The Impact of Culture, Identity and Intergenerational Connections on Indigenous Youth Mental Health: Qualitative Findings from a Longitudinal Digital Health Community Trial

Abstract Background: Indigenous youth in settler nations are susceptible to poor mental health due to complex inter-generational systemic inequities. The purpose of this study is to assess the impact of a culturally-responsive, land-based, active living initiative on the mental health of Indigenous youth. Methods: This study is part of Smart Indigenous Youth (SIY), a mixed-methods 5-year longitudinal digital citizen science initiative. SIY embeds culturally-responsive, landbased active living programs into the curricula of high schools in rural Indigenous communities in the western Canadian province of Saskatchewan. In year-1 (Winter 2019), 76 Indigenous youth citizen scientists (13-18 years) from 2 schools participated in the study. At the beginning of the term, each school initiated separate 4-month landbased active living programs specific to their culture, community, geography, and language (Cree and Saulteaux). Before and after the term, focus groups were conducted with the 2 Youth Citizen Scientist Councils, which includes students from both participating schools. This study includes data from focus groups of one participating school, with 11 youth citizen scientists (5 boys, 6 girls). Focus group data were transcribed and analyzed by two independent reviewers using Nvivo to identify themes and subthemes. Both reviewers discussed their thematic analysis to come to a consensus about final findings. Results: Baseline focus group analyses revealed themes demonstrating the importance of Indigenous culture, identity, history, and language. Youth emphasized the impact of loss of language and culture, the importance of being a helper, and the necessity of intergenerational knowledge transfer. Follow-up focus group analyses indicated that cultural school programming led to students expressing positive mental health benefits, increased interest in ceremonies, increased participation in physical activity, and greater knowledge of culture, identity, and ceremonial protocol. Conclusions: Land-based active living can play a critical role in improving Indigenous youth mental health. This study highlights the importance of linking active living with culture and the potential of leveraging citizen-owned ubiquitous tools in implementing interventions in rural communities. Digital citizen science shows promise for supporting Indigenous youth mental health initiatives.

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Smart Indigenous Youth: The Smart Platform Policy Solution for Systems Integration to Address Indigenous Youth Mental Health

JMIR Pediatrics and Parenting ◽

10.2196/21155 ◽

2020 ◽

Vol 3 (2) ◽

pp. e21155

Author(s):

Tarun Reddy Katapally

Keyword(s):

Mental Health ◽

Digital Health ◽

Community Based Participatory Research ◽

Indigenous Communities ◽

Youth Mental Health ◽

Public Health Issue ◽

Culturally Appropriate ◽

Rural And Remote ◽

Indigenous Youth ◽

School Curricula

Indigenous youth mental health is an urgent public health issue, which cannot be addressed with a one-size-fits-all approach. The success of health policies in Indigenous communities is dependent on bottom-up, culturally appropriate, and strengths-based prevention strategies. In order to maximize the effectiveness of these strategies, they need to be embedded in replicable and contextually relevant mechanisms such as school curricula across multiple communities. Moreover, to engage youth in the twenty-first century, especially in rural and remote areas, it is imperative to leverage ubiquitous mobile tools that empower Indigenous youth and facilitate novel Two-Eyed Seeing solutions. Smart Indigenous Youth is a 5-year community trial, which aims to improve Indigenous youth mental health by embedding a culturally appropriate digital health initiative into school curricula in rural and remote Indigenous communities in Canada. This policy analysis explores the benefits of such upstream initiatives. More importantly, this article describes evidence-based strategies to overcome barriers to implementation through the integration of citizen science and community-based participatory research action.

