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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Latimer M, Sylliboy JR, Francis J, Amey S, Rudderham S, Finley GA, MacLeod E, Paul K. Co-creating better healthcare experiences for First Nations children and youth: The FIRST approach emerges from Two-Eyed seeing. Paediatr Neonatal Pain 2020; 2:104-112. [PMID: 35548261 PMCID: PMC8975202 DOI: 10.1002/pne2.12024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 11/06/2022]
Abstract
To achieve health, Indigenous people seek a life that balances mental, spiritual, emotional, and physical wellness, yet the scope of these four dimensions is not typically considered in the Western-based health system. Indigenous people experience ongoing pain and hurt in all these dimensions as a result of a colonial legacy that persists in current-day policy and care contexts. Exploring ways to support Indigenous people to embrace ways of being well and reducing chronic pain has not been a priority area in health research. This community-based, qualitative study in four First Nations communities involved conversation sessions with 188 First Nations children, youth, parents, and Elders and 32 professionals who practice in those communities. The purpose was to gather perspectives related to pain expression, care experiences, and the strategies to improve the healthcare encounter. Thematic analysis was used to identify a more culturally thoughtful approach for clinicians to consider when First Nations people seek care. Two-Eyed Seeing consisting of four iterative steps was used to co-create the FIRST approach validating for community members that their perspectives were heard and providing a clinical approach for culturally safe practices with children, youth, and families. An overarching theme in the results was a clearer understanding about how pain and hurt translate into participants' health experiences and their desire to have their knowledge reflected in their health care. Participants describe experiencing pain and hurt in all four dimensions of health and from a historical, cultural, and spiritual identity, as well as from a community, family, and individual perspective. The FIRST approach captures Indigenous knowledge relating to Family, Information, Relationship, Safe-Space, and Two-Eyed treatment in the healthcare encounter. Considerations of this approach in clinical practice could enhance respectful and trusting relationships, knowledge exchange for better care experiences, and potentially improvement of culturally sensitive outcomes for Indigenous people.
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Affiliation(s)
- Margot Latimer
- IWK Health Centre Halifax Nova Scotia Canada.,Dalhousie University Halifax Nova Scotia Canada
| | - John R Sylliboy
- IWK Health Centre Halifax Nova Scotia Canada.,McGill University Montreal Quebec Canada
| | - Julie Francis
- IWK Health Centre Halifax Nova Scotia Canada.,Eskasoni First Nation Health Centre Nova Scotia Canada
| | - Sharon Amey
- IWK Health Centre Halifax Nova Scotia Canada
| | | | - G Allen Finley
- IWK Health Centre Halifax Nova Scotia Canada.,Dalhousie University Halifax Nova Scotia Canada
| | | | - Kara Paul
- IWK Health Centre Halifax Nova Scotia Canada
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Latimer M, Rudderham S, Lethbridge L, MacLeod E, Harman K, Sylliboy JR, Filiaggi C, Finley GA. Occurrence of and referral to specialists for pain-related diagnoses in First Nations and non-First Nations children and youth. CMAJ 2019; 190:E1434-E1440. [PMID: 30530610 DOI: 10.1503/cmaj.180198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Indigenous youth have higher rates of chronic health conditions interfering with healthy development, including high rates of ear, dental, chest and musculoskeletal pain, as well as headache, arthritis and mental health issues. This study explores differences in pain-related diagnoses in First Nations and non-First Nations children. METHODS Data from a study population of age- and sex-matched First Nations and non-First Nations children and youth were accessed from a specific region of Atlantic Canada. The primary