In recent years, an important focus has been placed on training counsellors to attend to cultural diversity. In an effort to assist counsellors in this process, models of Multicultural Counselling Competencies (MCC) have been developed for work with adult populations. Unfortunately, little attention has been given to adapting these models or developing specific models for counselling with adolescents. While clinical guidelines have been proposed for counsellors working with culturally diverse youth, they have yet to be empirically tested. The present study investigated the MCC which former adolescent clients believed to be important to them when they attended counselling. Participants included 20 women between the ages of 18 and 23 who sought counselling when they were between the ages of 12 and 19. Participants completed an in-depth qualitative interview about their counselling experiences and were asked to discuss the aspects of counselling they found to be most and least helpful. The interview data was analyzed using phenomenological methodology. The components of cultural competence (counsellor awareness, knowledge, and skills) proposed in the tripartite model of MCC and the multicultural counselling relationship were used as points of entry in the data analysis process. The results of this study provided support for the integration of these competencies in counselling with female adolescents. However, participant's accounts indicated that the competencies of awareness, knowledge, skills, and relationship are not sufficient for culturally competent counselling to occur. Additional MCC were found to be important for work with female adolescents, including cultural sensitivity, family interventions, and help beyond counselling. The results of this study have important implications for the training and practice of psychology. Obtaining the viewpoint of female clients who attended counselling during their adolescence was invaluable, as they offered a unique perspective, which was not previously available in the literature. This unique viewpoint informs us about the specific needs of female adolescents and provides useful information about the MCC counsellors may need to develop in order to work with this population.

This qualitative study utilized the action-project theory and method to investigate the close, long-term friendships (two to ten years in duration) of female, early adolescent dyads. Ten early adolescent girls between the ages of 11 and 13 were studied. The purpose of this study was twofold; first, to determine the characteristics of best friendship projects and how they manifested within early adolescent friendship conversations and; second, to investigate the nature of self-representations (descriptions of the self) made by the participants. The processes (cognitive, affective, and behavioural) and meaning (goals) of friendship jointly expressed within the conversations were identified. As well, self-representations were analyzed from the perspective of whether they functioned to advance friendship projects. In addition to the friendship conversations, collages explicating the girls’ meanings and processes around their close friendships were also explored through an individual interview with each participant. The participants engaged in five friendship projects within their friendship conversations. First, an overriding project to preserve and maintain the friendship was demonstrated. Other sub-projects demonstrated within the conversations were the desire to have fun, to provide support to each other, and to connect with each other. Simultaneously, while jointly enacting other friendship projects, the participants also demonstrated through action, the project of exploring and discovering aspects of their identities. Multiple functional steps (the means) to achieve these projects were utilized. Gossip, fictional and factual storytelling, teasing, joking, problem solving, asking for advice, and displaying physical affection are examples of these means. Self-representations from the conversations were not always consistent with those revealed during self-confrontation interviews, at times in the service of achieving friendship goals. Self-representations between the collage interviews and the friendship conversations were very consistent, suggesting the complementary nature of the data sources. Meanings and processes gleaned from the friendship conversations were also very consistent with those found within the friendship collages. Implications of these findings for parents, educators, and counsellors are discussed.

Depression in adolescents is a ubiquitous mental health problem presenting ambiguities, uncertainties, and diverse challenges in its conceptualization, presentation, detection, and treatment. Despite the plethora of research on adolescent depression, there exists a paucity of research in regards to obtaining information from the adolescents themselves. In a mixed method, cross-sectional study, adolescents (N= 332) in grades 8 and 11 provided their conceptions of depression. Adolescents' self-recognition of depression was examined in association with depressive symptomatology and reported pathways to talking to someone. Adolescents' social and emotional competence was also examined in association with severity of their depressive symptomatology. Developed categories and subcategories of adolescent depression were guided by the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR) criteria for Major Depressive Episode (MDE) (American Psychiatric Association [APA], 2000). Adolescents' definitions of depression were dominated by subjective, holistic interpretations and add new information and depth to the previous research on adolescent depression. Depressed Mood and Social Impairment were the core categories, both contained intricate subcategories. The frequencies of these constructs provide a map of the themes and subthemes that pervade adolescents' personal philosophies regarding adolescent depression. About half of the adolescents who self-recognized depression within two weeks (45%),qualify into screened depression (Reynolds Adolescent Depression Scale -2" version [RADS-2];Reynolds, 2002) criteria based on the DSM-IV-TR for MDE (APA, 2000). However, this study's findings showed that the mean for screened Depression Total Score (RADS-2; Reynolds, 2002)was significantly higher in those adolescents who self-recognized versus those who did not self-recognize depression. The majority of lifetime self-recognizers of depression thought that they needed to talk to someone and reported that they talked to someone when feeling depressed. Poor Emotion Awareness was a strong contributor to increasing vulnerability to depressive symptomatology. This study provides new theoretical insights regarding the concept and detection of adolescent depression, and links between social and emotional competence and depressive symptomatology. These findings extend previous research (APA, 2000), provide new understanding to guide future research, and have direct implications for research, policy, and practice strategies aimed to better communicate with and help young people with and without depression.

