"I Think Peer Support Helps to Demystify People Who Have Mental Health Issues and Helps to Remove That Stigma": Exploring the Defining Characteristics and Related Challenges of Youth Peer Support Through Participatory Research.

Despite the emerging body of literature on the benefits of youth peer support, there is also evidence that peer support can have unintended negative impacts on peers themselves. It is important to explore what aspects of the peer role contribute to these difficulties in order to mitigate risks. This paper uses a participatory approach to examine the unique attributes of youth peer practice and the related challenges. We conducted semi-structured interviews and focus groups with both peer and non-peer staff from a community-based youth mental health program that provides peer support services (N = 29). Thematic analyses were completed using QSR NVivo. Analyses capture the defining features and related challenges of the peer support role (self-disclosure, boundaries, role confusion and dynamic recovery), and risk factors that affect peers (stigma, exposure to harm and burnout). This paper contributes to the literature on peer support as well as youth participatory evaluation. The findings will be useful to support the development of improved organizational contexts for peer practice and more effective peer support programming.

"You can create a little bit more closure in your own story when someone really connects with it": exploring how involvement in youth peer support work can promote peer development.

BACKGROUND: Peer support relates to the provision of social/emotional support that is delivered by individuals with lived experience of a key characteristic that is shared with clients. Although the main objective of peer support is to enhance client outcomes, through their involvement, peers derive a secondary benefit to their own personal development. This study applied a hybrid participatory-realist approach to identify what works, for whom, why and in what circumstances within the LOFT Transitional Age Youth (TAY) peer services. This paper presents findings related to the processes and possible benefits of being involved in peer work for the peer supporters themselves. METHODS: Semi-structured interviews and focus groups were completed with peer and non-peer staff from the TAY program. A qualitative analysis applied a retroductive approach that involved both inductive and deductive processes to identify relevant themes. RESULTS: Four program theories and one over-arching context were identified through the analyses. Program theories were related to: (1) enhancing self-efficacy and self-determination through peer involvement in program design, (2) increasing peer resiliency and self-care through effective supervision, (3) developing professional skills and opportunities for career advancement through peer practice and (4) overcoming stigma through the recognition of the value of peer lived experience. CONCLUSIONS: Peer practice holds significant potential for the enhancement of the mental health system as well as to increase our understanding of stigma. The findings from this study offer critical new insights into the dynamics of how professional peer practice can support the personal development of youth peers and how programming can be intentionally designed to enhance these benefits.

By youth for youth: Empowering youth experiencing homelessness in Managua, Nicaragua.

There is a dearth of effective, evidence-based programming to support youth experiencing homelessness, particularly in low- and middle-income countries where the majority of these young people live. Programs focused on youth engagement and leadership appear to be promising means to effectively engage and promote positive outcomes in this population. By Youth for Youth (BYFY) is a peer-led youth leadership framework developed to promote youth engagement, empowerment, and skill development. To date, BYFY has been successfully implemented with promising process and outcome indicators for youth experiencing homelessness, both in Toronto and with Indigenous youth in Thunder Bay. In this article, we present the application of BYFY with 30 street-involved youth in Managua, Nicaragua. We highlight the key implementation factors leading to BYFY's success in Nicaragua as perceived by facilitators from the implementing organization, Covenant House International, and youth leaders. Using a General Inductive analysis of interview data, field notes, and artistic output generated by the project (rap video, graffiti art, street theater), we identify the processes that appeared to underlie positive outcomes observed in participants, including creating a sense of safety and providing opportunities to challenge negative self-perceptions. This article provides evidence for a scaleable model for youth engagement and empowerment that (a) is practical to implement in low-resource settings and (b) is effective at engaging street-involved youth across diverse cultures and contexts. We summarize practical implications and actionable measures that can be taken by stakeholders to capitalize on these findings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Stigma as a barrier to early intervention among youth seeking mental health services in Ontario, Canada: a qualitative study.

BACKGROUND: Stigma associated with mental health challenges is a major barrier to service seeking among youth. Understanding how stigma impacts service-seeking decisions from the perspectives of youth remains underexplored. Such research is necessary to inform effective stigma reduction. OBJECTIVE: This study aims to understand how stigma influences service seeking among youth with mental health challenges. METHODS: Qualitative inquiry was taken using youth engagement, underpinned by pragmatism. Data were collected via 4 virtual focus groups with 22 purposively selected youth participants with lived experience of mental health challenges in Ontario, Canada. Focus group guides were developed collaboratively among research team members, including youth co-researchers. Data were analyzed inductively using reflexive thematic analysis. RESULTS: Three main themes were constructed from the data: point of entry into the system, being biomedicalized or trivialized, and paving the way for non-stigmatizing services. Initial contact with the mental healthcare system was seen to be affected by stigma, causing participants to delay contact or be refused services if they do not fit with an expected profile. Participants described a constant negotiation between feeling 'sick enough' and 'not sick enough' to receive services. Once participants accessed services, they perceived the biomedicalization or trivialization of their challenges to be driven by stigma. Lastly, participants reflected on changes needed to reduce stigma's effects on seeking and obtaining services. CONCLUSION: A constant negotiation between being 'sick enough' or 'not sick enough' is a key component of stigma from the perspectives of youth. This tension influences youth decisions about whether to seek services, but also service provider decisions about whether to offer services. Building awareness around the invisibility of mental health challenges and the continuum of wellness to illness may help to break down stigma's impact as a barrier to service seeking. Early intervention models of care that propose services across the spectrum of challenges may prevent the sense of stigma that deters youth from accessing and continuing to access services.

