Kristin Cleverley

Developmental Trajectories of Physical and Indirect Aggression From Late Childhood to Adolescence: Sex Differences and Outcomes in Emerging Adulthood

OBJECTIVE Two common subtypes of aggression (physical and indirect) have been shown to develop concurrently throughout childhood and to uniquely predict maladjustment. However, nothing is known about psychiatric outcomes of joint trajectories of physical aggression (PA) and indirect aggression (IA) in emerging adulthood. METHOD Trajectories of PA and IA across ages 10 to 15 were modeled using 2,338 youth drawn from the National Longitudinal Study of Children and Youth. The identified trajectories were then used to predict delinquency problems, depressive symptoms, and emotional intelligence in emerging adulthood. RESULTS Three groups of children with distinct developmental trajectories of PA (no PA, 32.5%; moderate-declining PA 52.2%; and high-increasing PA, 15.3%) and three distinct developmental trajectories of IA (low-declining IA, 29.9%; moderate-declining IA, 65.5%; and high IA, 4.6%) were identified. Joint trajectories indicate that the largest group of children (41.6%) followed a moderate-declining IA trajectory and moderate-declining PA trajectory. Virtually no children were high on one type and low on the other. The proportion of boys was higher in the low IA-moderate declining PA and moderate IA-high increasing PA groups, whereas girls were more likely to be in the low IA-low PA and moderate IA-low PA groups. Individuals who followed elevated trajectories of IA and PA had significantly more depressive and delinquency symptoms and lower emotional quotient scores in emerging adulthood compared with those with lower trajectories. CONCLUSIONS These results suggest that some children have high PA and IA trajectories from childhood to adolescence and that these trajectories are associated with an increased risk for maladjustment.

Resilience, Loneliness, and Psychological Distress Among Homeless Youth

Extant quantitative research on loneliness among homeless youth has grouped loneliness with other elements of psychological distress. The current study seeks to determine if loneliness has a different relationship with resilience than does psychological distress among street youth. Using data from 47 participants, linear regression was conducted. Results indicate that homeless youth experiencing higher psychological distress reported lower resilience scores. However, levels of resilience are not significantly associated with feelings of loneliness when psychological distress was accounted for. This study has implications for how researchers and clinicians conceptualize and address feelings of loneliness among homeless youth.

Integrated collaborative care teams to enhance service delivery to youth with mental health and substance use challenges: protocol for a pragmatic randomised controlled trial

Introduction Among youth, the prevalence of mental health and addiction (MHA) disorders is roughly 20%, yet youth are challenged to access evidence-based services in a timely fashion. To address MHA system gaps, this study tests the benefits of an Integrated Collaborative Care Team (ICCT) model for youth with MHA challenges. A rapid, stepped-care approach geared to need in a youth-friendly environment is expected to result in better youth MHA outcomes. Moreover, the ICCT approach is expected to decrease service wait-times, be more youth-friendly and family-friendly, and be more cost-effective, providing substantial public health benefits. Methods and analysis In partnership with four community agencies, four adolescent psychiatry hospital departments, youth and family members with lived experience of MHA service use, and other stakeholders, we have developed an innovative model of collaborative, community-based service provision involving rapid access to needs-based MHA services. A total of 500 youth presenting for hospital-based, outpatient psychiatric service will be randomised to ICCT services or hospital-based treatment as usual, following a pragmatic randomised controlled trial design. The primary outcome variable will be the youths functioning, assessed at intake, 6 months and 12 months. Secondary outcomes will include clinical change, youth/family satisfaction and perception of care, empowerment, engagement and the incremental cost-effectiveness ratio (ICER). Intent-to-treat analyses will be used on repeated-measures data, along with cost-effectiveness and cost-utility analyses, to determine intervention effectiveness. Ethics and dissemination Research Ethics Board approval has been received from the Centre for Addiction and Mental Health, as well as institutional ethical approval from participating community sites. This study will be conducted according to Good Clinical Practice guidelines. Participants will provide informed consent prior to study participation and data confidentiality will be ensured. A data safety monitoring panel will monitor the study. Results will be disseminated through community and peer-reviewed academic channels. Trial registration number Clinicaltrials.gov NCT02836080.

