A Feasibility Trial of Mental Health First Aid First Nations: Acceptability, Cultural Adaptation, and Preliminary Outcomes.

The Mental Health First Aid First Nations course was adapted from Mental Health First Aid Basic to create a community-based, culturally safe and relevant approach to promoting mental health literacy in First Nations contexts. Over 2.5 days, the course aims to build community capacity by teaching individuals to recognize and respond to mental health crises. This feasibility trial utilized mixed methods to evaluate the acceptability, cultural adaptation, and preliminary effectiveness of MHFAFN. Our approach was grounded in community-based participatory research principles, emphasizing relationship-driven procedures to collecting data and choice for how participants shared their voices. Data included participant interviews (n = 89), and surveys (n = 91) from 10 groups in four provinces. Surveys contained open-ended questions, retrospective pre-post ratings, and a scenario. We utilized data from nine facilitator interviews and 24 facilitator implementation surveys. The different lines of evidence converged to highlight strong acceptability, mixed reactions to the cultural adaptation, and gains in participants' knowledge, mental health first aid skill application, awareness, and self-efficacy, and reductions in stigma beliefs. Beyond promoting individual gains, the course served as a community-wide prevention approach by situating mental health in a colonial context and highlighting local resources and cultural strengths for promoting mental well-being.

Two Years of Relationship-Focused Mentoring for First Nations, Métis, and Inuit Adolescents: Promoting Positive Mental Health.

First Nations, Métis, and Inuit (FNMI) youth are disproportionately affected by a range of negative health outcomes including poor emotional and psychosocial well-being. At the same time, there is increasing awareness of culturally-specific protective factors for these youth, such as cultural connectedness and identity. This article reports the findings of a mixed-methods, exploratory longitudinal study on the effects of a culturally-relevant school-based mentoring program for FNMI youth that focuses on promoting mental well-being and the development of cultural identity. Participants included a cohort of FNMI adolescents whom we tracked across the transition from elementary to secondary school. We utilized data from annual surveys (n = 105) and a subset of youth whom we interviewed (n = 28). Quantitative analyses compared youth who participated in 1 or 2 years of mentoring programs with those who did not participate. At Wave 3, the 2-year mentoring group demonstrated better mental health and improved cultural identity, accounting for Wave 1 functioning. These results were maintained when sex and school climate were accounted for in the models. Sex did not emerge as a significant moderator; however, post hoc analyses with simple slopes indicated that the mentoring program benefited girls more than boys for both outcomes. Interview data were coded and themed through a multi-phase process, and revealed that the mentoring program helped participants develop their intrapersonal and interpersonal skills, and enhanced their cultural and healthy relationships knowledge base. Collectively, the quantitative and qualitative components of this study identify multiple years of culturally-relevant mentoring as a promising approach for promoting well-being among FNMI youth.

Cultural Connectedness and Its Relation to Mental Wellness for First Nations Youth.

We explored the interrelationships among components of cultural connectedness (i.e., identity, traditions, and spirituality) and First Nations youth mental health using a brief version of the original Cultural Connectedness Scale. Participants included 290 First Nations youth (M age = 14.4) who were recruited from both urban and rural school settings in Saskatchewan and Southwestern Ontario. We performed a confirmatory factor analysis of the Cultural Connectedness Scale-Short Version (CCS-S) items to investigate the factor stability of the construct in our sample. We examined the relationships between the CCS-S subscales and self-efficacy, sense of self (present and future), school connectedness, and life satisfaction using hierarchical multiple linear regression analyses to establish the validity of the abbreviated measure. The results revealed that cultural connectedness, as measured by the 10-item CCS-S, had strong associations with the mental health indicators assessed and, in some cases, was associated with First Nations youth mental health above and beyond other social determinants of health. Our results extend findings from previous research on cultural connectedness by elucidating the meaning of its components and demonstrate the importance of culture for positive youth development.

Longitudinal prediction and concurrent functioning of adolescent girls demonstrating various profiles of dating violence and victimization.

