Assessing trustworthiness: Marginalized youth and the central relational paradox in treatment

Trauma in Context: an Integrative Treatment Model

Evidenced based trauma treatments benefit children, but they rarely suffice for youth with multiple and complex comorbidities. After the completion of standard treatments, many children continue to show residual social, behavioral, and emotional difficulties. Part of the difficulty is that while the literature on trauma describes numerous facets that contribute to the severity, expression, and outcomes of trauma exposure, clinical assessments and interventions do not sufficiently reflect that literature. Clinicians thus have little guidance on how to integrate the intricacies of client's circumstances into a trauma-informed framework. To expand the scope and efficacy of treatments and guide clinicians in selecting appropriate interventions, this paper explores factors associated with pretreatment traumatic responses and proposes an integrative treatment model that includes the trauma experience, itself, combined with pre- and post-trauma factors that are both internal and external to the child and family. Pre-trauma experiences influence the severity of traumatic responses, while post-trauma factors impact a person's ability to cope and recover. Both are important targets for direct intervention.

Psychometric properties of a Recovery Empowerment Scale: Testing emotional, cognitive, behavioral, and relational domains

Psychological empowerment (PE) is a multidimensional construct comprised of emotional, cognitive, behavioral, and relational domains. Although context-specific measures of PE exist, no study to date has introduced and tested a measure of the construct that captures all four domains for both women and men in recovery from substance misuse. Furthermore, research has largely neglected the relational dimension, particularly in studies involving people in recovery. In this study, we tested a measure of PE among a diverse sample (n = 200) of people in recovery who participated in a program designed to expand access to medications for opioid use disorder in the northeastern United States. Factor analysis results supported the hypothesized four-factor structure of the scale, and dimensions of PE were found to be associated in expected ways with measures of quality of life, self-reported health, and depression. Implications of the study are described and directions for future research discussed.

On the move: exploring Inuit and non-Inuit health service providers' perspectives about youth, family and community participation in care in Nunavik

Background

Literature about participation in health and social services suggests that youth, and more specifically Indigenous youth, are difficult to engage within health and social services. Youth are less likely to access services or to actively participate in decision-making regarding their personal care. Service providers play a crucial role in engaging youth based on the ways in which they seek, establish, and maintain relationships with youth and their families. The way in which providers engage with youth will depend on various factors including their own perceptions of the roles and relationships of the various people involved in youth’s lives. In this article, we analyze health and social service providers’ perspectives, experiences and expectations regarding the roles of Indigenous youth, families and community in care settings in Nunavik, Quebec.

Methods

Using a snowball sampling approach, we recruited 58 interview participants (39 non-Inuit and 19 Inuit), including psychiatrists, general practitioners, nurses, social workers, school principals, teachers, student counsellors, representatives of local committees, and police officers. The interviews focused on three broad areas: 1) participants’ current and past positions and roles; 2) participants’ perceptions of the clientele they work with (youth and their families); and 3) participants’ understandings of how collaboration takes place within and between services and the community. We conducted inductive applied thematic analyses and then analyzed the interview transcripts of Inuit and non-Inuit participants separately to explore the similarities and differences in perceptions based on positionality.

Results

We organized the findings around three themes: I) the most commonly described interventions, II) different types of challenges to and within participation; and III) what successful participation can look like according to service providers. Participants identified the challenges that families face in moving towards services as well as the challenges that services providers face in moving towards youth and families, including personal, organizational and historical factors.

Conclusion

We adopt a critical lens to reflect on the key findings in order to tease out points of tension and paradoxes that might hinder the participation of youth and families, specifically in a social context of decolonization and self-governance of services.