Effects of functional impairment on internalizing symptom trajectories in adolescence: a longitudinal, growth curve modelling study.

Despite the fact that psychosocial and functional impairment has long been acknowledged as an important aspect of psychiatric diagnosis and treatment, relatively little is known about the longitudinal relationship between psychiatric symptoms and functional impairment. This is particularly true in childhood and adolescence. Understanding how symptoms relate to functional impairment is of great importance to clinicians and researchers as it is essential to nosology, treatment, and prognosis. This study sought to understand the developmental relationship between internalizing symptoms, functional impairment and gender in a sample of youth aged 10-15 using growth curve methods. Key findings indicate that the presence of functional impairment was associated with increased baseline internalizing symptoms scores but had no effect on the slope of internalizing symptoms trajectories during adolescence. The study highlights that the association between internalizing symptoms and functional impairment appears to be constant, linear and does not vary by gender.

Collaborative partnerships: bridging the knowledge practice gap in client-centred care in mental health

Purpose – The purpose of this paper is to describe a partnership, the Ryerson-Centre for Addiction and Mental Health Collaborative for Client-Centred and Family Sensitive Care Collaborative, between an urban university and tertiary care mental health facility to build capacity in using research evidence to support client-centred care. A cornerstone of the partnership was a study exploring the connection between effective interprofessional collaboration and the capacity to provide exemplary client-centred care in mental health. Design/methodology/approach – The Collaborative brings together organizations with shared values and a commitment to client-centred interprofessional care. It is a strategic approach in amplifying opportunities for the uptake of research evidence and knowledge transfer. One of the principal deliverables for the Collaborative was a multi-phased study exploring the relationship between team collaboration and client-centred care. Findings – Research findings identified a significant as...

Implementing Best Practice Guidelines in Pain Assessment and Management on a Women's Psychiatric Inpatient Unit: Exploring Patients' Perceptions

ABSTRACT Assessing and managing chronic pain in women with histories of interpersonal trauma, mood disorders and co‐morbid addiction is complex. The aim of this paper is to report on the findings from a quality improvement project exploring womens experiences who have co‐occurring mental health issues, addiction and chronic pain. Exploring perceptions was an initial step in implementing the Registered Nurses’ Association of Ontario (RNAO) Best Practice Guideline (BPG) on the Assessment and Management of Pain. Focus group discussions were conducted using an exploratory design with 10 women who were hospitalized in an acute psychiatric unit. Our findings suggest that these women view their pain as complex and often feel powerless within an acute psychiatric setting resorting to coping through self management. The women expressed the importance of therapeutic relationships with clinicians in assessing and managing their pain. The implications of this study suggest that patients have a key role in informing the implementation and applicability of best practice guidelines. Validating the patients personal pain management experience and particular psychological and physical therapies were suggested as strategies to enhance the patients quality of life. Many clinicians working in mental health are knowledgeable about these therapies, but may not be aware of the application to managing physical pain.

Transitional-aged youth perceptions of influential factors for substance-use change and treatment seeking

There is an evident disparity between the number of youth who report experiencing problematic substance use and the number who seek treatment. To address this disparity, it is important to understand the reasons youth do and do not seek substance use treatment. Using qualitative data obtained from semistructured interviews with 31 youth aged 17–25 years presenting for treatment at a mental health hospital, the current study identifies themes in the factors that youth identify as having influenced them to seek or delay treatment. In alignment with self-determination theory, youth identified internal factors, such as wanting to better their academic, social, or financial situation, and external factors, such as familial pressure, as motivating them to seek treatment. Factors beyond those encompassed by self-determination theory were also revealed as having influenced youth decisions to seek treatment for substance abuse. These predominantly included structural factors, including satisfaction with previous treatment, accessibility of services, and availability of clinicians. These findings provide important insight for first-contact professionals and service providers looking to enhance youth motivation to seek and engage in treatment. Limitations and opportunities for future research are discussed.

