JBI systematic review protocol of text/opinions on how to best collect race-based data in healthcare contexts.

INTRODUCTION: Racialized population groups have worse health outcomes across the world compared with non-racialized populations. Evidence suggests that collecting race-based data should be done to mitigate racism as a barrier to health equity, and to amplify community voices, promote transparency, accountability, and shared governance of data. However, limited evidence exists on the best ways to collect race-based data in healthcare contexts. This systematic review aims to synthesize opinions and texts on the best practices for collecting race-based data in healthcare contexts. METHODS AND ANALYSES: We will use the Joanna Briggs Institute (JBI) method for synthesizing text and opinions. JBI is a global leader in evidence-based healthcare and provides guidelines for systematic reviews. The search strategy will locate both published and unpublished papers in English in CINAHL, Medline, PsycINFO, Scopus and Web of Science from 1 January 2013 to 1 January 2023, as well as unpublished studies and grey literature of relevant government and research websites using Google and ProQuest Dissertations and Theses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement methodology for systematic reviews of text and opinion will be applied, including screening and appraisal of the evidence by two independent reviewers and data extraction using JBI's Narrative, Opinion, Text, Assessment, Review Instrument. This JBI systematic review of opinion and text will address gaps in knowledge about the best ways to collect race-based data in healthcare. Improvements in race-based data collection, may be related to structural policies that address racism in healthcare. Community participation may also be used to increase knowledge about collecting race-based data. ETHICS AND DISSEMINATION: The systematic review does not involve human subjects. Findings will be disseminated through a peer-reviewed publication in JBI evidence synthesis, conferences and media. PROSPERO REGISTRATION NUMBER: CRD42022368270.

Effectiveness and Predictors of Outcomes in a Psychiatric Day Treatment Program for Elementary-Age.

OBJECTIVE: In this study, we aimed to (1) assess the effectiveness of an intensive multimodal day treatment program in improving externalizing problems and function in elementary-age children and (2) examine 3 predictors of the treatment outcome (i.e., family functioning, baseline severity, and comorbid disorders). METHODS: The sample included 261 children (80.9% boys) between ages of 5 and 12. A retrospective chart review, from 2013 to 2018, and a prospective chart review, from 2018 to 2019, were conducted to extract all relevant data for the present study. Parents and teachers provided reports on children's externalizing problems (i.e., aggressive behavior, attention problems, and rule-breaking behavior) and their level of function across different domains. The level of family functioning was also reported by parents, while clinicians assessed children's severity of disturbance and their diagnoses at intake. RESULTS: Based on both parents' and teachers' reports, children showed significant improvement in their externalizing problems. Moreover, children showed functional improvement at home, at school, with peers, and in hobbies by the end of the program. Based on teacher's reports, children with lower level of severity showed less improvement in their attention problems, and those with comorbid developmental problems showed less improvement in their aggressive and rule-breaking behaviors. Family functioning did not predict any treatment outcome. CONCLUSION: An intensive multimodal day treatment program was effective in reducing the symptoms of externalizing problems in elementary-age children. However, children with less severe difficulties and comorbid developmental problems showed less improvement in their externalizing problems.

What's race got to do with it? A proposed framework to address racism's impacts on child and adolescent mental health in Canada.

This commentary responds to current events that have highlighted the ways that systemic racism affects a wide variety of health outcomes. We specifically discuss how systemic racism adversely affects the mental health of children and adolescents in a Canadian context and use a structural framework to demonstrate how race is embedded in various Canadian systems and thus affects child and adolescent mental health in both conscious and unconscious ways throughout the lifespan. Experiences of systemic racism affect the mental health of Canadian young people in multiple complex and intersecting ways including access to care, experience of mental health services, and outcomes of care. We currently lack a national best practice framework for mental health professionals that unifies approaches to research, education, and clinical care for young racialized Canadians; in addition, concerted efforts to collect race-based data are lacking. We suggest that a blueprint for improved services for racialized young people in Canada would include: Development of a funded and sustainable research agenda responsive to community expertise, development and implementation of a Canadian Child and Adolescent task force focused on educational strategies on racism and service provision at both the postgraduate and continuing professional development (CPD) levels, and consideration of clinical parameters that improve access to, and experience of, care for Canadian racialized youth.