Adolescent girls are involved in physical dating violence as both perpetrators and victims, and there are negative consequences associated with each of these behaviors. This article used a prospective design with 519 girls dating in grade 9 to predict profiles of dating violence in grade 11 based on relationships with families of origin (child maltreatment experiences, harsh parenting), and peers (harassment, delinquency, relational aggression). In addition, dating violence profiles were compared on numerous indices of adjustment (school connectedness, grades, self-efficacy and community connectedness) and maladjustment (suicide attempts, distress, delinquency, sexual behavior) for descriptive purposes. The most common profile was no dating violence (n = 367) followed by mutual violence (n = 81). Smaller numbers of girls reported victimization or perpetration only (ns = 39 and 32, respectively). Predicting grade 11 dating violence profile membership from grade 9 relationships was limited, although delinquency, parental rejection, and sexual harassment perpetration predicted membership to the mutually violent group, and delinquency predicted the perpetrator-only group. Compared to the non-violent group, the mutually violent girls in grade 11 had lower grades, poorer self-efficacy, and lower school connectedness and community involvement. Furthermore, they had higher rates of peer aggression and delinquency, were less likely to use condoms and were much more likely to have considered suicide. There were fewer differences among the profiles for girls involved with dating violence. In addition, the victims-only group reported higher rates of sexual intercourse, comparable to the mutually violent group and those involved in nonviolent relationships. Implications for prevention and intervention are highlighted.

Observations of adolescent peer resistance skills following a classroom-based healthy relationship program: a post-intervention comparison.

This study examines peer resistance skills following a 21-lesson classroom-based intervention to build healthy relationships and decrease abusive and health-risk behaviors among adolescents. The Fourth R instructs students in positive relationship skills, such as negotiation and delay, for navigating challenging peer and dating scenarios. Observational data from 196 grade 9 students participating in a larger cluster randomized controlled trial were used to evaluate post-intervention acquisition of peer resistance skills. Pairs of students engaged in a role play paradigm with older student actors, where they were subjected to increasing pressure to comply with peer requests related to drugs and alcohol, bullying, and sexual behavior. Specific and global measures of change in peer resistance responses were obtained from two independent sets of observers, blinded to condition. Specific peer resistance responses (negotiation, delay, yielding to pressure, refusal, and compliance) were coded by research assistants; global peer resistance responses were rated by teachers from other schools (thinking / inquiry, application, communication, and perceived efficacy). Students who received the intervention were more likely to demonstrate negotiation skills and less likely to yield to negative pressure relative to controls. Intervention students were also more likely to use delay than controls; control girls were more likely to use refusal responses; the number of times students complied with peer requests did not differ. Teacher ratings demonstrated significant main effects favoring intervention youth on all measures. Program and research implications are highlighted.

Practical Guidelines and Case Examples for Adapting an Evidence-based Intervention in a Complex Community Setting.

THE PROBLEM: Evidence-based interventions are often tested in specific, structured settings, but may need modification to meet the complex needs of vulnerable youth in real-world settings. Nonetheless, past research has not provided practical guidelines to help community partners make decisions about how to adapt evidence-based interventions to their settings. PURPOSE OF ARTICLE: We identify barriers in implementing a mental health promotion and violence prevention intervention with youth in a complex community setting to provide practice examples of how the program was adapted to address different challenges. These adaptation decisions are framed within guidelines that are grounded in a wider evidence base. KEY POINTS: The guidelines underscore the importance of trauma-informed practice, emphasizing confidentiality, tailoring content to meet individual youth's clinical risk and responsivity factors, adjusting dosage and content to meet the group's needs, aligning programming with case planning, being flexible with format, and attending to contextual factors. CONCLUSIONS: Evidence-based interventions need to be adapted to meet the needs of both individual participants and groups. The guidelines and case examples presented here demonstrate how this adaptation was undertaken in an intentional and evidence-driven way in one agency in the context of a community-based research partnership.

Sex as Boys' Fame, But Girls' Shame: Adversarial Adolescent Gender Roles and Gender-based Violence in Guyana.

