Two-eyed Seeing for youth wellness: Promoting positive outcomes with interwoven resilience resources.

Despite the challenges facing Indigenous youth and their communities due to historical and contemporary institutionalised racism in Canada, communities are drawing on the richness of their own histories to reassert their cultural heritage. Doing so supports mental health outcomes of young people in particular, as highlighted in a compelling body of research. The question facing many communities, however, is how they can facilitate such child and youth engagement in order to support related positive mental health outcomes. This article reports on findings from a Participatory Action Research (PAR) study conducted in a First Nations community in Unama'ki (Cape Breton), Atlantic Canada. The study, Spaces & Places, was a partnership between the community-based mental health service provider (Eskasoni Mental Health Services, EMHS), eight community youth (14-18 years old), and a team of academics. Situated within a resilience framework, the team explored the ways in which the community facilitated, or restricted, youth civic and cultural engagement. Foregrounded against a strong legacy of cultural reassertion within the community, findings highlight the core resilience-promoting resources that support positive youth development. Additionally, findings demonstrate how these resources provide meaningful support for youth because of the way in which they are intertwined with one another. Furthermore, cultural engagement is underpinned by the Two-eyed Seeing model, supporting youth to integrate their own culture with settler culture in ways that work best for them. Findings support community-based service structures, and underscore the importance of community resilience in the effective support of Indigenous children and youth.

Photovoice and Being Intentional About Empowerment.

The intent of Photovoice is to produce research in collaboration with communities, ensuring that research is relevant to community needs and critically facilitates change required to address these needs. Accordingly, Photovoice extends research for knowledge production, emphasizing research for social change. Consequently, Photovoice stands to make an important contribution to relevant and impactful knowledge production with health promotion research. However, if the intent of Photovoice as reflected in its theoretical underpinnings is not accounted for from the outset, the value of the approach may not be fully realized. This article considers what the theoretical underpinnings of Photovoice are, how this relates to issues of power and empowerment theory, and how voice can be better ensured within a process that is intentional about empowerment and representation.

A Photovoice Exploration of the Lived Experience of Intersectional Stigma among People Living with HIV.

Stigma research among people living with HIV (PLWH) has been increasingly interpreted through the framework of intersectionality, which comprehends the interwovenness of vulnerable individuals' identities. However, community-based participatory methods have not been widely employed to better understand these forms of stigma through an intersectional lens, despite such methods offering the opportunity for participants to define issues and solutions from their lived experiences. To advance this research, we employed photovoice to elicit grounded, visceral definitions of stigma for PLWH. Participants took pictures representing their identities and experiences with HIV and other stigmas and discussed them in groups and individual interviews, ultimately creating a virtual exhibit to educate and inspire others. Theme and narrative analysis uncovered patterns in the visual and textual data, revealing participants' experiences of HIV stigma based on their intersections of sexuality, race/ethnicity, illness, and roles and expectations in specific scenarios. Stigma also fostered the development of participants' strengths, such as resiliency, and new identities, such as educators. Participatory methods like photovoice, where participants can define intersectionality on their own terms, can help direct interventions to limit the PLWH's lived stigmas and increase effective coping.

Reconsidering interactive resilience processes in mental health: Implications for child and youth services.

Research consistently demonstrates resilience as an interactive process, drawing on personal assets together with relational and contextual resources, to support improved outcomes in contexts of nonnormative adversity. What remains unclear are the dynamics of this process and what drives it. This article draws on a prior scoping review of the literature to conceptually explore the positioning of the individual within this dynamic interplay of risks, resilience, and sociocultural context as it pertains to child and youth mental health. The paper begins by summarizing findings from this scoping review, highlighting core resilience elements and processes. These are then considered in relational to the global meaning theory, situating meaning-making as a key mechanism that mediates the interaction between individuals and their ecologies. Drawing on the literature, this article considers how this interaction shapes the particular ways in which resilience then manifests itself in the lives of individuals and becomes available as a resource to assist in the promotion of mental health.

Lodox®: the invaluable radiographic solution in the forensic setting.

