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Halsall T, Daley M, Hawke LD, Henderson J, Wilson A, Matheson K. "I Think Peer Support Helps to Demystify People Who Have Mental Health Issues and Helps to Remove That Stigma": Exploring the Defining Characteristics and Related Challenges of Youth Peer Support Through Participatory Research. Community Ment Health J 2024; 60:784-795. [PMID: 38430287 DOI: 10.1007/s10597-024-01235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/09/2024] [Indexed: 03/03/2024]
Abstract
Despite the emerging body of literature on the benefits of youth peer support, there is also evidence that peer support can have unintended negative impacts on peers themselves. It is important to explore what aspects of the peer role contribute to these difficulties in order to mitigate risks. This paper uses a participatory approach to examine the unique attributes of youth peer practice and the related challenges. We conducted semi-structured interviews and focus groups with both peer and non-peer staff from a community-based youth mental health program that provides peer support services (N = 29). Thematic analyses were completed using QSR NVivo. Analyses capture the defining features and related challenges of the peer support role (self-disclosure, boundaries, role confusion and dynamic recovery), and risk factors that affect peers (stigma, exposure to harm and burnout). This paper contributes to the literature on peer support as well as youth participatory evaluation. The findings will be useful to support the development of improved organizational contexts for peer practice and more effective peer support programming.
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Affiliation(s)
- Tanya Halsall
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada.
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
| | - Mardi Daley
- LOFT Community Services, 721 Bloor St. W Suite 301, Toronto, ON, M6G 1L5, Canada
| | - Lisa D Hawke
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1L8, Canada
| | - Jo Henderson
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1L8, Canada
| | - Anne Wilson
- LOFT Community Services, 721 Bloor St. W Suite 301, Toronto, ON, M6G 1L5, Canada
| | - Kimberly Matheson
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
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Stich C, Lakrouf R, Moreau J. Support Interventions for Young People in Housing Programs: A Rapid Literature Review. JOURNAL OF PREVENTION (2022) 2023; 44:615-637. [PMID: 37642906 DOI: 10.1007/s10935-023-00743-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
This rapid review synthesizes current original research studies concerning support interventions intended for young people who experienced homelessness and are housed through youth-focused housing programs. Peer-reviewed articles on interventions for young people between 13 and 25 years of age with experience of homelessness living in youth-focused housing published between January 2017 and May 2022 were search in Scopus, Web of Sciences, PubMed, and EBSCO. Ten articles were included in the review. Interventions examined in the reviewed literature included case management, psychosocial and mental health support interventions; social support through peer support, mentorship, and positive social networks; and socioeconomic inclusion through skill building. Evidence found in the current review provides directions for the development of promising practices.
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Affiliation(s)
- Christine Stich
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | - Racha Lakrouf
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Juliane Moreau
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Lund JI, Toombs E, Mushquash CJ, Pitura V, Toneguzzi K, Bobinski T, Leon S, Vitopoulos N, Frederick T, Kidd SA. Cultural adaptation considerations of a comprehensive housing outreach program for indigenous youth exiting homelessness. Transcult Psychiatry 2022:13634615221135438. [PMID: 36567597 DOI: 10.1177/13634615221135438] [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] [Indexed: 12/27/2022]
Abstract
Generalist health interventions that aim to reduce chronic health disparities between Indigenous and non-Indigenous populations can be culturally adapted to better meet the needs of Indigenous people in Canada; however, little is known regarding best practices in implementing these adaptations. The present study first provides a review of the research process used to adapt a previous evidence-based housing initiative for Indigenous youth in Northwestern Ontario. Second, it includes an overview of the adaptations that were made and the associated rationale for such adaptations. Third, it examines the experiences of participants and staff involved in the cultural adaptation of the Housing Outreach Program Collaborative (HOP-C), a health intervention re-designed to improve physical and mental health outcomes, wellbeing, and social support for formerly homeless Indigenous youth as they secure housing. Qualitative feedback from interviews with 15 participants and eight program staff, in addition to one focus group with an additional six frontline workers, described perceived outcomes of the program's cultural adaptations. Modifications to the overall program structure, specific roles within the program (including counseling services, peer mentorship, cultural services, and case management), and adaptations to general implementation within the health organization providing the intervention were described by participants and staff as effective and helpful adaptations. The focus of Indigenous values at an organizational level led to consistent adaptations in counseling and case management to best meet the unique needs of the youth involved. Based upon participant interviews, recommendations to future adaptations are provided.
