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Harfield S, Purcell T, Schioldann E, Ward J, Pearson O, Azzopardi P. Enablers and barriers to primary health care access for Indigenous adolescents: a systematic review and meta-aggregation of studies across Australia, Canada, New Zealand, and USA. BMC Health Serv Res 2024; 24:553. [PMID: 38693527 PMCID: PMC11062015 DOI: 10.1186/s12913-024-10796-5] [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: 08/18/2023] [Accepted: 02/28/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Indigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review identifies the enablers and barriers to primary health care access for Indigenous adolescents to inform service and policy improvements. METHODS We systematically searched databases for publications reporting enablers or barriers to primary health care access for Indigenous adolescents from the perspective of adolescents, their parents and health care providers, and included studies focused on Indigenous adolescents aged 10-24 years from Australia, Canada, New Zealand, and United States of America. Results were analyzed against the WHO Global standards for quality health-care services for adolescents. An additional ninth standard was added which focused on cultural safety. RESULTS A total of 41 studies were included. More barriers were identified than enablers, and against the WHO Global standards most enablers and barriers related to supply factors - providers' competencies, appropriate package of services, and cultural safety. Providers who built trust, respect, and relationships; appropriate package of service; and culturally safe environments and care were enablers to care reported by adolescents, and health care providers and parents. Embarrassment, shame, or fear; a lack of culturally appropriate services; and privacy and confidentiality were common barriers identified by both adolescent and health care providers and parents. Cultural safety was identified as a key issue among Indigenous adolescents. Enablers and barriers related to cultural safety included culturally appropriate services, culturally safe environment and care, traditional and cultural practices, cultural protocols, Indigenous health care providers, cultural training for health care providers, and colonization, intergenerational trauma, and racism. Nine recommendations were identified which aim to address the enablers and barriers associated with primary health care access for Indigenous adolescents. CONCLUSION This review provides important evidence to inform how services, organizations and governments can create accessible primary health care services that specifically meet the needs of Indigenous adolescents. We identify nine recommendations for improving the accessibility of primary health care services for Indigenous adolescents.
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Affiliation(s)
- Stephen Harfield
- UQ Poche Centre for Indigenous Health, University of Queensland, St Lucia, Australia.
- School of Public Health, University of Queensland, Herston, Australia.
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia.
- School of Public Health, The University of Adelaide, Adelaide, Australia.
| | - Tara Purcell
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Eliza Schioldann
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, University of Queensland, St Lucia, Australia
| | - Odette Pearson
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Peter Azzopardi
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Centre for Adolescent Health, Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Isaacs A, Bonsey A, Couch D. Centralized Intake Models and Recommendations for Their Use in Non-Acute Mental Health Services: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095747. [PMID: 37174264 PMCID: PMC10177908 DOI: 10.3390/ijerph20095747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
Centralized intake [CI] or single-entry models are utilized in health systems to facilitate service access by reducing waiting times. This scoping review aims to consolidate the Literature on CI service models to identify their characteristics and rationales for their use, as well as contexts in which they are used and challenges and benefits in implementing them. The review also aims to offer some lessons learned from the Literature and to make recommendations for its implementation in non-acute mental health services. The findings show that CI is mostly considered when there is increased demand for services and clients are required to navigate multiple services that operate individually. Successful models have meaningfully engaged all stakeholders from the outset and the telephone is the most common mode of intake. Recommendations are made for planning and preparation, for elements of the model, and for setting up the service network. When successfully implemented, CI has been shown to improve access and increase demand for services. However, if CI is not supported by a network of service providers who offer care that is acceptable to clients, the purpose of its implementation could be lost.