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Smart Indigenous Youth: The Smart Platform Policy Solution for Systems Integration to Address Indigenous Youth Mental Health (Preprint)

10.2196/preprints.21155 ◽

2020 ◽

Author(s):

Tarun Reddy Katapally

Keyword(s):

Mental Health ◽

Digital Health ◽

Community Based Participatory Research ◽

Indigenous Communities ◽

Youth Mental Health ◽

Public Health Issue ◽

Culturally Appropriate ◽

Rural And Remote ◽

Indigenous Youth ◽

School Curricula

UNSTRUCTURED Indigenous youth mental health is an urgent public health issue, which cannot be addressed with a one-size-fits-all approach. The success of health policies in Indigenous communities is dependent on bottom-up, culturally appropriate, and strengths-based prevention strategies. In order to maximize the effectiveness of these strategies, they need to be embedded in replicable and contextually relevant mechanisms such as school curricula across multiple communities. Moreover, to engage youth in the twenty-first century, especially in rural and remote areas, it is imperative to leverage ubiquitous mobile tools that empower Indigenous youth and facilitate novel Two-Eyed Seeing solutions. Smart Indigenous Youth is a 5-year community trial, which aims to improve Indigenous youth mental health by embedding a culturally appropriate digital health initiative into school curricula in rural and remote Indigenous communities in Canada. This policy analysis explores the benefits of such upstream initiatives. More importantly, this article describes evidence-based strategies to overcome barriers to implementation through the integration of citizen science and community-based participatory research action.

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O007 Sleep health promotion in Aboriginal and Torres Strait Islander communities: untapped potential of Indigenous youth workers as sleep coaches

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.006 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A4-A4

Author(s):

S Jabran ◽

S Smith ◽

Y Fatima ◽

S King

Keyword(s):

Mental Health ◽

Indigenous Communities ◽

Youth Mental Health ◽

Youth Workers ◽

Culturally Appropriate ◽

Sleep Health ◽

Indigenous Youth ◽

Sleep Education ◽

Training Activities ◽

And Training

Abstract Purpose The lack of culturally appropriate sleep health programs and community-led support services are significant barriers to sleep health promotion in Indigenous communities. This project offers Australia’s first-ever training and upskilling program for Indigenous youth workers (IYWs) to work as “Sleep Coaches” in Indigenous communities. Methods Key stakeholders, i.e., community elders, service providers, Indigenous youth and sleep scientists, were consulted to develop a training program for IYWs. Stakeholder consultations ensured community ownership of the program, facilitated co-design of educational and training activities, and integrated traditional and scientific sleep health knowledge for developing sleep health resources. Results Consultations with the advisory group (n=48) identified the need for a multipronged approach for IYWs capacity building. The education and training activities are centred around sleep and include cultural training to cover Indigenous Australians’ understanding and interpretation of sleep health, youth mental health first aid training, and participation in youth alcohol and drug education workshops. For sleep education, two blocks of activities, i.e., foundation and advanced level, are offered to cover triaging, sleep education/support and monitoring. An interactive tool for diabetes education in Indigenous communities (FeltMan/FeltMum) has been adapted to offer culturally appropriate sleep education. Conclusion IYWs’ capacity building as sleep coaches is an innovative way to empower Indigenous communities to embrace sleep health. Going forward, the program will engage with youth mental health services to evaluate the program effectiveness and transferability to other Indigenous communities. There is a need to define the scope of practice and certification to ensure compliance with industry standards.

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59. General medicine residents' perception of the mini-CEXs

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2820 ◽

2007 ◽

Vol 30 (4) ◽

pp. 61

Author(s):

S. Malhotra ◽

R. Hatala ◽

C.-A. Courneya

Keyword(s):

Internal Medicine ◽

Medical Education ◽

Focus Group ◽

Qualitative Study ◽

Focus Groups ◽

General Medicine ◽

Clinical History ◽

Phenomenological Approach ◽

Medical Teacher ◽

The Impact

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior. Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed. Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX. The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam. Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8. De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52. DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.

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Implementing a digital health model of care in Australian youth mental health services: protocol for impact evaluation

BMC Health Services Research ◽

10.1186/s12913-021-06394-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sarah Piper ◽

Tracey A. Davenport ◽

Haley LaMonica ◽

Antonia Ottavio ◽

Frank Iorfino ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Impact Evaluation ◽

