Child & Youth | Family Medicine | School of Medicine

Family doctor places stethoscope on child's ears

Impacts of COVID-19 on Preventive Primary Care for Young Children: Consequences and Innovations

Principal Investigators: Imaan Bayoumi (co-PI), Patricia Li (co-PI)

Co-Investigators: David Barber, Amber Simpson, Michael Green, Michelle Greiver, Karen Tu, Erin Strumpf, Marie-Therese Lussier, Simone Dahrouge, Kimberly Munro, Ellen Stephenson, Catherine Birken

The COVID-19 pandemic caused significant disruption to accessing health care for young children, including shifts to virtual care (by telephone or video), and long wait times for specialty care. Preventive care in young children involves regularly scheduled visits with primary care providers. These visits are important for early detection of, and intervention for, various health problems, including developmental delay, feeding problems, and abnormal growth trajectories, as well as addressing socioeconomic issues (e.g., food insecurity, injury prevention, etc.).

This project consists of two parts. The first aims to understand the impacts of the COVID-19 pandemic on preventive primary care for young children (0-5 years old). Using data from primary care electronic medical records from Ontario and Quebec, we will investigate changes in the pre-COVID era (March 14, 2015-March 13, 2020) and during COVID era (March 14, 2020-present) in preventive care visits, child outcomes, and inequalities in these utilization and outcome measures. We will work with knowledge users to apply our study findings to inform health system planning, with the goal of mitigating potentially detrimental lifelong outcomes of missed or deferred care for young children.

The second part of this project aims to discover innovative primary care programs or services that were implemented during the COVID-19 pandemic to help facilitate delivering and accessing primary care for young children. Primary care providers and administrators and parents or caregivers of young children in both Ontario and Quebec are being invited to complete a brief on-line survey. Follow-up interviews will be conducted with a subset of the survey respondents to gain more in-depth knowledge of what helped both primary care providers and parents/caregivers get young children the health care they needed during the pandemic.

Connecting Families: A research study to learn what works best to help families with financial needs

Principal Investigators: Imaan Bayoumi, Cornelia Borkhoff

Child poverty remains a prevalent problem in Canada, affecting about one in five Canadian children and many more families are living under financial strain. Many families struggle to make ends meet and may be experiencing high levels of stress. Low income and high family stress can impact children’s social, emotional and behavioural development.

Because of the strong links between income and health, many professional organizations are encouraging healthcare providers to identify and address poverty, but little evidence exists regarding effective interventions. Social systems are complex and frequently difficult to navigate; therefore, many families may not be accessing all financially related benefits to which they are entitled. Our study will use a randomized controlled trial to test the effect of having a Community Support Worker work with families of young children to identify unmet financially related social needs (like food, housing or energy insecurity) and help families navigate the social service system. The Community Support Worker will help families complete income tax, apply for benefits and community supports to which they are entitled. We will study the effect on child emotional and behavioural health, parental stress and depression and family income.

This research is funded by the Canadian Institutes for Health Research, SEAMO Innovation Fund, and Queen’s Health Sciences. The research team is led by Imaan Bayoumi and includes colleagues from the Hospital for Sick Children in Toronto.

Results from this research will fill a critical evidence gap regarding the impact of an income security intervention on important child and parent health outcomes and will establish the role of non-health care providers in linking health and social systems. Effective income security interventions and improved emotional and behavioural health in this age group have the potential to establish a foundation for improved mental health trajectories and greater academic success, which in turn can positively influence health over the life course.

To download a copy of the Connecting Families Information Poster, please click here.

Children in Care and their Polypharmacy Experiences (CAPE)

Principal Investigators: Imaan Bayoumi

Children living in out of home care have complex mental, behavioural, and psychosocial needs and have a significantly higher prevalence of emotional and behavioural problems compared to the general population. The lived experience of youth in care of managing mental health conditions with medications have not been described. Clear evidence regarding youth preferences and perspectives are needed to inform a collaborative and trauma informed relationship with health care providers and child welfare staff.

One way to integrate the lived experience of youth living in foster care is by the creation of digital stories. A digital story is a two-to-five-minute multi-media narrative that uses photos, video clips, art, and sound to share a personal life story. These digital stories are created through a participatory media workshop that encourages individual self-reflection and growth. Trained facilitators assist groups through oral storytelling, script writing, voice recording, story boarding, and video editing. By the end of the workshop, all participants have completed their own digital story.

Participants will be youth aged 15-21 years, living in FACSFLA care (in foster care or group home care) who are currently prescribed at least one psychotropic medication. We will use purposive, maximum variation sampling to enroll 10-15 consenting participants. In the digital story workshop, the opening story circle and closing circle will be audio recorded, researcher field notes will be taken throughout the workshops, and digital stories will be transcribed to allow for qualitative analyses.

Bridging in the Gap: Fostering Success for Youth in Care

Principal Investigators: Imaan Bayoumi (co-PI), Alana Butler (co-PI)

Co-Investigators: Lindsay Morcom, Susan Brooks, Charles Lane

At least 59,283 Canadian children aged 0 to 17 years are in out-of-home care and informal kinship services, of which 45% are youth aged 16-20 years. Research overwhelmingly shows that these youth are at-risk for poor academic achievement, substance abuse, poor mental and physical health, as well as early involvement with the criminal justice system, all with important implications throughout the life course.

