1
|
Rao S. The Access Paradox: unmet healthcare needs among young adults in Alberta - an exploratory study of the systemic ironies in healthcare accessibility. Int J Ment Health Nurs 2024; 33:859-868. [PMID: 38183386 DOI: 10.1111/inm.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
There is a pressing need to investigate how young adults' access to healthcare, including how delayed help-seeking behaviours and the complexities inherent in traditional healthcare systems, exacerbate the challenges they face. This study explores the associations among functional impairments, self-perceptions of health, anxiety and mood disorders and their potential relationship to unmet healthcare needs among young adults aged 20-29. This cross-sectional study used data from the 2017-2018 Canadian Community Health Survey to analyse a sample of 1636 young adults from Alberta, Canada. Central to the analysis was the application of conceptual framework of access to health care, as it offers a comprehensive view of healthcare access. Among the sampled young adults, 7.0% reported unmet healthcare needs. Self-perceived unmet healthcare needs were significantly associated with anxiety disorders, functional impairments-specifically cognitive and social skills, and self-perceptions of poor or fair mental health, as opposed to those perceiving their mental health as excellent. Multivariable analyses incorporating extraneous variables were not statistically significant, emphasising the critical role of systemic and structural factors in healthcare access. The study presents preliminary insights into the intricate dynamics shaping unmet healthcare needs. These insights can guide future research and practice advances, particularly in developing targeted interventions that effectively reduce healthcare disparities and enhance access to healthcare services for young adults.
Collapse
Affiliation(s)
- Sandy Rao
- Faculty of Social Work, University of Calgary, Calgary, Canada
| |
Collapse
|
2
|
Ow N, Marchand K, Liu G, Mallia E, Mathias S, Sutherland J, Barbic SP. Patterns of service utilization among youth with substance use service need: a cohort study. Subst Abuse Treat Prev Policy 2023; 18:62. [PMID: 37924116 PMCID: PMC10623844 DOI: 10.1186/s13011-023-00572-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Integrated youth services (IYS) are vital to addressing the needs of youth who use substances. Evidence on the characteristics of youths accessing these services and the types of services accessed have been limited. The objectives were to identify sociodemographic, self-reported health and mental health, patterns of service utilization (service type and frequency of visits) among youths with different levels of substance use service needs (low, moderate, and high), and to estimate the extent to which substance use service needs, self-reported health and mental health influenced the frequency of visits and types of service utilized. METHODS Data were collected from youth (12-24 years) accessing IYS centres in Canada. Information on socio-demographic factors, substance use in the last month, self-rated health measures, number of service visits, and type of services utilized were included. Poisson regression was used to estimate the relationship between substance use needs and number of service visits and the different type of services utilized. RESULTS Of 6181 youths, 48.0% were categorized as low substance use service needs, 30.6% had moderate needs and 21.4% had high needs, with higher proportion of men in the high needs group. Mental health and substance use (MHSU) services were utilized the most across all three groups, followed by counseling. The median number of visits was 4 for the low and moderate needs group and 5 in the high needs group. People with high service needs had 10% higher rate of service visits and utilized 10% more services than people with low service needs (service visits: RR = 1.1 (95%CI: 1.1-1.2); service type: RR = 1.1 (95%CI:1.0-1.1)). The rate of service visits increased by 30 to 50% and the number of services increased by 10-20% for people who rated their health good/fair/poor. Similarly, the rate of service visits increased by 40 to 60% and the number of services increased by 20% for people who rated their mental health good/fair/poor. CONCLUSIONS AND IMPACTS Our study highlighted that regardless of service needs, youth who use alcohol and drugs have complex intersecting needs that present once they access integrated youth services.
