Poverty can be a powerful predictor of a child’s mental health.

KIDS, POVERTY AND MENTAL HEALTH
A child who lives in poverty is three times more likely to have a mental health problem. Reporter Denise Davy investigates why this happens and what’s being done. Davy’s research was supported with a journalism fellowship from the Canadian Institutes of Health Research.
PART ONE - Why kids in poverty are at higher risk of developing mental health problems
PART TWO - How Hamilton schools are helping students in lower income neighbourhoods
PART THREE - Anxiety: Why so many children in poverty struggle with anxiety
PART FOUR - Children of war: Healing immigrant and refugee children
PART FIVE - Making Hamilton a better place to raise a child

Data released exclusively to CBC Hamilton shows that Hamilton children who live in low income neighbourhoods can be so impacted by poverty-related stressors early in their lives that it can affect their ability to learn in school.

The data shows the rate of impacts in various developmental areas can be as much as 10 times higher in the city’s low income neighbourhoods compared to it's most wealthy ones.

The data, when combined with a McMaster University study that shows children living in poverty suffer from more mental health problems, illustrates the often devastating impact poverty can have on a child’s mental health and well being.

“Living in poverty is incredibly stressful,” said Michele Bates, mental health lead for the Hamilton-Wentworth District School Board.

“What does that do to a child’s sense of safety and well-being on a very foundational level? I think it’s a tremendous stress and strain. The burden is tremendous.” 

The data comes from the Early Development Instrument (EDI), a school readiness measurement tool developed in Hamilton which has been used since 2002 to analyze information on more than 5,200 kindergarten students every few years. 

The EDI is now recognized internationally as the most effective tool for measuring the whole child and is used in schools across Canada and around the world. In Hamilton and around Canada it is used to help determine where key services need to be located.

The EDI measures a child’s abilities in such areas as social/emotional health, communication skills, general knowledge and language and cognitive development.

Dr. Jean Clinton, child and adolescent psychiatrist at the Offord Centre for Child Studies at McMaster University, said the EDI data "gives a reflection of what life has been like before arriving at school" and shows how children who live in poverty can pay a heavy price in stress loads. 

 WHAT IS THE EDI?

The Early Development Instrument (EDI) was the first tool designed to measure a child’s overall health development and readiness for school. The idea originated in 1997 with the late Dr. Fraser Mustard, who championed programs to support children in their early years. It was developed at the Offord Centre for Child Studies at McMaster University and was introduced in Hamilton schools in 2002.

The EDI is not meant to be an individual screening tool but rather a tool to measure the school readiness of children in various neighbourhoods.

EDI data is used as a planning tool by school boards, the city of Hamilton and the Offord Centre for Child Studies to determine where services are needed.

Because it is considered a legal document, CBC Hamilton had to receive special approval from all stakeholders for its use in this series. This is the first time it has been shared publicly. 

The impact of that can be felt long term, as seen in a study that compared EDI rates with EQAO results, which measure academic achievement. It showed some children who rated as vulnerable, or lagging in certain areas in kindergarten, were still not achieving well academically in grade four.

Clinton stresses, however, that poverty is not a destiny, that many low income children do not have that vulnerability.

High vulnerability in Beasley, North End, Keith neighbourhoods

For children who live in high poverty areas, vulnerabilities are especially high in physical health and language and cognitive development. In areas such as the North End, Beasley and Keith neighbourhoods, the vulnerability rate in some domains was over 50 per cent, compared to higher income neighbourhoods in areas like Flamborough where it was as low as five per cent.

Part of the stress comes from watching their parents struggle. 

“It can be overwhelming for parents,” said Clinton, who is also Clinical Professor in the Department of Psychiatry and Behavioural Neuroscience at McMaster University.

“When you’re worried about feeding the kids and paying the rent, you don’t have as much energy or time to be talking to your kids because you’ve got a fire to put out.”

The McMaster study also showed that the lower the family income, the more toxic the impact of poverty. The study by Drs. Ellen Lipman and Michael Boyle showed the worse the poverty, the greater a child’s risk of developing one or more psychiatric disorders, behavioural problems and developmental delays.

Boyle, Professor in the Department of Psychiatry and Behavioual Neuroscences at McMaster University says a key question still to be resolved is what is it about being in poverty that causes the higher rates?

“Poverty is strongly related to mental health outcomes,” said Dr. Boyle.

“The $64,000 question is to what extent does that have to do with material deprivation and a variety of phenomena and to what extent is it an extension of the families.” 

Dr. Karen Francis, Clinical Director of the Child and Youth Mental Health program at Hamilton Health Sciences at McMaster Children’s Hospital, said poverty places pressure-cooker demands on parents and can compromise their ability to parent, which is why kids who live in poverty have higher rates of conduct problems and oppositional and defiant behaviours.

“The bottom line is, the more you have on your plate, the more your ability to parent is diminished,” said Francis.

FIVE DOMAINS of the EDI: 

1. Physical Health and Well-Being - physical readiness for the school day, physical independence and gross and fine motor skills.

2. Social Knowledge and Competence - social competence, responsibility and respect, approaches to learning and readiness to explore new things.

3. Emotional Health and Maturity - prosocial and helping behaviour, anxious and fearful behaviour, aggressive behaviour and hyperactivity and inattention.