Digital Health ◽

Youth Mental Health ◽

Model Of Care ◽

Health Service Provision ◽

Industrial Grade ◽

The Impact

Abstract Background The World Economic Forum has recently highlighted substantial problems in mental health service provision and called for the rapid deployment of smarter, digitally-enhanced health services as a means to facilitate effective care coordination and address issues of demand. In mental health, the biggest enabler of digital solutions is the implementation of an effective model of care that is facilitated by integrated health information technologies (HITs); the latter ensuring the solution is easily accessible, scalable and sustainable. The University of Sydney’s Brain and Mind Centre (BMC) has developed an innovative digital health solution – delivered through the Youth Mental Health and Technology Program – which incorporates two components: 1) a highly personalised and measurement-based (data-driven) model of youth mental health care; and 2) an industrial grade HIT registered on the Australian Register of Therapeutic Goods. This paper describes a research protocol to evaluate the impact of implementing the BMC’s digital health solution into youth mental health services (i.e. headspace - a highly accessible, youth-friendly integrated service that responds to the mental health, physical health, alcohol or other substance use, and vocational concerns of young people aged 12 to 25 years) within urban and regional areas of Australia. Methods The digital health solution will be implemented into participating headspace centres using a naturalistic research design. Quantitative and qualitative data will be collected from headspace health professionals, service managers and administrators, as well as from lead agency and local Primary Health Network (PHN) staff, via service audits, Implementation Officer logs, online surveys, and semi-structured interviews, at baseline and then three-monthly intervals over the course of 12 months. Discussion At the time of publication, six headspace centres had been recruited to this study and had commenced implementation and impact evaluation. The first results are expected to be submitted for publication in 2021. This study will focus on the impact of implementing a digital health solution at both a service and staff level, and will evaluate digital readiness of service and staff adoption; quality, usability and acceptability of the solution by staff; staff self-reported clinical competency; overall impact on headspace centres as well as their lead agencies and local PHNs; and social return on investment.

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Primary care teams’ experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study

BMC Family Practice ◽

10.1186/s12875-021-01496-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Rachelle Ashcroft ◽

Catherine Donnelly ◽

Maya Dancey ◽

Sandeep Gill ◽

Simon Lam ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Qualitative Study ◽

Mental Health Care ◽

Focus Groups ◽

Care Delivery ◽

Virtual Care ◽

Primary Care Teams ◽

The Impact

Abstract Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.

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The impact of first COVID-19 peak on patient referrals to Liaison Psychiatry Service and staff perception about service provision in Birmingham and Solihull Mental Health Trust Birmingham - a service evaluation project

BJPsych Open ◽

10.1192/bjo.2021.865 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S329-S329

Author(s):

Saima Jehanzeb ◽

Muhammad Suleman ◽

Ella Tumelty ◽

Joanne Okusanya ◽

Laxsan Karunanithy ◽

...

Keyword(s):

Mental Health ◽

Focus Groups ◽

Quantitative Methods ◽

Service Evaluation ◽

Psychotic Symptoms ◽

Healthcare Provision ◽

Liaison Psychiatry ◽

Clinical Databases ◽

The Impact ◽

Health Trust

AimsBased on recommendations from the Royal College of Psychiatrists, this project aimed to evaluate the impact of the first peak of the COVID-19 pandemic on referral patterns to the Queen Elizabeth Hospital Birmingham (QEHB) Liaison Psychiatry (LP) service. Additionally, we aimed to explore staff experiences in LP services across Birmingham and Solihull Mental Health Trust (BSMHFT) in order to generate Trust recommendations promoting optimal healthcare provision amidst the on-going pandemic.MethodA mixed method service evaluation was conducted using quantitative and qualitative analysis. Quantitative methods involved reviewing referrals made to the QEHB LP service from March to June 2020, compared with the equivalent time period in 2019. Data were retrospectively extracted from the electronic clinical databases RIO and PICS, and subsequently analysed using Microsoft Office. The number of, and reasons for referrals to LP were identified, whilst focus groups were conducted to explore the subjective experiences of staff working across BSMHFT LP services.ResultBetween 1st March and 30th June 2020, 984 referrals were made to the QEHB LP service, compared to 1020 referrals in 2019, representing a 3.5% reduction. From 2019 to 2020, referrals due to psychotic symptoms and deliberate self-harm rose by 12.8% and 14.1% respectively, whilst referrals for drug and alcohol-related causes reduced by 28.3%. A significant increase (150%) in referrals for medication or management advice was seen. Focus groups indicated that staff perceived an initial reduction in number of referrals, but an increase in the acuity of patient presentations.Staff reported anxiety around contracting and transmitting SARS-Cov-2, exacerbated by uncertainty around patients’ COVID-19 status. In QEHB, sixty-five of the 984 referrals (7%) had a positive SARS-Cov-2 PCR swab, with the remaining 919 referrals being either negative (68%) or unknown (25%). Ninety-six percent of consultations were conducted face-to-face in QEHB. There were conflicting views amongst staff regarding whether more consultations could have been conducted remotely. Furthermore, varying perceptions of support and communication from both the physical and mental health trust were reported.ConclusionQuantitative data indicates that COVID-19 impacted LP healthcare provision in BSMHFT. Whilst referral numbers remained similar between the equivalent period in 2019 and 2020, a change in the nature of referrals to LP at QEHB was seen. This was corroborated by qualitative data which highlighted a perceived change in acuity of referrals. These findings have been disseminated across the Trust and subsequent recommendations are being implemented during the on-going pandemic.