objective of the study was to compare diagnosis rates of painful conditions and specialist visits between cohorts. The secondary objective was to determine whether there were correlations between early physical pain exposure and pain in adolescence (physical and mental health). RESULTS Although ear- and throat-related diagnoses were more likely in the First Nations group than in the non-First Nations group (ear 67.3% v. 56.8%, p < 0.001; throat 89.3% v. 78.8%, p < 0.001, respectively), children in the First Nations group were less likely to see a relevant specialist (ear 11.8% v. 15.5%, p < 0.001; throat 12.7% v. 16.1%, p < 0.001, respectively). First Nations newborns were more likely to experience an admission to the neonatal intensive care unit (NICU) than non-First Nations newborns (24.4% v. 18.4%, p < 0.001, respectively). Non-First Nations newborns experiencing an NICU admission were more likely to receive a mental health diagnosis in adolescence, but the same was not found with the First Nations group (3.4% v. 5.7%, p < 0.03, respectively). First Nations children with a diagnosis of an ear or urinary tract infection in early childhood were almost twice as likely to have a diagnosis of headache or abdominal pain as adolescents (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1-3.0, and OR 1.7, 95% CI 1.2-2.3, respectively). INTERPRETATION First Nations children were diagnosed with more pain than non-First Nations children, but did not access specific specialists or mental health services, and were not diagnosed with mental health conditions, at the same rate as their non-First Nations counterparts. Discrepancies in pain-related diagnoses and treatment are evident in these specific comparative cohorts. Community-based health care access and treatment inquiries are required to determine ways to improve care delivery for common childhood conditions that affect health and development.
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Affiliation(s)
- Margot Latimer
- Faculty of Health (Latimer), Dalhousie University; Centre for Pediatric Pain Research (Latimer, MacLeod, Sylliboy, Filiaggi, Finley), IWK Health Centre, Halifax, NS; Department of Integrated Studies (Sylliboy), McGill University, Montréal, Que.; Eskasoni Health Centre (Rudderham), Eskasoni, NS; Departments of Surgery (Lethbridge) and Anesthesia, Pain Management and Perioperative Medicine (Finley), and School of Physiotherapy (Harman), Dalhousie University, Halifax, NS
| | - Sharon Rudderham
- Faculty of Health (Latimer), Dalhousie University; Centre for Pediatric Pain Research (Latimer, MacLeod, Sylliboy, Filiaggi, Finley), IWK Health Centre, Halifax, NS; Department of Integrated Studies (Sylliboy), McGill University, Montréal, Que.; Eskasoni Health Centre (Rudderham), Eskasoni, NS; Departments of Surgery (Lethbridge) and Anesthesia, Pain Management and Perioperative Medicine (Finley), and School of Physiotherapy (Harman), Dalhousie University, Halifax, NS
| | - Lynn Lethbridge
- Faculty of Health (Latimer), Dalhousie University; Centre for Pediatric Pain Research (Latimer, MacLeod, Sylliboy, Filiaggi, Finley), IWK Health Centre, Halifax, NS; Department of Integrated Studies (Sylliboy), McGill University, Montréal, Que.; Eskasoni Health Centre (Rudderham), Eskasoni, NS; Departments of Surgery (Lethbridge) and Anesthesia, Pain Management and Perioperative Medicine (Finley), and School of Physiotherapy (Harman), Dalhousie University, Halifax, NS
| | - Emily MacLeod
- Faculty of Health (Latimer), Dalhousie University; Centre for Pediatric Pain Research (Latimer, MacLeod, Sylliboy, Filiaggi, Finley), IWK Health Centre, Halifax, NS; Department of Integrated Studies (Sylliboy), McGill University, Montréal, Que.; Eskasoni Health Centre (Rudderham), Eskasoni, NS; Departments of Surgery (Lethbridge) and Anesthesia, Pain Management and Perioperative Medicine (Finley), and School of Physiotherapy (Harman), Dalhousie University, Halifax, NS
| | - Katherine Harman