Our multi-disciplinary, diverse research team will use of a youth participatory action research (YPAR) model to examine resilience and well-being among youth who are formerly or currently in out-of-home care. The YPAR approach is widely considered to be a high-risk, high-reward research method because YPAR research studies often involve vulnerable or at-risk youth. YPAR principles include commitment to open communication, shared decision making, and power sharing to embed equity throughout the process.

Using an equity-based approach, we will examine the relationship between health and educational achievement, and barriers and gaps in both systems. Our multidisciplinary team includes researchers and practitioners from medicine, education, child protection, and Indigenous community members with longstanding relationships to the academic researchers. We propose to include a cohort of youth aged 14-25 years currently or formerly in out-of-home care, foster parents, tutors, and staff. Qualitative data will be collected using a series of talking circles, an Indigenous, culturally appropriate data collection methodology, which will include foster youth, tutors, foster parents, and child welfare staff. An intersectional lens will be embedded to understand differences in experiences by youth identity including gender, race, ethnicity, sexuality, disability, and other intersecting identities.

The scholarly significance of the project is that we will follow a collaborative approach to ensure that the research findings are high reward in that they are meaningful and directly relevant to youth, foster parents, child welfare staff and leadership, community service providers, decision-makers, and researchers, and can inform more appropriately tailored and effective supports at a critical developmental stage for a vulnerable population.

Youth, anxiety, screen time and a whole lot more

Principal Investigator: Dr. Susan Phillips

Youth, anxiety, screen time and a whole lot more

Articles with titles like, "Have smartphones destroyed a generation?" (Atlantic 2017) tout the growing anxiety among youth and suggest that screen time is to blame. However, there is no evidence for this. I do have the sense that young patients are increasingly anxious and less able to cope. I have speculated as to whether parents trying to protect children from challenges are inadvertently diminishing their resilience. This has led to a series of linked studies, some ongoing, all with wonderful medical students and residents.

The first, a mixed methods assessment of youth and resilience, included interviews of 60 kids age 12-14, living in Kingston and northwestern Ontario, about stresses in their lives and how they managed these. I have never done such heartening research. The summary – the kids are alright. They had remarkable insight about their lives, stresses, and how to mitigate these. Whether by doing art, writing, team sports, or diversion, those with the most apparent life stressors often turned these into sources of strength.

A second study looked at social and emotional development among 4-6 year olds and found that although such development is central to future health, it is not really part of physicians' well child checks.

We are now assessing whether there has been any change in diagnoses of anxiety over the past 20 years. Preliminary results – the point prevalence of anxiety is higher among girls but has stayed relatively stable from the pre- to post-social media eras. There are some aberrations to this which we are still assessing.

Also ongoing is a study of whether adding some intervention to the well 4-6 year old check-up to address social and emotional development can be of benefit. We are doing the background work to develop an RCT to study this.

It might seem curious that all of this was precipitated by a previous study about healthy aging (IMIAS) that found that events across the life-course, and particularly in childhood, have an ongoing impact on health even among the elderly. And so, a study of aging became the springboard for a series of studies of childhood.

Some of the papers about this work include:

Phillips SP, Jiang M, Lakkadghatwala R, Wang, S. Assessing wellness in the well child check: what about social and emotional development? Can Fam Phys 2019, in press

Phillips SP, Swift SA, Reipas K, Zelek B. Adolescent Resilience Assessment in Person-centered Medical Care. International Journal of Person Centered Medicine 2016;6:289-97.

Phillips SP, King N, Michaelson V, Pickett W. Sex, drugs, risk and resilience. European J Publ Health 2018;0: doi:10.1093/eurpub/cky169.

Demetriou Y, Vondung C, Bucksch J, Schlund A, Schulze C, Knapp G, Coen SE, Puil L, Phillips SP, Reimers AK. Interventions on children’s and adolescents’ physical activity and sedentary behaviour: protocol for a systematic review from a sex/gender perspective. Systematic Reviews 2019; in press.

Gupta S, Bélanger E, Phillips SP. Low socioeconomic status but resilient: panacea or double trouble? John Henryism in the international IMIAS study of older adults. Journal of Cross-Cultural Gerontology 2018; 1-10: DOI 10.1007/s10823-018-9362-8

Lau Z, Guerra R, Barbosa JFS, Phillips SP. The impact of resilience on health in older adults: A cross-sectional analysis from the International Mobility in Aging Study (IMIAS). BMJ Open 2018; 8:e023779. doi:10.1136/ bmjopen-2018-023779.

Stewart JM, Auais M, Bélanger E, Phillips SP. Comparison of Self-Rated and Objective Successful Ageing in an International Cohort. Ageing and Society 2018;1-18 doi:10.1017/S0144686X17001489.

Phillips S, Auais M, Belanger E, Alvarado B, Zunzunegui MV. Early and current social and economic circumstances and resilience in older adults: findings from the longitudinal International Mobility in Aging Study (IMIAS). SSM Population Health 2016 http://dx.doi.org/10.1016/j.ssmph.2016.09.007.