Using Youth Voice To Inform Programs And Services Promoting Newcomers' Healthy Development, Alexandra C.G. Smith

Electronic Thesis and Dissertation Repository

Effective programs to support the healthy development and well-being of youth who have immigrated to Canada are needed. This integrated-article dissertation accentuated the perspectives of refugee and immigrant youth to identify considerations for programming and strategies to promote their healthy development. The first paper (Chapter Two) utilized focus groups to explore newcomer youths’ experiences relocating to a new country and advice for other youth who have recently arrived in Canada. We identified five overarching themes across groups through thematic analysis: (1) moving to a new county is hard, (2) maintain a healthy mindset, (3) take an active role in the …

Through An Equity Lens: Illuminating The Relationships Among Social Inequities, Stigma And Discrimination, And Patient Experiences Of Emergency Health Care, Colleen Varcoe, Annette J. Browne, Vicky Bungay, Nancy Perrin, Erin Wilson, C.Nadine Wathen, David Byres, Elder Roberta Price

Nursing Publications

People who experience the greatest social inequities often have poor experiences in emergency departments (EDs) so that they are deterred from seeking care, leave without care complete, receive inadequate care, and/or return repeatedly for unre- solved problems. However, efforts to measure and monitor experiences of care rarely capture the experiences of people facing the greatest inequities, experiences of discrimination, or relationships among these variables. This analysis examined how patients’ experiences, including self-reported ratings of care, experiences of discrimination, and repeat visits vary with social and economic circumstances. Every consecutive person presenting to three diverse EDs was invited if/when they were …

The Discursive Construction Of Substance Use And Harm Reduction In Canadian Health Policy, Sibel Kusdemir

Electronic Thesis and Dissertation Repository

Harm reduction as a philosophy has been widely recognized by healthcare professionals in Canada, yet the topic remains controversial in both political and public discourses. Understanding these discourses will allow health care providers to better respond to political and public concerns, as well as ensuring that services are aligned well with public health needs. This study explored the discursive use of the term “harm reduction” in Canadian health care and nursing policy documents’ contexts by using a Foucauldian framework and Bacchi’s ‘what’s the problem represented to be?’ approach. I propose three discursive themes: self-responsible citizen, evidenced-based practice, and what nurses …

"Man Up": Male Survivors Of Intimate Partner Violence Through The Eyes Of Their Providers, Xavier S. Borsato

Electronic Thesis and Dissertation Repository

Intimate partner violence (IPV) is a complex phenomenon that is often understood with women as the primary recipients of violence and men as the primary perpetrators. However, emerging literature on heterosexual relationships suggests that men also experience interpersonal violence, most often from their female partners. Drawing on research data gathered through semi-structured interviews with service providers (n = 4), this qualitative inquiry explores how gender, power, and the stigma associated with interpersonal violence impact men who have experienced abuse through the perspectives of the service providers who work with them. The findings from this study highlight how traditional constructions …

Barriers To Safety Planning And Best Practices For Supporting Survivors Of Domestic Violence In Rural, Remote, And Northern Regions, Sara Kohtala

Electronic Thesis and Dissertation Repository

Domestic violence (DV) or intimate partner violence (IPV) is defined as physical, emotional, psychological, or sexual harm in an intimate relationship. In extreme cases, it may culminate in domestic homicide which is defined as the killing of an intimate partner, their children or their family members. Intimate partner violence and domestic homicide is prevalent worldwide. Over ninety-nine thousand reports of DV were made to police in Canada in 2018. According to the Canadian Domestic Homicide Prevention Initiative for Vulnerable Populations, some victims may face greater barriers in receiving assistance on a timely basis such as immigrants and refugees, Indigenous people, …

Pilot Study Of Mental Health And Substance Use Of Detained Youths In Ontario, Canada, Evelyn R. Vingilis, Shannon Stewart, Hayley A. Hamilton, Jane Seeley, Kathleen M. Einarson, Nathan J. Kolla, Susan J. Bondy, Patricia G. Erickson

Family Medicine Publications

Detained youth display substantive mental health and substance use problems. However, Canadian information is limited. The purpose of this study was (1) to assess mental health and substance use problems of youth in residential detention/custody facilities in Ontario, Canada, at intake, using the interRAI Youth Justice in Custodial Facilities (YJCF), and (2) to explore the added value of using the YJCF in addition to the facilities’ standard intake tool. This paper presents the findings of this pilot study. Drawing on all 20 youth secure custody facilities in Ontario, Canada, two groups were created through stratified random group assignment: 10 intervention …

Intimate Partner Violence (Ipv): Clinical And Societal Perspectives, Marudan Sivagurunathan

Electronic Thesis and Dissertation Repository

Intimate Partner Violence (IPV) can have a lasting impact on survivors’ emotional, physical, and psychological wellbeing. IPV is multifaceted and can influence survivors’ interactions across various institutions, including healthcare settings. This PhD project consists of both qualitative and quantitative studies aimed at exploring the clinical and societal perspectives around IPV.

