and families.

Through partnerships with BC’s Child & Youth Mental Health Teams, family advocacy groups (e.g., F.O.R.C.E. Society for Kids’ Mental Health), Child Health BC, and the Provincial Health Services Authority, health professionals and families will have ongoing access to the screening protocols, assessment tools, and educational resources both online and in print. For example, the CAMESA clinical practice guidelines, Metabolic Assessment, Screening and Monitoring Tool (MMT), and Healthy Living Toolkits are available on a provincial child and youth mental health website, the Kelty Mental Health Resource Centre website. The project will also be sustained and further expanded through integration of the MMT into a provincial database that will have the capacity to collect data on youth taking SGA medications in BC. Furthermore, the CAMESA guidelines and MMT are integral components of an Online Metabolic Monitoring Training Module for health professionals, currently being developed by our team.

The Parenting Initiative: Invest in Kids (2003-2009)

Preparing parents for what they see as their most important role – raising a child

The healthy development of young children has been at the heart of The Lawson Foundation’s grantmaking for 20 years, bridging two generations of family leadership. Parenting has been of particular interest, propelled by the alarming findings of Canada’s National Longitudinal Survey of Children and Youth, which showed that nearly 30% of infants and young children have a cognitive and/or behavioural problem,[i] often related to a lack of high quality parenting. [ii]

The Foundation began a broad, thoughtful and informative review of opportunities to support early child development. Over this period, the Foundation funded Invest in Kids, a Canadian charity dedicated to improving outcomes for all children by supporting their parents, to investigate research questions to inform the review, including: What are the important early issues from fetus to age five?; What is known about key moments when an intervention will have a lasting impact on the kind of parents people become?; What parenting education opportunities are available in Canada for first-time parents?

Invest in Kids also conducted its own National Survey of Parents of Young Children. The survey results showed parents, regardless of income or education, evidenced low knowledge about child development, felt acutely unprepared for parenting and too many lacked positive parenting behaviour.[iii]

These findings provided the impetus to embark on the Parenting Initiative, an Invest in Kids project, funded by The Lawson Foundation, to create and test a new community-based parent education program.

The purpose of this initiative was bold: to transform the way Canada prepares and educates parents to attain the knowledge, confidence and skills they need for their most important role – raising a child. The objectives of the Parenting Initiative were to:

• Increase parents’ knowledge, confidence and skills in parenting and child development.
• Promote sensitive, responsive and warm parent/child and parent/parent relationships.
• Foster parents’ sense of support for their role.

The Parenting Initiative was an evaluation-driven project of three phases:

Phase I – exploration and discovery. Invest in Kids conducted an environmental scan of parent education programs and organizations, key informant interviews of leading parent educators, and focus groups of expectant/new parents and seasoned parent educators and completed literature reviews on parenting and parent education. Based on the results, The Parenting Partnership program model was created.

The Parenting Partnership is a comprehensive prenatal and parent education program to prepare and educate couples expecting their first baby. The program uniquely blends 73 online and 20 classroom sessions, beginning prenatally and lasting until the child’s 14^th month of life. Each group of five to 10 couples is led by a trained two-person Parent Educator team with substantial experience in prenatal/parent education and counseling.

This program is committed to engaging both mothers and fathers as a parenting team. The emphases are on preparing parents for coping with their pregnancy and childbirth, increasing parents’ knowledge, confidence and parenting skills, building the couple relationship and ability to “parent as a team” and to feel supported in their parenting role. Program content is timed to the baby’s development and the family’s changing needs. Topics cover the gamut from pregnancy, labour, delivery and recovery to shifted priorities in the couple relationship, finances and self-care; caring for the physical health of their child including health, safety and nutrition; and guiding behaviour and supporting children’s healthy social, emotional and intellectual development through positive parenting. 

Phase II – process evaluation. Multiple research methods were employed over three pretests to create, and then to iteratively refine and optimize the program to the needs of parents, parent educators and communities. Through this phase, Invest in Kids affirmed The Parenting Partnership is a program that parents and parent educators find beneficial and that can be delivered with fidelity to the model across a range of sites.

“The topics addressed in the sessions spark great discussions between Wayne and me after the class ends, and it's great to feel that we're in this together as a couple and as well as part of a group of people going through the same thing.”

-Parent who completed the program

“When I first signed up to do this I had no idea what a wonderful experience this would be – not just for the parents, but for myself as well. I have taught many parenting groups over the years, but this one is unique.

