Sean A. Kidd

Practicing Participatory Action Research.

This article provides an overview of several core theoretical and practical aspects of participatory action research (PAR). An effort is made to define PAR and the types of work that fall under that rubric. Historical underpinnings, roles of the individuals involved, contexts, methods, and the challenges and benefits of this mode of inquiry are discussed. The authors argue that the approach and mindset of the researcher, referred to here as a type of “attitude,” are key in the development of a successful and genuine participatory process. The authors situate PAR methodology within psychology and, more specifically, propose it as an approach to knowing that has the potential to make significant contributions in areas relevant to counseling psychology.

Youth Homelessness and Social Stigma

Building upon previous exploratory qualitative research (Kidd SA (2003) Child Adol Social Work J 20(4):235–261), this paper examines the mental health implications of social stigma as it is experienced by homeless youth. Surveys conducted with 208 youths on the streets and in agencies in New York City and Toronto revealed significant associations between perceived stigma due to homeless status and sexual orientation, pan handling and sex trade involvement, and amount of time homeless. Higher perceived stigma was also related to low self esteem, loneliness, feeling trapped, and suicidal ideation, with guilt/self-blame due to homeless status having the strongest impact on mental health variables.

Resilience in Homeless Youth: The Key Role of Self-Esteem

This study examined the protective role of self-esteem, social involvement, and secure attachment among homeless youths. These protective factors were examined as they ameliorate risks among 208 homeless youths surveyed in New York City and Toronto. Both mental and physical health indicators were employed in this study, including loneliness, feeling trapped, suicidal ideation, subjective health status, and substance use. Self-esteem emerged as a key protective factor, predicting levels of loneliness, feeling trapped, and suicide ideation, and buffering against the deleterious effect of fearful attachment on loneliness. Findings highlight the role of the self-concept in risk and resilience among homeless youth.

The Walls Were Closing in, and We Were Trapped: A Qualitative Analysis of Street Youth Suicide.

Semistructured interviews focusing on suicide were conducted with 80 street youth in agencies and on the streets of Toronto, Ontario, Canada, and Vancouver, British Columbia, Canada. Participants described their understandings of the phenomenon of suicide among street youth and the meanings suicide held for them. Qualitative analysis of the interviews revealed themes of worthlessness, loneliness, hopelessness, and most centrally the feeling of being “trapped” as forming the construct of suicide held by the participants. These idioms of distress were situated within the context of a street life that included social stigma and drug abuse.

Factors precipitating suicidality among homeless youth: a quantitative follow-up

Homeless youth are a population at a high risk for suicidal behavior. A previous exploratory study emphasized the importance of feeling trapped or helpless, which appeared to mediate the impact of other risk variables. Confirmatory work was needed to test this inductively derived model. Two hundred eight homeless youths completed surveys on the streets and in agencies in New York City and Toronto. Structural equation modeling was used to test a theoretical model developed from exploratory work, and regression analyses were used to examine the influence of home and street contextual variables. The centrality of the trapped experience in a model incorporating drug use and dependence, abusive family history, loneliness, low self-esteem, and suicidality was confirmed. Other findings included a marked reduction in reported suicidal behavior following participants’ leaving home, with family violence, being thrown out of the home, neglect, poor physical health, and having suicidal friends showing strong relationships with suicidality.

Youth Mental Health Interventions via Mobile Phones: A Scoping Review

Mobile phone technologies have been hailed as a promising means for delivering mental health interventions to youth and adolescents, the age group with high cell phone penetration and with the onset of 75% of all lifetime mental disorders. Despite the growing evidence in physical health and adult mental health, however, little information is available about how mobile phones are implemented to deliver mental health services to the younger population. The purpose of this scoping study was to map the current state of knowledge regarding mobile mental health (mMental Health) for young people (age 13-24 years), identify gaps, and consider implications for future research. Seventeen articles that met the inclusion criteria provided evidence for mobile phones as a way to engage youth in therapeutic activities. The flexibility, interactivity, and spontaneous nature of mobile communications were also considered advantageous in encouraging persistent and continual access to care outside clinical settings. Four gaps in current knowledge were identified: the scarcity of studies conducted in low and middle income countries, the absence of information about the real-life feasibility of mobile tools, the need to address the issue of technical and health literacy of both young users and health professionals, and the need for critical discussion regarding diverse ethical issues associated with mobile phone use. We suggest that mMental Health researchers and clinicians should carefully consider the ethical issues related to patient-practitioner relationship, best practices, and the logic of self-surveillance.

Lesbian, Gay, and Transgender Persons with Severe Mental Illness: Negotiating Wellness in the Context of Multiple Sources of Stigma

The experiences of lesbian, gay, and transgender (LGT) individuals with severe mental illness (SMI) have received minimal attention within the clinical and research literatures despite evidence to suggest that these groups receive inadequate psychiatric services. In the present study, 11 individuals from a midsized Canadian city who self-identified as lesbian, gay, or transgender were interviewed about their experiences of sexual identity, gender, mental illness, and psychiatric services. Their narratives were analyzed using grounded theory methods. The findings highlight the complex interactions of the stigma associated with mental illness and LGT identities, as well as the illness and identity-related challenges these persons face in psychiatric services. The participant narratives also speak to resilience and wellness, suggesting that these are cultivated through connection and community. Finally, strategies that service providers can use to deliver more effective services for this population are discussed.

Mental health reform at a systems level: widening the lens on recovery-oriented care.

This paper is an initial attempt to collate the literature on psychiatric inpatient recovery-based care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recovery-oriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada.

Home Is Where You Draw Strength and Rest: The Meanings of Home for Houseless Young People:

This qualitative study examined the meanings ascribed to the construct “home” by 208 youths defined by mainstream society as “homeless”. Youth narratives on the topic of home ranged across a continuum with home as state at one end (i.e., home is a state of mind, comprised of one’s friends) and home as place at the other (i.e., home as a physical dwelling). Youths employing the former meanings had typically been on the street for longer periods and identified with counterculture-type ideologies. For youths who defined home as place, home was constructed in direct opposition to street experiences. For both of these groups, control emerged as a central theme in their narratives. The implications of these findings for engaging youth and goal setting regarding exiting the streets are described.

Fidelity and Recovery-Orientation in Assertive Community Treatment

There has been increasing commentary about the degree to which Assertive Community Treatment (ACT) teams provide recovery-oriented services, often centered around the question of the use of coercion. The present study was designed to contribute to this discussion through an examination of recovery-oriented service provision and ACT fidelity among 67 teams in the province of Ontario, Canada. The findings indicated a moderate to high degree of recovery orientation in service provision, with no significant relationship between ACT fidelity and consumer and family/key support ratings of recovery orientation. A significant relationship was found, however, between the ‘nature of services’ domain of the Dartmouth Assertive Community Treatment Scale (DACTS) and ratings of recovery orientation provided by staff and ACT coordinators. These findings extend the existing dialogue regarding the evaluation of ACT intervention process factors and indicate that current measures of fidelity may not be adequately addressing dimensions of recovery-oriented service provision.