|Home | About | Journals | Submit | Contact Us | Français|
When the Canadian Paediatric Society (CPS)’s Mental Health Committee was formed in 1971, it quickly established links with the Canadian Psychiatric Association, the Canadian Academy of Child Psychiatry and the corresponding committee of the American Academy of Pediatrics. Early statements included those on child abuse and the management of hyperactivity.
I was invited to join in 1985 to replace a neurologist. Many who have served on organizational committees will sympathize with my recollection that for some years I could not grasp either the objectives or the modus operandi of the committee, which met only twice a year. Clearly, most of the work was done behind the scenes. At meetings, members would vent their experiences and their frustrations. Some would perseverate around child abuse, others on hyperactivity, another on the psychoanalytic approach to paediatrics. I found it hard to understand what the CPS meant by ‘mental health’.
In 1989 I was elected chair, still feeling something of a neophyte. Fortunately there were a number of projects under way, including an excellent series of papers designed to inform the legal profession of the developmental issues surrounding the child as a witness. It was also time for an update of the statement on drug treatment of attention deficit disorder. Coauthoring the statement with Dr Helena Ho, I now found the discussions at the committee meetings to be extremely helpful. Members put forth conflicting views, and expressed the experiences and needs of the community as well as the academic paediatrician.
As a developmental paediatrician, I was concerned that my subspecialty be recognized and become a vocal agent for change towards the ‘new morbidity’ that was beginning to dominate everyday office paediatrics. Since 1981, I had been working with Drs Bob Shea, Peter Rosenbaum, Bob Armstrong and Katerina Haka-Ikse (a long-standing member and former chair of the Mental Health Committee) to establish a Developmental Paediatrics Section of the CPS. To do this, we steered the agenda of the mental health committee towards the topics that are subspecialty priorities and involved trained developmentalists in committee business.
Of course, what the board asked of us took precedence, but the requirements tended to be few. One was a draft response to the Royal Commission on New Reproductive Technologies, involving a review of current trends and outcome studies in adoption. We also prepared a paper on the effects of television viewing on child behaviour. Even more controversy ensued when the board requested a review of the current issues and evidence about corporal punishment. The committee has consistently promoted better disciplinary practices while refusing to limit the rights of parents to exercise reasonable restraint upon their offspring.
Developmental paediatricians are trained in social paediatrics and systems theory. Discussions about child abuse moved from exploring the parental psyche and searching for early detection to considering the socioeconomic system in which abuse occurs, and recognizing the need for an ecological or environmental approach to paediatrics. Poverty became the area of focus, culminating in the 1992 9th Canadian Ross Conference called Health Care Needs of the Disadvantaged Child (1). Other action areas, reflecting subspecialty priorities as well as major personal concerns, were the varied practice and knowledge base of community paediatricians in providing anticipatory guidance and in assessing school readiness. The committee was able to persuade the board to hold Heinz seminars on these topics.
I had never been sure what ‘mental health’ entailed, so I was delighted when the name of the committee changed to the Psychosocial Committee in the early 1990s. In 1987 the Developmental Paediatrics Section was established, and from the beginning it enjoyed close links with the committee. When I stepped down in 1994, Dr William Mahoney took over, another newcomer who brought a disciplined developmental paediatric approach.
The relevance of psychosocial issues to children’s health and to their attainment of developmental goals has been increasingly recognized by both paediatricians and the CPS in recent years. As in other subspecialties of paediatrics, the current level of evidence forms the backbone of our discussions. We also commit ourselves to evaluating the impact of our activities. So, for instance, in 1996 we held a one-day session on the progress the organization had made regarding the approach to the disadvantaged child, further to the 1992 Ross Conference.
While insisting on evaluating current literature has prolonged the process of producing documents, it has greatly improved the quality of the guidelines and practice points. The CPS has also changed its approach to promoting the work of its committees. “Effective Discipline for children” (2) was developed under the leadership of Dr Peter Nieman, with a supporting commentary (3) and parent handout (3). The impact of developing recognition for the CPS as an important voice for children has exceeded expectations. It also helped committee members develop their public relations skills.
Many former members of the committee have continued their activities by contributing to documents associated with their expertise or interests. Drs Margaret Cox, Katerina Haka-Ikse, Mervyn Fox and Marcellina Mian have been particularly helpful. Although the current and past chairs are developmental paediatricians, this is certainly not a requirement for the committee to function. The perspective of community-based general paediatricians is a major and central factor in setting our objectives and in our discussions. The link to developmental paediatrics is also a priority. For this reason, the president of the Developmental Paediatrics Section is also a member of the committee. This has fostered collaborative activities and will continue to do so.
It is clear that the demands for comment and contribution by this committee will only increase. Constant renewal of an energetic membership will allow us to develop the range of comment needed to continue to improve the health of Canadian children.