Homelessness in the youth population is associated with elevated rates of mental illness, substance abuse, and suicidality compared to the housed population in the United States (Berdahl, Hoyt, and Whitbeck, 2005; Hodgson, Shelton, Van den Bree, 2014; Hughes et al., 2010). With a survival-focused perspective, exacerbating issues, stigmatization, and transience housing; homeless youth require special consideration to meet their diverse health needs. When barriers impede homeless youth's access to necessary health resources, their health concerns are left untreated and impound until emergency services are required. This review of literature is focused on identifying and synthesizing barriers and facilitators for homeless youth to access and utilize mental health care services. When untreated mental illness reaches a crisis point, it becomes more expensive to treat (Taylor, Stuttaford, and Vostanis, 2006). For youth experiencing homelessness, various factors influence their decisions to wait until a crisis to reach out to emergency services. Within the literature, barriers and facilitators were bracketed into personal, social, and structural factors. These factors ranged from financial concerns, communication with health care providers and between health care service locations, stigmatization, lack of awareness, and administrative requirements. While further research is required, evidence from the literature shows promise in developing and altering interventions and communication to meet homeless youth's mental health and substance abuse needs.

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The literature indicates that engaging parents in child/youth mental health services is crucial for achieving positive outcomes. Yet, little research exists on how providers and organizations might hinder or facilitate parental engagement. This study aims to address this gap in literature by answering three research questions: (1) how do service providers working in child and youth mental health services define parental engagement? (2) Why does engaging parents in treatment remain a challenge for service providers? (3) What organizational- and provider-level factors contribute to this challenge? To facilitate this aim, semi-structured interviews were conducted with four service providers, including those working in community-based or outpatient child and youth mental health services. Participants were recruited using a snowball sampling recruitment method. Interviews were audio-recorded, transcribed and analyzed following principles of Constructivist Grounded Theory. Study results highlighted system- (e.g., access), organizational- (e.g., expectations and constraints), provider- (e.g., stance) and parental-level (e.g., shame) factors impacting parental engagement in services. These findings coincide with the documented impacts of neoliberalism and New Public Management on shaping mental health services. This study thus challenges traditional conceptualizations of engagement and underscores the interplay of complex factors that occur between service-levels. An expanded definition of parental engagement is therefore warranted if providers and organizations intend on holistically engaging parents in their child/youth’s care. / Thesis / Master of Social Work (MSW)

Youth mental health impairments are a leading and growing cause of disability. Mental health deficits during childhood and adolescence often portend more serious illness later in life, and early intervention at time of symptom onset may be critical to ameliorating disease trajectories. However, despite their importance, the neural and developmental underpinnings of many psychiatric disorders are not well understood. This dissertation aims to improve our understanding of pediatric psychiatric disorders by harnessing the power of machine learning, large sample sizes, and distinct training and replication subsamples to robustly examine functional magnetic resonance imaging data in two large samples of youth. In Chapter 2, we review prior uses of machine learning in the psychiatric neuroimaging literature. We also develop a framework for evaluating machine learning applications in psychiatric neuroimaging, which we apply throughout this dissertation. In Chapter 3 (Study 1), we use several supervised and unsupervised machine learning techniques to probe functional neural correlates of obsessive-compulsive symptoms in a large, multi-site community sample of youth. We find that patterns of individual obsessive-compulsive symptoms are fairly stable across subsamples. Granular resting state functional connectivity patterns associated with those symptom dimensions are not reliable, but broader large-scale network patterns appear to be more stable across subsamples. In Chapter 4 (Study 2), we use a different large sample of youth to assess clinical, cognitive, and demographic factors associated with head motion during fMRI. Head motion is a known source of artifact in fMRI data, especially data collected from youth. Our findings suggest that head motion may be systematically associated with neuropsychiatric symptom severity, thus potentially confounding neuroimaging studies involving patient populations. Across studies, this dissertation highlights the need for reproducibility and replicability, with a focus on research transparency, code sharing, and pre-registration of analyses. We hope herein to provide a solid methodological foundation from which to build our understanding of the neural basis of pediatric psychiatric symptoms.

