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Klymkiw DF, Day DM, Henderson JL, Hawke LD. What do justice-involved youth want from integrated youth services? A conjoint analysis. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2024; 33:18-32. [PMID: 38449724 PMCID: PMC10914151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/09/2023] [Indexed: 03/08/2024]
Abstract
Background Many youth in the criminal justice system are affected by mental health and/or substance use (MHS) challenges, yet only a minority receive treatment. One way to increase access to MHS care is integrated youth services (IYS), a community-based model of service delivery where youth can access evidence-based treatment for their MHS problems and other wellbeing needs, in one location. However, it is unknown what IYS services justice-involved youth prioritize. Objective This study explored what components of IYS justice-involved youth deem to be the most important in meeting their MHS service needs, in comparison with non-justice-involved youth, by conducting a secondary analysis of data gathered from a larger Ontario-wide study. Method Using a conjoint analysis, n = 55 justice-involved youth, and n = 188 non-justice-involved youth, completed thirteen choice tasks representing different combinations of IYS. Results Both justice-involved and non-justice-involved youth exhibited preferences for a broad range of core health services, including mental health services, substance misuse counseling, medication management, and physical or sexual health services. They also preferred a broad range of additional support services, in addition to fast access to care in a community setting that specializes in mental health services, with the incorporation of e-health services. Justice-involved youth prioritized working with a trained peer support worker to learn life skills and help them with the services they need. The importance of youth playing a leadership role in making decisions within IYS organizations was also a distinguishing preference among justice-involved youth. Conclusions Tailoring IYS to meet the service preferences of justice-involved youth may enhance service utilization, potentially leading to better outcomes for justice-involved youth and their communities.
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Affiliation(s)
- Deanna F Klymkiw
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario
| | - David M Day
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario
| | - J L Henderson
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Lisa D Hawke
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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2
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Henderson JL, Chiodo D, Varatharasan N, Andari S, Luce J, Wolfe J. Youth Wellness Hubs Ontario: Development and initial implementation of integrated youth services in Ontario, Canada. Early Interv Psychiatry 2023; 17:107-114. [PMID: 35748798 PMCID: PMC10084342 DOI: 10.1111/eip.13315] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/12/2022] [Accepted: 05/29/2022] [Indexed: 01/21/2023]
Abstract
AIM The need for youth-friendly early intervention services to meet the mental health, substance use, primary care, and other social needs of adolescents and young adults is well-documented. This article describes Youth Wellness Hubs Ontario, a province-wide initiative in Ontario, Canada to build and implement a one-stop-shop model of integrated youth services. METHODS We describe the development of Youth Wellness Hubs Ontario, in the context of global youth mental health system transformation, as well as pan-Canadian youth mental health system change. We also describe Youth Wellness Hubs Ontario's values and services. RESULTS The demonstration phase of Youth Wellness Hubs Ontario was initiated in 2017-2018. Youth Wellness Hubs Ontario is co-created with youth for youth aged 12-25 years old across diverse community contexts. Youth Wellness Hubs Ontario centres engagement and equity, and offers developmentally-appropriate services in an integrated, community-based walk-in format. As an initiative committed to continuous learning and quality improvement, Youth Wellness Hubs Ontario offers evidence-based and evidence-generating services, and measurement-based care. Youth Wellness Hubs Ontario is supported by backbone resources with expertise in implementation science, health equity, Indigenous practices, youth and family engagement, evaluation, and knowledge translation. In 2020 Youth Wellness Hubs Ontario secured sustainable funding for the first 10 locations and scale-up began in 2021, with 10 additional locations in development. CONCLUSIONS Youth Wellness Hubs Ontario demonstrates the feasibility of integrated mental health and substance use early intervention services, offered in the context of a broad range of health and social services.
