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.

A Systematic Review of Childhood Adversity and Executive Functions Outcomes among Adults.

OBJECTIVE: Exposure to adverse childhood experiences (ACEs) is linked to disruptions in typical neurodevelopment of brain structures and functioning, including changes in executive functions. Although the relationships among ACEs, executive functions, and psychopathology are well documented in pediatric samples, a systematic review is needed to examine these relationships in adulthood. METHOD: A systematic review examining the link between ACEs and executive functions among adult clinical and nonclinical samples was conducted across 33 scientific and grey literature databases. Among reviewed studies, 17 sources met review criteria, with 11 involving clinical samples and six involving nonclinical samples. RESULTS: Among clinical samples, evidence suggested that ACEs increased risk for executive function difficulties among those diagnosed with bipolar disorder, schizophrenia, post-traumatic stress disorder, and those experiencing a first episode of psychosis, however not within those diagnosed with major depressive disorder. Among nonclinical samples, executive function difficulties associated with ACEs were found among those in early and middle adulthood. Not all retrieved sources showed consistent findings, and two studies described better executive function outcomes among those who experienced childhood sexual abuse and emotional abuse. CONCLUSIONS: Executive function difficulties associated with ACEs appear to persist into adulthood, though inconsistently. Future research may further explore distinct differences among specific ACEs and executive function difficulties to further inform ongoing prevention and treatment efforts.

Intergenerational residential school attendance and increased substance use among First Nation adults living off-reserve: An analysis of the aboriginal peoples survey 2017.

Introduction: The Truth and Reconciliation Commission of Canada (TRCC) published 94 Calls to Action in 2015 to address long-term, intergenerational effects of the residential school system, highlighting the pervasive impact of colonialism on the wellbeing of Indigenous peoples in Canada. Indeed, research with Indigenous populations in Canada has captured that prior experiences of residential schools contributes to the intergenerational transmission of mental and physical health disparities. Despite these studies, further research is needed that contextualizes the influence of residential schools within broader frameworks that consider Indigenous social determinants of health in Canada. As such, the purpose of the present study was to examine patterns of substance use and mental and physical health among individuals with a history of residential school attendance (RSA) and individuals reporting parent or two-generation (parent and grandparent) RSA. Method: Data from the Aboriginal Peoples Survey (2017), involving 10,030 First Nations individuals living off reserve, were analyzed. Results: Self-reported mental and physical health scores were significantly lower among those had attended residential schools, whose parents attended residential schools, and whose grandparents attended residential schools, when compared to those who did not. Further, family RSA was associated with increased substance use among participants, though the findings were variable based on sex and specific substance analyzed. Meanwhile, individual and family RSA was not associated with increased likelihood of a mental health diagnosis. Discussion: These findings provide additional support for how both parental and two-generation family histories of RSA are associated with individual physical and mental health outcomes. Further, these findings articulate the need for the TRCC's Calls to Action to be actually implemented, including community-based approaches that harness the strength of Indigenous people and communities who aim to close the gap in these health disparities for their children and families.

The influence of pre and postnatal adversity on depression and anxiety over two decades.

INTRODUCTION: Perinatal and later postnatal adversity (e.g., child sexual abuse) are predictors of psychopathology across the lifespan. However, little is known about the impact of the joint effects of perinatal and postnatal adversity on the longitudinal trajectories of mental health problems from adolescence through adulthood. METHOD: We utilized data from a prospective, longitudinal birth cohort of extremely low birth weight (ELBW; < 1000 g) survivors and normal birth weight (NBW; > 2500 g) control participants. Self-report data on internalizing (depression, anxiety) and externalizing (antisocial) problems were collected at 12-16, 22-26, and 30-35 years of age. RESULTS: A birth weight by child sexual abuse (CSA) interaction was observed such that ELBW survivors exposed to CSA had higher levels of internalizing problems from adolescence through adulthood than NBW participants exposed to CSA. Differences remained significant after adjustment for covariates. Likewise, ELBW survivors exposed to CSA had higher levels of internalizing problems from adolescence through adulthood than ELBW participants who were not exposed to CSA. LIMITATIONS: Findings are limited by sample attrition due to the longitudinal nature of the study spanning over 30 years as well as the retrospective nature of child sexual abuse reporting. CONCLUSIONS: Exposure to both perinatal and later postnatal adversity leads to persistently higher internalizing problems than exposure to either adversity alone over more than two decades. These findings suggest that individuals exposed to perinatal adversity may be especially vulnerable to, and persistently affected by, childhood adversity, particularly in the form of depression and anxiety.