Recent South African research has confirmed that there is reason to be concerned about the mental health status and well-being of our youth. School-going youth are engaging in a wide array of risk behaviours that seriously threaten their well-being and hamper their chances of experiencing success in the future. The aim of this research was to explore factors relating to risk, resilience and health promoting schools in order to enhance the well-being of youth in South Africa.

Recent South African research has confirmed that there is reason to be concerned about the mental health status and well-being of our youth. School-going youth are engaging in a wide array of risk behaviours that seriously threaten their well-being and hamper their chances of experiencing success in the future. The aim of this research was to explore factors relating to risk, resilience and health promoting schools in order to enhance the well-being of youth in South Africa.

Philosophiae Doctor - PhD / Recent South African research has confirmed that there is reason to be concerned about the mental health status and well-being of our youth. School-going youth are engaging in a wide array of risk behaviours that seriously threaten their well-being and hamper their chances of experiencing success in the future. The aim of this research was to explore factors relating to risk, resilience and health promoting schools in order to enhance the well-being of youth in South Africa. / South Africa

published_or_final_version / Social Work / Master / Master of Social Work

The purpose of this study was to gain a deep phenomenological understanding of how young adults living in a detoxification centre for people with no fixed abode made the life changing decision to free themselves from substance use and provide insights that could be helpful for counselling psychologists working therapeutically with this client group. An exploratory study was conducted using Interpretative Phenomenological Analysis (IPA). The participants were between the ages of 25 and 29 years old (1 female and 5 males). All participants had spent 6 weeks in the detoxification centre at the time the interview took place. Two specific areas were pinpointed for exploration during the semi-structured interviews: (1) self-concept before entering the project and after having entered the project and been abstinent for at least 6 weeks, and (2) possible links between homelessness and substance use. Emerging themes were clustered in terms of polarities and existential dimensions. Four superordinate themes comprising of eight existential polarities were extrapolated: control-chaos; connectedness-disconnection; meaning-meaninglessness; responsibility-guilt. The data analysis revealed participants’ struggle to resolve the conflict between these polarities. Identity issues seemed to be crucial, as well as a sense of having lost touch with or possibly never developed an authentic self and a struggle to live and accept emotions in the present moment. Another aspect that emerged was difficulties in grieving losses as well as death anxiety. Connecting with others and caring about oneself seemed to be closely linked and conducive to wellbeing in participants’ experience of abstinence from substance use. On the basis of this study recommendations are made for professionals working therapeutically with this group of clients. These include taking an existential approach and using mindfulness techniques to support clients to accept the polarities we experience in life and to develop the capacity to embrace the contradictions of our existence.

Background Mental health stigma-reducing and awareness trainings encourage trainees to talk about mental health with the hope that increased discussions will lead to reduced stigma and increased access to mental health services. This survey study aimed to examine the current levels of confidence among participants, or “first aiders” who completed the Youth Mental Health First Aid (YMHFA) training in their ability to demonstrate the skills that were taught in the training. Additionally, this study examined the difference in levels of confidence between the YMHFA instructors and first aiders in the ability of the first aiders to demonstrate the skills that were taught in the training. We examined differences in levels of confidence among first aiders according to their socio-demographic and personal characteristics. Finally, we explored the ways in which first aiders who completed the course used their knowledge and skills after the training. Methods Seven hundred fifty-seven first aider participants were surveyed post-training and 129 first aider participants were surveyed at follow-up. Fourteen YMHFA instructors were surveyed. Results The data indicated that there was a significant decrease in confidence among first aiders between post-training and follow-up. With the exception of age, there were no statistically significant differences in levels of confidence among first aiders according to the following sociodemographic and personal characteristics: a.) gender; b.) race; c.) reason for attendance; d.) role of use. Survey data also indicated the various ways in which first aiders are currently using their training. Conclusions First aiders’ confidence declined after follow-up even though they reported various ways in which they are using their training. Instructors reported positive perceptions of the training and reported a high level of confidence in the ability of their trained first aiders to demonstrate the taught skills.