Gender-based violence (GBV) is a significant issue for youth in Guyana, particularly among young women. Yet, discussions about sex, dating, and violence rarely occur at the community level. To understand the heightened risk for GBV with youth in Guyana, we utilized a critical qualitative design to explore adolescent dating violence with adolescents (14-16 years old), parents, and school officials in a public secondary school in Guyana. In total, 36 racially and religiously diverse participants from low to middle-income households participated in focus groups (n = 30) and interviews (n = 6). Discussions centered on dating in adolescence; community awareness of dating violence; gender, racialization, and class in relation to dating violence; and dating violence prevention in schools and family settings. Our results revealed that heteronormative, adversarial gender roles in Guyana are enacted in adolescent relationships in ways that contribute to violence. Two important factors emerged in relation to femininity: female respectability related to sexuality; and the relationship between clothing, sexuality, and social class. Masculinity for adolescent boys was centered on reproducing normative assumptions about femininity and explaining the use of violence through pathologizing race. Participants were also asked to identify gender roles that adolescent boys and girls should embody in relationships, which revealed possibilities for overcoming adversarial roles in relationships. We propose that adolescent GBV prevention initiatives consider long-standing and deeply embedded ideas within gender norms that are connected to sexuality, class, and race. Without accounting for these systemic factors, GBV prevention initiatives and programs may inadvertently perpetuate traditional definitions of masculinity and femininity that contribute to violence.

Who Are We Missing? The Impact of Requiring Parental or Guardian Consent on Research With Lesbian, Gay, Bisexual, Trans, Two-Spirit, Queer/Questioning Youth.

PURPOSE: The purpose was to examine whether a requirement for parental or guardian consent systematically limits which lesbian, gay, bisexual, trans, two-spirit, queer/questioning (LGBT2Q+) youth participate in research. METHODS: A total of 60 LGBT2Q+ youth (aged 14-18 years) completed measures assessing gender and sexual minority identity, depression and anxiety, help-seeking intentions, and social support. RESULTS: A substantial proportion (37.6%) of youth reported that they would not have participated in the research if parental or guardian consent was required. Those who would not have participated had more negative attitudes about their sexual and gender identity, less family support, lower levels of help-seeking intentions, and higher levels of negative affect. CONCLUSIONS: The results suggest that requiring parental or guardian consent may exclude the most at-risk youth. Policy and practice decisions regarding the health and mental health outcomes of LGBT2Q+ youth might be based on incomplete and unrepresentative data.

Preventing Gender-Based Violence Among Adolescents and Young Adults: Lessons From 25 Years of Program Development and Evaluation.

Effective prevention of intimate partner violence (IPV) among adolescents and young adults is a key strategy for reducing rates of gender-based violence (GBV). Numerous initiatives have been developed and evaluated over the past 25 years. There is emerging evidence about effective strategies for universal prevention of dating violence in high school settings and effective bystander interventions on university and college campuses. In addition, there have been some effective practices identified for specific groups of youth who are vulnerable to victimization (either based on past experiences of exposure to domestic violence or previous dating victimization). At the same time, though our evidence about school and college-based interventions has grown, there are significant gaps in our knowledge of effective prevention among marginalized groups. For example, there is a lack of evidence-based strategies for preventing IPV among Indigenous youth; lesbian, gay, bisexual, transgender, questioning+ [LGBTQ+] youth; and young women with disabilities, even though these groups are at elevated risk for experiencing violence. Our review of the current state of evidence for effective GBV prevention among adolescents and young adults suggests significant gaps. Our analysis of these gaps highlights the need to think more broadly about what constitutes evidence. We identify some strategies and a call to action for moving the field forward and provide examples from our work with vulnerable youth in a variety of settings.

Preventing adolescent dating violence: An outcomes protocol for evaluating a gender-transformative healthy relationships promotion program.

