With the opioid crisis now decades old, and hundreds of young people dying of fentanyl overdoses each year, provincial governments across Canada are spending hundreds of millions of dollars on law enforcement, addictions treatment, awareness campaigns, and overdose countermeasures such as handing out naloxone kits at clinics and schools.
But for Angelique Jenney, an associate professor in UCalgary's Faculty of Social Work and the Woods Homes Research Chair in Children's Mental Health, there's a simpler, less reactionary, longer-term solution: treat the problem at its root before it balloons into something as tragic as a fentanyl overdose.
"We should be asking ourselves, 'what on Earth would drive someone to take a drug like fentanyl?'" says Jenney. "Fentanyl is a pain killer, but not all pain is physical. Many of these young people are trying to dull the pain of traumatic experiences. Preventing and intervening with childhood trauma is surely a better long-term investment than fentanyl task forces and all the work that goes into treatment after the fact."
Jenney says the hurdles to taking what seems like such an obvious approach are part lack of political will, part disconnect between research and clinical practice. "Unfortunately, people still think there's only one group who will ever need the child protection system," says Jenney. With only so many tax dollars to go around, more universal programs with broader appeal tend to get budget priority. Also, while governments want to fund evidence-based programs only after they've been proven to work, non-profit agencies rarely have the resources to do their own research.
As a result, says Jenney, the effectiveness of some programs is not always understood and conversely, a lot of clinical innovations never make it into the academic literature and therefore don't get adopted by others in the field.
Jenney describes her newly created research chair role as an attempt to address some of these discrepancies. "This position bridges that gap between research and practice, and brings the academic literature out to front-line practitioners so they can make use of it," says Jenney. "It also brings practice wisdom to the forefront so that we can begin to look at better ways to monitor and assess and research some of the innovative therapeutic interventions that we see in the field."
So what's the payoff? Jenney says that with closer ties between research and practice in the field, not only will those working directly with at-risk kids be able to validate what they're doing in their day-to-day work, but perspectives will start to change around the importance of funding this kind of research.
"Numerous studies have shown how investing in prevention and early intervention in addressing mental health saves governments millions," says Jenney. "Entrepreneurial thinking in social work is realizing that when you invest in a child now, you're saving hundreds of thousands a year in future social costs – think child protection and the justice system – down the road.
"Now imagine we could get people to see their tax dollars as a social investment in not having to pay for something else. That if all the kids in their neighbourhood are doing well, then they won't have to worry about children being bullied, being robbed on transit, property break-ins, or street kids, or fentanyl. Everyone benefits from healthy communities."
Prenatal mental health? There's an app for that
If the mental health of children is an indicator of problems later in life, then surely the mental health of their mothers plays a huge role. Dawn Kingston, an associate professor in UCalgary's Faculty of Nursing and the Lois Hole Hospital for Women Cross-Provincial Chair in Perinatal Mental Health, has spent years researching the effects on children of stress, depression and anxiety in pregnant mothers. "It's not just immediate birth problems," says Kingston. "There are connections with mental health and developmental problems into adulthood."
Eventually, Kingston realized that one of the major issues was a lack of screening for mental-health issues during pregnancy and afterward. "This is one of the most common complications of pregnancy," says Kingston. "We know that prenatally, mental-health issues are double what they are postpartum, and those are three times more prevalent than anything else we screen for. Yet we do not offer regular mental health care for pregnant or postpartum women."
In an effort to find out why, Kingston began researching the barriers to mental health care during pregnancy. She found a host of issues, from a fear of medication in mothers to a lack of mental-health expertise in front-line health-care providers to the limited resources of an underfunded, overburdened system. "That's when we started thinking about technology," says Kingston. "What if we could screen women for mental-health issues on a tablet while they were waiting for their obstetrical care appointments, and then deliver care electronically?"
The resulting four-year study, with about 1,800 participants, led to the development of HOPE, a smartphone app that helps pregnant women screen for and manage common mental-health issues. Personalized care and links to resources in their community are delivered electronically, and women have access to a live coach whenever they want. "This approach to screening and treatment is dropping anxiety and depression rates in pregnancy significantly," says Kingston. "And it prevents postpartum depression, too."
HOPE is scheduled to be released to select communities in the summer of 2018. Kingston says the goal is for HOPE to eventually be adopted system-wide in Alberta and beyond. If successfully piloted for pregnant women, Kingston adds, the app could lay the foundation for an electronic mental health-care system for other populations, too.
For Kingston, entrepreneurial thinking is a way to solve one of the most frustrating obstacles in mental health care. "It's about coming up with novel, sustainable, resource-friendly solutions to problems that are intractable," she says. "I'm tired of hearing there's no access, no services, no money. But that's the reality, so how do we deal with such an immovable problem?"