Study #1 sought to explore the discourses around male IPV drawn from a social networking site (Reddit.com). While some areas related to IPV are well researched, studies on male intimate partner violence survivors are limited. The results from study #1 show that male IPV disclosure is a complex process. While …

Developing And Evaluating The Integrated Addiction Recovery Model For The Persons' Engagement And Retention In The Recovery Process Among Clinical Populations From Rwanda, Boniface Harerimana

Electronic Thesis and Dissertation Repository

Background

To date, research that has investigated psychosocial processes and mechanisms, which underpin addiction recovery outcomes are scarce. This study sought to develop and test an integrated addiction recovery model for the recovery process while accounting for an individual’s psychosocial context.

Methods

This predictive study used consecutive sampling strategies to recruit 315 participants from tertiary addiction care settings in Rwanda. Data on the hypothesized model variables and individual’s characteristics were collected with self-reported measures. Structural equation modelling techniques were used to test the model psychometric measures and associations between latent variables.

Results

Baseline data analyses showed a mean age at …

Healthcare Utilization Costs Of Emerging Adults With Mood And Anxiety Disorders In An Early Intervention Treatment Program Compared To A Matched Cohort, Ava A. John-Baptiste, Lihua Li, Wanrudee Isaranuwatchai, Elizabeth Osuch, Kelly K. Anderson

Epidemiology and Biostatistics Publications

AIM: The First Episode Mood and Anxiety Disorder Program (FEMAP) provides treatment to emerging adults with mood and anxiety disorders in an accessible, youth-friendly environment. We sought to investigate FEMAP's impact on the costs of care.

METHODS: We conducted a retrospective observational study of one-year health service costs using linked administrative datasets to compare emerging adults treated at FEMAP (FEMAP users) to propensity-score matched controls (non-users). Costs from the perspective of the Ontario Ministry of Health and Long-Term Care, included drug benefit claims, inpatient, physician and ambulatory care services. We used bootstrapping to perform unadjusted comparisons between FEMAP users and …

Exploring The Mental Health Care Experiences Of Youth Transitioning From Paediatric To Adult Psychiatric Services Using The Photovoice Method: A Participatory Analysis Of The Photostream Project, Brianna Jackson

Electronic Thesis and Dissertation Repository

The transition from adolescence to adulthood brings with it many new challenges and stressors that may negatively impact psychosocial wellbeing. Unfortunately, the disjointed progression from paediatric to adult psychiatric services leaves transitional-aged youth (TAY) vulnerable to its deleterious sequelae, including social isolation, self-harm, substance use, and suicidal ideation. As devised, the Canadian mental health sector is ill-equipped to meet the care demands of emerging adults, resulting in undue suffering. Current evidence validates the need for clinical practice reform and policy revision to address this issue, yet the perspectives of young people are consistently underrepresented in conversations regarding youth-oriented psychiatric program …

Involuntary Hospitalization Among Young People With Early Psychosis: A Population-Based Study Using Health Administrative Data., Rebecca Rodrigues, Arlene G Macdougall, Guangyong Zou, Michael Lebenbaum, Paul Kurdyak, Lihua Li, Salimah Z Shariff, Kelly K Anderson

Epidemiology and Biostatistics Publications

OBJECTIVE: Early psychosis is an important window for establishing long-term trajectories. Involuntary hospitalization during this period may impact subsequent service engagement in people with newly diagnosed psychotic disorder. However, population-based studies of involuntary hospitalization in early psychosis are lacking. We sought to estimate the proportion of people aged 16 to 35 years with early psychosis in Ontario who are hospitalized involuntarily at first admission, and to identify the associated risk factors and outcomes.

METHODS: Using linked population-based health administrative data, we identified incident cases of non-affective psychosis over a five-year period (2009-2013) and followed cases for two years to ascertain …

Child Abuse As A Determinant Of Barriers To Hiv Status Disclosure Among Women In Canada, Siobhan M. Churchill

Electronic Thesis and Dissertation Repository

Introduction: In Canada, people with HIV are legally required to disclose their HIV status to their sexual partners prior to having sex that presents a “realistic possibility of HIV transmission”. This policy has been criticized for failing to consider the safety and autonomy of women with HIV, which can be compromised following disclosure.