Ce commentaire est en réponse aux événements actuels qui ont fait ressortir les façons dont le racisme systémique touche une grande variété de résultats de santé. Nous discutons particulièrement de la façon dont le racisme systémique affecte la santé mentale des enfants et des adolescents dans un contexte canadien et nous utilisons un cadre structurel pour démontrer comment la race est intégrée dans divers systèmes canadiens et qu'elle affecte ainsi la santé mentale des enfants et des adolescents tant au niveau conscient qu'inconscient toute la vie. Les expériences de racisme systémique affectent la santé mentale des jeunes canadiens de multiples façons complexes et croisées, notamment l'accès aux soins, l'expérience des services de santé mentale, et les résultats des soins. Nous n'avons pas présentement de cadre national des pratiques exemplaires pour les professionnels de la santé mentale qui unifie les approches de la recherche de l'éducation, et des soins cliniques pour les jeunes canadiens racialisés; en outre, les efforts concertés pour recueillir les données basées sur la race sont manquants. Nous suggérons qu'un plan de services améliorés pour les jeunes racialisés au Canada comprenne : le développement d'un programme de recherche financé et viable sensible à l'expertise communautaire, la formation et la mise en œuvre d'un groupe de travail pour enfants et adolescents canadiens axé sur les stratégies éducatives à l'égard du racisme, la prestation de services aux niveaux des études supérieures et du développement professionnel continu (DPC), et la prise en compte des paramètres cliniques qui améliorent l'accès aux soins et l'expérience qu'en font les jeunes canadiens racialisés.

Guidelines for Training in Cultural Psychiatry.

This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)'s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA's Board of Directors on February 8, 2019. The original position paper1 was first approved by the CPA Board on September 28, 2011.

The ethics of relationality in implementation and evaluation research in global health: reflections from the Dream-A-World program in Kingston, Jamaica.

BACKGROUND: Despite recent developments aimed at creating international guidelines for ethical global health research, critical disconnections remain between how global health research is conducted in the field and the institutional ethics frameworks intended to guide research practice. DISCUSSION: In this paper we attempt to map out the ethical tensions likely to arise in global health fieldwork as researchers negotiate the challenges of balancing ethics committees' rules and bureaucracies with actual fieldwork processes in local contexts. Drawing from our research experiences with an implementation and evaluation project in Jamaica, we argue that ethical research is produced through negotiated spaces and reflexivity practices that are centred on relationships between researchers and study participants and which critically examine issues of positionality and power that emerge at multiple levels. In doing so, we position ethical research practice in global health as a dialectical movement between the spoken and unspoken, or, more generally, between operationalized rules and the embodied relational understanding of persons. Global health research ethics should be premised not upon passive accordance with existing guidelines on ethical conduct, but on tactile modes of knowing that rely upon being engaged with, and responsive to, research participants. Rather than focusing on the operationalization of ethical practice through forms and procedures, it is crucial that researchers recognize that each ethical dilemma encountered during fieldwork is unique and rooted in social contexts, interpersonal relationships, and personal narratives.

The mothering experience of women with FGM/C raising 'uncut' daughters, in Ivory Coast and in Canada.

BACKGROUND: While Female Genital Cutting (FGM/C) is a deeply entrenched cultural practice, there is now mounting evidence for a gradual decline in prevalence in a number of geographical areas in Africa and following migration to non-practicing countries. Consequently, there is now a growing number of women with FGM/C who are raising 'uncut' daughters. This study used a qualitative methodology to investigate the experience of women with FGM/C raising daughters who have not been subjected to the ritual. The aim of this study was to shed light on mothers' perception of the meaning and cultural significance of the practice and to gain insight into their mothering experience of 'uncut' girls. METHODS: To this end, in-depth interviews were conducted with fifteen mothers living in Abidjan, Ivory Coast and in Montreal, Canada (8 and 7, respectively). RESULTS: Thirteen mothers intrinsically refused to perpetuate FGM/C onto their daughters and two diasporic mothers were in favour of FGM/C but forewent the practice for fear of legal repercussions. Whether the eschewing of FGM/C was deliberate or legally imposed, raising 'uncut' daughters had significant consequences in terms of women's mothering experiences. Mothers faced specific challenges pertaining to community and family pressure to have daughters undergo FGM/C, and expressed concerns regarding their daughters' sexuality. Conversely, women's narratives were also infused with pride and hope for their daughters, and revealed an accrued dialogue between the mother-daughter dyad about cultural norms and sexuality. Interestingly, women's mothering experience was also bolstered by the existence of informal networks of support between mothers with FGM/C whose daughters were 'uncut'. These communities of mothers engaged in open dialogue about the consequences of FGM/C and offered reciprocal solidarity and support in their decision to forego FGM/C for their children. CONCLUSION: Women with FGM/C who are raising 'uncut' daughters in their homeland and in their country of immigration vastly report a positive experience. However, they also face specific challenges related to immigration, psychosocial, and psychosexual considerations, which must be tackled from a multidisciplinary perspective.

Refugee children and their families: supporting psychological well-being and positive adaptation following migration.

The support of refugee children and their families is a worldwide concern. This article will highlight models of mental health care for refugee children and their families, focusing on collaborative care with primary care providers. Case vignettes are provided to illustrate how collaborative care can support refugee children׳s psychological well-being and positive adaptation following migration.