Purpose: A majority of childhood and adolescent cancer survivors face life-long cancer- and treatment-related sequelae. Long-term follow-up is necessary to facilitate timely diagnosis and management of these health conditions. As part of strategic long-term follow-up, provider continuity of care (PCOC) may improve outcomes through appropriate use of surveillance, screening, and coordination of services. The purpose of this thesis was to assess physician services utilization and PCOC among survivors of childhood cancer compared with general population subjects, and to examine factors associated with survivors' use of physician services and PCOC scores. Methods: Physician services utilization and PCOC were assessed in a population-based cohort of 1322 five-year cancer survivors diagnosed between 1981 and 1995 under age 20 in British Columbia, and a group of 13,220 age- and gender-frequency matched, randomly selected population-based subjects, whose records were linked to individual-level administrative healthcare datasets. Effects of clinical and sociodemographic modifiers on utilization and PCOC were examined using generalized linear modeling. Changes in utilization and PCOC by age were estimated using a longitudinal, repeated measures modeling approach. Results: Survivors incurred an average of 8.94 medical visits per year: 4.82 to primary care physicians, 2.69 to specialists, and 1.43 to non-physician providers. Survivors had more visits than comparators in all visit categories (p<0.0001 for all). As they age, survivors' use of primary care services increases significantly, while their use of specialist services declines, trends that are not mirrored by the comparison population. The average PCOC score for survivors was 0.54 ± 0.22, indicating survivors saw the same primary care provider for only 50% of their primary care visits. Mean score did not differ between survivors and comparators; however, in the population sample scores improved with age (p=0.02), while among survivors, scores worsened (p=0.05). Conclusions: The dramatic age-related increase in primary care visits observed in the survivor group suggests that primary care physicians play a key role in ensuring quality long-term follow-up care. Survivors are at heightened risk for poor PCOC as they age and transition into adult-oriented community care, raising concerns about whether they are receiving the appropriate follow-up care encompassing screening, surveillance and psychosocial support.

While taking a personological approach to decision making theory, this thesis addresses the issue of how adolescents make occupational decisions. Implicit in this thesis is the idea that a personological approach to decision making has theoretical and practical significance when it is conducted through a personality orientation. The personality orientation used to examine adolescent decision making is the social cognitive theory of Berzonsky's identity-processing styles. Based on Berzonsky's identity-processing styles, 63 adolescents were classified as Informational, Normative and Diffuse/ avoidant for assessing the extent compensatory (high demand) and non-compensatory (reduced-demand) processing was used in an occupational choice situation that varied in cognitive complexity. Additional interest was also directed at determining whether the identity-processing styles reflected different intrinsic or extrinsic value preferences in their final choices. All processing data was derived through a computerizedinformation acquisition system called MOUSELAB. As hypothesized, the three identity-processing styles differed significantly in cognitive strategy usage and search behavior. Informational adolescents were seen to use a compensatory additive linear procedure; that is, they searched a large amount of information, in a constant fashion, for an extended period of time. Normative adolescents were seen to use a non-compensatory conjunctive procedure; that is, they searched a smaller amount of information, in a selective fashion, fora shorter period of time. Diffuse/avoidant adolescents were seen to use a non-compensatory elimination-by-aspect procedure; where the amount, selectivity and time of search was similar to the Normative adolescents. In regards to search direction, Informationals and Normatives were seen to assess occupational choices through an alternative-based search pattern whereas; Diffuse/avoidants were seen to lean towards an attribute-based search pattern. These processing results were true only for the high information load condition. Finally, as expected theoretically, value preferences were seen to vary according to an adolescent's identity-processing style. When making an occupational selection, Informational adolescents placed more emphases on intrinsic values (Feeling of Self-fulfilment, Intellectual Stimulation, Autonomy ect) whereas Normative adolescents placed more emphases on extrinsic values (Authority, Prestige, Wage etc). Diffuse/avoidant adolescents oscillated between the two value systems. Implications for decision making theory, applied suggestions for professionals counselling job-seeking adolescents and limitations of the study are discussed.