Collapse
Affiliation(s)
- Nikki Ow
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Providence Research, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Kirsten Marchand
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Providence Research, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Guiping Liu
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Emilie Mallia
- Foundry Central Office, 201-1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
| | - Steve Mathias
- Foundry Central Office, 201-1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Jason Sutherland
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Skye Pamela Barbic
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Providence Research, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Foundry Central Office, 201-1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
| |
Collapse
|
3
|
Waters KA, Salinas-Miranda A, Kirby RS. The association between parent-child quality time and children's flourishing level. J Pediatr Nurs 2023; 73:e187-e196. [PMID: 37775429 DOI: 10.1016/j.pedn.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Few studies have examined the association between parental quality time and flourishing measures in young children. This study explored the association between parental quality time and children's flourishing in a national sample of USA children 1-5 years of age. DESIGN AND METHODS A cross sectional study using data from the 2019-2020 National Survey of Children's Health (N = 17,855). Flourishing was measured with a composite score (values 0-4) derived from 4 questions on attachment with parent, resilience, learning, and contentment with life. Having all 4 items was optimal. Parent-child quality time per week was measured with 3 items: singing or storytelling, reading to child, and family meal with child; using a 4-point scale: 0 days, 1-3 days, 4-6 days, and every day/week. Multivariable logistic regression models were conducted to assess the odds of lower flourishing in SAS 9.4. RESULTS After controlling for confounding, only the lack of singing and storytelling were negatively associated with greater odds of lower levels of flourishing (0-2 items OR = 5.06, 95% CI 2.11-12.14; 3 items OR = 2.92, 95% CI 1.73-4.93). CONCLUSIONS Insufficient parent-child quality time is associated with lower flourishing levels. Fostering parental opportunities to engage in weekly quality time with their children should be a priority of child health programs seeking to improve child flourishing. PRACTICE IMPLICATIONS Nurses should provide guidance to parents on ways to nurture quality family time and promote children's psychosocial, environmental, and physical well-being. Nurses can advocate for programmatic and policy changes to ensure familial work/life balance and licensing/accreditation of all child centers.
Collapse
Affiliation(s)
- Karah A Waters
- Center of Excellence in Maternal and Child Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA.
| | - Abraham Salinas-Miranda
- Center of Excellence in Maternal and Child Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA.
| | - Russell S Kirby
- Center of Excellence in Maternal and Child Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA.
| |
Collapse
|
4
|
Kreim S, Marchand K, Mallia E, Dubras R, McMaster WR, Tee K, Mathias S, Barbic S. Identifying early intervention opportunities for illicit stimulant use: A cross-sectional study of factors associated with illicit stimulant use among young people accessing integrated youth services in British Columbia, Canada. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023:209076. [PMID: 37182544 DOI: 10.1016/j.josat.2023.209076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/12/2022] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Illicit stimulant (cocaine and/or amphetamine) use among young people aged 12-24 is a public health priority given that substance use initiation tends to peak in this developmental period and significant associated immediate and long-term harms are associated with its use. Young people using stimulants must be engaged in services as early as possible to reduce these harms. To inform early intervention opportunities, this study aimed to identify the risk/protective factors associated with illicit stimulant use among young people. METHODS We conducted a cross-sectional study on routinely collected self-reported data among young people accessing integrated youth services in British Columbia (Canada) between April 2018 and January 2022. Data were collected on young peoples' socio-demographic characteristics, and social, behavioral, and health profiles. Variable selection was guided by established risk/protective factors for substance use among young people. The study used multivariable logistic regression to identify risk/protective factors that were independently associated with past 30-day illicit stimulant use. RESULTS The analytic sample included n = 5620 young people aged 12-24 and a total of 163 (2.9 %) reported past 30-day illicit cocaine and/or amphetamine use. Demographic characteristics that were independently associated with illicit stimulant use included older age (aOR = 1.27, 95 % CI = 1.17-1.38) and gender identity as man vs woman (aOR = 1.71, 95 % CI = 1.10-2.70). Social and environmental risk factors included recently witnessing or experiencing violence (aOR = 2.32, 95 % CI = 1.47-3.68) and higher past-year crime/violent behaviors score (aOR = 1.39, 95 % CI = 1.13-1.69). Finally, regular alcohol (aOR = 6.90, 95 % CI = 2.36-25.42), regular (aOR = 3.74, 95 % CI = 1.95-7.54) or social (aOR = 3.06, 95 % CI = 1.44-6.60) tobacco use, and lifetime hallucinogen (aOR = 3.24, 95 % CI = 1.8-5.91) and ecstasy/MDMA (aOR = 2.53, 95 % CI = 1.48-4.39) use were also statistically significant risk factors. CONCLUSIONS These risk/protective factors support identification of young people who may benefit from further screening, assessment, and treatment for illicit stimulant use. This study also underscores the need to expand early intervention and harm reduction programs that can comprehensively respond to young peoples' stimulant use, health, and social needs.