-Parent educator

Phase III – dissemination. In September 2012, Invest in Kids transferred the ownership of The Parenting Partnership to The Phoenix Centre for Children and Families to continue the roll out of the curriculum. Working to meet the overall goal to transform the way Canada prepares and educates parents, the Phoenix Centre continues to reach communities across Canada and beyond through the website www.welcometoparenting.com. An impact evaluation is next, to examine the effectiveness of the program on parents who have completed the program.

The Lawson Foundation is proud to have supported this transformative work, with the hope that, over the long term, the curriculum created by the Parenting Initiative will evolve in a variety of forms to positively influence how parents fulfill their most important role – raising a child.

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[i] J. Douglas Willms (ed), Vulnerable Children: Findings from Canada’s National Longitudinal Survey of Children and Youth, The University of Alberta Press and Human Resources Development Canada, 2002, p. 54, J. Douglas Willms, Ch. 3, “The Prevalence of Vulnerable Children”.  The percentages for the various age groups are 27.76% of infants, 26.06% of babies, 30.98% of toddlers and 29.54% of preschoolers.  These problems include social, emotional, language and intellectual problems, but exclude physical or mental handicaps, learning disabilities or health problems.

[ii] Ibid., p. 165. Ruth K. Chao & J. Douglas Willms, Ch. 8, “The Effects of Parenting Practices on Children’s Outcomes”

[iii] Lynn Oldershaw, A National Survey of Parents of Young Children, Invest in Kids: 2002.  Ch. 3, “What Parents Don’t Know”, pp. 33 – 50; Ch. 4, “Parents’ Confidence in their Knowledge,” pp. 51 – 53

Physical Activity & Exercise Toolkit: Acadia University, Diabetes Care Program of Nova Scotia and Canadian Diabetes Association (2008-2012)

SWEET TALK: Mount Sinai Hospital (2006-2007)

“Whenever I [am] in a situation… it always pops up in the back of my head reminding me, ‘This is what I should do… I can have a positive or negative outcome…What do I want it to be?’”  

“Since SWEET Talk, [I’ve] found [I’ve been] more assertive and [have] advocated for myself about my diabetes needs”                                                                

“I think the thought record has helped me not only for my diabetes but in other areas, interactions with people, other situations.”                    

-SWEET Talk Participants

Adolescents and emerging adults have an increased challenge of balancing the daily demands of diabetes with confounding developmental tasks, often resulting in a period of poor glycemic control with increased vulnerability to diabetes complications and/or psychosocial issues. It is also a time when many young people with diabetes are moving away from home for higher education, gaining independence from family, may have difficulty attending regularly scheduled appointments with their diabetes team, and have very hectic schedules.  Adolescence is consistently reported as the period of worst glycemic control (Frank, 2000).  A single percent increase in A1C levels results in a 45% increased risk of microvascular complications (DCCT, 1993).  Early intervention and aggressive glycemic treatment have long-term benefits, such as a 57% reduction in cardiovascular disease (EDIC, 2005).

Existing research suggests that diabetes self-efficacy, self-care and glycemic control can be enhanced with cognitive-behavioural strategies such as coping skills training. Therefore, we designed a program geared for young adults with type 1 diabetes to learn to use these techniques using a combination of face-to-face sessions and online web-based discussions which would allow for more flexible session planning. 

A facilitator manual, participant manual, a SWEET Talk Situation Analysis Record geared to the needs of this population as well as a series of trigger videos which demonstrate behaviours and trigger discussion were produced and used in the study. The program focused on the different ways of behaving/communicating, problem solving, making an assertive request as well as the link between thoughts, feelings, and ultimately one’s behaviour and diabetes self-care.

Additional video vignettes focusing on important day-to-day issues of young adults living with type 1 diabetes were produced after completion of the study for use with the program in the future.

While there were no statistically significant changes in diabetes quality of life and A1C, likely due to the small sample size, but some trends to using better ways of coping and self-efficacy were observed. Regarding program acceptability, participants were highly satisfied with the program, would recommend it to others and valued the peer support aspect of the program.

A post program focus group done a year after completion illustrated the impact and durability of participation in the program. Participants were still using tools and skills learned to make assertive requests and challenge their automatic thoughts.

The SWEET Talk program is targeted for any older teen or young adult with type 1 diabetes between the ages of 17-25 years who is having difficulty achieving good glycemic control, difficulty coping, or interested in learning skills to enhance life with diabetes.

In June 2011, a two-day SWEET Talk train the trainer facilitator workshop was attended by 20 diabetes health care professionals working in pediatric and adult care. Another facilitator workshop is being planned for the fall of 2012.

The diabetes education team has incorporated the coping skills training techniques into their daily counseling of people of all ages with both type 1 and type 2 diabetes who face similar social and self-care behavioural challenges. Our team and patients thank The Lawson Foundation for their incredible support!