Adolescent dating violence (ADV) is a pressing public health problem in North America. Strategies to prevent perpetration are needed, and a substantial body of research demonstrates the importance of applying a gender lens to target root causes of adolescent dating violence as part of effective prevention. To date, however, there has been limited research on how to specifically engage boys in adolescent dating violence prevention. In this short communication, we describe the protocol for a longitudinal, quasi-experimental outcome evaluation of a program called WiseGuyz. WiseGuyz is a community-facilitated, gender-transformative healthy relationships program for mid-adolescent male-identified youth that aims to reduce male-perpetrated dating violence and improve mental and sexual health, by allowing participants to critically examine and deconstruct male gender role expectations. The primary goal of this evaluation is to explore the impact of WiseGuyz on adolescent dating violence outcomes at one-year follow-up among participants, as compared to a risk- and demographically-matched comparison group. Knowledge generated and shared from this project will provide evidence on if and for whom WiseGuyz works, with important implications for adolescent health and well-being.

The essential role of cultural safety in developing culturally-relevant prevention programming in First Nations communities: Lessons learned from a national evaluation of Mental Health First Aid First Nations.

Mental Health First Aid is a population health approach that educates people to recognize and respond to mental health challenges. Since 2012, the Mental Health Commission of Canada has worked with six First Nations communities to develop a culturally-relevant version of the program called Mental Health First Aid First Nations (MHFAFN). This paper presents mixed methods, multi-informant data from a national evaluation to assess the extent to which the course was experienced as culturally safe by Indigenous participants, factors that contributed to these experiences, and ways in which cultural relevancy of MHFAFN can be improved. Our evaluation team conducted participant interviews and surveys, as well as facilitator interviews. Nearly all Indigenous participants (94.6%) experienced the course as safe. Participants and facilitators identified a range of factors that promoted cultural safety, including the knowledge and skills of the facilitators and the cultural components of the course. Participants that did not experience safety identified trauma-related factors and facilitation style. The findings suggest that MHFAFN may be situated in a way where shared cultural backgrounds are imperative to the success of the course. Further evaluation of the MHFAFN curriculum, with the goal of continual improvement, may help to further enhance participants' experiences in taking the course.

Cyberbullying and Internalizing Difficulties among Indigenous Adolescents in Canada: Beyond the Effect of Traditional Bullying.

Most research on bullying and cyberbullying has focused on dominant populations. In particular, inquiries into Indigenous adolescents' involvement in bullying and cyberbullying are scarce. The present study examines the relationship between bullying and cyberbullying involvement and self-reported depression, anxiety, and stress among a sample of 170 Indigenous adolescents (54% female; M age = 15.2 years). Controlling for age and gender, the results of a series of hierarchical multiple regression models indicate that cyberbullying victimization uniquely contributes to self-reported anxiety and stress among Indigenous adolescents, beyond the contribution of traditional bullying victimization. The implications of these findings are discussed.

The role of relationships in collaborative partnership success: Lessons from the Alaska Fourth R project.

Collaborative partnerships are critical to achieving health equity. As such, it is important to understand what contributes to the success of such partnerships. This paper describes the Alaska Fourth R collaborative, a multisectoral group of agencies (including education, health and human services, the violence against women sector, the governor's council on domestic violence, and an external evaluator) that successfully planned, implemented and evaluated a multi-focus health education program statewide. The purpose of this paper was to explore the ways in which seven pre-identified factors contributed to the successful achievement of the collaborative's goals. This project was grounded in community-based research principles, and collectively, the group chose to use Roussos and Fawcett's (2000) seven-factor model as the basis for the project. Using this model as a guide, semi-structured interviews were conducted with five leaders from the key organizations in the collaborative. In interviews, stakeholders described how each of the seven factors functioned in the Alaska collaborative to contribute to project success, with a particular focus on the critical role of relationships. Three specific relationship facets emerged as cross-cutting themes: flexibility, transparency, and prioritization. In sum, taking the time to build deep and authentic relationships, and then developing a shared vision and mission within the context of relationships that are flexible, transparent and prioritized, provided a strong foundation for future success in this collaborative.

Understanding the link between childhood maltreatment and violent delinquency: what do schools have to add?

