The effect of the Roots of Empathy program on the use of psychotropic medications among youth in Manitoba by Lindsey Dahl A Thesis submitted to the Faculty of Graduate Studies of The University of Manitoba in partial fulfilment of the requirements of the degree of MASTER OF SCIENCE Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine University of Manitoba Winnipeg Copyright © 2017 by Lindsey Dahl Abstract Background: Psychotropic medications prescriptions to youth have increased. Roots of Empathy (ROE) is a social and emotional learning program that may influence the use of psychotropic medication. Methods: Administrative data was analyzed in a matched sample of children who received ROE during 2002/03 to 2012/13. Kaplan-Meier survival curves and Cox proportional hazard models were used to estimate the association between ROE and psychotropic medication dispensations. Results: Few significant differences were observed. Children who received ROE in kindergarten to grade 3 had a lower adjusted hazard for an anxiolytic dispensation. Children who received ROE in grade 7 to 8 had a higher hazard for an antipsychotic dispensation. Males who received the program had an increased hazard for an antipsychotic dispensation. Conclusion: There was no consistent differences in the likelihood of being dispensed a psychotropic medication between children who received ROE and children who did not in Manitoba. ii Acknowledgments I would like to first thank my thesis advisor Dr. Randy Fransoo of the Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine at the University of Manitoba. Right from our initial meeting, Dr. Fransoo’s energy and positivity was obvious. More importantly, he maintained those qualities throughout the entire process. I am grateful, not only for his expert guidance, but also his mentorship style that is best characterized as respectful and understanding. He also had my best interests in mind as well, encouraging me, and giving me the confidence to apply for awards and studentship. I would like to thank the members of my thesis committee: Dr. Mariette Chartier, and Dr. Nathan Nickel of the Department of Community Health Sciences at the University of Manitoba, and Dr. Bruce Tefft of the Department of Psychology at the University of Manitoba. Each of your contributions and perspectives truly helped shape and strengthen the final thesis. You have challenged me in ways that will only go on to improve the way I approach science from the initial idea to the way it is translated. I would also like to thank other members of the Manitoba Centre for Health Policy organization. Matt Dahl, Yao Nie, and Charles Burchill, who provided invaluable statistical programming support. Responses to requests and questions were always timely, which did not go unnoticed. I would also like to acknowledge Dan Chateau, who answered many questions related to statistics, and did so most often with a good dose of humor. I would like to thank Theresa Kennedy, the Community Health Sciences Graduate Program Coordinator, who made sure all forms were completed, and processes followed, to ensure smooth transitions through the various stages of the program. I would like to thank the Western Regional Training Centre and its’ coordinator Dr. Malcolm Doupe. This studentship introduced me to the field of health services research and provided financial support. I would also like to thank the family of Evelyn Shapiro for establishing the Evelyn Shapiro Award for Health Services Research, of which I was fortunate enough to receive in 2016. Finally, I would like to thank the PATHs research team at MCHP, which gave me an opportunity to witness a large research project in action and provided financial support through the graduate enhancement tri-council stipend. This thesis would have been a lot more difficult to complete without all this support! Thank you to Little Wheels Daycare and the amazing staff who provided a fun, loving environment for our two boys Nathan and Cameron. Just knowing they were in your hands made it easier for Dad to go off to school! Lastly, I must thank my incredible family! Deanna, without your love and support this could not have been possible. You know when to be tough, and when to take it easy on me, and never once made me feel pressured to just “hurry up and finish already!” For that I am extremely grateful. To my main man, Nathan, and my little mister extra special, Cameron. Thanks for being you!! Thanks for not really caring about what Dad does at school. While my thesis was important, you were a constant reminder of what truly is the best part of my day and life! iii Table of Contents Abstract ........................................................................................................................................... ii Table of Contents ........................................................................................................................... iv List of Tables ................................................................................................................................. vi List of Figures ............................................................................................................................... vii Introduction ..................................................................................................................................... 1 Chapter 1. Literature Review .......................................................................................................... 1 Social and Emotional Learning (SEL) ........................................................................................ 1 The “Roots of Empathy” Program .............................................................................................. 2 Description............................................................................................................................... 2 History ..................................................................................................................................... 4 Effectiveness ............................................................................................................................ 5 Mental Health/Mental Illness ...................................................................................................... 7 Definition ................................................................................................................................. 7 Epidemiology of Mental Illness Among Youth ...................................................................... 8 Mental Health Services .......................................................................................................... 10 Psychotropic Medications...................................................................................................... 12 Epidemiology of Psychotropic Medication Use Among Youth ............................................ 12 Study Rationale ......................................................................................................................... 17 Study Objective and Hypothesis ............................................................................................... 18 Chapter 2. Methods ....................................................................................................................... 19 Research Design ........................................................................................................................ 19 Data Sources .............................................................................................................................. 19 (1) Drug Program Information Network (DPIN) database (April 1st, 1995 – March 31, 2015) ........................................................................................................................... 20 (2) Enrollment, Marks, and Assessment database (April 1st, 1994 – March 31st, 2014).. 20 (3) Roots of Empathy program class lists (September 1st, 2002 – June 30th, 2013) ......... 20 (4) Manitoba Health Insurance Registry (April 1st, 1984 – March 31st, 2015) ................ 20 (5) Medical Services database (April 1st, 1988 – March 31st, 2014)................................ 21 (6) Hospital Abstracts (April 1st, 1988 – March 31st, 2014)............................................. 21 (7) Canada Census (2006) ................................................................................................ 21 (8) Social Allowances Management Income Network database (April 1st, 1995 – March 31st, 2014) ................................................................................................................... 22 iv (9) Child and Family Services: Applications and Intake (April 1st, 1992– March 31st, 2014) ........................................................................................................................... 22 (10) Fetal Alcohol Spectrum Disorder (April 1st, 1999 – March 31st, 2014) ..................... 22 Study Period .............................................................................................................................. 22 Study Sample............................................................................................................................. 23 Variables.................................................................................................................................... 24 Hard-Matching Variables .....................................................................................................