- Faculty of Health (Latimer), Dalhousie University; Centre for Pediatric Pain Research (Latimer, MacLeod, Sylliboy, Filiaggi, Finley), IWK Health Centre, Halifax, NS; Department of Integrated Studies (Sylliboy), McGill University, Montréal, Que.; Eskasoni Health Centre (Rudderham), Eskasoni, NS; Departments of Surgery (Lethbridge) and Anesthesia, Pain Management and Perioperative Medicine (Finley), and School of Physiotherapy (Harman), Dalhousie University, Halifax, NS
| | - John R Sylliboy
- Faculty of Health (Latimer), Dalhousie University; Centre for Pediatric Pain Research (Latimer, MacLeod, Sylliboy, Filiaggi, Finley), IWK Health Centre, Halifax, NS; Department of Integrated Studies (Sylliboy), McGill University, Montréal, Que.; Eskasoni Health Centre (Rudderham), Eskasoni, NS; Departments of Surgery (Lethbridge) and Anesthesia, Pain Management and Perioperative Medicine (Finley), and School of Physiotherapy (Harman), Dalhousie University, Halifax, NS
| | - Corey Filiaggi
- Faculty of Health (Latimer), Dalhousie University; Centre for Pediatric Pain Research (Latimer, MacLeod, Sylliboy, Filiaggi, Finley), IWK Health Centre, Halifax, NS; Department of Integrated Studies (Sylliboy), McGill University, Montréal, Que.; Eskasoni Health Centre (Rudderham), Eskasoni, NS; Departments of Surgery (Lethbridge) and Anesthesia, Pain Management and Perioperative Medicine (Finley), and School of Physiotherapy (Harman), Dalhousie University, Halifax, NS
| | - G Allen Finley
- Faculty of Health (Latimer), Dalhousie University; Centre for Pediatric Pain Research (Latimer, MacLeod, Sylliboy, Filiaggi, Finley), IWK Health Centre, Halifax, NS; Department of Integrated Studies (Sylliboy), McGill University, Montréal, Que.; Eskasoni Health Centre (Rudderham), Eskasoni, NS; Departments of Surgery (Lethbridge) and Anesthesia, Pain Management and Perioperative Medicine (Finley), and School of Physiotherapy (Harman), Dalhousie University, Halifax, NS
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Latimer M, Rudderham S, Harman K, Finley A, Dutcher L, Hutt-Macleod D, Paul K. Using Art as a Medium for First Nations Youth to Express Their Pain: A Two-Eyed Seeing Qualitative Study. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e94a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: First Nations (FN) youth in Canada have the highest rates of pain-related conditions (ear, dental, headaches) yet may be least likely to be treated for them. Untreated pain has an arresting impact on growth and development and is detrimental to the achievement of life goals. In recent research conducted by the Aboriginal Children’s Hurt & Healing Initiative (ACHH), community participants reported that First Nation children are stoic and are reluctant to talk about their pain (Latimer & Rudderham, 2013). Clinicians are trained to assess pain based on overt signs of expression (cry, facial grimace, ability to describe) however if you do not present your pain this way it may reduce the chance of proper assessment and treatment.
OBJECTIVES: Using a Two-Eyed Seeing qualitative perspective (best of Indigenous and Western knowledge) the purpose of this research was to provide FN youth with the method of art making to determine how they express their pain.
DESIGN/METHODS: Youth from four FN communities, in three Maritime Provinces were invited to participate in art workshops facilitated by internationally renowned Mi’kmaq artist Alan Syliboy. The workshop began with a conversation circle about pain experiences and then proceeded to the art making. A FN documentary cinematographer captured the workshops and the results are documented in art and film. Three team members independently themed the data using thematic analysis and the inter-rater reliability was >85%.
RESULTS: 39 youth aged 10-18 years participated in 4 community-based conversation and art sessions. The themes for the sessions were themed using the four dimensions of the Medicine Wheel. While the overwhelming theme discussed in the conversation sessions was physical pain, when provided the nonverbal, art mode of expression, the youth painted emotional pain more frequently than physical, spiritual and mental pain. There was overlap between the four themes but 70% of the artwork prominently illustrated emotional pain with 54% overlapping with physical, 30% mental and 31% spiritual.