Helpseeking of immigrant and native born parents: a qualitative study from a montreal child day hospital.

OBJECTIVES: This qualitative study of the perceptions of native-born Canadian and immigrant parents whose children attended a psychiatric day hospital for significant behavior impairment, focused on parental helpseeking pathways, explanatory models of mental health, and referral or access experiences. METHODS: A sample of ten immigrant and ten native born parents were recruited for semi-structured interviews analyzed thematically to discern similarities and differences between the two groups. RESULTS: The immigrant group more frequently reported barriers and delays in accessing mental health services. They often reported lack of primary care physicians and language barriers. They were less likely to have a biomedical perspective or to use specialized resources for their children prior to admission. Both groups reported apprehension about medication trials, though the immigrant parents were less likely to agree to psychopharmacological treatment. None of the professionals treating parents for mental health problems initiated referral of their impaired children. CONCLUSIONS: Based on the qualitative analysis of this sample, native born single parents and immigrant parents may feel especially vulnerable to lack of social support. Adjustments of primary care, schools and community resources, as well as promoting best practices of culturally competent child mental health care, may increase access and willingness to pursue treatment in both groups.

OBJECTIFS: Cette étude qualitative des perceptions de parents canadiens de naissance et immigrants dont les enfants fréquentaient un hôpital psychiatrique de jour pour une déficience significative portait sur les voies empruntées par les parents à la recherche d'aide, les modèles explicatifs de santé mentale, et les expériences d'aiguillage ou d'accès. MÉTHODES: Un échantillon de dix parents immigrants et de dix parents canadiens de naissance a été recruté pour des entrevues semi-structurées analysées thématiquement afin de discerner les similitudes et les différences entre les deux groupes. RÉSULTATS: Le groupe immigrant rapportait plus souvent des obstacles et des délais pour accéder aux services de santé mentale. Les immigrants déploraient souvent l'absence de médecins de soins de première ligne et les obstacles linguistiques. Ils étaient moins susceptibles d'avoir une perspective biomédicale ou de recourir à des ressources spécialisées pour leurs enfants avant l'admission à l'hôpital. Les deux groupes déclaraient une appréhension au sujet des essais de médicaments, mais les parents immigrants étaient moins enclins à accepter un traitement psychopharmacologique. Aucun des professionnels traitant les parents pour des problèmes de santé mentale n'a initié l'aiguillage de leurs enfants déficients. CONCLUSIONS: Selon l'analyse qualitative de cet échantillon de chefs de famille monoparentale canadiens de naissance et de parents immigrants, ils peuvent se sentir particulièrement vulnérables à l'absence de soutien social. Des adaptations des soins de première ligne, des écoles et des ressources communautaires, ainsi que la promotion des pratiques exemplaires de soins de santé mentale pédiatriques adaptés à la culture peuvent accroître l'accès et la volonté de suivre le traitement dans les deux groupes.

Promoting Resilience in High-risk Children in Jamaica: A Pilot Study of a Multimodal Intervention.

OBJECTIVE: To assess the effectiveness of a multimodal afterschool and summer intervention called the Dream-A-World (DAW) Project for a cohort of school-aged Jamaican children from an impoverished, disadvantaged inner-city community in Kingston, Jamaica. Children were selected by their teachers based on severe disruptive disorders and academic underachievement and compared with a matched control group. The pilot was a child focused therapeutic modality without parental intervention for disruptive conduct and academic failure. METHOD: A group psychotherapeutic intervention of creative arts therapies and remedial academic support adapted for the Jamaican context was implemented with 30 children from an inner-city primary school. The intervention was implemented over 2½ years spanning grade three to six with evaluation of outcomes using the ASEBA Teacher Report Form (TRF) and end of term grades for the intervention group versus matched controls who were offered usual school supports. RESULTS: The intervention group made significant improvements in school social and behavior adjustment measured by the TRF, with more successful outcome amongst boys for behavioral gains. No significant improvements were made by the girls. Limitations of cohort size, lack of parent data and questions of gender disparities in outcome were unresolved interpretative issues. CONCLUSION: This multi-modal mental health and academic intervention for high-risk children living in an impoverished, violent neighbourhood, improved global functioning of boys more than girls, and raised questions for design of further preventive planning.