Collapse
Affiliation(s)
- Sara Kreim
- Faculty of Science, University of British Columbia, 2207 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Kirsten Marchand
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Emilie Mallia
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Richard Dubras
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - W Robert McMaster
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201-4500 Oak Street, Vancouver, BC V6H3N1, Canada
| | - Karen Tee
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Steve Mathias
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Providence Research, 1190 Hornby Street, Vancouver, BC V6Z 1Y6, Canada; Department of Psychiatry, 2255 Wesbrook Mall, University of British Columbia, Vancouver, BC V6T 2A1, Canada
| | - Skye Barbic
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Providence Research, 1190 Hornby Street, Vancouver, BC V6Z 1Y6, Canada
| |
Collapse
|
5
|
Halsall T, Mahmoud K, Pouliot A, Iyer SN. Building engagement to support adoption of community-based substance use prevention initiatives. BMC Public Health 2022; 22:2213. [PMID: 36447185 PMCID: PMC9706831 DOI: 10.1186/s12889-022-14496-9] [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: 11/05/2021] [Accepted: 10/31/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND System-level approaches that target social determinants of health are promising strategies to support substance use prevention, holistic youth development and wellbeing. Yet, the youth services system is largely based on individual-focused programs that do not adequately account for social determinants of health and place the responsibility for wellness on the individual. There is a need to understand how to enhance adoption of complex system-level approaches that support comprehensive youth development. The Icelandic Prevention Model (IPM) represents a collaborative initiative that takes an ecological, system-level approach to prevent substance use and promote wellness in youth. This research was designed to examine key stakeholder perceptions to better understand social motivations and contextual complexities that influence stakeholder support to garner community-level adoption of the IPM in a rural Canadian community. METHODS This research applies a case study approach using qualitative interviews to explore strategies to support uptake in the early stages of IPM adoption associated with developing community buy-in and acceptance. A thematic analysis was applied using QSR NVivo. RESULTS Nine interviews were conducted with community partners leading the implementation of the IPM. Three over-arching themes emerged from the data: 1) Motivating influences 2) Strategies to develop buy-in, and 3) Resistance to the adoption of the IPM. Findings reflect issues that affect behaviour change in system transformation in general as well as upstream prevention and the IPM, in particular. CONCLUSIONS The findings from this research describe critical insight derived from implementing community-driven initiatives that are designed to support health promotion. It contributes new scientific knowledge related to implementation of complex system-level innovations and practical information that is useful for communities interested in implementing the IPM or following similar approaches to prevent substance use.
Collapse
Affiliation(s)
- Tanya Halsall
- grid.28046.380000 0001 2182 2255University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, ON K1Z 7K4 Canada ,Department of Neuroscience, 1125 Colonel By Drive, Ottawa, ON K1S 5B6 Canada
| | - Kianna Mahmoud
- grid.55602.340000 0004 1936 8200Faculty of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS B3H 4R2 Canada
| | - Annie Pouliot
- grid.415368.d0000 0001 0805 4386Public Health Agency of Canada, 130 Colonnade Rd, A.L. 6501H, Ottawa, ON K1A 0K9 Canada
| | - Srividya N. Iyer
- ACCESS Open Minds (pan-Canadian youth mental health research network), Montreal, Quebec Canada ,grid.412078.80000 0001 2353 5268Douglas Mental Health University Institute, Montreal, Quebec Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, 1033 Av. des Pins, Montreal, QC H3A 1A1 Canada
| |
Collapse
|
6
|
Halsall T, Daley M, Hawke L, Henderson J, Matheson K. “You can kind of just feel the power behind what someone's saying”: a participatory-realist evaluation of peer support for young people coping with complex mental health and substance use challenges. BMC Health Serv Res 2022; 22:1358. [PMCID: PMC9667436 DOI: 10.1186/s12913-022-08743-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Youth peer support, as a practice that aligns youth engagement and participatory approaches, has become increasingly popular in the context of youth mental health services. However, there is a need for more evidence that describes how and why youth peer support practice might be effective. This study was designed to examine a peer support service for youth experiencing complex challenges with mental health, physical health and/or substance use to better understand key features and underlying mechanisms that lead to improved client outcomes.
Methods
We applied a hybrid realist-participatory approach to explore key issues and underlying theoretical assumptions within a youth peer support approach for young people (age 14–26) experiencing complex mental health and substance use challenges. We used semi-structured interviews and focus groups with staff, including peers (N = 8), clinical service providers and administrative staff (N = 15), to develop the theories and a client survey to validate them. Our qualitative thematic analysis applied a retroductive approach that involved both inductive and deductive processes. For the client survey (N = 77), we calculated descriptive statistics to examine participant profiles and usage patterns. Pearson correlations were examined to determine relationships among concepts outlined in the program theories, including context, mechanism and outcome variables.
