Increasing access to mental health supports for 12-17-year-old Indigenous youth with the JoyPop mobile mental health app: study protocol for a randomized controlled trial.

BACKGROUND: Indigenous youth in Northwestern Ontario who need mental health supports experience longer waits than non-Indigenous youth within the region and when compared to youth in urban areas. Limited access and extended waits can exacerbate symptoms, prolong distress, and increase risk for adverse outcomes. Innovative approaches are urgently needed to provide support for Indigenous youth in Northwestern Ontario. Using a randomized controlled trial design, the primary objective of this study is to determine the effectiveness of the JoyPop app compared to usual practice (UP; monitoring) in improving emotion regulation among Indigenous youth (12-17 years) who are awaiting mental health services. The secondary objectives are to (1) assess change in mental health difficulties and treatment readiness between youth in each condition to better understand the app's broader impact as a waitlist tool and (2) conduct an economic analysis to determine whether receiving the app while waiting for mental health services reduces other health service use and associated costs. METHODS: A pragmatic, parallel arm randomized controlled superiority trial will be used. Participants will be randomly allocated in a 1:1 ratio to the control (UP) or intervention (UP + JoyPop) condition. Stratified block randomization will be used to randomly assign participants to each condition. All participants will be monitored through existing waitlist practices, which involve regular phone calls to check in and assess functioning. Participants in the intervention condition will receive access to the JoyPop app for 4 weeks and will be asked to use it at least twice daily. All participants will be asked to complete outcome measures at baseline, after 2 weeks, and after 4 weeks. DISCUSSION: This trial will evaluate the effectiveness of the JoyPop app as a tool to support Indigenous youth waiting for mental health services. Should findings show that using the JoyPop app is beneficial, there may be support from partners and other organizations to integrate it into usual care pathways. TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT05898516 [registered on June 1, 2023].

Female youth and mental health service providers' perspectives on the JoyPop™ app: a qualitative study.

Introduction: Mobile health (mHealth) apps are a promising adjunct to traditional mental health services, especially in underserviced areas. Developed to foster resilience in youth, the JoyPop™ app has a growing evidence base showing improvement in emotion regulation and mental health symptoms among youth. However, whether this novel technology will be accepted among those using or providing mental health services remains unknown. This study aimed to evaluate the JoyPop™ app's acceptance among (a) a clinical sample of youth and (b) mental health service providers. Method: A qualitative descriptive approach involving one-on-one semi-structured interviews was conducted. Interviews were guided by the Technology Acceptance Model and were analyzed using a deductive-inductive content analysis approach. Results: All youth (n = 6 females; Mage = 14.60, range 12-17) found the app easy to learn and use and expressed positive feelings towards using the app. Youth found the app useful because it facilitated accessibility to helpful coping skills (e.g., journaling to express their emotions; breathing exercises to increase calmness) and positive mental health outcomes (e.g., increased relaxation and reduced stress). All service providers (n = 7 females; Mage = 43.75, range 32-60) perceived the app to be useful and easy to use by youth within their services and expressed positive feelings about integrating the app into usual care. Service providers also highlighted various organizational factors affecting the app's acceptance. Youth and service providers raised some concerns about apps in general and provided recommendations to improve the JoyPop™ app. Discussion: Results support youth and service providers' acceptance of the JoyPop™ app and lend support for it as an adjunctive resource to traditional mental health services for youth with emotion regulation difficulties.

Cultural adaptation considerations of a comprehensive housing outreach program for indigenous youth exiting homelessness.

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.

Adverse Childhood Experiences (ACEs) and Health Histories Among Clients in a First Nations-Led Treatment for Substance Use.

First Nations adults continue to experience significant health disparities compared to non-First Nations adults in Canada. Ongoing difficulties associated with intergenerational trauma among First Nations peoples may be examined using the adverse childhood experiences (ACEs) model, which measures various forms of abuse, neglect, and household dysfunction. We examined prevalence rates of ACEs and physical and mental health outcomes within a predominately First Nation sample of clients seeking substance use treatment from a First Nations-led treatment facility. The prevalence of ACEs was higher than national averages and previous data collected with broader Indigenous samples in Canada. Descriptive analyses of ACEs and health outcomes for those seeking First Nations-led substance use treatment showed these participants had more chronic health difficulties co-morbid with clinical levels of problematic substance use. To improve ongoing best-treatment options for those seeking substance use treatment, continued assessment and promotion of broader aspects of health and wellbeing are required, including the balance of physical, emotional, spiritual, and mental health and wellbeing across a lifespan.

Client and staff experiences assessing adverse childhood experiences in a clinical setting: Results from the First Nations ACE Study.

BACKGROUND: Conducting culturally-relevant research with Indigenous populations requires a balance of approaches that benefit Indigenous communities, while perceiving and mitigating the potential risk of harm when engaging in research-related activities. Reducing the burden of research is especially useful for research with Indigenous populations as ongoing systemic marginalization and discrimination through historical colonial practices may result in a higher likelihood of experiencing harm from research activities. One way to ensure that stakeholder experiences with the research processes are not burdensome, and to understand how study implementation practices are perceived across research teams, supporting organizations, and individual participants is to build this into the study method. OBJECTIVE: The current study describes stakeholder experiences within a broader research study, entitled the First Nations ACE Study, which examined early childhood experiences and health outcomes for Indigenous people seeking treatment for substance use. PARTICIPANTS AND SETTING: Five treatment centre staff participated in ongoing consultations with the research team and described their experiences within a Community-Based Participatory Research (CBPR) study. METHOD: A document review of client satisfaction questionnaires of seventy-five participants provided quantitative feedback on experiences in addition to qualitative interviews with staff. RESULTS: Overall, experiences of both treatment centre staff and clients were generally positive. Additional results described the importance of continuous stakeholder participation, and ongoing study adaptations to remain aligned with CBPR approaches as pressure for expediency and convenience have the potential to encroach upon CBPR values. The study method was described to mitigate participant and staff burden, as well as risk of participant harm. CONCLUSIONS: Directions for future research are discussed, including discussion of modifications that will be made to future iterations of the presented research study.