Seeing research through to delivery
Nicole Letourneau is no stranger to using research to develop programs that address gaps in the health-care system. Letourneau, a professor in the Faculty of Nursing and Cumming School of Medicine, and the Alberta Children’s Hospital Foundation Research Chair in Parent-Infant Mental Health, co-founded MOMS Link, a service that provides mental health services via telephone to mothers with postpartum depression, and ATTACH, a program that helps at-risk new mothers form secure attachments with their infant children.
For Letourneau, the research doesn't stop once the paper's published. "I've been doing research for a lot of years," she says. "And the old way of thinking was that when you finished a paper, you thought, 'okay, well maybe somebody will learn from this and deliver it somewhere,' and you moved on to the next project."
But after seeing several research breakthroughs go nowhere, Letourneau decided it was up to her to make sure that her discoveries actually ended up helping people. "The work I do should have an impact on patients and families," she says. "If it doesn't, then I feel like I'm not quite doing my job."
Letourneau says that while it's an adjustment for academics to think this way, they're the ones who ultimately are best suited to make sure their work fulfills its potential. "If we truly believe in what we're doing, that it will have an impact," she says, "then there's nobody better to take ownership of turning your program or service into a company that you can market."
Letourneau says the ultimate goal isn't profit, but making sure that valuable research work isn't wasted. "Maybe all researchers should be thinking this way a little more," she says. "But we're developing these programs, and testing them and finding them to be effective and publishing about them. We should be taking more of a hand in making sure they're known to the people who should know about them, and that they're being delivered where they should be delivered.
"To me, entrepreneurial thinking means taking your research to the next level, taking it to the people who could benefit from the work you're doing."
Catching the entrepreneurial bug
If more academics start developing their research into companies or programs, chances are pretty good they'll be talking to a lawyer at some point. "When a business starts up, a lawyer is almost always the first or second person who gets a call," says Bryce Tingle, who holds the N. Murray Edwards Chair in Business Law in UCalgary's Faculty of Law.
Tingle, who also runs the Business Venture Clinic, where law students get paired up with local businesses to provide them with free legal assistance, says lawyers are essential to new businesses. "A company is a nexus of different contracts," says Tingle. "Lawyers help assemble the pieces. They incorporate the company, they bring the intellectual property into the company, they draft employment agreements, they draft the documents that regulate various relationships."
Tingle says that teaching entrepreneurial thinking to law students is less about teaching them to innovate themselves and more about teaching them how to support such enterprises. "There's the founding idea, the flash of genius that leads to a new venture, and if anyone's been successful in teaching how to come up with that, I've never seen it," he says. "But then there's all the other intellectual capital that's necessary to get a venture up and running. That you can teach."
Once exposed to working with entrepreneurial ventures, Tingle says, law students often prefer to continue doing that kind of work rather than taking higher-paying routine law jobs. "A certain percentage of students will find that they just like startups better than the alternatives," says Tingle. "They catch the bug, if you will."
Part of what Tingle teaches his students is that they can make a viable career out of working with ventures getting off the ground. "It's socializing them into entrepreneurial thinking," he says. "It's fun, it's a realistic way to live your life, the monetary and non-monetary rewards are great, there's an enormous esprit de corps when it's you and a small team against the world. The pleasures of creating something out of nothing, of looking around at a Christmas party and seeing 60 or 70 families that didn't have work when you helped start this thing three years ago."
After all, says Tingle, the energy that typically surrounds a startup venture is infectious, and like attracts like. "I don't think making money is the most important or even the second-most important thing for most entrepreneurs. They're motivated by having found a solution that can help people. And our students are interested in helping people in the community."
Design as a force for social good
If entrepreneurial thinking in law is about navigating the rules and turning them to advantage, then in design it's about actively looking for ways to break them. "Entrepreneurial thinking is about making massive change to the status quo," says John Brown, dean of UCalgary's Faculty of Environmental Design. "Almost everything we do here is about making a disruptive change for social innovation. But for social good, not just for profit. We're always talking about how are we going to disrupt things."
Pointing to suburban traffic jams or the damage that occurred with Calgary's 2013 flood as examples, Brown says many of the world's environmental problems are the result of poor design in the past. But now students are taught to consider the impact of their design decisions, and to look for opportunities to do things better. "We recognize that the built environment, the natural environment, and a lot of our social context is, if not broken, seriously in peril," says Brown. "Our society can't continue to do things the same old way. It's just not sustainable, it's not resilient, and it's not socially equitable. We're integrating this into our teaching."
Brown says this approach makes design a lot more complicated, as students have to factor in legislation, political environment, environmental impacts, and social and cultural contexts as well as the more mundane aspects of design, such as construction practices, building codes and financing. "While we're teaching students to design and plan buildings and landscapes and urban environments, we're also integrating these other conversations into our classes," says Brown. "The idea that you need to explicitly incorporate all of these different components into a design solution."