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Affiliation(s)
- Joanna Lyn Henderson
- Youth Wellness Hubs Ontario, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Debbie Chiodo
- Youth Wellness Hubs Ontario, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Faculty of Education, Western University, London, Ontario, Canada
| | - Nirupa Varatharasan
- Youth Wellness Hubs Ontario, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Swelen Andari
- Youth Wellness Hubs Ontario, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Janine Luce
- Youth Wellness Hubs Ontario, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Janis Wolfe
- Youth Wellness Hubs Ontario, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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3
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Impact Potpourri: A Multimethod Survey Study on Youth Substance Use During COVID-19. CANADIAN JOURNAL OF ADDICTION 2022; 13:46-55. [PMID: 36452036 PMCID: PMC9677386 DOI: 10.1097/cxa.0000000000000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Given the important implications of youth substance use, it is essential to document and describe changes in substance use during the coronavirus disease 2019 pandemic. METHODS This multimethod survey study examines the impacts of the coronavirus disease 2019 pandemic on youth substance use among 149 Canadian youth who were using substances at a mid-pandemic period. Participants were 21.9 years of age on average (SD=2.2), including 99 girls/young women, 42 boys/young men, and 8 transgender or nonbinary individuals. The majority were Caucasian and born in Canada. Qualitative and quantitative findings are reported, with thematic analysis combined with descriptive and inferential statistical analyses. RESULTS Qualitatively, many youth reported increases or shifts in their substance use over the course of the pandemic. Youth reported using substances with limited numbers of peers, with family, or alone. Many reported using substances out of boredom and to cope. While legal substances remained highly accessible, illegal substances were reported to be more difficult to acquire and less trustworthy. Spending had increased. Quantitative findings suggested alcohol use has decreased, but other substance use has remained stable in the sample as a whole, although for each substance, some youth reported increases. DISCUSSION Despite minimal quantitative change, qualitative findings show that some youth increased their use of some substances during the pandemic, decreased others, changed their motivation to use, and decreased in safety behaviors. Youth-serving organizations should be aware of individual differences, the changing context of substance use, and the potential long-term impacts.
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Zhu N, Hawke LD, Henderson J. Substance Use Problem Trajectories in Canadian Adolescents: A Longitudinal Study. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2022; 31:176-188. [PMID: 36425020 PMCID: PMC9661905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 07/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Adolescents experience rapid changes and are more vulnerable for developing substance use problems than other age groups. Many studies have focused on the trajectories of adolescent substance use frequencies, rather than symptoms. OBJECTIVE The present study examined the trajectory of substance use disorder symptoms, particularly beginning in early adolescence and within a Canadian context. METHODS Data were drawn from a Canadian longitudinal project, in which a province-wide survey was administered to students across three biennial waves starting in grades 7-8. The final sample was comprised of 765 adolescents (baseline M age = 12.73, SD = 0.67, 49.7% female, 57.6% White). Latent class analysis was conducted to identify substance use disorder symptom classes based on participants' responses on a substance use disorder screener across the three waves. Group differences tests were also computed to examine if the substance use classes differed in participants' demographics. RESULTS Four classes were identified, labelled as low stable (n = 538, 70.3%), deteriorating (n = 169, 22.1%), recovered (n = 12, 1.6%), and high-risk relapse (n = 46, 6.0%) substance use. Among the demographic variables, non-White ethnicity, both parents being born outside of Canada, and parents' completion of post-secondary education were significantly associated with a less severe substance use class. CONCLUSIONS Results fill a gap in the evidence on the trajectory of symptoms of substance use disorder among adolescents, using a Canadian sample, an area of limited study. Results highlight an at-risk group (i.e., high-risk relapse class) that warrants further tailored prevention and intervention efforts.
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Affiliation(s)
- Na Zhu
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Lisa D Hawke
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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5
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Sheikhan NY, Hawke LD, Ma C, Courtney D, Szatmari P, Cleverley K, Voineskos A, Cheung A, Henderson J. A Longitudinal Cohort Study of Youth Mental Health and Substance use Before and During the COVID-19 Pandemic in Ontario, Canada: An Exploratory Analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:841-853. [PMID: 35635281 PMCID: PMC9157274 DOI: 10.1177/07067437221097906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Youth mental health appears to have been negatively impacted by the COVID-19 pandemic. The impact on substance use is less clear, as is the impact on subgroups of youth, including those with pre-existing mental health or substance use challenges. OBJECTIVE This hypothesis-generating study examines the longitudinal evolution of youth mental health and substance use from before the COVID-19 pandemic to over one year into the pandemic among youth with pre-existing mental health or substance use challenges. METHOD A total of 168 youth aged 14-24 participated. Participants provided sociodemographic data, as well as internalizing disorder, externalizing disorder, and substance use data prior to the pandemic's onset, then every two months between April 2020-2021. Linear mixed models and Generalized Estimating Equations were used to analyze the effect of time on mental health and substance use. Exploratory analyses were conducted to examine interactions with sociodemographic and clinical characteristics. RESULTS There was no change in internalizing or externalizing disorder scores from prior to the pandemic to any point throughout the first year of the pandemic. Substance use scores during the pandemic declined compared to pre-pandemic scores. Exploratory analyses suggest that students appear to have experienced more mental health repercussions than non-students; other sociodemographic and clinical characteristics did not appear to be associated with mental health or substance use trajectories. CONCLUSIONS While mental health remained stable and substance use declined from before the COVID-19 pandemic to during the pandemic among youth with pre-existing mental health challenges, some youth experienced greater challenges than others. Longitudinal monitoring among various population subgroups is crucial to identifying higher risk populations. This information is needed to provide empirical evidence to inform future research directions.