Enhancing Self-Efficacy for Help-Seeking Among Transition-Aged Youth in Postsecondary Settings With Mental Health and/or Substance Use Concerns, Using Crowd-Sourced Online and Mobile Technologies: The Thought Spot Protocol

Background Seventy percent of lifetime cases of mental illness emerge prior to age 24. While early detection and intervention can address approximately 70% of child and youth cases of mental health concerns, the majority of youth with mental health concerns do not receive the services they need. Objective The objective of this paper is to describe the protocol for optimizing and evaluating Thought Spot, a Web- and mobile-based platform cocreated with end users that is designed to improve the ability of students to access mental health and substance use services. Methods This project will be conducted in 2 distinct phases, which will aim to (1) optimize the existing Thought Spot electronic health/mobile health intervention through youth engagement, and (2) evaluate the impact of Thought Spot on self-efficacy for mental health help-seeking and health literacy among university and college students. Phase 1 will utilize participatory action research and participatory design research to cocreate and coproduce solutions with members of our target audience. Phase 2 will consist of a randomized controlled trial to test the hypothesis that the Thought Spot intervention will show improvements in intentions for, and self-efficacy in, help-seeking for mental health concerns. Results We anticipate that enhancements will include (1) user analytics and feedback mechanisms, (2) peer mentorship and/or coaching functionality, (3) crowd-sourcing and data hygiene, and (4) integration of evidence-based consumer health and research information. Conclusions This protocol outlines the important next steps in understanding the impact of the Thought Spot platform on the behavior of postsecondary, transition-aged youth students when they seek information and services related to mental health and substance use.

Youths Perceived Parental Influence on Substance Use Changes and Motivation to Seek Treatment

Drug and alcohol use among youth has serious consequences for the physical and mental health of youth and strains their relationships with family and friends. While the task of dealing with substance-related issues often falls on families, particularly parents, very little research has explored the importance of family as a motivator for seeking treatment. This paper reports on a qualitative study of youth seeking substance abuse treatment at a large urban psychiatric hospital. Following primarily self-determination theory, the study examines youths’ descriptions of how their parents motivated them to (1) change their substance use behaviors and (2) seek treatment. The sample consisted of 31 youth ages 17 to 25 engaged in outpatient services with various substance use concerns. Youth described complex and evolving relationships with their parents along their journey to enter treatment. Implications for service delivery and important insights for engaging youth and their parents are discussed.

Youth friendliness in mental health and addiction services: protocol for a scoping review

Introduction To better reach youth in need of mental health and addiction (MHA) services, there is increasing emphasis on making MHA services ‘youth friendly.’ However, it is unclear what youth friendliness means on a practical level. This scoping review explores (1) how youth friendliness in mental health services is defined in the literature, (2) what characteristics make MHA services youth friendly and (3) how youth friendliness is expected to impact service use by young people. Methods A search will be conducted of eight electronic bibliographic databases over the last 15 years (2002–2017) to identify literature on youth friendliness consistent with the modern youth experience. Grey literature will also be searched. The search and literature selection process will include all study designs, as well as non-research literature. Two independent raters will determine eligibility based on a review of the titles and abstracts of the identified literature, followed by full text reviews when required. Data will be extracted from the identified literature and then synthesised using qualitative and quantitative approaches. As a final step, we will conduct stakeholder consultations with youth, family members and service provider groups to validate the findings and identify any characteristics of youth friendliness that they deem important that were not reported in the findings. Ethics and dissemination Results will be disseminated through a peer-reviewed publication, as well as international, national and local conference presentations. Agency reports will be developed to present the findings in a user-friendly format, including a youth-friendliness checklist for youth-serving organisations. Research ethics approval has been obtained for the consultation component of this study.