Objectives: To investigate whether experiences of childhood physical or sexual abuse (CPSA) affect barriers to HIV disclosure to partners in adulthood, which include: later physical or sexual abuse, sexual agency, HIV stigma, and perceived social support.

Methods: Propensity scores and inverse probability of treatment weights were used …

Women's Quality Of Life After Leaving An Abusive Relationship: The Effects Of Past And Ongoing Intimate Partner Violence, Mastery And Social Support, Diana Jaradat

Electronic Thesis and Dissertation Repository

Intimate Partner Violence (IPV) is considered a major stressor that threatens the lives of women globally. Although qualitative research suggests that IPV has substantial negative effects on women’s quality of life, few quantitative studies have examined the quality of life of women who have experienced IPV due, in part, to the lack of an appropriate, brief measure of QOL. Consequently, little is known about the contextual process by which IPV experiences affect women’s quality of life (QOL) after leaving an abusive relationship. Mastery and social support are two important resources that women may use to deal with IPV but whether …

Estimating Costs And Benefits Associated With Evidence-Based Prevention: Four Case Studies Based On The Fourth R Program, Claire Crooks, Jennifer Zwicker, Lana Wells, Ray Hughes, Amanda Langlois, J.C. Herb Emery

Journal Articles

Teen violence in dating and peer relationships has huge costs to society in numerous areas including health care, social services, the workforce and the justice system. Physical, psychological, and sexual abuse have long-lasting ramifications for the perpetrators as well as the victims, and for the families involved on both sides of that equation. An effective violence prevention program that is part of a school’s curriculum is beneficial not only for teaching teenagers what is appropriate behaviour in a relationship, but also for helping them break the cycle of violence which may have begun at home with their own maltreatment as …

Self-Disclosure Among Male Survivors Of Child Sexual Abuse: Service Providers’ Perspective, Marudan Sivagurunathan

Electronic Thesis and Dissertation Repository

Previous research regarding child sexual abuse (CSA) indicates significant gender differences in disclosure rates: specifically, males are less likely to disclose their child sexual abuse in comparison to females. CSA can have lasting impact on a child’s emotional, physical, and psychological wellbeing. Trauma studies show support and early intervention is necessary for CSA survivors to re-establish a sense of safety and to experience better quality of life. Service providers play a key role in providing care and support for male CSA survivors. However, little is known about service providers, who work with male CSA survivors, and their perceptions and attitudes …

Domestic Homicide And Homicide-Suicide In The Older Population, Brianna L. O'Neil

Electronic Thesis and Dissertation Repository

Extensive research has been conducted on domestic homicide in younger populations; however, very little is known about such incidents in the older population. It is vital that this gap in the literature be filled as Canada’s older population has been increasing. Data for this study was provided by the Ontario Domestic Violence Death Review Committee. Ninety-two domestic homicide and suicide cases were examined to determine whether there were differences between younger age groups (30 to 50 years of age) and older age groups (55 years of age and older). Information was gathered on prominent characteristics and risk factors within cases …

Predictors Of Engagement In Community-Based Therapy For Youths With Mood And Anxiety Disorders, Hailey S. Saunders

Electronic Thesis and Dissertation Repository

The First Episode Mood and Anxiety Program (FEMAP) aims to identify and treat youths with mood and anxiety disorders. This research sought to identify factors associated with engagement in FEMAP, based on extensive data collected by FEMAP researchers. A logistic regression model was built from candidate variables using purposeful selection. Of the 366 participants offered treatment, 87% engaged in FEMAP. Quantity of alcohol consumed per occasion, gender, and anxiety sensitivity were found to be significant predictors of engagement. Gender and anxiety sensitivity interacted with each other such that at low anxiety sensitivity levels, the odds of engaging in FEMAP for …

Access To Care And The Impact Of Inequality Among Individuals With A History Of Mental Illness, Heather Atyeo

Electronic Thesis and Dissertation Repository

Using an Intersectionality framework, a secondary analysis of pre-existing data from the CURA2 Poverty and Social Inclusion study (Forchuk et al., 2010-2015) was used to explore the relationship between experiences of oppression and self-rated health among a cross-section of 293 community dwelling participants with a mental illness. Binary logistic regression was used to estimate the association between self-rated health and social identity (gender, ethnicity, education, homelessness, employment, disability); health care access was tested for both mediating and moderating effects. The final model explained between 18.9-25.2% of the variance in self-rated health; four independent variables made unique statistically significant contributions to …

