Youths' Perceived Impact of Invalidation and Validation on Their Mental Health Treatment Journeys.

Youths' experiences in seeking and accessing help for mental health problems can have pervasive and lasting effects on personal and interpersonal functioning. In particular, youth who experience validating experiences presumably persevere in seeking help and generally have positive treatment outcomes, whereas youth who experience invalidation are also likely to experience, at least in the short term, ruptures in therapeutic relationships, shame, and reluctance to seek services. The goal of the current study was to expand on previous research assessing youths' interactions with mental health providers, allied professionals, family members, and peers, with a focus on subjective experiences of validation and invalidation. The current study investigated both validating and invalidating experiences in seeking, accessing, and maintaining professional services among 31 Canadian youth (n = 20 girls, n = 11 boys; 12 to 21 years old [M = 16.97, SD = 2.01]) who were diagnosed or self-identified with at least one of five conditions: depression (n = 26), anxiety (n = 22), eating disorders (n = 9), autism spectrum disorder (n = 2), or conduct disorder or oppositional defiant disorder (n = 2). Youth were recruited using convenience (e.g., posted advertisements in mental health clinics) and snowball sampling methods. Journey mapping methodology (i.e., participants created visual representations of milestones of their mental health journeys) was employed accompanied by semi-structured interviews to prompt youth to expand on their experiences (e.g., "Could you describe what was happening in your life when you first felt you would need support for your mental health?"). Four themes emerged using inductive thematic analysis, marked by the presence (validation) or lack (invalidation) of: feeling heard, feeling seen, feeling understood, and receiving helpful actions. Participants also reported key consequences of validation and invalidation. Findings broaden a conceptualization of validation across supportive relationships and an understanding of factors that enhance or impede the formation or maintenance of therapeutic relationships with youth. Clinical implications and limitations are discussed.

Longitudinal examination of youth readmission to mental health inpatient units.

OBJECTIVE: Significant barriers exist for youth in obtaining mental health services. These barriers are exacerbated by growing demand, attributed partially to children and adolescents who have repeat hospital admissions. The purpose of this study was to identify demographic, socioeconomic and clinical predictors of readmission to inpatient psychiatric services in New Brunswick, Canada. METHOD: Key demographic, support and clinical predictors of readmission were identified. The New Brunswick Discharge Abstract Database (DAD) was used to compile a cohort of all children and adolescents ages 3-19 years with psychiatric hospital admissions between 1 April 2003 and 31 March 2014 (N = 3825). Primary analyses consisted of Kaplan-Meier survival methods with log-rank tests to assess time-to-readmission variability, and Cox regression to identify significant predictors of readmission. RESULTS: In total, 27.8% of admitted children and adolescents experienced at least one readmission within the 10-year period, with 57.3% readmitted to hospital within 90 days following discharge. Bivariate results indicated that male, upper-middle socioeconomic status (SES) youths aged 11-15 years from nonrural communities were most likely to be readmitted. Notable predictors of increased readmission likelihood were older age, being male, higher SES, referral to care by medical practitioner, discharge to another health facility, psychosis, and previous psychiatric admission. CONCLUSION: A significant portion of the variance in readmission was accounted for by youth demographic characteristics (i.e. age, SES, geographic location) and various support structures, including referrals to inpatient care and aftercare support services. KEY PRACTITIONER MESSAGE: Readmission to inpatient psychiatric care among youth is affected by a number of multifaceted risk factors across individual, environmental and clinical domains. This study used provincial population-scale longitudinal administrative data to demonstrate the influence of various individual and demographic factors on likelihood of readmission, which is notably absent from the majority of studies that make use of smaller, short-term data samples. Ensuring that multiple factors outside of the clinical context are considered when examining readmission among youth may contribute to a more thorough understanding of youth hospitalization patterns.

Family perspectives on pathways to mental health care for children and youth in rural communities.

CONTEXT: There is insufficient literature documenting the mental health experiences and needs of rural communities, and a lack of focus on children in particular. This is of concern given that up to 20% of children and youth suffer from a diagnosable mental health problem. PURPOSE: This study examines issues of access to mental health care for children and youth in rural communities from the family perspective. METHODS: In-depth interviews were conducted in rural Ontario, Canada, with 30 parents of children aged 3-17 who had been diagnosed with emotional and behavioral disorders. FINDINGS: Interview data indicate 3 overall thematic areas that describe the main barriers and facilitators to care. These include personal, systemic, and environmental factors. Family members are constantly negotiating ongoing tension, struggle, and contradiction vis-à-vis their attempts to access and provide mental health care. Most factors identified as barriers are also, under different circumstances, facilitators. Analysis clustered around the contrasts, contradictions, and paradoxes present throughout the interviews. CONCLUSIONS: The route to mental health care for children in rural communities is complex, dynamic, and nonlinear, with multiple roadblocks. Although faced with multiple roadblocks, there are also several factors that help minimize these barriers.