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Affiliation(s)
- Anton Isaacs
- School of Rural Health, Faculty of Medicine Nursing and Health Sciences, Monash University, Warragul, VIC 3820, Australia
| | - Alistair Bonsey
- Victorian and Tasmanian Primary Health Network Alliance, Parkville, VIC 3052, Australia
| | - Danielle Couch
- School of Rural Health, Faculty of Medicine Nursing and Health Sciences, Monash University, Warragul, VIC 3820, Australia
- Victorian and Tasmanian Primary Health Network Alliance, Parkville, VIC 3052, Australia
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Shah JL, Moinfar Z, Anderson KK, Gould H, Hutt-Macleod D, Jacobs P, Mitchell S, Nguyen T, Rodrigues R, Reaume-Zimmer P, Rudderham H, Rudderham S, Smyth R, Surood S, Urichuk L, Malla AK, Iyer SN, Latimer E. Return on investment from service transformation for young people experiencing mental health problems: Approach to economic evaluations in ACCESS Open Minds (Esprits ouverts), a multi-site pan-Canadian youth mental health project. Front Psychiatry 2023; 14:1030407. [PMID: 36896344 PMCID: PMC9988897 DOI: 10.3389/fpsyt.2023.1030407] [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: 08/28/2022] [Accepted: 01/03/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Mental health problems are common globally, and typically have their onset in adolescence and early adulthood-making youth (aged 11-25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth mental health (YMH) initiatives are now underway, thus far few have been subject to economic evaluations. Here we describe an approach to determining the return on investment of YMH service transformation via the pan-Canadian ACCESS Open Minds (AOM) project, for which a key focus is on improving access to mental health care and reducing unmet need in community settings. APPROACH As a complex intervention package, it is hoped that the AOM transformation will: (i) enable early intervention through accessible, community-based services; (ii) shift care away toward these primary/community settings and away from acute hospital and emergency services; and (iii) offset at least some of the increased costs of primary care/community-based mental health services with reductions in the volume of more resource-intensive acute, emergency, hospital or specialist services utilized. Co-designed with three diverse sites that represent different Canadian contexts, a return on investment analysis will (separately at each site) compare the costs generated by the intervention, including volumes and expenditures associated with the AOM service transformation and any contemporaneous changes in acute, emergency, hospital or service utilization (vs. historical or parallel comparators). Available data from health system partners are being mobilized to assess these hypotheses. ANTICIPATED RESULTS Across urban, semi-urban and Indigenous sites, the additional costs of the AOM transformation and its implementation in community settings are expected to be at least partially offset by a reduction in the need for acute, emergency, hospital or specialist care. DISCUSSION Complex interventions such as AOM aim to shift care "upstream": away from acute, emergency, hospital and specialist services and toward community-based programming which is more easily accessible, often more appropriate for early-stage presentations, and more resource-efficient. Carrying out economic evaluations of such interventions is challenging given the constraints of available data and health system organization. Nonetheless, such analyses can advance knowledge, strengthen stakeholder engagement, and further implementation of this public health priority.
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Affiliation(s)
- Jai L Shah
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Zeinab Moinfar
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Institute of Clinical and Evaluative Sciences, Toronto, ON, Canada
| | | | | | - Philip Jacobs
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stephen Mitchell
- Canadian Mental Health Association Lambton Kent, Chatham-Kent, ON, Canada
| | - Thanh Nguyen
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Paula Reaume-Zimmer
- Canadian Mental Health Association Lambton Kent, Chatham-Kent, ON, Canada.,Bluewater Health, Chatham-Kent, ON, Canada
| | | | | | - Rebecca Smyth
- Canadian Mental Health Association Lambton Kent, Chatham-Kent, ON, Canada
| | | | | | - Ashok K Malla
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Srividya N Iyer
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Eric Latimer
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, 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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Okpalauwaekwe U, Ballantyne C, Tunison S, Ramsden VR. Enhancing health and wellness by, for and with Indigenous youth in Canada: a scoping review. BMC Public Health 2022; 22:1630. [PMID: 36038858 PMCID: PMC9422134 DOI: 10.1186/s12889-022-14047-2] [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: 04/14/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous youth in Canada face profound health inequities which are shaped by the rippling effects of intergenerational trauma, caused by the historical and contemporary colonial policies that reinforce negative stereotypes regarding them. Moreover, wellness promotion strategies for these youth are replete with individualistic Western concepts that excludes avenues for them to access holistic practices grounded in their culture. Our scoping review explored strategies, approaches, and ways health and wellness can be enhanced by, for, and with Indigenous youth in Canada by identifying barriers/roadblocks and facilitators/strengths to enhancing wellness among Indigenous youth in Canada. METHODS We applied a systematic approach to searching and critically reviewing peer-reviewed literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews [PRISMA-ScR] as a reporting guideline. Our search strategy focused on specific keywords and MeSH terms for three major areas: Indigenous youth, health, and Canada. We used these keywords, to systematically search the following electronic databases published in English between January 01, 2017, to May 22, 2021: Medline [Ovid], PubMed, ERIC, Web of Science, Scopus, and iportal. We also used hand-searching and snowballing methods to identify relevant articles. Data collected were analysed for contents and themes. RESULTS From an initial 1695 articles collated, 20 articles met inclusion criteria for this review. Key facilitators/strengths to enhancing health and wellness by, for, and with Indigenous youth that emerged from our review included: promoting culturally appropriate interventions to engage Indigenous youth; using strength-based approaches; reliance on the wisdom of community Elders; taking responsibility; and providing access to wellness supports. Key barriers/roadblocks included: lack of community support for wellness promotion activities among Indigenous youth; structural/organizational issues within Indigenous communities; discrimination and social exclusion; cultural illiteracy among youth; cultural discordance with mainstream health systems and services; and addictions and risky behaviours. CONCLUSION This scoping review extracted 20 relevant articles about ways to engage Indigenous youth in health and wellness enhancement. Our findings demonstrate the importance of promoting health by, and with Indigenous youth, by engaging them in activities reflexive of their cultural norms, rather than imposing control measures that are incompatible with their value systems.