Results
Our analyses resulted in one over-arching context, one over-arching outcome and four program theories. Program theories were focused on mechanisms related to 1) positive identity development through identification with peers, 2) enhanced social connections, 3) observational learning and 4) enhanced autonomy and empowerment.
Conclusions
This study serves as a unique example of a participatory-realist hybrid approach. Findings highlight possible key components of youth peer practice and shed light on the functional mechanisms that underlie successful peer practice. These key components can be examined in other settings to develop more comprehensive theories of change with respect to youth peer support and can eventually be used to develop guidelines and standards to strengthen practice. This research contributes to an expanding body of literature on youth peer support in mental health and connects peer practice with several social theories. This research begins to lay a foundation for enhanced youth peer support program design and improved outcomes for young people experiencing complex mental health and substance use challenges.
Collapse
|
7
|
Mental Health Problems among Young People-A Scoping Review of Help-Seeking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031430. [PMID: 35162452 PMCID: PMC8835517 DOI: 10.3390/ijerph19031430] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 02/06/2023]
Abstract
Young people’s mental health is a public health priority, particularly as mental health problems in this group seem to be increasing. Even in countries with supposedly good access to healthcare, few young people seek support for mental health problems. The aim of this study was twofold, firstly to map the published literature on young people’s experiences of seeking help for mental health problems and secondly to validate whether the Lost in Space model was adaptable as a theoretical model of the help-seeking process described in the included articles in this scoping review. A scoping review was conducted in which we searched for literature on mental health help-seeking with a user perspective published between 2010 and 2020 in different databases. From the 2905 studies identified, we selected 12 articles for inclusion. The review showed how young people experience unfamiliarity and insecurity with regard to issues related to mental health and help-seeking. A strong wish for self-reliance and to safe-guard one’s own health were consistent among young people. Support structures were often regarded as inaccessible and unresponsive. There was a high level of conformity between the model on help-seeking and the analysed articles, reinforcing that help-seeking is a dynamic and psychosocial process.
Collapse
|
8
|
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.
Collapse
|
9
|
Halsall T, McCann E, Armstrong J. Engaging young people within a collaborative knowledge mobilization network: Development and evaluation. Health Expect 2021; 25:617-627. [PMID: 34953012 PMCID: PMC8957748 DOI: 10.1111/hex.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 09/01/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background It is critical that mental health systems place a focus on prevention and early intervention focused on young people while integrating youth voice to guide priority directions. Objective This study was designed to better understand how youth advisories can be utilized to influence strategic directions within integrated knowledge mobilization networks operating within the youth mental health system. Design To support this objective, we reviewed the detailed stages of development in establishing a youth advisory within a national network designed to support the integration of youth services. We also engaged the advisory in a participatory evaluation process that examined the extent to which the network had created processes to include youth voice in decision‐making. Results Results from the surveys identified moderate to high levels of individual engagement as well as strong development of processes and procedures that support the inclusion of youth voice across the network. Discussion Major successes and challenges are presented and discussed with respect to the development of the advisory. The findings are useful for youth advocates and adult allies working to support youth engagement (YE) in knowledge mobilization to enhance the mental health services system. This study also contributes to research and evaluation efforts examining YE and represents an exemplar methodology for evaluating YE efforts at the system level. Patient or Public Contribution Young people as mental health service users and youth mental health advocates were involved in the design, data collection, analysis and interpretation of the data as well as the preparation of this manuscript.
Collapse
Affiliation(s)
- Tanya Halsall
- Youth Research Unit, University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada.,Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Emma McCann
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Julia Armstrong
- Mental Health and Substance Use, Mental Health Commission of Canada, Ottawa, Ontario, Canada
| |
Collapse
|
10
|
Stubbing J, Gibson K. Can We Build 'Somewhere That You Want to Go'? Conducting Collaborative Mental Health Service Design with New Zealand's Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9983. [PMID: 34639289 PMCID: PMC8507894 DOI: 10.3390/ijerph18199983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022]
Abstract
Globally, young people are at high risk of mental health problems, but have poor engagement with services. Several international models have emerged seeking to address this gap by providing youth-specific care designed in collaboration with young people. In this study, 94 young people in New Zealand participated in collaborative workshops exploring their vision of an ideal mental health service. Participants were aged 16-25. Reflexive thematic analysis was used to identify seven themes. These describe the ideal mental health service for these young people as comfortable, accessible, welcoming, embedded in the community, holistic, adaptable, and youth-focused. In addition to describing how services might better serve the needs of youth, this article outlines a method for adapting international principles for youth-friendly care to the specific needs of a population of young people. This article provides supporting evidence that services should consider how to improve their engagement with youth through collaboration with local populations of young people.