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Affiliation(s)
- Natasha Y Sheikhan
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, 274071University of Toronto, Ontario, Canada
| | - Lisa D Hawke
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Clement Ma
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, 274071University of Toronto, Ontario, Canada
| | - Darren Courtney
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Peter Szatmari
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Kristin Cleverley
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada.,70379Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | - Aristotle Voineskos
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Amy Cheung
- 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Joanna Henderson
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
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Couturier J, Gayowsky A, Findlay S, Webb C, Sami S, Chan AKC, Chanchlani R, Kurdyak P. A retrospective cohort study examining health care utilization patterns in individuals diagnosed with an eating disorder in childhood and/or adolescence. Int J Eat Disord 2022; 55:1316-1330. [PMID: 35920409 DOI: 10.1002/eat.23789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined a 2-year period following an eating disorder (ED) diagnosis in order to determine patterns of health care utilization. METHOD We conducted a retrospective cohort study of children (n = 1560) diagnosed with an ED between 2000 and 2017. The ED diagnosis was made at a tertiary level hospital for children and adolescents presenting for outpatient assessment by specialist adolescent medicine physicians and recorded in a program database over this period of time. We then created three sex- and age-matched comparison cohorts using provincial health administrative databases including: a general population cohort, a diabetes cohort (to compare nonmental health care utilization) and a mood disorder cohort (to compare mental health care utilization). Outcomes included hospitalizations, emergency department visits, as well as general practitioner, psychiatrist, and pediatrician visits. Odds ratios (dichotomous outcomes) and rate ratios (continuous outcomes) were calculated. RESULTS Compared to the general population cohort, the ED cohort had higher odds and rates of all types of health care utilization. Compared to the diabetes cohort, the ED cohort had higher odds of nonmental health-related admissions (OR 1.45, 95% CI 1.09-1.95) and higher rates of nonmental health-related emergency department visits (RR 1.59, 95% CI 1.18-2.13). Compared to the mood disorder cohort, the ED cohort had higher rates of pediatrician visits, which were mental health-related (RR 14.88, 95% CI 10.64-20.82), however most other types of mental health service utilization were lower. DISCUSSION These patterns indicate that the service needs of young people diagnosed with EDs are higher than those with diabetes with respect to nonmental health admissions and emergency department visits, while in terms of mental health service utilization, there appears to be a lack of use of mental health services compared to youth with mood disorders with the exception of pediatrician mental health visits. These findings must be interpreted in the context of under-detection and under-treatment of EDs. PUBLIC SIGNIFICANCE STATEMENT Our study found that the health service needs of young people with EDs are higher than those with diabetes with respect to admissions and emergency department visits, while there appears to be a lack of use of mental health services compared to youth with mood disorders with the exception of pediatrician mental health visits.
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Affiliation(s)
- Jennifer Couturier
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Sheri Findlay
- Division of Adolescent Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Webb
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sadaf Sami
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Anthony K C Chan
- Division of Hematology and Oncology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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7
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Barriers and Facilitators to the Implementation of an Integrated Youth Services Network in Ontario. Int J Integr Care 2022; 22:19. [PMID: 36569415 PMCID: PMC9756906 DOI: 10.5334/ijic.6737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction In response to the challenges of the traditional mental health system for youth both in Canada and abroad, models of integrated youth services (IYS) that span the integration of mental health, health, substance use, eucation, employment, peer support, and navigation into 'one-stop shops' are being established nationally and internationally. IYS models, however, need to be better described and evaluated to inform the replicability of this approach in other jurisdictions. Description This paper describes the implementation of an IYS in a small urban city and rural county in Ontario, Canada, including insights from key informants into barriers, facilitators, and lessons learned. Discussion This evaluation identified a number of barriers and facilitators to the implementation of the IYS model in this specific context. Implementation facilitators included youth and family engagement, network partner collaboration, leadership, governance structure, community enthusiasm and support, and collaborative funding models. Barriers to implementation included the COVID-19 pandemic and related public health restrictions, the diverse needs of youth, change management, sustainable funding, and transportation. Lessons learned By establishing a shared vision of delivering youth services across the integrated network, and engaging youth early in the process of model development, IYS have the potential to transform the service system for youth and their families. Meeting the diverse needs and challenges of youth who live in rural or small urban communities will enhance service delivery and experience for young people.