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Affiliation(s)
- Udoka Okpalauwaekwe
- Health Sciences Program, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E5, Canada.
| | - Clifford Ballantyne
- Sturgeon Lake Youth Center, Sturgeon Lake First Nation, Sturgeon Lake, Saskatchewan, S0J 2E1, Canada
| | - Scott Tunison
- University of Saskatchewan, Saskatoon, Saskatchewan, S7N 0X1, Canada
| | - Vivian R Ramsden
- Research Division, Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7M 3Y5, Canada.
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6
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Corso M, DeSouza A, Brunton G, Yu H, Cancelliere C, Mior S, Taylor-Vaisey A, MacLeod-Beaver K, Côté P. Integrating Indigenous healing practices within collaborative care models in primary healthcare in Canada: a rapid scoping review. BMJ Open 2022; 12:e059323. [PMID: 35710234 PMCID: PMC9207893 DOI: 10.1136/bmjopen-2021-059323] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES In November 2020, a series of reports, In Plain Sight, described widespread Indigenous-specific stereotyping, racism and discrimination limiting access to medical treatment and negatively impacting the health and wellness of Indigenous Peoples in British Columbia, Canada. To address the health inequalities experienced by Indigenous peoples, Indigenous healing practices must be integrated within the delivery of care. This rapid scoping review aimed to identify and synthesise strategies used to integrate Indigenous healing practices within collaborative care models available in community-based primary healthcare, delivered by regulated health professionals in Canada. ELIGIBILITY CRITERIA We included quantitative, qualitative and mixed-methods studies conducted in community-based primary healthcare practices that used strategies to integrate Indigenous healing practices within collaborative care models. SOURCES OF EVIDENCE We searched MEDLINE, Embase, Indigenous Studies Portal, Informit Indigenous Collection and Native Health Database for studies published from 2015 to 2021. CHARTING METHODS Our data extraction used three frameworks to categorise the findings. These frameworks defined elements of integrated healthcare (ie, functional, organisational, normative and professional), culturally appropriate primary healthcare and the extent of community engagement. We narratively summarised the included study characteristics. RESULTS We identified 2573 citations and included 31 in our review. Thirty-nine per cent of reported strategies used functional integration (n=12), 26% organisational (n=8), 19% normative (n=6) and 16% professional (n=5). Eighteen studies (58%) integrated all characteristics of culturally appropriate Indigenous healing practices into primary healthcare. Twenty-four studies (77%) involved Indigenous leadership or collaboration at each phase of the study and, seven (23%) included consultation only or the level of engagement was unclear. CONCLUSIONS We found that collaborative and Indigenous-led strategies were more likely to facilitate and implement the integration of Indigenous healing practices. Commonalities across strategies included community engagement, elder support or Indigenous ceremony or traditions. However, we did not evaluate the effectiveness of these strategies.