Making things even more complicated is the rapidly changing nature of the industry itself, with digital design and fabrication becoming more and more common. Brown says that's leading to conversations about the way buildings are built and cities are organized. New fabrication methods are making "mass customization" feasible, where it's just as cost-effective to produce one-offs as it is to mass-produce the same thing over and over.
“This could mean that one day, everyone could have a custom house, not just the wealthy," says Brown. "Or an office building could have a façade that automatically changes depending on the temperature outside and the amount of daylighting required so that the building regulates itself to save energy. Or the building learns how you use it and adjusts power, light, and heat to the areas you'll be using. We’re exploring how to make these disruptive innovations happen within the realities of a large and complex construction industry.”
Part of the difficulty in adopting new methods, says Brown, is that buildings and landscape design and city planning are typically very expensive undertakings and the people who pay for them can be reluctant to take risks with such large investments. "It's a hugely difficult world to infiltrate," he says.
But that's where entrepreneurial thinking comes in. "We teach students to look at the world in new ways in order to identify needs and opportunities," says Brown. "And then to design changes that meet those needs in economically, socially, and environmentally responsible ways."
An entrepreneurial approach to health care policies
"In my mind, entrepreneurial thinking is the identification of an unmet need, and building a service to fill that need," says Fiona Clement, an assistant professor in the Cumming School of Medicine and director of the Health Technology Assessment Unit in UCalgary's O'Brien Institute for Public Health.
As an example, Clement points to her own position. The functions of her job virtually non-existent when she was appointed, Clement has shaped her unit to provide policy consultation on a wide variety of issues not just to the Alberta government, but other governments across Canada. Most recently, the unit helped the Alberta government formulate its policy on cannabis, ahead of the expected federal government's legalization of the drug next summer.
Clement's unit also helped the British Columbia Ministry of Health determine the best way to implement new stroke treatment technology, developed at UCalgary, so everyone in the province would have reasonable access to a facility that could provide the treatment in the event of a stroke.
"When the government or the health-care system is considering new technology or procedures, they come to us and say, 'What do you think? Should we invest in this? Is this good value for money?'" says Clement.
Clement says by being able to synthesize large amounts of research – or doing it themselves if it doesn't already exist – and having an impartial view of all the related issues, her unit is able to provide governments with the ability to make sound decisions and examine all sides of a topic before proceeding. "The common thread is that a policy needs to be made and the government or health care system wants to develop that policy based on the best evidence available," she says. "So we put forward the best-informed policies that we can for them to think about."
In addition to saving the system money, Clement says sometimes the result is simply providing recommendations for better service, such as the work her group did with the palliative care system in the province. "I learned a ton about how badly we're doing with palliative care," she says. "And when I think about how I'd want to spend my last days, it would not be filling out paperwork and telling my family's story over and over to a new caseworker who doesn't know our situation. It was a meaningful project for me in the sense that I was able to put forward recommendations on if we were to do this differently, what would that look like?"
Clement says the ability to influence policy decisions for the better is a driving force for her, and she tries to pass that motivation along to her students. "I try to teach my students that there's a lot more to academics than papers and grants, that you have to set out to make an impact in the world around you."
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ABOUT OUR EXPERTS
Dr. Angelique Jenney, PhD, is an associate professor and the Woods Homes Research Chair in Children's Mental Health in UCalgary's Faculty of Social Work. Angelique’s research and program development has been devoted to understanding and responding to the impact of interpersonal violence on children and families. See Angelique's publications on ResearchGate
Dr. Dawn Kingston, PhD, is an associate professor in UCalgary’s Faculty of Nursing, and the Lois Hole Hospital for Women Cross-Provincial Chair in Perinatal Mental Health. Dawn’s research focuses on improving perinatal mental health as one of the strongest, modifiable influences of child mental health and development. Read more about Dawn
Dr. Nicole Letourneau, PhD, is a professor and the Norlien/ACHF Chair in Parent-Infant Mental Health in the University of Calgary’s Faculty of Nursing. Her areas of research include parenting and child development in the context of teen motherhood, family violence, substance abuse, interventions for mothers, fathers, and infants exposed to postpartum depression, and origins of fetal programming of infant stress reactivity associated with exposure to maternal depression in utero. Read more about Nicole
Bryce C. Tingle holds the N. Murray Edwards Chair in Jurisdiction and Business Law with the University of Calgary’s Faculty of Law. He is a member of the founding teams for several companies active in the technology, energy and financial industries. He also advises several private and public companies. Read more about Bryce
Dr. John Brown, PhD, is dean and a professor of architecture with the University of Calgary’s Faculty of Environmental Design. His research interests include housing, aging-in-place, and architectural entrepreneurship. Read more about John
Dr. Fiona Clement, PhD, is an assistant professor in UCalgary's Cumming School of Medicine and the director of the O'Brien Institute for Public Health's Health Technology Assessment Unit. Her research interests include drug and non-drug technology reimbursement and cost containment policy, evidence in decision-making, and evidence in health policy development. Read more about Fiona