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8
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Henderson JL, Wilkins LK, Hawke LD, Wang W, Sanches M, Brownlie EB, Beitchman JH. Longitudinal Emergence of Concurrent Mental Health and Substance Use Concerns in an Ontario School-Based Sample: The Research and Action for Teens Study. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:249-263. [PMID: 34777508 PMCID: PMC8561851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study characterizes patterns of mental health, substance use and their co-occurrence, and identifies developmental trajectories associated with progression from single to concurrent mental health and substance use concerns in an Ontario school-based population. It is a longitudinal extension of the Ontario Student Drug Use and Mental Health Survey, as part of the RAFT collaborative project. METHODS In this study, an Ontario-wide survey was administered to students across three biennial waves starting in grades 7-8 (ages 12-14). We explored how developmental patterns of externalizing, internalizing and co-occurring symptoms were differentially associated with late-adolescent (ages 17-19) problematic substance use. RESULTS On average, students exhibited early (ages 12-14) moderate risk of an internalizing and/or externalizing disorder and approached the low threshold for a diagnostic concern for substance use disorder at age 17-19. The pattern confirmed a potential pathway from early mental health concerns to later adolescent problematic substance use, with rates of co-occurrence increasing with age. Youth with early moderate-to high externalizing and co-occurring internalizing and externalizing symptomology had the highest levels of problematic substance use, with scores indicating high likelihood of a substance use disorder diagnosis. CONCLUSIONS Given the overall pattern of progression, early identification and referral of at-risk youth, especially youth with co-occurring mental health concerns, is of critical importance. Findings support the importance of integrated and co-located mental health and substance use services for youth to more effectively serve a diverse population of youth with varying levels of need.
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Affiliation(s)
- Joanna L Henderson
- Centre for Addiction and Mental Health, Toronto, Ontario
- University of Toronto, Toronto, Ontario
| | | | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario
- University of Toronto, Toronto, Ontario
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - Marcos Sanches
- Centre for Addiction and Mental Health, Toronto, Ontario
- University of Toronto, Toronto, Ontario
| | - E B Brownlie
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - Joseph H Beitchman
- Centre for Addiction and Mental Health, Toronto, Ontario
- University of Toronto, Toronto, Ontario
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9
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Tubman JG, Meca A, Schwartz SJ, Velazquez MR, Egbert AW, Soares MH, Regan T. Brief Underage Alcohol Use Screener Scores Predict Health Risk Behaviors. J Sch Nurs 2021; 37:323-332. [PMID: 31455127 PMCID: PMC7388151 DOI: 10.1177/1059840519871092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to determine if adolescents' scores on a 2-item underage alcohol use screener predict risky consequences of past-year alcohol use and other health risk behaviors in a nonclinical, school-based sample of adolescents. A predominantly minority sample of 756 middle and high school students completed in-school tablet-based surveys on past-year underage alcohol use and a range of health risk behaviors. Higher scores for self alcohol risk and peer alcohol risk were associated with higher risk of past-year riding with a drunk driver and past 90-day measures of cigarette use, marijuana use, unplanned sex, and unprotected intercourse. The National Institute of Alcohol Abuse and Alcoholism Brief Alcohol Screener is a useful tool for school-based service providers, including school nurses, to identify and address the needs of adolescents at high risk of the development of alcohol use disorders, as well as a range of preventable health risk behaviors.