Adaption and implementation of the Housing Outreach Program Collaborative (HOP-C) North for Indigenous youth.

There is a high prevalence of Indigenous youth experiencing either precarious housing or homelessness in northwestern Ontario. Given that Indigenous pathways to homelessness can differ from non-Indigenous youth, interventions that address homelessness must also adapt to meet diverse needs. The Housing Outreach Program Collaborative (HOP-C) is a tertiary prevention intervention designed to provide congruent housing and peer and mental health supports for youth experiencing homelessness in Toronto, Ontario. Less is known regarding its adaptability to adequately serve Indigenous youth in northwestern Ontario. This study assessed the preliminary effectiveness and feasibility of an adaptation of the HOP-C North program for transitional aged Indigenous youth exiting homelessness in Thunder Bay, Ontario. Participants completed premeasures (n = 15) and postmeasures (n = 8) as well as qualitative interviews regarding their experiences in the program. Qualitative interviews were also conducted with staff (n = 14) engaged in implementing the program. After completing the HOP-C North program, participants reported improvements in a number of outcomes, including increased educational enrollment, attainment of employment, reduced hospitalizations, and increased engagement in clinical mental health services. Specific program aspects that participants found helpful included increased program flexibility, accessibility, emphasis on relationships, relevance of programming, fostering participant autonomy, and an adaptive approach to program implementation. These findings suggest that the HOP-C North model, when adapted, is a helpful program for Indigenous youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Translating Anxiety-Focused CBT for Youth in a First Nations Context in Northwestern Ontario.

OBJECTIVE: We sought to evaluate a translation of anxiety-focused cognitive behavioral therapy (CBT) to a First Nations children's mental health provider in rural Ontario and to enhance our understanding of CBT challenges and adaptations unique to the First Nations context. METHODS: The study was conceptualized as a mixed methods sequential explanatory approach using a quasi-experimental (before and after) design with quantitative and qualitative components. Data were produced in two ways: questionnaires completed by therapists, parents and clients pre- and post-training, and through a focus group with therapists working with First Nations clients. Participants of this study were a subset of a larger knowledge translation study involving ten agencies, and comprised nine therapists (two males and seven females), and seven children (six males and one female) from a single First Nations agency. The mean age of children was 11.8 years (±2.71), comparable to children in other agencies. RESULTS: First Nations therapists' scores on a child CBT knowledge questionnaire post-training did not differ from those of therapists in other agencies when controlling for initial values, suggesting comparable training benefit. Children did not differ between groups on any key measures, and all key measures showed improvement from pre- to post-training. Four key themes emerged from therapist focus groups: client challenges, value of supervision, practice challenges, and Northern/rural/remote challenges. CONCLUSIONS: The study highlights the importance of delivering a culturally appropriate CBT program to First Nations populations in Northern Ontario, and provides preliminary evidence of its effectiveness.

OBJECTIF: Nous avons cherché à évaluer une adaptation de la thérapie cognitivo-comportementale (TCC) axée sur l'anxiété pour un prestataire de soins de santé mentale aux enfants des Premières nations en région rurale de l'Ontario, et à accroître notre compréhension des problèmes et des adaptations de la TCC propres au contexte des Premières nations. MÉTHODES: L'étude a été conceptualisée comme une approche de méthodes mixtes séquentielles explicatives à l'aide d'un devis quasi-expérimental (avant et après) avec des composantes quantitatives et qualitatives. Les données ont été produites de deux manières: des questionnaires remplis par les thérapeutes, les parents et les clients avant et après la formation, et à l'aide d'un groupe de discussion formé des thérapeutes travaillant avec les clients des Première nations. Les participants à cette étude étaient un sous-ensemble d'une étude plus vaste du transfert des connaissances comportant dix organismes et composée de neuf thérapeutes (deux masculins et sept féminins), et sept enfants (six garçons et une fille) d'un seul organisme des Premières nations. L'âge moyen des enfants était de 11,8 ans (±2,71), comparable aux enfants d'autres organismes. RÉSULTATS: Les scores des thérapeutes des Premières nations à un questionnaire sur les connaissances de la TCC après la formation ne différaient pas de ceux des thérapeutes d'autres organismes, après contrôle des valeurs initiales, ce qui suggère des avantages comparables de la formation. Les enfants ne différaient pas entre les groupes à aucune des mesures clés, et toutes les mesures clés montraient une amélioration entre avant et après la formation. Quatre thèmes principaux se sont dégagés des groupes de discussion des thérapeutes: les problèmes des clients, la valeur de la supervision, les problèmes organisationnels, et les problèmes des régions nordiques/rurales/ éloignées. CONCLUSIONS: L'étude souligne l'importance d'exécuter un programme de TCC culturellement adapté aux populations des Premières nations du nord de l'Ontario, et fournit des données probantes préliminaires de son efficacité.