4. Language and Cognitive Development - basic and advanced literacy skills, interest in literacy/ numeracy and memory, and basic numeracy skills.

5. Communication Skills & General Knowledge - a child’s ability to communicate needs and ideas effectively and interest in the surrounding world.

EDI data has been an important planning tool used by school boards, the city of Hamilton and Hamilton’s Offord Centre for Child Studies and has played a critical part in determining where some mental health services are located.

David Hoy, manager of social work services at the Hamilton-Wentworth District School Board, said the data is important because accessing services is such a huge problem for families living in poverty. 

“If you don’t have a phone then it’s harder to access services,” said Hoy.

“Our social workers help them problem solve around that. They also look at how to access supports.”

Making access easier for low income families was a key reason why Hamilton Health Sciences relocated its mental health and pediatric services to a new $100-million children’s treatment centre next to the Hamilton General.

Francis said they recognized that people in the inner city and north Hamilton were having problems getting to the Mountain site. 

“We’re hoping that helps make it easier for lower income families to access,” said Francis. 

Problems accessing services

Cenza Cacciotti is a family support worker with Parents for Children’s Mental Health, a province-wide support and advocacy group, and has seen families beaten down by poverty and talked to parents who’ve felt totally demoralized because they were unable to help their child.

Clinton

Dr. Jean Clinton (Denise Davy)

Cacciotti said sometimes an access problem is as basic as not having enough bus money to get their child to an appointment or not having child care for their other kids.

“It can come down to the family having to decide whether to spend money on gas and parking or having milk in the fridge or bread in the cupboard,” said Cacciotti, adding that sometimes having a child with a mental illness can throw a family into poverty.

“It could be that the parent lost their job because of all the appointments or don’t have any money because of all the expenses.”

Experts are quick to point out that not all children are negatively impacted by poverty. Indeed, sometimes it’s not the poverty but a parent’s mental health problems that can create stress that’s picked up by a child, said Dr. Magdelana Janus, associate professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, who co-developed the EDI questionnaire.

That’s one of the reasons why Janus would like to see more early intervention programs and universal programs that are available to all families.

“There will never be enough child psychiatrists for every child who needs it but there are all kinds of problems that show up (in children) that could have been prevented with a little more resources, a little bit more accessibility to good quality child care or playground or play area,” said Janus.

Critical for Hamilton where 1 in 4 children live in poverty

EDI data is critical to a city like Hamilton where poverty rates are so high. One in four children lives in poverty in Hamilton, compared to the provincial rate of one in seven, and 60 per cent of single mothers with children under 12 live in poverty. The equivalent of 370 classrooms filled with children who use food banks every month.

Annette Hammond can speak first hand to the challenges of getting her children to their appointments. It’s a tiring ordeal for Hammond from her east end home to Chedoke where her son R.C. sees a specialist for his autism. 

Hammond takes a bus because she doesn’t have a car and is slowed by a back disability which requires her to to use a walker. Without the free bus fare she gets with disability pension, she says, “I wouldn’t be able to get there.” 

There are also appointments for her eight-year-old daughter, Shyenne, who is being diagnosed for a learning disability. During a photo shoot, Shyenne was in constant motion, leaping from chairs and running down the street.

“She’s like that all night,” said Hammond.

Hammond is also dealing with her own mental health problem. She has bipolar disorder and takes medication to stay on an even keel. Her common law partner John Stewart has a learning disability.

Dr. Fraser Mustard was among the first in Canada to recognize the complex link between children’s mental health and poverty. A co-founder of McMaster’s Medical School, Mustard spoke passionately about how a child’s environment can have a long-term impact on their ability to learn. Mustard died in 2011 at the age of 84.

One of the many students who followed in his footsteps was Dr. Clyde Hertzman, who founded the Human Early Learning Partnership (HELP) in Vancouver, B.C, and was internationally renowned for his work with EDI data.

Hertzman, who died last year, used the data to show the province it needed to establish a British Columbia-wide poverty plan. He also spoke about what he called “biological embedding,” the experience of poverty “getting under the skin” and altering the developmental processes to the extent that it impacted a child’s mental and physical health well into adulthood. 

BELOW ARE EDI MAPS FOR HAMILTON

Map 1: The map below shows results for percentages of children showing vulnerabilities in any one of the five EDI domains, by neighbourhood.

Hamilton Census Maps

MAP 2:  The map below shows results for percentages of children showing vulnerabilities in any one of the five EDI domains, this time broken down by census tract. The data in the grey areas is "shielded" because the numbers of children studied is so small individuals might be able to be identified. This shows how localized the data can be and how it can be used to help determine where services are needed.

Hamilton Census Maps

MAP 3: The map below shows results for percentages of children showing difficulties with emotional maturity, by neighbourhood.

Hamilton Census Maps

MAP 4: The map below shows results for percentages of children showing vulnerabilities with physical health and well-being by neighbourhood.

Hamilton Census Maps

Where to go for help:

Contact Hamilton - 905-570-8888

COAST (Crisis Outreach and Support Team) — 905-972-8338

Schizophrenia Society of Ontario (family support) — 905-777-9921

Alternatives for Youth (substance abuse issues) — 905-527-4469

Canadian Mental Health Association (Hamilton) — 905-521-0090