The Sixties Scoop Among Aboriginal Veterans: A Critical Narrative Study, Munira Abdulwasi

Electronic Thesis and Dissertation Repository

This study explored the experience of Aboriginal Veterans adopted and/or fostered during the Sixties Scoop using critical narrative inquiry. The objectives were to: 1) understand the lived experience of Aboriginal veterans adopted and/or fostered during the Sixties Scoop, 2) explore any health needs expressed by Aboriginal veterans adopted and/or fostered during the Sixties Scoop, and 3) provide recommendations for the implementation of health services and programs to assist this group of Aboriginal veterans with their health needs. Eight individual interviews were conducted with participants in Kitchener-Waterloo, London, Ottawa, Winnipeg, and Vancouver. All interviews were audio-taped, transcribed verbatim, and analyzed using …

The Experiences Of Criminalized Women When Accessing Health Care Services During Incarceration Within Provincial Jails: A Critical Narrative Study, Shamiram Zendo

Electronic Thesis and Dissertation Repository

Abstract

There has been a noticeable increase in the imprisonment of women in Canada, within the last 20 years. The purpose of this critical inquiry was to capture and promote the voices and stories of criminalized women, in order to serve their interest. Five individual in-depth interviews were conducted with women, who were incarcerated in provincial jail. A critical paradigm was used to explore how socioeconomic and gender inequalities, embedded in the social, political, and historical contexts, influenced criminalized women’s experiences when accessing health care. The findings of this study described how criminalized women experience fragmentation in health care access, …

The Impact Of Childhood Symptoms Of Conduct Disorder On Driver Aggression In Adulthood, Christine Wickens, Evelyn R. Vingilis, Robert Mann, Patricia Erickson, Maggie Toplak, Natan Kolla, Jane Seeley, Anca Ialomiteanu, Gina Stoduto, Gabriela Ilie

Family Medicine Publications

Background: Despite limited empirical investigation, existing scientific literature suggests that individuals with a history or current diagnosis of conduct disorder (CD) may be more likely to demonstrate reckless and aggressive driving. Much of the limited research in this field examines the impact of childhood CD on driver behaviour and collision risk in young adults. Few, if any, studies assess the impact of this disorder on driver behaviour beyond age 21 years. The current research is a population-based study of the impact of CD symptoms during childhood on the risk of engaging in driver aggression during adulthood.

Methods: Data are based …

Caregivers' Experiences Raising A Child With Fetal Alcohol Spectrum Disorder, Aamena Kapasi

Electronic Thesis and Dissertation Repository

The purpose of this study was to identify challenges and strengths of caregivers to a child with Fetal Alcohol Spectrum Disorder (FASD). Thirty-two caregivers raising a child with FASD participated in phone interviews that included the questions: "What challenges do you face in making your household function well?" and "What strengths do you have to make your household function well?" Responses to the questions were sorted by participants and the data was analyzed using multi-dimensional scaling and cluster analysis. In response to the question about challenges, seven concepts emerged: 1) Extra Responsibility on Caregivers, 2) Difficulty Keeping Daily Routine, 3) …

Promoting First Nations, Metis, And Inuit Youth Wellbeing Through Culturally-Relevant Programming: The Role Of Cultural Connectedness And Identity, Claire Crooks, Dawn V. Burleigh, Ashley Sisco

Journal Articles

Objectives: Although culturally relevant programming has been identified as a promising practice for promoting resiliency among First Nations, Métis, and Inuit (FNMI) youth, the specific ways in which these programs contribute to wellbeing are unclear. The Fourth R: Uniting Our Nations programs include an array of strengths-based culturally relevant programs for FNMI youth that have been found to increase wellbeing. The purpose of this study was to explore how culturally relevant programming provides a forum for intrapersonal and interpersonal growth.

Methods: In-depth interviews were conducted with 12 adult FNMI community and education stakeholders who have had extensive involvement with the …

A Phenomenological Study Of Prescription Drug Abuse Among Children And Youth, Eric A. Collins

Electronic Thesis and Dissertation Repository

Prescription drugs ranked as the third highest substance used/abused among Canadian youth (Health Canada, 2014). This research is a retrospective phenomenological study on child and youth prescription drug abuse. Currently, there is a lack of qualitative research in this area. The primary goal of this study is to understand the lived experiences of child and youth prescription drug abuse in order to provide greater depth and breadth into the complexities of this behaviour. Based on the aim of this study, I developed the following research question: what are the lived experiences of prescription drug abuse during childhood and adolescence? Six …