The current models for stigma measurement are disease-specific and created for use with adults, despite the fact that stigma may be experienced also by adolescents and may be layered, and not simply the result of one disease. Stigma in adolescents may effect their life outcome, as many emotional and social changes are happening at this point in life, therefore developing a measure to address stigma in youth is important. Focus groups of youth will be chosen based on sexual orientation, ethnic minority, street involvement, visible physical disability and history of sexual exploitation, with an eye to ensuring the sample contains individuals experiencing layered stigma. The result of research will be an adolescent- specific measure of perceived stigma, enacted stigma and internalized stigma that can be used to understand how stigma effects the perceptions, risk-behaviours and futures of youth, and to develop stigma reduction strategies.

Violent and aggressive behavior is a subset of antisocial behavior that is of particular concern to the criminal justice system and to the general public. A challenge facing mental health professionals and the criminal justice system is to assess—with a reasonable degree of accuracy—the likelihood that a young offender will recidivate and to arrange appropriate interventions. Because of its psychometric properties and high predictive validity, the Hare Psychopathy Checklist-Revised (PCL-R) is being incorporated into risk assessment batteries for use with adults. The purpose of the study was to extend the risk paradigm to adolescent offenders, investigating the predictive validity of the Psychopathy Checklist: Youth Version (PCL:YV) from adolescence to adulthood. Subjects were 157 admissions, ages 12-18, referred to Youth Court Services for psychological or psychiatric assessment. Archival data were used to complete retrospectively the PCL:YV and to code criminal history and demographic data on each of the subjects. Follow-up criminal record data were collected, with an average follow-up time of ten years. Over the follow-up period psychopaths demonstrated a greater risk for committing violent offences than nonpsychopaths. They committed violent offences at a higher rate, earlier following their release from custody, and were more likely to escape from custody than nonpsychopaths. Further, results indicate that PCL:YV score, a difference in performance - verbal intellectual functioning (P > V Index), and history of self-harm contributed significantly to the prediction of violent outcome, over and above the contribution of a combination of criminal-history and demographic variables. Finally, background and demographic characteristics were compared between violent and nonviolent psychopaths. Findings are discussed in the context of current conceptualizations of psychopathy and adolescent antisocial behavior.

In Canada, 3,300 children under the age of 20 are living with Crohn’s Disease (CD) (Crohn’s and Colitis Foundation of Canada, 2008). When an illness such as CD occurs in adolescence, the challenges associated with it are further compounded by the developmental tasks associated with this life stage. The purpose of this study was to understand how adolescents experience living with CD; to explore the impact of disease activity on their quality of life (QOL) and the strategies utilized to maintain and improve their QOL. Using a resiliency framework and narrative inquiry as a research methodology, seven adolescents were interviewed. The results include seven individual stories exemplifying their experiences, and from the stories shared, four patterns emerged: (1) Unconditional Support, (2) Embracing and Accepting Differences, (3) Attitudes and Personal Beliefs and (4) Daily Coping Strategies. These findings may have relevance for health professionals and families and adolescents with CD.

Traumatic experiences can have a profound and lasting impact on the mental health of children and adolescents. In this meta-analysis, psychosocial interventions for children and adolescents who have been exposed to traumatic experiences were systematically reviewed. Twelve main intervention components were identified. Of the main intervention components, cognitive Behavioural Therapy (CBT) was the most common and the most effective at reducing Post-traumatic Stress Disorder (PTSD) /Post-traumatic Stress Symptoms (PTSS) in children and adolescents. These findings on the effectiveness of CBT add to the findings of previous reviews on intervention effectiveness on alleviating trauma symptoms in children and adolescents. Components of Cognitive Behavioural Therapy (CBT), Exposure Therapy, Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing Therapy (EMDR), Meditation- Relaxation Therapy, Family-Focused Therapy, Psychological Debriefing, Resiliency-Focused Therapy, Sensory Therapy, Psychoeducational Therapy, Time-Limited Dynamic Therapy (TLDP-A), and general unspecific counselling were used in the various treatments. Taking into account methodological quality, there was evidence for effectiveness for school-based and sexual trauma-based interventions in alleviating trauma symptoms. More research is needed to understand the effect of methodological quality on effect sizes based on intervention type. The implications for researchers and clinicians are discussed.

No description available.