The benefits of a comparatively inexpensive radiographic system such as the Lodox® scanner in forensic facilities where CT-imaging and radiologist support is not financially viable will be explored. Prodigious caseloads in many under-resourced mortuaries preclude the use of advanced radiological modalities. The aim of this research is to examine the utilization of the Lodox® scanner in one of the busiest mortuaries in South Africa in relation to the nature of the cases scanned and, furthermore, to provide case studies where this imaging modality proved vital in the examination of the deceased and in the approach to the autopsy. The research is a retrospective epidemiological review on the use of the Lodox® scanner at the Salt River Medico-legal Laboratory, Cape Town, South Africa, from 1 January 2017 to 31 December 2017. A total of 3885 cases was admitted to the mortuary; the majority was scanned. A large proportion of cases were male. Ages ranged from foetuses to the elderly. The manner of death in more than a third of the cases was homicide which mainly involved firearm fatalities. This was followed by natural deaths. Pertinent case studies are presented to demonstrate that the use of the Lodox® scanner as an adjunct (or even obviating autopsy) proves to save time and labour and is financially beneficial. In conclusion, the Lodox® scanner is an indispensable tool in mortuaries with heavy caseloads because its use improves quality assurance, saves time, and is cost effective in the examination of both natural and unnatural deaths.

Double rarity: an unusual case of bromoform poisoning detected by post-mortem radiography.

Bromoform ingestion and toxicity is a rare finding. Historically, bromoform was therapeutically prescribed as a sedative in whooping cough, and accidental overdoses occurred mainly in children. Bromoform is used in various industries. In the twenty-first century, bromoform ingestion can occur in the form of chlorinated water such as in pools and drinking water. We present a case report where the initial history and circumstances of death were unknown. A pre-autopsy full-body X-ray image using the Lodox® Xmplar-dr scanner revealed a dense radiopaque material in the stomach and intestines. This radiological finding proved vital in the approach and subsequent follow-up of the case.

Adaptation and Psychometric Properties of the Spanish Version of Child and Youth Resilience Measure (CYRM-32).

Resilience is defined as a dynamic process that entails a positive adaptation to contexts of adversity. According to the ecological model, resilient behavior emerges as a result of the interaction between individual, relational, community and cultural variables. The Child and Youth Resilience Measure (CYRM-28), developed in Canada and based on the ecological model, has been validated in several countries. The objective of this article is to present the cultural adaptation (studies I and II) and validation (study III) in Spanish at risk youth. A three-study mixed-method design was selected. Study I includes translations and a confirmatory and exploratory factor analysis of a sample of 270 Spanish young persons (56.9% boys) aged between 12 and 18 years (M = 14.65; SD = 1.27) from an urban public elementary school. Study II uses semi-structured interviews with adolescents identified as resilient and presents a content analysis and a reformulation of items with experts. Study III includes the confirmatory factor analysis, internal consistency, test-retest, convergent and discriminant validity, and multivariate analysis of variance to explore group differences of the resulting scale CYRM-32. The sample consisted of 432 at-risk young persons (54.9% boys) aged between 12 and 19 years old (M = 14.99; SD = 2.23). The results confirm the adequate psychometric properties of the CYRM-32 scale. From the original scale, 4 items were eliminated, 5 were reformulated presenting very low saturations. Meanwhile, 6 items were added to the cultural adaptation phase, resulting in a 32-item scale. The confirmatory analysis confirms the 3 factors expected in the CYRM-32 scale with good reliability indexes (Cronbach's α total scale 0.88, family interaction 0.79, interaction with others 0.72 and individual skills 0.78). The scale has convergent and discriminant validity in relation to the Brief Resilient Coping Scale, Coping Scale for Adolescents and Self-Concept. Significant differences were found in the scores of the CYRM-32 scale for the ethnic variable [F(71. 358) = 1.714, p < 0.001], while no differences appear according to age and gender. This finding confirms the importance of culture in the resiliency processes. The CYRM-32 scale has good psychometric properties and is a new alternative for measuring resilience in Spanish at-risk youth.

Eskasoni First Nation's transformation of youth mental healthcare: Partnership between a Mi'kmaq community and the ACCESS Open Minds research project in implementing innovative practice and service evaluation.