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Affiliation(s)
- Melissa Corso
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Astrid DeSouza
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Ginny Brunton
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | - Hainan Yu
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Carolina Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Silvano Mior
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
- Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Anne Taylor-Vaisey
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | | | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
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7
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Boksa P, Hutt-MacLeod D, Clair L, Brass G, Bighead S, MacKinnon A, Etter M, Gould H, Sock E, Matoush J, Rabbitskin N, Ballantyne C, Goose A, Rudderham H, Plourde V, Gordon M, Gilbert L, Ramsden VR, Noel V, Malla A, Iyer SN. Demographic and Clinical Presentations of Youth using Enhanced Mental Health Services in Six Indigenous Communities from the ACCESS Open Minds Network. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:179-191. [PMID: 34796730 PMCID: PMC8935596 DOI: 10.1177/07067437211055416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In many Indigenous communities, youth mental health services are inadequate. Six Indigenous communities participating in the ACCESS Open Minds (AOM) network implemented strategies to transform their youth mental health services. This report documents the demographic and clinical presentations of youth accessing AOM services at these Indigenous sites. METHODS Four First Nations and two Inuit communities contributed to this study. Youth presenting for mental health services responded to a customized sociodemographic questionnaire and presenting concerns checklist, and scales assessing distress, self-rated health and mental health, and suicidal thoughts and behaviors. RESULTS Combined data from the First Nations sites indicated that youth across the range of 11-29 years accessed services. More girls/women than boys/men accessed services; 17% identified as LBGTQ+. Most (83%) youth indicated having access to at least one reliable adult and getting along well with the people living with them. Twenty-five percent of youth reported difficulty meeting basic expenses. Kessler (K10) distress scores indicated that half likely had a moderate mental health problem and a fourth had severe problems. Fifty-five percent of youth rated their mental health as fair or poor, while 50% reported suicidal thoughts in the last month. Anxiety, stress, depression and sleep issues were the most common presenting problems. Fifty-one percent of youth either accessed services themselves or were referred by family members. AOM was the first mental health service accessed that year for 68% of youth. CONCLUSIONS This report is the first to present a demographic and clinical portrait of youth presenting at mental health services in multiple Indigenous settings in Canada. It illustrates the acceptability and feasibility of transforming youth mental health services using core principles tailored to meet communities' unique needs, resources, and cultures, and evaluating these using a common protocol. Data obtained can be valuable in evaluating services and guiding future service design. Trial registration name and number at Clinicaltrials.gov: ACCESS Open Minds/ACCESS Esprits ouverts, ISRCTN23349893.
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Affiliation(s)
- Patricia Boksa
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Daphne Hutt-MacLeod
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Eskasoni Mental Health Services and ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada
| | - Lacey Clair
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Elsipogtog Health and Wellness Centre and ACCESS Open Minds New Brunswick, Elsipogtog First Nation, New Brunswick, Canada
| | - Gregory Brass
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Aaschihkuwaataauch (ACCESS Open Minds Cree Nation of Mistissini) and Mental Health Maanuuhiikuu, Pimuhteheu (Public Health Department), Cree Board of Health and Social Services of James Bay, Cree Nation of Mistissini, Quebec, Canada
| | - Shirley Bighead
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Sturgeon Lake Health Centre, Sturgeon Lake First Nation, Saskatchewan, Canada
| | - Aileen MacKinnon
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Saqijuq-ACCESS OM-Puvirnituq, Puvirnituq, Quebec, Canada and Saqijuaq (Puvirnituq, Kangirsuk, Akulivik)
| | - Meghan Etter
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,ACCESS Open Minds Ulukhaktok, Ulukhaktok, Northwest Territories and Inuvialuit Regional Corporation, Inuvik, Northwest Territories, Canada
| | - Hayley Gould
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Eskasoni Mental Health Services and ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada
| | - Eva Sock
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Elsipogtog Health and Wellness Centre and ACCESS Open Minds New Brunswick, Elsipogtog First Nation, New Brunswick, Canada
| | - Julie Matoush