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Affiliation(s)
| | - Alan Meca
- Old Dominion University, Norfolk, VA, USA
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10
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Understanding the service needs of youth with opioid use: A descriptive study of demographics and co-occurring substance use and mental health concerns. J Subst Abuse Treat 2021; 132:108592. [PMID: 34538518 DOI: 10.1016/j.jsat.2021.108592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 07/06/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Opioid misuse among youth is a significant concern given its potential negative consequences; yet youth who use opioids continue to face challenges in seeking treatment. The goal of this study was to understand the demographics, mental health, and substance use and co-occurring concerns of service-seeking youth with opioid use to inform future services and research. METHODS This study characterized 1769 youth between 14 and 24 years old seeking services at an urban treatment facility in Toronto, Ontario (ON) between 2008 and 2019. Youth who could adequately read English, had no immediate psychiatric service needs, provided research consent, and responded to a question about opioid use history were eligible. Participants provided information on demographics, substance use, mental health, and treatment motivation. RESULTS Youth who use opioids were more likely to report challenges with social determinants of health, use more substances, initiate substance use earlier, and use some substances at a higher frequency than youth who do not use opioids. Youth with opioid use reported more co-occurring mental health and substance use concerns than youth with no opioid use. They also endorsed more trauma and a likely PTSD diagnosis. Not being in employment, education, or training and using a higher number of substances positively predicted youth opioid use. In terms of treatment motivation, youth who use opioids endorsed more internal forms of motivation than youth who do not use opioids. CONCLUSIONS Youth who use opioids have complex social and co-occurring mental health and substance use needs that may be addressed with integrated community-based services. Future research should focus on developing evidence-based opioid treatment programs in this context and other innovative platforms.
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11
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Marsh TN, Eshakakogan C, Eibl JK, Spence M, Morin KA, Gauthier GJ, Marsh DC. A study protocol for a quasi-experimental community trial evaluating the integration of indigenous healing practices and a harm reduction approach with principles of seeking safety in an indigenous residential treatment program in Northern Ontario. Harm Reduct J 2021; 18:35. [PMID: 33731138 PMCID: PMC7967948 DOI: 10.1186/s12954-021-00483-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Indigenous communities in Canada face significant challenges with intergenerational trauma, which manifests in substance use disorders. There is consensus that connecting treatment approaches to culture, land, community, and spiritual practices is a pathway to healing trauma and substance use disorders for Indigenous peoples. Indigenous residential addiction treatment programs have been established as the primary intervention to provide healing for Indigenous peoples with substance use disorders and intergenerational trauma. However, there is limited evidence demonstrating the effectiveness of these programs. In collaboration with the Benbowopka Treatment Centre, this paper describes a study protocol which aims to evaluate the effectiveness of blending Indigenous Healing Practices and Seeking Safety for the treatment of Indigenous patients with intergenerational trauma and substance use disorders. Methods We will conduct a pre/post Quasi Experimental Community trial, to compare historical treatment outcomes for patients following the implementation of Indigenous Healing and Seeking Safety. We will conduct quantitative and qualitative analyses to understand the differences before and after the intervention is implemented. The pre- Indigenous Healing and Seeking Safety intervention study window will span from 2013 to 2016; n = 343, and the post-Indigenous Healing and Seeking Safety intervention study window from 2018 to 2020; n > 300. All participants will be enrolled in the Benbowopka residential treatment for the first time during the study periods. All data will be anonymized at the time of data entry. Propensity matching will be undertaken for patient characteristics, including sex/gender, age, and substance use type. Results and conclusions The study findings could be used to inform intergenerational trauma and substance use disorders residential treatment programming for Indigenous communities across Canada. Our work will contribute to the field of community-based intergenerational trauma and substance use disorders programming by addressing objectives that consider: (a) the patient perspective, (b) the program perspective, and (c) the community perspective. The study findings may validate an innovative approach for evaluating the effectiveness of residential addiction treatment and particularly the effective and appropriate care for Indigenous patients with intergenerational trauma and substance use disorders.