Adverse Childhood Experiences and Executive Function Difficulties in Children: A Systematic Review.

BACKGROUND: The relationship between adverse childhood experiences (ACEs) and detrimental mental health outcomes has been increasingly explored within scientific literature since the original ACE study was published by Felitti et al. (1998). Given that deficits in executive functions (EF) are prominent in most forms of psychopathology across the lifespan, there is utility in considering how ACEs relate to EF outcomes. OBJECTIVE: To consolidate the research to date on the relationship between ACEs and EF outcomes among child samples. METHODS: A systematic review was conducted that included 16 scientific databases and 17 grey literatures. RESULTS: Across 36 studies, many examined EF related to forms of maltreatment (e.g. abuse, neglect, and exposure to intimate partner violence) and found a strong relationship between maltreatment and EF deficits among children. Similarly, family member mental illness (maternal depression in particular) was associated with poor EF outcomes. The relationship between other ACEs and EF outcomes have not been uniquely examined, including intimate partner violence and family member incarceration. CONCLUSIONS: This review acts as a preliminary step towards broader understanding of outcomes related to early childhood experiences through the consideration of EFs. Through documentation of such relationships, it is possible to consider how prevention and treatment approaches may be improved.

The Relationship Between the Sexual Self and the Experience of Pregnancy.

Studies reveal that prenatal health-care providers and educators often refrain from discussing sexuality with their patients. The present study explored the relationship between sexuality and pregnancy by considering whether the way in which women view themselves sexually is associated with their experience of pregnancy. Findings revealed that a positive sexual self was significantly related to a positive experience of pregnancy and that particular experiences of pregnancy were more significantly related to how women viewed themselves sexually than others. The findings encourage further discussion regarding the role that comprehensive sex education and training of prenatal health-care providers might play in ultimately establishing open, honest, and nonjudgmental discussions about sexuality between providers and their pregnant patients and partners.

Adult mental health outcomes of child sexual abuse survivors born at extremely low birth weight.

The high prevalence of child sexual abuse (CSA) is concerning, particularly as survivors are at increased risk for multiple adverse outcomes, including poor mental health across the lifespan. Children born at an extremely low birth weight (ELBW; <1000g) and who experience CSA may be a group that is especially vulnerable to psychopathology later in life. However, no research has considered the mental health risks associated with being born at ELBW and experiencing CSA. In this study, we investigated the mental health of 179 ELBW survivors and 145 matched normal birth weight (NBW; >2500g) participants at ages 22-26 and 29-36. At age 22-26, CSA was associated with increased odds of clinically significant internalizing (OR=7.32, 95% CI: 2.31-23.23) and externalizing (OR=4.65, 95% CI: 1.11-19.51) problems among ELBW participants exposed to CSA compared to those who did not, though confidence intervals were wide. At age 29-36, CSA was linked to increased odds of any current (OR=3.43, 95% CI: 1.08-10.87) and lifetime (OR=7.09, 95% CI: 2.00-25.03) non-substance use psychiatric disorders, however, this did not hold after adjustment for covariates. Statistically significant differences in mental health outcomes were not observed in NBW participants exposed to CSA compared to NBW participants who were not exposed. Survivors of significant perinatal adversity who are also exposed to CSA may be at higher risk for psychopathology through the fourth decade of life.