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Aaschihkuwaataauch (ACCESS Open Minds Cree Nation of Mistissini) and Mental Health Maanuuhiikuu, Pimuhteheu (Public Health Department), Cree Board of Health and Social Services of James Bay, Cree Nation of Mistissini, Quebec, Canada
| | - Norma Rabbitskin
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Sturgeon Lake Health Centre, Sturgeon Lake First Nation, Saskatchewan, Canada
| | - Clifford Ballantyne
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Sturgeon Lake Health Centre, Sturgeon Lake First Nation, Saskatchewan, Canada
| | - Annie Goose
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,ACCESS Open Minds Ulukhaktok, Ulukhaktok, Northwest Territories and Inuvialuit Regional Corporation, Inuvik, Northwest Territories, Canada
| | - Heather Rudderham
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Eskasoni Mental Health Services and ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada
| | - Vickie Plourde
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,School of Psychology, 5568University of Moncton, Moncton, New Brunswick, Canada
| | - Maria Gordon
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Aaschihkuwaataauch (ACCESS Open Minds Cree Nation of Mistissini) and Mental Health Maanuuhiikuu, Pimuhteheu (Public Health Department), Cree Board of Health and Social Services of James Bay, Cree Nation of Mistissini, Quebec, Canada
| | - Lorna Gilbert
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Sturgeon Lake Health Centre, Sturgeon Lake First Nation, Saskatchewan, Canada
| | - Vivian R Ramsden
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Academic Family Medicine, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Valerie Noel
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ashok Malla
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Srividya N Iyer
- ACCESS Open Minds Youth Mental Health Services Research Network, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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8
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Liebenberg L, Scherman V. Resilience and the Sustainable Development Goals (SDGs): Promoting child and youth resilience and related mental health outcomes. JOURNAL OF PSYCHOLOGY IN AFRICA 2021. [DOI: 10.1080/14330237.2021.1978180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Linda Liebenberg
- Department of Psychology of Education, University of South Africa, Pretoria, South Africa
| | - Vanessa Scherman
- Department of Psychology of Education, University of South Africa, Pretoria, South Africa
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9
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Murphy K, Branje K, White T, Cunsolo A, Latimer M, McMillan J, Sylliboy JR, McKibbon S, Martin D. Are we walking the talk of participatory Indigenous health research? A scoping review of the literature in Atlantic Canada. PLoS One 2021; 16:e0255265. [PMID: 34314455 PMCID: PMC8315539 DOI: 10.1371/journal.pone.0255265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/13/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Participatory research involving community engagement is considered the gold standard in Indigenous health research. However, it is sometimes unclear whether and how Indigenous communities are engaged in research that impacts them, and whether and how engagement is reported. Indigenous health research varies in its degree of community engagement from minimal involvement to being community-directed and led. Research led and directed by Indigenous communities can support reconciliation and reclamation in Canada and globally, however clearer reporting and understandings of community-led research is needed. This scoping review assesses (a) how and to what extent researchers are reporting community engagement in Indigenous health research in Atlantic Canada, and (b) what recommendations exist in the literature regarding participatory and community-led research. METHODS Eleven databases were searched using keywords for Indigeneity, geographic regions, health, and Indigenous communities in Atlantic Canada between 2001-June 2020. Records were independently screened by two reviewers and were included if they were: peer-reviewed; written in English; health-related; and focused on Atlantic Canada. Data were extracted using a piloted data charting form, and a descriptive and thematic analysis was performed. 211 articles were retained for inclusion. RESULTS Few empirical articles reported community engagement in all aspects of the research process. Most described incorporating community engagement at the project's onset and/or during data collection; only a few articles explicitly identified as entirely community-directed or led. Results revealed a gap in reported capacity-building for both Indigenous communities and researchers, necessary for holistic community engagement. Also revealed was the need for funding bodies, ethics boards, and peer review processes to better facilitate participatory and community-led Indigenous health research. CONCLUSION As Indigenous communities continue reclaiming sovereignty over identities and territories, participatory research must involve substantive, agreed-upon involvement of Indigenous communities, with community-directed and led research as the ultimate goal.