Impact Potpourri: A Multimethod Survey Study on Youth Substance Use During COVID-19.

Background: Given the important implications of youth substance use, it is essential to document and describe changes in substance use during the coronavirus disease 2019 pandemic. Methods: This multimethod survey study examines the impacts of the coronavirus disease 2019 pandemic on youth substance use among 149 Canadian youth who were using substances at a mid-pandemic period. Participants were 21.9 years of age on average (SD=2.2), including 99 girls/young women, 42 boys/young men, and 8 transgender or nonbinary individuals. The majority were Caucasian and born in Canada. Qualitative and quantitative findings are reported, with thematic analysis combined with descriptive and inferential statistical analyses. Results: Qualitatively, many youth reported increases or shifts in their substance use over the course of the pandemic. Youth reported using substances with limited numbers of peers, with family, or alone. Many reported using substances out of boredom and to cope. While legal substances remained highly accessible, illegal substances were reported to be more difficult to acquire and less trustworthy. Spending had increased. Quantitative findings suggested alcohol use has decreased, but other substance use has remained stable in the sample as a whole, although for each substance, some youth reported increases. Discussion: Despite minimal quantitative change, qualitative findings show that some youth increased their use of some substances during the pandemic, decreased others, changed their motivation to use, and decreased in safety behaviors. Youth-serving organizations should be aware of individual differences, the changing context of substance use, and the potential long-term impacts.

Contexte: Compte tenu des implications importantes de la consommation de substances chez les jeunes, il est essentiel d'identifier, documenter et décrire l'évolution de la consommation de substances pendant la pandémie de COVID-19 afin d'élaborer des stratégies de prévention et des traitements efficaces. Méthode: Cette étude d'enquête multiméthodes examine les impacts de la pandémie de COVID-19 sur la consommation de substances chez 149 jeunes canadiens qui consommaient des substances au milieu de la période de la pandémie. Les participants avaient 21,9 ans en moyenne (ET=2,2), dont 99 filles/jeunes femmes, 42 garçons/jeunes hommes et 8 personnes transgenres ou non binaires. La majorité des participants étaient caucasien et née au Canada. Les résultats qualitatifs et quantitatifs sont rapportés avec une analyse thématique combinée à des analyses statistiques descriptives et analogiques. Résultats: Sur le plan qualitatif, de nombreux jeunes qui consommaient des substances pendant la pandémie ont signalé des augmentations ou des changements dans leur consommation de substances au cours de la pandémie. Les jeunes ont déclaré consommer des substances avec un nombre limité de pairs, en famille ou seul. De nombreux jeunes ont déclaré consommer des substances par ennui et pour faire face à la situation. Alors que les substances légales sont restées très accessibles, les substances illicites sont devenues plus difficiles à acquérir et moins dignes de confiance ce qui a entraîné une augmentation des dépenses. Les résultats quantitatifs suggèrent que la consommation d'alcool a diminué pour ces jeunes, mais la consommation d'autres substances est restée stable dans l'ensemble de l'échantillon, bien que pour chaque substance, certains jeunes ont signalé des augmentations. Analyse: Malgré un changement quantitatif minime, les résultats qualitatifs montrent que chez les jeunes qui consommaient des substances au milieu de la période de la pandémie, certains jeunes ont connu une augmentation de la consommation de certaines substances pendant la pandémie, une diminution de leur consommation d'autres substances, des changements dans leur motivation à consommer des substances et une diminution des comportements sécuritaires. Les organisations au service des jeunes doivent être conscientes des différences individuelles, du contexte changeant de la consommation de substances et des impacts potentiels à long terme. Les prestataires de services devraient travailler avec les jeunes de manière centrée sur la personne pour identifier des solutions dans le contexte des expériences vécues en lien avec la COVID-19.

"You can kind of just feel the power behind what someone's saying": a participatory-realist evaluation of peer support for young people coping with complex mental health and substance use challenges.