Child maltreatment constitutes significant risk for adolescent delinquency. Although an ecological model has been proposed to explain this relationship, most studies focus on individual risk factors. Prospective data from 1,788 students attending 23 schools were used to examine the additive influence of childhood maltreatment, individual-level risk factors, and school-level variables assessed at the beginning of Grade 9 on delinquency 4 to 6 months later. Individual-level results indicated that being male, experiencing childhood maltreatment, and poor parental nurturing were predictors of violent delinquency. School climate also played a significant role: Given the same individual risk profile, a student attending a school that was perceived by students as safe was less likely to engage in violent delinquency than was a student attending a school perceived to be unsafe. Moreover, the impact of childhood maltreatment on risk for engaging in violent delinquency was somewhat mitigated by schools' participation in a comprehensive violence prevention program.

Engaging men and boys in preventing violence against women: applying a cognitive-behavioral model.

Although historically the prevention of relationship violence has been seen as a women's issue, more recently recognition has emerged regarding the need to engage men as partners in these initiatives. Early attempts have been mainly driven by grassroots efforts and have not been consistent with a particular theory of behavior and attitude change. This article investigates the application of cognitive-behavioral strategies to engaging men and boys in violence prevention, within a profeminist framework. Three fundamental components of a cognitive-behavioral therapy approach--goal setting, core beliefs, and strategies for change--are discussed and examples of promising initiatives are used to highlight these ideas.

Development of a Cultural Connectedness Scale for First Nations youth.

Despite a growing recognition of cultural connectedness as an important protective factor for First Nations (FN) peoples' health, there remains a clear need for a conceptual model that organizes, explains, and leads to an understanding of the resiliency mechanisms underlying this concept for FN youth. The current study involved the development of the Cultural Connectedness Scale (CCS) to identify a new scale of cultural connectedness. A sample of 319 FN, Métis, and Inuit youths enrolled in Grades 8-12 from reserve and urban areas in Saskatchewan and Southwestern Ontario, Canada, participated in the current study. A combination of rational expert judgments and empirical data were used to refine the pool of items to a set that is a representative sample of the indicators of the cultural connectedness construct. Exploratory factor analysis (EFA) was used to examine the latent structure of the cultural connectedness items, and a confirmatory factor analysis was used to test the fit of a more parsimonious version of the final EFA model. The resulting 29-item inventory consisted of 3 dimensions: identity, traditions, and spirituality. Criterion validity was demonstrated with cultural connectedness dimensions correlating well with other youth well-being indicators. The conceptualization and operationalization of the cultural connectedness has a number of potential applications both for research and prevention. This study provides an orienting framework that guides measurement of cultural connectedness that researchers need to further explore the role of culture in enhancing resiliency and well-being among FN youth in Canada.

Legal and policy responses to children exposed to domestic violence: the need to evaluate intended and unintended consequences.

Greater training and specialization in working with children exposed to domestic violence has resulted in new policies, interagency protocols, and legislation in many states. This paper examines court-related responses in criminal, child protection, and family court custody proceedings, which highlight legislative changes and resulting systemic change. Although this legislation originated with the best of intentions to assist and protect children, some of the most striking outcomes have been negative and unintended. Laws that mandate reporting of children exposed to domestic violence can clash with inadequate training and resources, or inadvertently revictimize abused women. Similarly, child custody legislation that raises a rebuttable presumption that a violent spouse will not receive custody or joint custody of children after parental separation has resulted in greater skepticism about abuse allegations We propose that efforts at law reform can be enhanced by a more thoughtful analysis of potential intended and unintended consequences, and should be accompanied by a comprehensive evaluation plan to monitor implementation effects.

The effects of children's exposure to domestic violence: a meta-analysis and critique.

A wide range of children's developmental outcomes are compromised by exposure to domestic violence, including social, emotional, behavioral, cognitive, and general health functioning. However, there are relatively few empirical studies with adequate control of confounding variables and a sound theoretical basis. We identified 41 studies that provided relevant and adequate data for inclusion in a meta-analysis. Forty of these studies indicated that children's exposure to domestic violence was related to emotional and behavioral problems, translating to a small overall effect (Zr = .28). Age, sex, and type of outcome were not significant moderators, most likely due to considerable heterogeneity within each of these groups. Co-occurrence of child abuse increased the level of emotional and behavioral problems above and beyond exposure alone, based on 4 available studies. Future research needs are identified, including the need for large-scale longitudinal data and theoretically guided approaches that take into account relevant contextual factors.

