Preventing Indigenous youth homelessness in Canada: A qualitative study on structural challenges and upstream prevention in education.

Drawing on a partnership with a group of Indigenous youth experiencing homelessness in Vancouver, Canada, this study identifies four structural challenges that have impacted them and four actionable upstream strategies to further prevent youth housing precarity. As a secondary analysis of a community-engaged study with youth experiencing homelessness, we conducted a thematic analysis with qualitative data, which included qualitative interviews with five young people and researcher observations. The results reflect the racial, colonial, and economic concerns that impact Indigenous youth experiencing homelessness. The four actionable upstream solutions highlight human rights-based approaches to homelessness, ranging from advancing and strengthening public services, transitional justice processes, and cultural and socioeconomic safety. This study provides strategies to promote Indigenous youth wellbeing and decrease risk of housing precarity, while centering and drawing from youth knowledge production. Strengths and limitations of the study are also discussed.

First Nations and Inuit mental health and the Non-Insured Health Benefits program: Urgent priorities for evaluation.

The mental health needs and disparities facing First Nations and Inuit in Canada far exceed those of the general population and yet accessing culturally safe care remains a serious challenge. One means for accessing mental health care is through the Non-Insured Health Benefits (NIHB) mental health counselling program run by Indigenous Services Canada. However, evaluations of the efficacy of the NIHB's mental health counselling program remain entirely absent in the academic literature and this is startling given that this program receives significant federal funding to care for a population that experiences extreme marginalization. The following commentary will present three challenges observed with the present state of the program in the areas of service accessibility, the need for an Indigenous mental health workforce, and culturally safe care. For each challenge presented, we make recommendations on how to improve the program in its current state. The conclusion of this article advocates for a broader evaluation of the NIHB mental health counselling program from the perspective of its service users and its registered mental health professionals. This type of evaluation is commensurate with the Calls to Action outlined by the Truth and Reconciliation Commission of Canada.

RéSUMé: Les besoins en santé mentale et les disparités rencontrés par les Premières Nations et les Inuits au Canada dépassent de loin ceux de la population générale, et pourtant, l'accès à des soins culturellement sécuritaires demeure un sérieux défi. Une des manières d'accéder aux soins de santé mentale est par le biais du programme de counselling en santé mentale des Services de santé non assurés (SSNA), géré par Services aux Autochtones Canada. Cependant, les évaluations de l'efficacité du programme de counselling en santé mentale des SSNA sont entièrement absentes de la littérature académique, ce qui est surprenant compte tenu que ce programme reçoit un financement fédéral important pour prendre en charge une population qui vit une marginalisation extrême. Le commentaire suivant présentera trois défis observés avec l'état actuel du programme dans les domaines de l'accessibilité des services, la nécessité d'une main-d'œuvre en santé mentale autochtone, et des soins culturellement sécuritaires. Pour chaque défi présenté, nous faisons des recommandations sur la manière d'améliorer le programme dans son état actuel. La conclusion de cet article plaide pour une évaluation plus large du programme de counselling en santé mentale des SSNA du point de vue de ses utilisateurs de services et des professionnels de la santé mentale inscrits. Ce type d'évaluation est conforme aux Appels à l'action décrits par la Commission de vérité et réconciliation du Canada.

Feasibility and acceptability of Narrative Exposure Therapy to treat individuals with PTSD who are homeless or vulnerably housed: a pilot randomized controlled trial.

BACKGROUND: Diagnosed PTSD rates in people who are homeless are more than double that of the general population, ranging between 21 and 53%. Complex PTSD (cPTSD) also appears to be more common than PTSD. One treatment option is Narrative Exposure Therapy (NET), a brief trauma-focused psychotherapy which attempts to place trauma within a narrative of the person's life. Our primary aim was to assess the feasibility and acceptability of recruiting people to a randomized controlled trial (RCT) of NET alone compared to NET augmented by a genealogical assessment. We hypothesized that incorporating a genealogical assessment may be more effective than NET alone in a population with predominately complex PTSD. METHODS: This pilot RCT enrolled participants who were 18 years of age or older, currently homeless or vulnerably housed, and with active symptoms of PTSD. Participants were randomized to NET alone or NET plus a genealogical assessment. Rates of referral, consent, and retention were examined as part of feasibility. Demographic and clinical data were collected at baseline. Symptoms of PTSD, drug use, and housing status were re-assessed at follow-up visits. We conducted a thematic analysis of qualitative interviews of service providers involved in the study which explored barriers and facilitators of study participation. RESULTS: Twenty-two potential participants were referred to the study, with 15 consenting to participate. Of these, one was a screen failure and 14 were randomized equally to the treatment arms. One randomized participant was withdrawn for safety. Attrition occurred primarily prior to starting therapy. Once therapy began, retention was high with 80% of participants completing all six sessions. Seven participants completed all follow-up sessions. Service providers identified a clear need for the treatment and emphasized the importance of trauma-informed care, a desire to know more about NET, and more communication about the process of referral. CONCLUSION: Recruiting participants who were vulnerably housed to an RCT of a trauma-based therapy was possible. Once therapy had started, participants were likely to stay engaged. We will incorporate the results of this trial into a conceptual model which we will test in a factorial study as part of the optimization phase of MOST. TRIAL REGISTRATION: ClinicalTrials.gov NCT03781297 . Registered: December 19, 2018.