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3015 Enhancing Outcomes in Childcare Settings for Young Children with Behavior Disorders: An Examination of Conscious Discipline Implementation

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.203 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 88-88

Author(s):

Sufna Gheyara John ◽

Nicola Edge ◽

Michael Cucciare ◽

Nicholas Long

Keyword(s):

Early Childhood ◽

Focus Group ◽

Focus Groups ◽

Positive Impact ◽

Teacher Perspectives ◽

Self Control ◽

Barriers And Facilitators ◽

Full Implementation ◽

Perceived Impact ◽

The Impact

OBJECTIVES/SPECIFIC AIMS: 1. Identify the extent of CD implementation for trained childcare teachers. 2. Explore teacher perspectives on the impact of CD. 3. Explore teacher perspectives on barriers and facilitators to full implementation of CD. METHODS/STUDY POPULATION: We conducted a survey with 267 childcare teachers who had been trained in CD across the state, representing early childhood educational environments in urban and rural settings. Specific questions were asked related to level of CD implementation, perceived benefit, and facilitators/barriers to full implementation. A random subset of the sample (8 teachers) participated in a subsequent focus group to explore survey themes in greater depth. Focus group members were asked about their rationale for attending CD training, CD implementation (including barriers/facilitators to full implementation), and perceived impact on their classrooms. The focus group was recorded and transcribed to capture questions and comments. RESULTS/ANTICIPATED RESULTS: Objective 1: 1. 30% of teachers reported full implementation of CD. 2. 50% of teachers reported partial implementation of CD. Objective 2: 1. The vast majority of teachers (95%) agreed that CD had a positive impact on their classroom, including better structure and enhanced relationships with the children. 2. The vast majority of teachers (85%) agreed that CD had a positive impact on the children in their classroom, including increases in problem-solving abilities and self-control. Objective 3: 1. Most teachers (71%) reported experiencing barriers to CD implementation, with the majority of those surveyed (93%) stating that additional implementation support would be helpful. 2. The top three barriers to implementation elicited in survey and focus groups included uncertainty regarding how to begin implementing CD in the classroom, lacking materials for CD implementation, and lacking time to focus on applying knowledge from training into the classroom. 3. The top three facilitators for implementation elicited in survey and focus groups included coaching support for teachers, training agency leadership in CD, and greater perceived impact of CD. DISCUSSION/SIGNIFICANCE OF IMPACT: Childhood disruptive behaviors are among the most frequent reasons for referral to specialized services in and out of the classroom (Sukhodolsky, Smith, McCauley, Ibrahim, & Piasecka, 2016). Disruptive and aggressive behaviors are problematic, not only for victims of children who are aggressive but also for aggressive children as they age. Although effective treatments exist, the level of effective implementation of these interventions are understudied. These results demonstrate that 2/3 of teachers trained in CD are not fully implementing the model and provides concrete barriers and facilitators to current implementation. These data will provide the initial foundation for the development of a targeted implementation strategy that supports full implementation of CD within early childhood education settings.