Collapse
Affiliation(s)
- Jessica Stubbing
- School of Psychology, The University of Auckland, Auckland 1142, New Zealand;
| | | |
Collapse
|
11
|
Distributive Leadership Within an Emerging Network of Integrated Youth Health Centres: A Case Study of Foundry. Int J Integr Care 2020; 20:19. [PMID: 33335460 PMCID: PMC7716781 DOI: 10.5334/ijic.4709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Distributive leadership has been proposed as an effective means towards achieving integrated health services. This study draws from the case of Foundry, a network of integrated youth health centres in British Columbia, Canada, and explores the function and impact of distributive leadership in the context of a large-scale effort towards integrated service delivery for youth experiencing mental health and substance use challenges. Methods Qualitative data was obtained from a developmental evaluation of Foundry using a longitudinal, ethnographic approach. Over 150 participants involved in the development of six Foundry centres were interviewed individually or in focus groups. Purposive and theoretical sampling strategies were used to maximize the diversity of perspectives represented in the data set. Results and Discussion Distributive leadership was observed to be a facilitator for achieving service and system-level integration. Distributive leadership was effective in promoting streamlined service provision, and coordinating efforts towards optimized access to care. A new culture of leadership emerged through collaboration and relationship-building based on a common value system to prioritize youth needs. Conclusion As Foundry, and other integrated youth services, continues to expand, distributive leadership shows promise in assuring diverse and coordinated input for integrating services.
Collapse
|
12
|
Influences on Physicians' Participation in Coordinated Ambulatory Cardiology Care: A Mixed-Methods Study. Int J Integr Care 2020; 20:17. [PMID: 33281528 PMCID: PMC7693876 DOI: 10.5334/ijic.5495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: In 2009 a managed care programme for coordinated ambulatory cardiology care was established in Southern Germany. Designed as a voluntary contract between health insurers and ambulatory medical specialists, it aims for a guideline-oriented, efficient health care by general practitioners and medical specialists. In this study, we aimed to identify factors associated with physicians’ participation and their relation to the aims of the programme. Methods: A mixed-methods study was designed. We conducted semi-structured interviews with a sample of 21 specialists participating and 11 specialists not participating in the programme. Structured questionnaires were sent to all eligible medical specialists, of whom 75 specialists participating and 21 specialists not participating in the programme responded. Both the interview and questionnaire covered a range of questions on the participation and implementation of the program. Results: Financial benefits were the most frequently named reason to participate. Other prevalent motives were the prospect of an alternative to regular health care, expected diagnostic possibilities and recommendations from peers. Reasons for not participating were mainly structural, such as technical modifications as well as economic investments and fear for one’s professional autonomy. Conclusion: Physicians’ participation in the programme was mainly financially driven and largely unrelated to its care-related aims. Still, it is unclear if these divergences between motivation to participate and aims of a managed care programme affect its eventual impact, hence further research is required.