AIM: ACCESS Open Minds (ACCESS OM) is a pan-Canadian project aimed at improving youth mental healthcare. This paper describes implementation of the ACCESS OM objectives for youth mental health service transformation within a pre-existing Fish Net Model of transformative youth mental healthcare service in the First Nation community of Eskasoni, on Canada's east coast. METHODS: We describe an adaptation of the ACCESS OM service transformation objectives through the complementary blending of Indigenous and Western methodologies. This concept of "Two-Eyed Seeing" is illustrated as central to engaging youth in the community and attending to their mental health needs and wellness. RESULTS: The ACCESS OM Eskasoni First Nation Youth Space acts as a central location for the site team and its activities, which expand into the rest of the community to facilitate early identification of youth in need. Rapid access to care is promoted via barrier-free availability through a central intake crisis and referral centre, and ease of contact through social media and other modalities. Youth are given the choice between standard Western mental health services, or Indigenous methods of improving well-being, or a combination of the two. CONCLUSIONS: The ACCESS OM framework has shown early results of being a positive addition to the Eskasoni community. Local leadership and community buy-in are identified as key factors to success. Further exploration, research, and evaluation of this transformation is ongoing. Successful implementation of this model in Eskasoni could act as a model for youth mental health programmes in other First Nations across Canada.

Validity and reliability of the Mexican resilience measurement scale in families of children with chronic conditions.

BACKGROUND: The resilience to face disease is a process of positive adaptation despite the loss of health. It involves developing vitality and skills to overcome the negative effects of adversity, risks, and vulnerability caused by disease. In Mexico, the Mexican Resilience Measurement Scale (RESI-M) has been validated with a general population and has a five-factor structure. However, this scale does not allow evaluation of resilience in specific subpopulations, such as caregivers. METHOD: This study investigated the psychometric properties of RESI-M in 446 family caregivers of children with chronic diseases. A confirmatory factor analysis (CFA) was performed, internal consistency values were calculated using Cronbach's alpha coefficient, and mean comparisons were determined using t-tests. RESULTS: The expected five-factor model showed an adequate fit with the data based on a maximum likelihood test. The internal consistency for each factor ranged from .76 to .93, and the global internal consistency was .95. No average difference in RESI-M and its factors was found between women and men. CONCLUSION: The RESI-M showed internal consistency and its model of five correlated factors was valid among family caregivers of children with chronic diseases.

"I Have Strong Hopes for the Future": Time Orientations and Resilience Among Canadian Indigenous Youth.

In this article, we demonstrate how concepts of time and the future inform processes of resilience among Indigenous adolescents within an urban Canadian context. This study employed a modified grounded theory methodology by conducting 38 qualitative interviews with 28 Indigenous youth (ages 15-25) over the course of 1 year. The analysis revealed complex processes of and navigations between moments of distress and strategies for resilience. The distressing contexts in which Indigenous youth often find themselves can impact the development of their concepts of time and limit their abilities to conceptualize a future. A future time orientation (FTO) emerged as central to processes of resilience and was supported by (a) nurturing a sense of belonging, (b) developing self-mastery, and

Positive youth development practices and better outcomes for high risk youth.

This paper reports on the findings from a New Zealand longitudinal study of outcomes for a group of high risk, service-using youth (13-21 years, n=495). Consistent use of positive youth development practices (PYD) (rather than the total number of services used) predicted better outcomes. Patterns of risk and resilience endured over time. Individual risks undermined outcomes while resilience had a significant positive impact on outcomes. Contextual risks predicted increases in individual risks, but service delivery that adopted PYD practices contributed to reductions in levels of contextual risks over time. Youth with higher individual and contextual risks were less likely to report PYD service experiences. Individual risks were highest for indigenous youth (Maori) at entry to the study, levels which dropped significantly over time. White (Pakeha) youth had the lowest resilience and highest contextual risks over the course of the study. These differential patterns in risks and resilience indicate a need for services to adapt their responses to youth based on ethnicity and overall study findings confirm that when used consistently across service systems PYD-oriented service delivery produces better outcomes for high risk youth.

The role of positive youth development practices in building resilience and enhancing wellbeing for at-risk youth.

Services that utilise positive youth development practices (PYD) are thought to improve the quality of the service experience leading to better outcomes for at-risk youth. This article reports on a study of 605 adolescents (aged 12-17 years) who were concurrent clients of two or more service systems (child welfare, juvenile justice, additional education, mental health). It was hypothesised that services adopting PYD approaches would be related to increases in youth resilience and better wellbeing outcomes. It was also hypothesised that risks, resilience, service experiences and wellbeing outcomes would differ by age, gender and ethnicity. Youth completed a self-report questionnaire administered individually. Path analysis was used to determine the relationship between risk, service use, resilience and a wellbeing outcome measure. MANOVA was then used to determine patterns of risk, service use, resilience and wellbeing among participants based on their demographic characteristics. Services using PYD approaches were significantly related to higher levels of youth resilience. Similarly, increased resilience was related to increased indicators of wellbeing, suggesting the mediating role of resilience between risk factors and wellbeing outcomes. When professionals adopt PYD practices and work with the positive resources around youth (their own resilience processes) interventions can make a significant contribution to wellbeing outcomes for at-risk youth.