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Affiliation(s)
- T N Marsh
- Northern Ontario School of Medicine, Sudbury, Canada.
| | | | - J K Eibl
- Northern Ontario School of Medicine, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Canada.,ICES North, Sudbury, Canada
| | - M Spence
- Northern Ontario School of Medicine, Sudbury, Canada
| | - K A Morin
- Northern Ontario School of Medicine, Sudbury, Canada
| | - G J Gauthier
- Northern Ontario School of Medicine, Sudbury, Canada
| | - D C Marsh
- Northern Ontario School of Medicine, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Canada.,ICES North, Sudbury, Canada.,Canadian Addiction Treatment Centres, Markham, Canada
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12
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Bath K, Hawke LD, Skilling T, Chaim G, Henderson J. The service-seeking profiles of youth reporting a legal mandate or perceived coercion for substance use treatment. Addict Behav 2019; 90:27-34. [PMID: 30352342 DOI: 10.1016/j.addbeh.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION There is paucity of research on treatment-related coercion in youth: most research focuses on adult populations and legally mandated treatment. This study aims to examine the service-seeking profiles of youth with substance misuse issues who report a legal mandate or perceived coercion to enter treatment. METHODS Differences between youth who were legally mandated and not legally mandated, and differences between youth reporting high and low perceived coercion, were examined for demographic characteristics, mental health and substance use profiles, motivation, and readiness to change. RESULTS Compared to participants reporting low perceived coercion, those experiencing high perceived coercion reported more substance use problems, greater mental health needs, and greater external and introjected motivation. Legally mandated youth reported fewer mental health issues, lower identified motivation, and greater readiness to change than those reporting no legal mandate. DISCUSSION Many youth who present for substance use services report experiencing a sense of coercion, which suggests the potential importance of considering youth-centered strategies for involving youth in treatment planning and the development of treatment goals. Youth seeking treatment also have multiple intersecting needs which may benefit from a collaborative and integrative approach.
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Brownlie E, Beitchman JH, Chaim G, Wolfe DA, Rush B, Henderson J. Early Adolescent Substance Use and Mental Health Problems and Service Utilisation in a School-based Sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:116-125. [PMID: 29929386 PMCID: PMC6405806 DOI: 10.1177/0706743718784935] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This paper reports on substance use, mental health problems, and mental health service utilisation in an early adolescent school-based sample. METHOD Participants were 1,360 grade 7 and 8 students from 4 regions of Ontario, Canada. Students completed an in-class survey on mental health and substance use. The sampling strategy and survey items on demographics, substance use, service utilisation, and distress were adapted from the Ontario Student Drug Use and Health Survey. Internalising and externalising mental health problems were assessed using the Global Assessment of Individual Needs - Short Screener. Distress was defined as fair or poor self-rated mental health. RESULTS Rates of internalising and/or externalising problems above the threshold exceeded 30%; yet, fewer than half had received mental health services in the past 12 mo. Substance use was associated with increased odds of internalising and externalising problems above the threshold and distress. Youth using cannabis had 10-times the odds of exceeding the threshold for internalising or externalising problems. The use of substances other than alcohol or cannabis was associated with increased odds of fair or poor self-rated mental health among grade 8 students. Of the youth who confirmed at least a substance use problem, most also reported mental health problems; this association was stronger among girls than boys. CONCLUSIONS Early adolescent substance use was associated with concurrent self-reported mental health problems in a non-clinical sample. The low levels of service utilisation reported highlight the need for improved access to early identification and intervention to prevent the development of concurrent disorders.
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Affiliation(s)
- Elizabeth Brownlie
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Joseph H. Beitchman
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Gloria Chaim
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - David A. Wolfe
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Centre for Prevention Science, Centre for Addiction and Mental Health, Toronto, Ontario
- Centre for Research and Education on Violence against Women and Children at the Faculty of Education, Western University, London, Ontario
| | - Brian Rush
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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McGihon R, Hawke LD, Chaim G, Henderson J. Cross-sectoral integration in youth-focused health and social services in Canada: a social network analysis. BMC Health Serv Res 2018; 18:901. [PMID: 30486805 PMCID: PMC6264042 DOI: 10.1186/s12913-018-3742-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/20/2018] [Indexed: 11/22/2022] Open
Abstract
Background Youth with concurrent substance use and mental health concerns have diverse psychosocial needs and may present to a multitude of clinical and social service sectors. By integrating service sectors at a system level, the diversity of needs of youth with concurrent disorders can be addressed in a more holistic way. The objective of the present study was to quantify the level of cross-sectoral integration in youth-focused services in Canada. Methods Social network analysis (SNA) was used to examine the relationships between eight sectors: addictions, child welfare, education, physical health, housing, mental health, youth justice, and other social services. A total of 597 participants representing twelve networks of youth-serving agencies across Canada provided information on their cross-sectoral contacts and referrals. Results Overall, results suggested a moderate level of integration between sectors. The mental health and the addictions sectors demonstrated only moderate integration, while the addictions sector was strongly connected with the youth justice sector. Conclusions Despite evidence of moderate integration, increased integration is called for to better meet the needs of youth with concurrent mental health and substance use concerns across youth-serving sectors. Ongoing efforts to enhance the integration between youth-serving sectors should be a primary focus in organizing networks serving youth with concurrent mental health and substance use needs.