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Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa

BMC Women s Health ◽

10.1186/s12905-020-01093-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lorrein Shamiso Muhwava ◽

Katherine Murphy ◽

Christina Zarowsky ◽

Naomi Levitt

Keyword(s):

Mental Health ◽

South Africa ◽

Gestational Diabetes ◽

Focus Groups ◽

Lived Experiences ◽

Cape Town ◽

Psychological Burden ◽

Pregnancy And Postpartum ◽

The Impact ◽

Depth Interviews

Abstract Background The diagnosis of gestational diabetes mellitus (GDM) may affect women’s mental wellbeing, functioning and quality of life, with potentially negative effects on treatment adherence. Identifying and addressing the psychological and emotional needs of women with GDM, could have benefits for sustainable long-term behavioural change following the affected pregnancy. This study explored the lived experiences of women with GDM and the impact of GDM on their experience of pregnancy and sense of well-being. Methods Purposive sampling was used to recruit women who had been diagnosed with GDM in their previous pregnancy and received antenatal care at a tertiary hospital in Cape Town, South Africa. This was a descriptive qualitative study using a combination of focus groups and in-depth interviews for an in- depth exploration of women’s lived experiences of GDM, their context and perceived needs. Data analysis followed an iterative thematic analysis approach. Results Thirty-five women participated in nine focus groups and five in-depth interviews. Women discussed the emotional and psychological burden of having GDM, highlighting (i) their initial emotional reactions to receiving a GDM diagnosis, (ii) their experience of adjusting to the constraints of living with GDM (iii) their feelings of apprehension about childbirth and their maternal role and (iv) their feelings of abandonment in the post-partum period once the intensive support from both health system and family ends. Conclusions The current biomedical model used in the management of GDM, is highly foetal-centric and fails to acknowledge important psychological factors that contribute to women’s overall wellbeing and experience of pregnancy. These results demonstrate the importance of incorporating mental health support in the management and care for women with GDM in public health services, along with facilitating emotional support from partners and family members. Based on our findings, we recommend routine mental health and psychosocial vulnerability screening and monitoring for women diagnosed with GDM throughout pregnancy and postpartum to improve prognoses.

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An evaluation of the transition from BAME community mental health worker to IAPT low intensity psychological wellbeing practitioner

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x18000296 ◽

2019 ◽

Vol 12 ◽

Cited By ~ 2

Author(s):

Naheem Hakim ◽

Andrew R. Thompson ◽

Gail Coleman-Oluwabusola

Keyword(s):

Mental Health ◽

Community Mental Health ◽

Health Worker ◽

Culturally Responsive ◽

Behavioural Therapy ◽

Psychological Wellbeing ◽

Mental Health Worker ◽

Structured Interviews ◽

Low Intensity ◽

The Impact

AbstractThe Improving Access to Psychological Therapies (IAPT) programme started in 2008, but it contained little provision for specifically meeting the needs of Black, Asian and minority ethnic (BAME) groups. The purpose of this evaluation was to describe the experience of transition from BAME community mental health worker (CMHW) to IAPT low-intensity psychological wellbeing practitioner (PWP) in order to identify possible gains and losses for the former communities served, and the factors that might contribute to successful training of people with BAME expertise. Four former CMHWs who had transitioned into working as PWPs were interviewed. Semi-structured interviews were used. The data were analysed using thematic analysis. Six major themes were identified with the benefits of training emerging as an important factor for the participants in enhancing their role. Three of the themes interconnected and focused on the impact for BAME communities in terms of access to service and barriers. Evident in the interviews were descriptions of adaptations that were made as a result of CMHW having access to both new and old skills. Finally, two themes focused on the participant recommendations as to how IAPT services might become more culturally responsive. The findings suggest that there can be significant benefits for services to provide IAPT training to people already providing culturally specific services. The participants reported that low-intensity cognitive behavioural therapy (LICBT) was effective, but only when cultural sensitive adaptations were made. The evaluation has some clear recommendations as to how IAPT services might seek to offer culturally responsive CBT. Suggestions for carrying out further practice-based evaluations are made.

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