OBJECTIF: Évaluer l'efficacité d'une intervention multimodale parascolaire en été, nommée Projet Dream-A-World (DAW, rêver un monde), pour une cohorte d'enfants d'âge scolaire jamaïcains issus d'une communauté pauvre défavorisée du centre-ville de Kingston, en Jamaïque. Les enfants ont été choisis par leurs enseignants en fonction de graves troubles perturbateurs et d'un mauvais rendement scolaire, et comparés avec un groupe témoin apparié. Le pilote était une modalité thérapeutique axée sur les enfants sans intervention parentale pour les conduites perturbatrices et l'échec scolaire. MÉTHODE: Une intervention psychothérapeutique de groupe basée sur des thérapies d'activités créatrices et un soutien de redressement scolaire, adaptée au contexte jamaïcain, a été mise en œuvre auprès de 30 enfants d'une école primaire du centre-ville. L'intervention a duré plus de 2,5 ans et a été appliquée de la 3e à la 6e année. Les résultats ont été évalués à l'aide du formulaire d'évaluation des enseignants (FEE) ASEBA et des notes de fin de session pour le groupe de l'intervention contre les groupes témoins appariés à qui des soutiens scolaires usuels ont été offerts. RÉSULTATS: Le groupe de l'intervention s'est amélioré significativement en ce qui concerne le redressement scolaire social et comportemental mesuré par le FEE, les résultats étant plus réussis chez les garçons pour ce qui est des améliorations du comportement. Aucune amélioration significative n'a été observée chez les filles. Les limitations de la taille de cohorte, l'absence de données des parents et les questions de disparité des résultats selon le sexe sont demeurées des questions interprétatives non résolues. CONCLUSION: Cette intervention multimodale et théorique en santé mentale, destinée aux enfants à risque élevé vivant dans un quartier défavorisé violent, améliorait le fonctionnement général davantage chez les garçons que chez les filles, et soulevait des questions quant à la méthode de futures planifications préventives.

A diversity of voices: the McGill 'Working with Culture' seminars.

The Working with Culture seminar is offered as a course during the month long Annual McGill Summer Program for Social and Transcultural Psychiatry, attended by local and international participants each May since 1994. The article outlines some of the premises and pedagogical approaches of this clinically oriented biweekly seminar series with discussions and didactic teaching on cultural dimensions of mental health care. The course readings, seminar topics and invited speakers focus mainly on therapist client encounters constructed by the multiple voices with dimensions of psychiatric, social, historical, legal, ethical, political, systemic and intra-psychic domains. The dual leadership emphasizes the gaps and complementarity amongst voices, and it invites and supports a destabilizing decentering process and the creation of solidarities amongst participants. Applying a bio-psychosocial case study method, each 3-h seminar engages the participants in a critical dialogue on apprehending the enmeshment of social suffering with psychiatric disorders whilst examining the usefulness and the limits of cultural formulation models. The seminar working group and teaching approach acknowledges cultural hybridity as a dynamic process marked by continuous therapist attunement to uncertainty or 'not knowing' which implies a dethroning of an expert position.

Women who jump into wells: reflections on suicidality in women from conflict regions of the Indian subcontinent.

This paper examines narratives of women from the Indian subcontinent, including Canadian refugee claimants, emerging from the conflict regions of Pakistan, Punjab, Bangladesh, and Sri Lanka, who have presented suicidal ideation or attempts or died by suicide. The focus is on the relationship of suicide and suicide behavior to particular systemic stressors related to familial, social, and group agendas. The vulnerability of individual women is presented in the context of gender issues, deeply embedded group trauma, historical legacies, and intragenerational dynamics, as well as acute stressors that contribute to the underlying distress of these women.

The Relationship between Alliance, Attachment and Outcome in a Child Multi-Modal Treatment Population: Pilot Study.

OBJECTIVES: This pilot study explored the relationship between parental therapeutic alliance, maternal attachment style and child and family functioning in a sample of families with a child aged five to twelve years receiving child psychiatry day hospital treatment for complex co-morbid disorders. METHOD: Self-report measures of therapeutic alliance, maternal attachment style, child behaviour and family functioning were administered to parents at the end of the assessment period (T1) and at discharge (T2). The original study cohort included 90 families, and 44 families completed all the study measures at T2. Correlational analysis was conducted on these 44 families measuring parental alliance, maternal attachment style with child and family functioning scores. Comparisons were made between participants that completed T1 and T2 of the study with participants that only completed T1. RESULTS: For the 44 families who completed both T1 and T2 measures, the combination of secure maternal attachment style and positive therapeutic alliance at T1 was associated with positive child outcomes, that is, improved scores on both the internalizing and externalizing dimensions as measured by the CBCL between T1 and T2. Significant changes were identified in family functioning with improvement on cohesion and expressiveness, enhanced intellectual-cultural orientation and improved family organization as measured by the FES. CONCLUSIONS: Capacity for secure attachment and positive alliance are associated with improved child and family systems outcomes in a high risk cohort of children with co-morbid disorders from a day and evening multimodal family treatment program.

Common mental health problems in immigrants and refugees: general approach in primary care.

BACKGROUND: Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care. METHODS: We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health. RESULTS: The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations. INTERPRETATION: Systematic inquiry into patients' migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.