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Affiliation(s)
- Kathleen Murphy
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karina Branje
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tara White
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashlee Cunsolo
- School of Arctic and Sub-Arctic Studies, Labrador Institute of Memorial University, Memorial University, Happy Valley-Goose Bay, Newfoundland & Labrador, Canada
| | - Margot Latimer
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jane McMillan
- Department of Anthropology, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - John R. Sylliboy
- Department of Integrated Studies in Education (DISE), McGill University, Montreal, Quebec, Canada
| | - Shelley McKibbon
- Kellogg Health Sciences Library, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Debbie Martin
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
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10
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Roher SIG, Yu Z, Martin DH, Benoit AC. How is Etuaptmumk/Two-Eyed Seeing characterized in Indigenous health research? A scoping review. PLoS One 2021; 16:e0254612. [PMID: 34283831 PMCID: PMC8291645 DOI: 10.1371/journal.pone.0254612] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
Our scoping review sought to consider how Etuaptmumk or Two-Eyed Seeing is described in Indigenous health research and to compare descriptions of Two-Eyed Seeing between original authors (Elders Albert and Murdena Marshall, and Dr. Cheryl Bartlett) and new authors. Using the JBI scoping review methodology and qualitative thematic coding, we identified seven categories describing the meaning of Two-Eyed Seeing from 80 articles: guide for life, responsibility for the greater good and future generations, co-learning journey, multiple or diverse perspectives, spirit, decolonization and self-determination, and humans being part of ecosystems. We discuss inconsistencies between the original and new authors, important observations across the thematic categories, and our reflections from the review process. We intend to contribute to a wider dialogue about how Two-Eyed Seeing is understood in Indigenous health research and to encourage thoughtful and rich descriptions of the guiding principle.
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Affiliation(s)
- Sophie I. G. Roher
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Circumpolar Health Research, Yellowknife, Northwest Territories, Canada
| | - Ziwa Yu
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Debbie H. Martin
- Health Promotion Division, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anita C. Benoit
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute-Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
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11
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Iyer SN, Shah J, Boksa P, Lal S, Joober R, Andersson N, Fuhrer R, Abdel-Baki A, Beaton AM, Reaume-Zimmer P, Hutt-MacLeod D, Levasseur MA, Chandrasena R, Rousseau C, Torrie J, Etter M, Vallianatos H, Abba-Aji A, Bighead S, MacKinnon A, Malla AK. A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project. BMC Psychiatry 2019; 19:273. [PMID: 31488144 PMCID: PMC6729084 DOI: 10.1186/s12888-019-2232-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Many Canadian adolescents and young adults with mental health problems face delayed detection, long waiting lists, poorly accessible services, care of inconsistent quality and abrupt or absent inter-service transitions. To address these issues, ACCESS Open Minds, a multi-stakeholder network, is implementing and systematically evaluating a transformation of mental health services for youth aged 11 to 25 at 14 sites across Canada. The transformation plan has five key foci: early identification, rapid access, appropriate care, the elimination of age-based transitions between services, and the engagement of youth and families. METHODS The ACCESS Open Minds Research Protocol has multiple components including a minimum evaluation protocol and a stepped-wedge cluster randomized trial, that are detailed in this paper. Additional components include qualitative methods and cost-effectiveness analyses. The services transformation is being evaluated at all sites via a minimum evaluation protocol. Six sites are participating in the stepped-wedge trial whereby the intervention (a service transformation along the key foci) was rolled out in three waves, each commencing six months apart. Two sites, one high-population and one low-population, were randomly assigned to each of the three waves, i.e., randomization was stratified by population size. Our primary hypotheses pertain to increased referral numbers, and reduced wait times to initial assessment and to the commencement of appropriate care. Secondary hypotheses pertain to simplified pathways to care; improved clinical, functional and subjective outcomes; and increased satisfaction among youth and families. Quantitative measures addressing these hypotheses are being used to determine the effectiveness of the intervention. DISCUSSION Data from our overall research strategy will help test the effectiveness of the ACCESS Open Minds transformation, refine it further, and inform its scale-up. The process by which our research strategy was developed has implications for the practice of research itself in that it highlights the need to actively engage all stakeholder groups and address unique considerations in designing evaluations of complex healthcare interventions in multiple, diverse contexts. Our approach will generate both concrete evidence and nuanced insights, including about the challenges of conducting research in real-world settings. More such innovative approaches are needed to advance youth mental health services research. TRIAL REGISTRATION NUMBER Clinicaltrials.gov, ISRCTN23349893 (Retrospectively registered: 16/02/2017).