CONCLUSION: These results present a more complicated issue regarding the integration of the different types of pain, intertwined together. The finding that when asked-youth primarily discussed physical pain but given the opportunity, more frequently painted emotional pain may shed new light on the degree to which emotional pain is a factor for these youth. The artwork and accompanying narratives are powerful and have implications for understanding the complexity of assessing the different dimensions of pain in a culturally meaningful manner and for clinician education purposes. A sample of the artwork is attached.
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Latimer M, Finley GA, Rudderham S, Inglis S, Francis J, Young S, Hutt-MacLeod D. Expression of pain among Mi'kmaq children in one Atlantic Canadian community: a qualitative study. CMAJ Open 2014; 2:E133-8. [PMID: 25114895 PMCID: PMC4117360 DOI: 10.9778/cmajo.20130086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND First Nation children have the highest rates of pain-related conditions among Canadian children, yet there is little research on how this population expresses its pain or how and whether the pain is successfully treated. The aim of this study was to understand how Mi'kmaq children express pain and how others interpret it. METHODS We conducted a qualitative ethnographic study in a large Canadian Mi'kmaq community using interviews and conversation sessions. Participants included children and youth (n = 76), parents (n = 12) teachers (n = 7), elders (n = 6) and health care professionals (n = 13). RESULTS Interpretive descriptive analysis was used and themes regarding pain expression, care seeking and pain management were identified. Pain expression included stoicism and hiding behaviour, and, when pain was discussed, it was via storytelling and descriptive language, such as similes. Participants reported feeling unheard, stereotyped and frustrated when they sought pain care. Frustration led to avoidance of seeking further care, perceptions of racism and repeat visits because of unsuccessful previous treatment. Participants voiced concerns about the utility of the numeric and faces pain scales to describe pain meaningfully. Positive encounters occurred when participants felt respected and heard. INTERPRETATION Mi'kmaq children are stoic and often hide their pain. Community members feel frustrated and discriminated against when their pain is not identified, and conventional pain assessment tools may not be useful. If clinicians consider cultural context, build trust and allow for additional time to assess pain via storytelling or word descriptions as well as a family-centred approach, better pain care may occur.
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Affiliation(s)
- Margot Latimer
- Faculty of Health Professions, Dalhousie University, Halifax, NS ; Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
| | - G Allen Finley
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS
| | | | | | | | - Shelley Young
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
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Vukic A, Rudderham S, Misener RM. A community partnership to explore mental health services in First Nations communities in Nova Scotia. Can J Public Health 2010. [PMID: 20209736 DOI: 10.1007/bf03404339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed at identifying the gaps, barriers and successes/solutions associated with mental health services in Mi'kmaq communities in Nova Scotia. METHODS Community-based participatory research, which is consistent with Ownership, Control, Access and Possession principles of research with Aboriginal communities, was employed for this work. Health directors of the 13 Mi'kmaq communities in Nova Scotia were involved with the research question, design and write-up of the study. This qualitative descriptive study consisted of open-ended structured interviews with consumers, family members and health care providers. Systematic data collection and analysis of interviews present an understanding of issues of mental health services in the communities. RESULTS The findings identified barriers and successes/solutions in mental health services in First Nations communities, where services and resources are different from those in more urban communities. Core programs, covering aspects of education, collaboration and culturally relevant community-based services, were identified as solutions to problems identified by participants. Service providers specified core funding for services as essential for continuity and sustainability. DISCUSSION While efforts have been made in the past to address mental illness in Mi'kmaq communities, many of these efforts have been proposal driven or crisis oriented. The need for community-based, culturally appropriate, coordinated and sustainable services is evident on the basis of the study's findings. The final report has been disseminated to local community members, participants, Atlantic First Nations and Inuit Health Branch, the Provincial Department of Health and the Atlantic Policy Congress to provide evidence that can inform policy and practice related to mental health in Mi'kmaq communities in Nova Scotia.
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Affiliation(s)
- Adele Vukic
- School of Nursing, Dalhousie University, 5869 University Ave., Halifax, NS B3H 3J5.
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