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Affiliation(s)
- Rachel McGihon
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, M6J 1H4, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lisa D Hawke
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, M6J 1H4, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gloria Chaim
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, M6J 1H4, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, M6J 1H4, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Hawke LD, Koyama E, Henderson J. Cannabis use, other substance use, and co-occurring mental health concerns among youth presenting for substance use treatment services: Sex and age differences. J Subst Abuse Treat 2018; 91:12-19. [PMID: 29910010 DOI: 10.1016/j.jsat.2018.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
Cannabis use among youth is of significant concern given the potential negative health impacts on young people. This study describes the mental health characteristics, cannabis use, and substance use profiles of youth aged 14 to 24 years seen at the Youth Addiction and Concurrent Disorders Service at the Centre for Addiction and Mental Health, through an age and gender lens. Almost all participating youth indicated lifetime cannabis use. Substance use and mental health profiles among those indicating a history of cannabis use differed along sex and age. Male youth were more likely to use cannabis more frequently, while female youth were more likely to use greater variety of substances and display more co-occurring mental health problems. Adolescent problematic substance use tended to co-occur with externalizing problems whereas problematic young adult substance use tended to co-occur with internalizing problems. Implications for the integrated, coordinated care of substance use and mental health concerns, with attention to the unique needs of subgroups of youth, are discussed.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Emiko Koyama
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, Canada.
| | - Joanna Henderson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Dratva J, Stronski S, Chiolero A. Towards a national child and adolescent health strategy in Switzerland: strengthening surveillance to improve prevention and care. Int J Public Health 2017; 63:159-161. [PMID: 29184967 DOI: 10.1007/s00038-017-1062-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 11/21/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Julia Dratva
- ZHAW School of Health Professions, Institute of Health Sciences, Winterthur, Switzerland.
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, CH, Petersplatz 1, 4031, Basel, Switzerland.
| | - Susanne Stronski
- Independent Consultant Child, Adolescent and School Health, Bern, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Smith T, Hawke L, Chaim G, Henderson J. Housing Instability and Concurrent Substance use and Mental Health Concerns: An Examination of Canadian Youth. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2017; 26:214-223. [PMID: 29056984 PMCID: PMC5642461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Though previous research has identified the high burden of mental health and addiction (MHA) concerns among precariously housed youth, earlier studies have not examined differences in MHA concerns among housing insecure Canadian youth across sectors. This study examines this issue using the Global Appraisal of Individual Needs Short Screener (GAIN-SS) in a cross-sectoral sample of Canadian youth. METHOD A total of 2605 youth ages 12 to 24 seeking services across sectors completed the GAIN-SS and a sociodemographic form. The analyses described demographic variables and sector of presentation, then evaluated internalizing, externalizing, substance use, and crime/violence concerns based on housing status. RESULTS While many precariously housed youth presented through the housing/outreach/support sector, 33.6% presented to other sectors. Housing groups endorsed comparably high levels of internalizing and externalizing problems. However, precariously housed youth reported higher rates of problematic substance use (OR = 1.54; 95% CI 1.25, 1.88; p < 0.01) and crime/violence issues (OR = 1.95; 95% CI 1.54, 2.46; p < 0.01). Precariously housed youth were 48% more likely to endorse concurrent disorders (OR = 1.48; 95% CI 1.21, 1.82; p < 0.01), which was largely driven by the high rate of concurrent disorders among precariously housed females. CONCLUSIONS Since precariously housed youth with multiple clinical needs presented across sectors, attention must be given to screening for both housing stability and MHA and building stronger cross-sectoral partnerships. The findings should encourage systematic screening, MHA training and capacity building within housing sectors as well as integrated services across all youth-serving organizations.
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Affiliation(s)
- Tayla Smith
- Centre for Addiction and Mental Health, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Lisa Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - Gloria Chaim
- Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Joanna Henderson
- Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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