BACKGROUND: Youth peer support, as a practice that aligns youth engagement and participatory approaches, has become increasingly popular in the context of youth mental health services. However, there is a need for more evidence that describes how and why youth peer support practice might be effective. This study was designed to examine a peer support service for youth experiencing complex challenges with mental health, physical health and/or substance use to better understand key features and underlying mechanisms that lead to improved client outcomes. METHODS: We applied a hybrid realist-participatory approach to explore key issues and underlying theoretical assumptions within a youth peer support approach for young people (age 14-26) experiencing complex mental health and substance use challenges. We used semi-structured interviews and focus groups with staff, including peers (N = 8), clinical service providers and administrative staff (N = 15), to develop the theories and a client survey to validate them. Our qualitative thematic analysis applied a retroductive approach that involved both inductive and deductive processes. For the client survey (N = 77), we calculated descriptive statistics to examine participant profiles and usage patterns. Pearson correlations were examined to determine relationships among concepts outlined in the program theories, including context, mechanism and outcome variables. RESULTS: Our analyses resulted in one over-arching context, one over-arching outcome and four program theories. Program theories were focused on mechanisms related to 1) positive identity development through identification with peers, 2) enhanced social connections, 3) observational learning and 4) enhanced autonomy and empowerment. CONCLUSIONS: This study serves as a unique example of a participatory-realist hybrid approach. Findings highlight possible key components of youth peer practice and shed light on the functional mechanisms that underlie successful peer practice. These key components can be examined in other settings to develop more comprehensive theories of change with respect to youth peer support and can eventually be used to develop guidelines and standards to strengthen practice. This research contributes to an expanding body of literature on youth peer support in mental health and connects peer practice with several social theories. This research begins to lay a foundation for enhanced youth peer support program design and improved outcomes for young people experiencing complex mental health and substance use challenges.

Learning Through a Pandemic: Youth Experiences With Remote Learning During the COVID-19 Pandemic.

The objective of this paper was to examine the school-related experiences of youth during the COVID-19 pandemic. Participants represented both clinical and community youth aged 14 to 28 who were sampled as part of a larger study. Feedback from youth attending school during the pandemic was qualitatively examined and youth who planned to attend school prior to the pandemic and did (n = 246) and youth who planned to attend but did not (n = 28) were compared quantitatively. Youth appreciated the flexibility of online learning and some also reported experiencing a lack of support from their school and the need for instructor training on how to deliver virtual classes effectively. Future studies should examine what factors influence student engagement with virtual learning, what strategies could improve supports for student in their long-term career development, and the longitudinal experiences of youth who may have chosen not to go back to school due to the pandemic. This survey was conducted in Ontario, Canada. A more diverse sample collected outside of Ontario would improve generalizability. Qualitative data were based on survey responses and not interviews. Thus we were unable to discern the reasons youth decided to attend school, or not, during the COVID-19 pandemic.

Impacts of COVID-19 on Youth Mental Health, Substance Use, and Well-being: A Rapid Survey of Clinical and Community Samples: Répercussions de la COVID-19 sur la santé mentale, l'utilisation de substances et le bien-être des adolescents : un sondage rapide d'échantillons cliniques et communautaires.

OBJECTIVES: The current novel coronavirus disease of 2019 (COVID-19) pandemic presents a time-sensitive opportunity to rapidly enhance our knowledge about the impacts of public health crises on youth mental health, substance use, and well-being. This study examines youth mental health and substance use during the pandemic period. METHODS: A cross-sectional survey was conducted with 622 youth participants across existing clinical and community cohorts. Using the National Institute of Mental Health-developed CRISIS tool and other measures, participants reported on the impacts of COVID-19 on their mental health, substance use, and other constructs. RESULTS: Reports of prepandemic mental health compared to intrapandemic mental health show a statistically significant deterioration of mental health across clinical and community samples (P < 0.001), with greater deterioration in the community sample. A total of 68.4% of youth in the clinical sample and 39.9% in the community sample met screening criteria for an internalizing disorder. Substance use declined in both clinical and community samples (P < 0.001), although 23.2% of youth in the clinical sample and 3.0% in the community sample met screening criteria for a substance use disorder. Participants across samples report substantial mental health service disruptions (48.7% and 10.8%) and unmet support needs (44.1% and 16.2%). Participants report some positive impacts, are using a variety of coping strategies to manage their wellness, and shared a variety of ideas of strategies to support youth during the pandemic. CONCLUSIONS: Among youth with histories of mental health concerns, the pandemic context poses a significant risk for exacerbation of need. In addition, youth may experience the onset of new difficulties. We call on service planners to attend to youth mental health during COVID-19 by bolstering the accessibility of services. Moreover, there is an urgent need to engage young people as coresearchers to understand and address the impacts of the pandemic and the short, medium, and long terms.