Collapse
|
13
|
Halsall T, Manion I, Mathias S, Robeson P, Benlamri M, Helfrich W, Iyer SN, Purcell R, Henderson J. Frayme: Building the structure to support the international spread of integrated youth services. Early Interv Psychiatry 2020; 14:495-502. [PMID: 31943853 DOI: 10.1111/eip.12927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 09/03/2019] [Accepted: 12/14/2019] [Indexed: 11/28/2022]
Abstract
AIM Frayme is a Canadian-based international network designed to accelerate the adoption and scaling up of integrated youth services (IYS). This is done through the synthesis of evidence from a variety of sources and a commitment to integrated knowledge mobilization (KMb) to inform research policy and practice. Frayme is utilizing innovative approaches to stakeholder engagement (youth, families, policy makers, funders, researchers and practitioners) and KMb in order to co-design system change. The purpose of this article describes the overall Frayme strategy and presents findings from a participatory needs assessment implemented to inform policy-related priorities. METHODS The Frayme leadership team facilitated a participatory needs assessment with major stakeholder groups that applied a modified problem-solving activity. The needs assessment was on a designed to support diverse stakeholder perspectives on ways to improve knowledge mobilization of IYS. Qualitative data were analysed using a thematic analysis. RESULTS The four themes identified through the needs assessment were: (a) traditional scientific practices, (b) organizational obstacles, (c) change aversion, and (d) pre-established stakeholder hierarchies. CONCLUSIONS Through the recognition of these challenges, Frayme has developed a set of major objectives to inform projects, opportunities for knowledge sharing, implementation of evidence and scaling up of efforts. The Frayme integrated KMb model represents a unique applied example of an evidence-informed approach to practice collaboration in KMb to promote system change. The findings from this research also contribute to the expanding knowledge base with regard to complex evaluation and system transformation.
Collapse
Affiliation(s)
- Tanya Halsall
- Youth Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Ian Manion
- Youth Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Steve Mathias
- Foundry, Providence Health Care, Vancouver, British Columbia.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Paula Robeson
- Children's Healthcare Canada, Ottawa, Ontario, Canada
| | - Meriem Benlamri
- Frayme, International Knowledge Translation Platform, Ottawa, Ontario, Canada
| | - Warren Helfrich
- Foundry, Providence Health Care, Vancouver, British Columbia
| | - Srividya N Iyer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Research Network), Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Rosie Purcell
- Orygen, National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Toronto, Ontario, Canada.,University of Toronto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Halsall T, Manion I, Henderson J, Robeson P, Purcell R, Liversidge P, Iyer SN. Examining partnerships within an international knowledge translation network focused on youth mental health promotion. Health Res Policy Syst 2020; 18:29. [PMID: 32131848 PMCID: PMC7057628 DOI: 10.1186/s12961-020-0535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/05/2020] [Indexed: 11/25/2022] Open
Abstract
Background Systems transformation for health promotion, involving engagement from multiple disciplines and levels of influence, requires an investment in partnership development. Integrated youth service is a collaborative model that brings organisations together to provide holistic care for youth. Frayme is an international knowledge translation network designed to support the uptake and scaling of integrated youth service. Social network analysis (SNA) is the study of relationships among social units and is useful to better understand how partners collaborate within a network to achieve major objectives. The purpose of this paper is to apply SNA to the Frayme network in order to (1) examine the level and strength of partnerships, (2) identify the strategies being employed to promote the main objectives and (3) apply the findings to current research in youth mental health and system transformation. Methods The PARTNER tool includes a validated survey and analysis software designed to examine partner interconnections. This tool was used to perform the SNA and 51 of the 75 partners completed the survey (14 researchers, 2 advisory groups and 35 organisations). A network map was created and descriptive frequencies were calculated. Results The overall network scores for the Frayme network were 20.6% for density, 81.5% for centralisation and 71.7% for overall trust. The Frayme secretariat received a 3.84 out of a possible 4 for value. In addition, the youth and family advisories each received a value score of 4 and all Leadership Team organisations received a score of 2.97 or above. Conclusions The Frayme secretariat links many partners who would otherwise be disconnected and acts as a significant conduit for novel information. Frayme may have the opportunity to enhance value perceptions among broader network members by profiling individual organisations and the potential leveraging opportunities that might exist through their work. These findings increase understanding with respect to the mechanisms of network development and will be helpful to inform partnership development in the future. In addition, they contribute to the literature with respect to knowledge translation practice as well as the scaling of collaborative interventions within youth mental health.
Collapse
Affiliation(s)
- T Halsall
- Youth Research Unit, The Royal's Institute of Mental Health Research, 1145 Carling Ave., Ottawa, Ontario, K1Z 7K4, Canada.
| | - I Manion
- Youth Research Unit, The Royal's Institute of Mental Health Research, 1145 Carling Ave., Ottawa, Ontario, K1Z 7K4, Canada
| | - J Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - P Robeson
- Children's Healthcare Canada, Ottawa, Ontario, Canada
| | - R Purcell
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - P Liversidge
- Alberta Integrated Youth Services Initiative, Edmonton, Alberta, Canada
| | - S N Iyer
- ACCESS Open Minds (pan-Canadian youth mental health research network), Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| |
Collapse
|