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Affiliation(s)
- Srividya N. Iyer
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Patricia Boksa
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Shalini Lal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec Canada
- Centre de recherche du Centre hospitalier de l’Universite de Montreal (CRCHUM), Montréal, Québec Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Neil Andersson
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Family Medicine, Community Information and Epidemiological Technologies (CIET) Institute and Participatory Research at McGill (PRAM), McGill University, Montréal, Québec Canada
- McGill University Institute for Human Development and Well-being, Montréal, Québec Canada
| | - Rebecca Fuhrer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec Canada
| | - Amal Abdel-Baki
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Centre de recherche du Centre hospitalier de l’Universite de Montreal (CRCHUM), Montréal, Québec Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec Canada
- Centre hospitalier de l’Université de Montréal (CHUM), CRCHUM, Montréal, Québec Canada
| | - Ann M. Beaton
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- School of Psychology, Faculty of Health Sciences and Community Services, Université de Moncton, Moncton, New Brunswick, Canada
| | - Paula Reaume-Zimmer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Mental Health and Addictions Services, Bluewater Health and Canadian Mental Health Association, Lambton Kent, Ontario, Canada
| | - Daphne Hutt-MacLeod
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada
| | - Mary Anne Levasseur
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- ACCESS Open Minds Family and Carers Council, Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Ranjith Chandrasena
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Schulich School of Medicine, Western University, London, Ontario Canada
| | - Cécile Rousseau
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Centre de recherche SHERPA, Institut Universitaire au regard des communautés ethno culturelles, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Ouest-de-l’Île-de-Montreal, Montréal, Québec Canada
| | - Jill Torrie
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Public Health Department, Cree Board of Health and Social Services of James Bay, Cree Nation of Mistissini, Québec Canada
| | - Meghan Etter
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Counselling Services, Inuvialuit Regional Corporation, Inuvik, Northwest Territories, Canada
| | - Helen Vallianatos
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Anthropology, University of Alberta, Edmonton, Alberta Canada
| | - Adam Abba-Aji
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Alberta Health Services, Edmonton Zone, Edmonton, Alberta Canada
- Department of Psychiatry, University of Alberta, Edmonton, Alberta Canada
| | - Shirley Bighead
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Sturgeon Lake Health Centre, Sturgeon Lake First Nation, Saskatchewan, Canada
| | - Aileen MacKinnon
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Saqijuq Project, Nunavik, Québec Canada
| | - Ashok K. Malla
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec Canada
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12
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Hutt-MacLeod D, Rudderham H, Sylliboy A, Sylliboy-Denny M, Liebenberg L, Denny JF, Gould MR, Gould N, Nossal M, Iyer SN, Malla A, Boksa P. Eskasoni First Nation's transformation of youth mental healthcare: Partnership between a Mi'kmaq community and the ACCESS Open Minds research project in implementing innovative practice and service evaluation. Early Interv Psychiatry 2019; 13 Suppl 1:42-47. [PMID: 31243913 PMCID: PMC6771551 DOI: 10.1111/eip.12817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM ACCESS Open Minds (ACCESS OM) is a pan-Canadian project aimed at improving youth mental healthcare. This paper describes implementation of the ACCESS OM objectives for youth mental health service transformation within a pre-existing Fish Net Model of transformative youth mental healthcare service in the First Nation community of Eskasoni, on Canada's east coast. METHODS We describe an adaptation of the ACCESS OM service transformation objectives through the complementary blending of Indigenous and Western methodologies. This concept of "Two-Eyed Seeing" is illustrated as central to engaging youth in the community and attending to their mental health needs and wellness. RESULTS The ACCESS OM Eskasoni First Nation Youth Space acts as a central location for the site team and its activities, which expand into the rest of the community to facilitate early identification of youth in need. Rapid access to care is promoted via barrier-free availability through a central intake crisis and referral centre, and ease of contact through social media and other modalities. Youth are given the choice between standard Western mental health services, or Indigenous methods of improving well-being, or a combination of the two. CONCLUSIONS The ACCESS OM framework has shown early results of being a positive addition to the Eskasoni community. Local leadership and community buy-in are identified as key factors to success. Further exploration, research, and evaluation of this transformation is ongoing. Successful implementation of this model in Eskasoni could act as a model for youth mental health programmes in other First Nations across Canada.
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Affiliation(s)
- Daphne Hutt-MacLeod
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Heather Rudderham
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Arnold Sylliboy
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Mallery Sylliboy-Denny
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Linda Liebenberg
- Faculty of Graduate Studies, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeannine F Denny
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada
| | - Matthew R Gould
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Norma Gould
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Margot Nossal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Srividya N Iyer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ashok Malla
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Patricia Boksa
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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