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Affiliation(s)
- Jessie I Lund
- Department of Psychology, 7890Lakehead University, Canada
| | - Elaine Toombs
- Department of Psychology, 7890Lakehead University, Canada
- Dilico Anishinabek Family Care, Fort William First Nation, Canada
| | - Christopher J Mushquash
- Department of Psychology, 7890Lakehead University, Canada
- Dilico Anishinabek Family Care, Fort William First Nation, Canada
- Northern Ontario School of Medicine (NOSM), 7890Lakehead University, Canada
- Thunder Bay Regional Health Research Institute, Canada
| | | | | | - Tina Bobinski
- Dilico Anishinabek Family Care, Fort William First Nation, Canada
| | | | | | - Tyler Frederick
- Department of Criminology and Justice, 85458Ontario Tech University, Canada
| | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Canada
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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.
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Exploring the conceptualization, operationalization, implementation, and measurement of outreach in community settings with hard-to-reach and hidden populations: A scoping review. Soc Sci Med 2022; 309:115232. [DOI: 10.1016/j.socscimed.2022.115232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/23/2022] [Accepted: 07/16/2022] [Indexed: 11/20/2022]
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Thulien NS, Wang A, Mathewson C, Wang R, Hwang SW. Tackling exclusion: A pilot mixed method quasi-experimental identity capital intervention for young people exiting homelessness. PLoS One 2021; 16:e0256288. [PMID: 34415951 PMCID: PMC8378743 DOI: 10.1371/journal.pone.0256288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Longitudinal studies examining the life trajectories of young people after they have exited homelessness have identified concerns with persistent social and economic exclusion, struggles to shake off identities of homelessness, and housing instability. This pilot study sought to explore the feasibility of improving socioeconomic inclusion outcomes by bolstering identity capital (sense of purpose and control, self-efficacy and self-esteem) among young people who had experienced homelessness. Methods Nineteen individuals (aged 18–26) who had transitioned out of homelessness within the past three years participated in a six-week, six-session program focused on building identity capital. The study employed a mixed method prospective cohort hybrid design with an intervention group (Group One) and a delayed intervention comparison group (Group Two). Participants were interviewed every three months until nine months post-intervention. Results None of the youth who began the intervention dropped out of the program, with the exception of one participant who moved across the country and was unable to continue. Immediately after participating in the intervention, Group One had statistically significant improvements (p < .05) and large to very large effect sizes in self-esteem (d = 1.16) and physical community integration (d = 1.79) compared to changes in Group Two over the same period, which had not yet begun the intervention. In the pooled analysis, small to moderate effect sizes in hopelessness, physical community integration, and self-esteem were observed at all post-intervention time points. Notably, at six- and nine-months post-intervention, statistically significant improvements (p < .05) and moderate effect sizes in hopelessness (d = -0.73 and d = -0.60 respectively) and self-esteem (d = 0.71 and d = 0.53 respectively) were observed. Youth shared they appreciated the normalizing (vs. pathologizing) of strategies they needed to learn and spoke of the importance of framing new skills as something one needs “to have a better life” vs. “to get better.” Conclusions These early findings signal that targeting identity capital is feasible and may be a promising approach to incorporate into a more complex intervention that includes housing, education, and employment supports to help youth transition out of homelessness. Future research could build on these findings through a sufficiently powered randomized controlled trial.