Fatal air embolism during endoresection of choroidal melanoma.

PURPOSE: To describe a case of intraoperative mortality because of air embolism during resection of a choroidal melanoma by pars plana vitrectomy. METHODS: Retrospective interventional case report. RESULTS: A 69-year-old man died unexpectedly at the time of pars plana vitrectomy. The operative technique involved the use of high-pressure air (60 mmHg) in the presence of traumatically exposed choroidal vasculature. Autopsy revealed a large air embolus in the right ventricle, which resulted in sudden cardiovascular collapse. CONCLUSION: Air embolism is a rare complication of ophthalmic surgery. Infusion of air in the presence of traumatically exposed choroidal vasculature exposes the patient to the risk of air embolism. Ophthalmic surgeons and anesthetists should be aware of the possibility of air embolism during certain ophthalmic procedures, and appropriate intraoperative monitoring should be considered.

Multiple service use: the impact of consistency in service quality for vulnerable youth.

Little is known about the way in which variations in service quality influence outcomes when youth are clients of more than one service system. This article reports on a study of 1,210 adolescents (aged 13-17 years), half were concurrent clients of two or more services and half were not involved in two or more services. Youth completed a self-report questionnaire administered by a trained interviewer. It was hypothesized that youth reporting two positive service experiences would report lower risks, higher resilience, and better outcomes than youth reporting inconsistent or two negative service experiences and that their resilience, risks, and outcomes would be similar to those of youth not involved in two or more services. MANCOVA was used to determine the relationship among service quality and resilience, risk, and outcomes with four covariates that assessed family and neighborhood environments, history of abuse and neglect, and chronic need. Results indicate that service quality had an effect on resilience, risks, and outcomes. These relationships were mediated quite strongly by the influence of the risks youth faced in their neighborhoods and to a lesser extent by the other three covariates. Of the three dependent variables, risk appeared to be the most consistently influenced by all the covariates, and it also differentiated service experience groups. Results point to the importance of services developing strategies to effectively address risks confronted by youth and also to ensure that when more than one service is involved with youth, consistency in service delivery is achieved.

The CYRM-12: a brief measure of resilience.

OBJECTIVES: This article details the reduction of the Child and Youth Resilience Measure (CYRM) from a 28-item to a 12-item measure. The CYRM-28 is a measure of youth resilience that accounts for cultural and contextual diversity across youth populations. A reduced version of the CYRM is better suited to inclusion in omnibus surveys. METHODS: Data from two samples of youth from Atlantic Canada are included in the analysis: a) a sample of multiple-service-using youth (n=122; mean age = 18); b) a school-based sample of youth (n=1494; mean age = 15). RESULTS: Three iterations of an Exploratory Factor Analysis were conducted on data from the first sample of youth to identify items for inclusion in the CYRM-12. In the third analysis, a varimax rotated factor analysis of the 12 items resulted in a four-factor solution, with 10 of the items loading well. Reliability of this grouping of questions is satisfactory (α=0.754). Confirmatory factor analysis was then conducted on the second sample of youth. A satisfactory fit was obtained (χ² (51, N=1540) = 255.419, p=0.0001; Adjusted Goodness of Fit Index = 0.960; Comparative Fit Index = 0.957; Root Mean Square Error of Approximation = 0.050). Cronbach's Alpha for the 12 items was also satisfactory (α=0.840). CONCLUSION: Results show sufficient content validity of the CYRM-12 to merit its use as a screener for resilience processes in the lives of adolescents.

Patterns of service use, individual and contextual risk factors, and resilience among adolescents using multiple psychosocial services.