The meaning of smoking as health and social risk in adolescence.

This investigation describes what smoking means to adolescents, and attempts to better understand it as a rite of passage. Applying a social ontology to an often-individualized issue, interviews were conducted with 20 adolescent smokers between the ages of 13 and 19. Results show that adolescents possess detailed information about the risks of smoking. Both age and gender differentiated the meanings of smoking which were found to be both positive and negative. Valence inconsistency increased with age. Results are interpreted within a cultural, developmental framework and suggest reconstructing smoking risks as potentially positive. Implications for research and prevention are discussed.

Measuring adolescent smoking expectancies by incorporating judgments about the expected time of occurrence of smoking outcomes.

French and English Canadian adolescents completed a smoking expectancy questionnaire and 2 measures of current smoking status. Multiple regression revealed that beliefs about the expected time of occurrence of smoking outcomes explained unique variance in current smoking after controlling for judgments about the probability and desirability of these outcomes. In addition, the relationship between the perceived probability of the general costs of smoking and current smoking was moderated by beliefs about the expected time of occurrence of these costs. There was no relationship between perceived probability of general costs and smoking for adolescents who expected the costs to occur far in the future, whereas there was a significant negative relationship between these 2 variables for adolescents who expected the costs to occur soon after smoking. The authors' results suggest that it may be possible to increase the concurrent validity of traditional smoking expectancy measures by incorporating expected-time-of-occurrence judgments.

Innovations and issues in the delivery of continuing education to nurse practitioners in rural and northern communities.

This paper addresses the need to provide rural nurse practitioners (NPs) with the distance education that is considered vital to the upgrading of their professional skills. The method of delivering the courses is a critical aspect of their success. The authors trace and describe the innovative delivery of the Rural Ontario Nurse Practitioner Continuing Education Initiative, from the initial needs assessment study through to the implementation and evaluation study. In each study, a multi-method action research model was used. The respondents showed a preference for face-to-face modalities that were perceived to be constrained by barriers. These barriers were subsequently addressed by the pilot project. Those living in rural areas recognized the benefits of information technologies. Implementation was effectively weighted on multiple modes of online course delivery and the use of constructivist pedagogy. The findings suggest that the delivery of continuing education to rural and remote NPs is still wrought with challenges.

Child and adolescent health in Northern Ontario: a quantitative profile for public health planning.

Health in Northern Ontario is poorer than in the province of Ontario. Late childhood is the period in which adult habits and health behaviours are solidified, thus, health indicators are important to guide the development and implementation of disease prevention strategies. The Northern Ontario Child and Youth Health Report evaluated the health of children in Northern Ontario. The importance of public health planning is presented with the value of health status information for youth. The hospitalization rate for Northern Ontario youths was higher than for Ontario. In both areas, injuries and poisonings were the leading cause of hospitalization (7-13 year olds), however rates in the North were higher. Hospitalizations for injuries and poisonings were double the provincial rate in 14-19 year olds. The mortality rate for all youth was significantly higher. Health risk behaviour prevalence (e.g., alcohol consumption) was higher in the region. Current data emphasize the need for primordial and primary prevention in regional health planning and are also useful in secondary and tertiary prevention. Data for public health planning is critical to address population health needs and prevent chronic diseases.

A comparison of the mediational properties of four adolescent smoking expectancy measures.

This prospective study compared the ability of 4 smoking expectancy measures to mediate the influence of peer, parent, and current smoking on adolescents' cigarette use 3 months later. No evidence for mediation was found when expectancies were operationalized as unidimensional subjective expected utility (SEU), multidimensional SEU, or unidimensional SEU decomposed into probability and desirability main effects and their interaction. Evidence for partial mediation was found for the decomposed multidimensional SEU measure. The results suggest that (a) peer and current cigarette use may influence future smoking indirectly through adolescents' probability estimates that smoking will control negative emotions and (b) the relationship between current and future smoking also may be mediated by adolescents' beliefs about the desirability of weight control.