Transitioning To Motherhood After Trauma: Interacting With The Healthcare System, Karen E. Haines

Electronic Thesis and Dissertation Repository

Little is known about the interactions with the healthcare system among women with past interpersonal trauma accessing maternal health care. The purpose of this study was to critically examine the experiences of women with past interpersonal trauma as they interacted with the healthcare system during the transition to motherhood. A critical feminist perspective informed by Relational-Cultural Theory was used to guide this secondary analysis of 29 interview transcripts from: (a) Aboriginal women, (b) refugees, and (c) survivors of childhood sexual abuse. Four themes emerged: 1. Birthing a healthy baby: the common relational thread; 2. Receiving physical care over the emotional …

Children First: It’S Time To Change! Mental Health Promotion, Prevention, And Treatment Informed By Public Health, And Resiliency Approaches, Vicki Schwean, Susan Rodger

Journal Articles

Although the importance of healthy mental development in children and youth is not disputed, the mental health needs of far too many Canadian children are being ignored. Within the context of recent federal and provincial calls for systemic reform of the mental health care systems for children and youth, we underscore the necessity for ongoing innovation, development, education, and evaluation. This article describes our aims to establish demonstration and research sites focused on promising frameworks that draw from systems of care, public health, and resiliency approaches.

Determinants Of Negative Pathways To Care And Their Impact On Service Disengagement In First-Episode Psychosis., Kelly K. Anderson, Rebecca Fuhrer, Norbert Schmitz, Ashok K Malla

Epidemiology and Biostatistics Publications

PURPOSE: Although there have been numerous studies on pathways to care in first-episode psychosis (FEP), few have examined the determinants of the pathway to care and its impact on subsequent engagement with mental health services.

METHODS: Using a sample of 324 FEP patients from a catchment area-based early intervention (EI) program in Montréal, we estimated the association of several socio-demographic, clinical, and service-level factors with negative pathways to care and treatment delay. We also assessed the impact of the pathway to care on time to disengagement from EI services.

RESULTS: Few socio-demographic or clinical factors were predictive of negative pathways …

A Cross-Sectional Survey Of Prevalence And Correlates Of Suicidal Ideation And Suicide Attempts Among Prisoners In New South Wales, Australia, Sarah Larney, Libby Topp, Devon Indig, ColmáN O'Driscoll, David Greenberg

Aboriginal Policy Research Consortium International (APRCi)

Background: We aimed to estimate the prevalence of suicidal ideation and suicide attempt among prisoners in New South Wales, Australia; and, among prisoners reporting suicidal ideation, to identify factors associated with suicide attempt.

Methods: A cross-sectional design was used. Participants were a random, stratified sample of 996 inmates who completed a telephone survey. The estimated population prevalence of suicidal ideation and suicide attempt were calculated and differences by sex and Aboriginality were tested using c2 tests. Correlates of suicidal ideation and suicide attempt were tested using logistic regression.

Results: One-third of inmates reported lifetime suicidal ideation and one-fifth had attempted …

Indigenous Family Violence: An Attempt To Understand The Problems And Inform Appropriate And Effective Responses To Criminal Justice System Intervention, Andrew Day, Robin Jones, Martin Nakata, Dennis Mcdermott

Aboriginal Policy Research Consortium International (APRCi)

Whilst high levels of concern about the prevalence of family violence within Indigenous communities have long been expressed, progress in the development of evidence-based intervention programs for known perpetrators has been slow. This review of the literature aims to provide a resource for practitioners who work in this area, and a framework from within which culturally specific violence prevention programs can be developed and delivered. It is suggested that effective responses to Indigenous family violence need to be informed by culturally informed models of violence, and that significant work is needed to develop interventions that successfully manage the risk of …

Measuring Cultural Appropriateness Of Mental Health Services For Australian Aboriginal Peoples In Rural And Remote Western Australia: A Client/Clinician's Journey, Kerrie Doyle

Aboriginal Policy Research Consortium International (APRCi)

Aboriginal and Torres Strait Islander people in Australia suffer from poorer mental health than non-Aboriginal people, especially in remote and rural settings. Even with the ongoing adoption of the World Health Organisation’s ‘Closing the Gap’ recommendations, the determinants of mental health, including suicide rates, hospitalisation rates and access to healthcare are not noticeably improving. One of the issues for this gap is the poor cultural proficiently of mental health services, creating a cultural security threat to the workers and service users. In my work as a senior Aboriginal Mental Health worker, I have observed incidents of ongoing cultural incompetence across …