Impact of a universal school-based violence prevention program on violent delinquency: distinctive benefits for youth with maltreatment histories.

OBJECTIVE: Child maltreatment constitutes a strong risk factor for violent delinquency in adolescence, with cumulative experiences of maltreatment creating increasingly greater risk. Our previous work demonstrated that a universal school-based violence prevention program could provide a protective impact for youth at risk for violent delinquency due to child maltreatment history. In this study we conducted a follow-up to determine if participation in a school-based violence prevention program in grade 9 continued to provide a buffering effect on engaging in acts of violent delinquency for maltreated youth, 2 years post-intervention. METHODS: Secondary analyses were conducted using data from a cluster randomized controlled trial of a comprehensive school-based violence prevention program. Students (N=1,722; 52.8% female) from 20 schools participated in 21 75-min lessons in grade 9 health classes. Individual data (i.e., gender, child maltreatment experiences, and violent delinquency in grade 9) and school-level data (i.e., student perception of safety averaged across students in each school) were entered in a multilevel model to predict violent delinquency at the end of grade 11. RESULTS: Individual- and school-level factors predicting violent delinquency in grade 11 replicated previous findings from grade 9: being male, experiencing child maltreatment, being violent in grade 9, and attending a school with a lower perceived sense of safety among the entire student body increased violent delinquency. The cross-level interaction of individual maltreatment history and school-level intervention was also replicated: in non-intervention schools, youth with more maltreatment in their background were increasingly likely to engage in violent delinquency. The strength of this relationship was significantly attenuated in intervention schools. CONCLUSIONS: Follow-up findings are consistent with the buffering effect of the prevention program previously found post-intervention for the subsample of youth with maltreatment histories. PRACTICE IMPLICATIONS: A relative inexpensive school-based violence prevention program that has been shown to reduce dating violence among the whole student body also creates a protective effect for maltreated youth with respect to lowering their likelihood of engaging in violent delinquency.

Impact of sexual harassment victimization by peers on subsequent adolescent victimization and adjustment: a longitudinal study.

PURPOSE: To examine gender differences in prevalence and types of sexual harassment victimization experienced in grade 9 and how it contributes to relationship victimization and psychological adjustment 2.5 years later. METHODS: A total of 1734 students from 23 schools completed self-report surveys at entry to grade 9 and end of grade 11. Self-report data were collected on victimization experiences (sexual harassment, physical dating violence, peer violence, and relational victimization) and adjustment (emotional distress, problem substance use, self-harm, suicidal thoughts, maladaptive dieting, feeling unsafe at school, and perpetration of violent delinquency). Separate analyses by sex were prespecified. RESULTS: Sexual harassment victimization was common among boys (42.4%) and girls (44.1%) in grade 9, with girls reporting more sexual jokes, comments, and unwanted touch than among boys, and with boys reporting more homosexual slurs or receiving unwanted sexual content. For girls, sexual harassment victimization in grade 9 was associated with elevated risk of self-harm, suicidal thoughts, maladaptive dieting, early dating, substance use, and feeling unsafe at school. A similar pattern of risk was found for boys, with the exception of dieting and self-harm behaviors. Adjusted odds ratios (AOR) indicated these students were significantly more likely than nonharassed students to report victimization by peers and dating partners 2.5 years later (AOR for boys and girls, respectively; all p < .01), including sexual harassment (AOR: 2.45; 2.9), physical dating violence (AOR: 2.02; 3.73), and physical peer violence (AOR: 2.75; 2.79). Gr 9 sexual harassment also contributed significantly to emotional distress (AOR: 2.09; 2.24), problem substance use (AOR: 1.79; 2.04), and violent delinquency perpetration (AOR: 2.1; 3.34) 2.5 years later (boys and girls, respectively; all p < .01). CONCLUSIONS: Sexual harassment at the beginning of high school is a strong predictor of future victimization by peers and dating partners for both girls and boys, and warrants greater prevention and intervention efforts.