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Affiliation(s)
- Naomi S. Thulien
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Andrea Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- School of Medicine, Boston University, Boston, Massachusetts, United States of America
| | | | - Ri Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Mercado M, Marroquín JM, Ferguson KM, Bender K, Shelton J, Prock KA, Maria DS, Hsu HT, Narendorf SC, Petering R, Barman-Adhikari A. The intersection of housing and mental well-being: Examining the needs of formerly homeless young adults transitioning to stable housing. SSM Popul Health 2021; 14:100775. [PMID: 33816749 PMCID: PMC8005844 DOI: 10.1016/j.ssmph.2021.100775] [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] [Received: 10/19/2020] [Revised: 02/03/2021] [Accepted: 03/05/2021] [Indexed: 11/27/2022] Open
Abstract
We examine the challenges formerly homeless young adults (FHYAs) face after they transition out of homelessness. Considering the adversities FHYAs face, it is unclear how transitioning to stable housing may affect their mental well-being or what types of stressors they may experience once housed. This study investigates the social environment young adults encounter in their transition to stable housing and examines trauma and social coping predictors of mental health symptoms in a sample of FHYAs to generate new knowledge for better intervening to meet their needs. Data were obtained from REALYST, a national research collaborative comprised of interdisciplinary researchers investigating young adults' (ages 18-26) experiences with homelessness. Cross-sectional data for 1426 young adults experiencing homelessness were collected from 2016 to 2017 across seven cities in the United States (i.e., Los Angeles, Phoenix, Denver, Houston, San Jose, St. Louis, and New York City). The analytical sub-sample for this study consisted of 173 FHYAs who were housed in their own apartment (via voucher from Housing and Urban Development or another source) or in transitional living programs during their participation in the study. Ordinary Least Squares regression was used to examine the influence of trauma and social coping strategies on indicators of mental well-being. Findings indicated that higher adversity scores and higher mental health help-seeking intentions were positively associated with higher levels of stress, psychological distress, and depression severity. Higher level of social coping was associated with lower levels of depression severity. Logistic regression results showed that young adults with higher adversity scores had higher odds of reporting clinical levels of post-traumatic symptoms. The study implications suggest that FHYAs who transition to stable housing continue to need support navigating and coping with stressful life events; and interventions that help FHYAs develop strong networks of social supports are needed to promote positive mental well-being.
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Affiliation(s)
- Micaela Mercado
- Arizona State University 201 North Central Avenue, 33rd Floor Phoenix, AZ, 85004, USA
| | - J Marisol Marroquín
- Arizona State University 201 North Central Avenue, 33rd Floor Phoenix, AZ, 85004, USA
| | - Kristin M Ferguson
- Arizona State University 201 North Central Avenue, 33rd Floor Phoenix, AZ, 85004, USA
| | - Kimberly Bender
- University of Denver, Graduate School of Social Work, 2148 S. High Street Denver, CO, 80208, USA
| | - Jama Shelton
- Silberman School of Social Work, Hunter College, 2180 3rd Avenue NYC, NY, 10035, USA
| | - Kristen A Prock
- University of Wisconsin-Whitewater, Department of Social Work, 800 W Main St, Whitewater, WI, 53190, USA
| | - Diane Santa Maria
- University of Texas Health Science Center at Houston, Cizik School of Nursing, 6901 Bertner Ave, Houston, TX, 77030, USA
| | - Hsun-Ta Hsu
- University of Missouri.edu, 709 Clark Hall, Columbia, MO, 65211, USA
| | - Sarah Carter Narendorf
- University of Houston, Graduate College of Social Work 3511 Cullen Blvd., Houston, TX, 77204, USA
| | - Robin Petering
- Lens Co, Research and Advocacy Consulting, Los Angeles, CA, 90026, USA
| | - Anamika Barman-Adhikari
- University of Denver, Graduate School of Social Work, 2148 S. High Street Denver, CO, 80208, USA
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