BACKGROUND: Very little research has examined the relationship between resilience, risk, and the service use patterns of adolescents with complex needs who use multiple formal and mandated services such as child welfare, mental health, juvenile justice, and special educational supports. This article reports on a study of 497 adolescents in Atlantic Canada who were known to have used at least 2 of these services in the last 6 months. It was hypothesized that greater service use and satisfaction with services would predict both resilience, and better functional outcomes such as prosocial behavior, school engagement and participation in community. METHODS: Youth who were known to be multiple service users and who were between the ages of 13 and 21 participated in the study. Participants completed a self-report questionnaire administered individually. Path analysis was used to determine the relationship between risk, service use, resilience, and functional outcomes. MANOVA was then used to determine patterns of service use and service use satisfaction among participants. RESULTS: Findings show that there was no significant relationship between service use history and resilience or any of the three functional outcomes. Service use satisfaction, a measure of an adolescent's perception of the quality of the services received, did however show a strong positive relationship with resilience. Resilience mediates the impact of risk factors on outcomes and is affected positively by the quality, but not the quantity, of the psychosocial services provided to adolescents with complex needs. CONCLUSIONS: Results show that resilience is related to service satisfaction but not the quantity of services used by youth. Coordinated services may not increase resilience or be more effective unless the quality of individual services is experienced by an adolescent receiving intervention as personally empowering and sensitive to his or her needs.

Caregivers, young people with complex needs, and multiple service providers: a study of triangulated relationships.

Five patterns of service provider-caregiver-adolescent interaction are discussed using qualitative interviews and file review data from 44 youth with complex needs who were clients of more than one psychosocial service (child welfare, mental health, addictions, juvenile justice, and special education). Findings show that young people and their families become triangulated with service providers, either engaging with, or resisting, interventions. For young people with complex needs involved with multiple service providers, both positive and negative patterns of interaction contribute to the complexity of caregiver-child interactions. According to young people themselves, the most functional of these patterns, empowerment, was experienced as protective when it helped them to meet their personal needs and enhance communication. In contrast, four problematic patterns produced triangulations described as conflictual or unsupportive. The implications of these patterns for family therapy are discussed with an emphasis on the therapist as both clinician and advocate for better services from multiple providers.

Using visual methods to capture embedded processes of resilience for youth across cultures and contexts.

OBJECTIVES: We review the value of using visual data in a dialogue with youth, to reflect, explore and find language to better understand processes of resilience. METHODS: The argument is demonstrated with examples from the Negotiating Resilience Project (NRP): an international study of 16 youth which uses video recording a day in the life of youth participants, photographs produced by youth, and reflective interviews with the youth about their visual data. RESULTS: Three examples from the NRP are used to show the ways that visual methods can capture and elucidate previously hidden aspects of youth's positive psychosocial development in stressful social ecologies. CONCLUSION: Incorporating images as research data can aid in understanding previously unarticulated constructions of youth resilience. When the researcher is reflexive about power dynamics and their role in co-constructing the research environment, visual methods have the potential to reduce power imbalances in the field, meaningfully engage youth in the research process, and help to overcome language barriers.

Unique pathways to resilience across cultures.

An international mixed methods study of resilience of 14 sites in eleven countries identified seven tensions that youth resolve in culturally specific ways. Resolution of these tensions is foundational to experiences of resilience. This paper reports on the qualitative findings from interviews with 89 youth. Results support a culturally embedded understanding of positive youth development that better accounts for young people's resilience in western and non-western countries. Specifically, the seven tensions identified include: access to material resources, relationships, identity, cohesion, power and control, social justice, and cultural adherence. Findings show that no one pattern in the resolution of these tensions predicts resilience better than another. A case study of a Palestinian boy demonstrates the intersection of the seven tensions and the uniqueness of their resolution. The implications of this work for interventions is discussed.

Cultural understandings of resilience: roots for wings in the development of affective resources for resilience.

The authors examine one of the precursors of positive development: attachment. Attachment and the positive growth it portends for populations of children under stress underpins positive developmental outcomes now termed "resilience." Resilience may be understood as a process of adaptation to adversity that is scaffolded by environmental, cultural, social, psychologic, and physiologic processes. The authors focus on two methodologically different approaches to studying attachments that contribute to resilient functioning at two different phases of development (toddlerhood and adolescence). The authors examine the cultural differences found in manifestations of resilience in different countries and cultures. Organized around this theme of attachment, the authors identify adaptive factors in resistance to risk from adverse circumstances. The authors strive to identify how the adaptation involved in attachment relations can protect against vulnerability. The authors conclude with a description of the processes that might help us to understand situational, experiential, and personal resources that intersect to protect the developing individual against assaults on normal growth and development.