Immigrant youth face uncertainty in many aspects of their lives. Most have little control over their family’s decision to immigrate and once they arrive, many encounter challenges. The Navigating Multiple Worlds project worked with a group of youth researchers to explore the relationship between stress, resilience and expressions of subjectivity among immigrant youth. Moving beyond the negative conceptualizations of stress and acculturative stress that dominate the literature, this research gathered youth perspectives on stress and what could be done to enhance supports for immigrant youth in Victoria. Through our participatory approach, the youth research team was involved in the design and implementation of interviews, focus groups and finally a photovoice exercise. Our methodology sought to highlight narrative complexities and the fluidity of experiences, with the research team reflecting on their own experiences while gathering perspectives on stress from other immigrant youth. The benefits and challenges of working in participatory paradigms with youth and the value of arts based methods for capturing youth voices and creating ‘thinking spaces’ for community engagement are highlighted. Historically, research has problematized immigrant youth identities. A focus on immigrant youth perspectives reveals that while many youth face challenges after immigration, they also emphasize the value of flexibility in self-definition. The combination of our methods, participatory approach, our focus on youth voices and taking an ethnographic approach to documenting experiences of stress, contributed to the distinctiveness of our findings. Considering stress as an idiom of narrative expression rather than an index of negative experience, acknowledges its place as part of the worldview of the participants, who use the term in multiple ways. The physicality of stress, the spatial and temporal dimensions of stress and ‘everyday stressors’ emerged from our analysis as thematic categories that describe the ways that youth experience ‘stress’. The findings of the Navigating Multiple Worlds project speak to the value of conceptualizing stress as a narrative idiom. Over the course of our research it became apparent that youth were talking about stress in ways that allowed them to discuss and normalize negative experiences, re-framing experiences of ‘stress’ in positive terms. For many, this facilitated fluid movement from a focus on challenges to a focus on coping and resilience. Our research suggests that while conflicting expectations in the lives of immigrant youth are sources of ‘stress’ for many, they can also be understood as key ‘sites of flexibility’. The processes of negotiation that occur in these ‘sites of flexibility’, as youth use the language of stress to name challenging experiences and overcome them, contribute to the resilience of youth. Although our findings are specific to a small group of immigrant youth in Victoria, BC, considering stress as an idiom of resilience as well as distress creates opportunities to recognize and enhance the strengths of immigrant youth and the supports available to them. Recommendations from our research in terms of service provision, supports, and participatory research with youth are provided, as well as suggestions for future research in anthropology related to immigrant youth and stress. / Graduate / 0339 / 0326 / 0347 / sarah.fletcher@gmail.com

Thesis (M.S.)--University of North Texas, Dec., 2007. / Title from title page display. Includes bibliographical references.

Thesis (Ph.D.)--University of Melbourne, School of Population Health, 2007. / Typescript. Includes bibliographical references (leaves 226-266).

Thesis (M. Soc. Sc.)--University of Hong Kong, 1992.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1992. / Also available in print.

The findings of this PhD provide a significant contribution to early intervention research. The ability to detect those at ultra-high risk for psychosis (UHR) has been made possible in recent years. It is well known that people with serious mental illness have poor physical health, yet prior to this PhD little was known about the physical health of UHR individuals. This PhD explores the physical health and lifestyle of the UHR group, and makes recommendations for the development of a physical health intervention. A range of methods have been used including quantitative and qualitative methods, systematic reviews and meta-analyses, and a clinical audit. Therefore, a multifaceted approach to investigate the physical health and lifestyle of UHR individuals has been taken. Papers 1-3 suggest UHR individuals are more likely to live an unhealthy lifestyle than their peers. This includes lower levels of physical activity, and higher levels of substance use (generally cannabis, tobacco and alcohol). Paper 4 contains a clinical audit showing physical health and lifestyle factors are not monitored routinely in early detection services, despite the UHR phase being an ideal opportunity to intervene. Living an unhealthy lifestyle can have a detrimental effect on physical and mental health. Papers 1-4 emphasise the need to intervene to promote a healthy lifestyle for the UHR group. In line with the Medical Research Guidelines for the development of complex interventions, a theoretical model is applied in Paper 5. The final paper presents a qualitative study with UHR individuals, their parents and clinicians to explore barriers and facilitators to living a healthy lifestyle and inform the development of a physical health intervention. A final evidence synthesis includes recommendations for future work and the clinical implications of this thesis. The findings of this PhD provide an important and timely contribution to early intervention research. Prior to this work, the physical health of UHR individuals had been largely under researched. For the first time, this PhD presents evidence to suggest individuals at ultra-high risk for psychosis experience cardiovascular risk, and there is an opportunity to intervene to promote physical health. Although not all UHR individuals will develop psychosis, many will continue to experience difficulties with their mental health. Given that this group are also more likely to live an unhealthy lifestyle, it is important to take a holistic approach to treating those at imminent risk for psychosis, considering both mental and physical health.

Philosophiae Doctor - PhD / HIV counselling and testing (HCT) is an essential element in the response to the HIV epidemic. Thereare still major gaps in research about the best ways to provide HCT, especially to young people. School-based HCT is a model which has been suggested for providing HCT to young people in a youth friendly manner. This study was aimed at producing recommendations for providing a youth friendly school-based HCT service using the World Health Organisation (WHO) framework for youth friendly health services. It was conducted in six secondary schools in Cape Town, where a mobile HCT service is provided by a nongovernmental organisation (NGO). It was an exploratory descriptive study, using a mixed-methods approach. Twelve focus group discussions (FGDs) were held with learners to explore their needs with regards to school-based HCT. An evaluation (which consisted of observation of the HCT site, service provider interviews and direct observation of the HCT counselling process) was done to determine whether the mobile school-based HCT service was youth friendly. A learner survey was conducted with 529 learners to investigate the factors that influence the uptake of HCT and to explore learners’ behaviours and experiences under test conditions. In the FGDs, learners said that they wanted HCT to be provided in schools on condition that their fears and expressed needs were taken into account. They wanted their concerns regarding privacy and confidentiality addressed; they wanted to be provided with information regarding the benefits and procedure of HCT before testing took place; they wanted service providers to be competent to work with young people, and they wanted to be assured that those who tested positive were followed up and supported. On evaluation of the mobile school-based HCT service, it was evident that the service did not meet all the needs of the learners nor did it have all the characteristics of a youth friendly health service. The model of ‘mass testing’ used by the NGO did not fulfil learners’ expressed need for privacy with regards to HCT. Service providers were friendly and on-judgemental but had not been trained to work with young people (especially marginalised groups e.g. young men who have sex with men). The information needs of learners were not addressed, and learners were not involved in the provision of the HCT service. Learners who tested positive were not assisted in accessing care and support. The learner survey revealed a high uptake of HCT (71% of learners) at schools with learners who do not identify themselves as Black, with female learners and older learners being more likely to have had an HIV test. Factors that influenced uptake of HCT were complex, with learners reporting many different motivators and barriers to testing. Of concern was the low risk perception of learners with regards to HIV infection and the fact that learners who tested HIV positive were not being linked up with treatment and care. Based on the findings of the study, recommendations were made for proving youth friendly school based HCT. A multisectoral approach, with learner and community involvement, was suggested in order to provide a service which is equitable, accessible, acceptable, appropriate and effective.

Multi-purpose clinically relevant measures such as the Child and Adolescent Needs and Strengths (CANS; Lyons, 2009) and the Global Appraisal of Individual Needs (GAIN; Dennis et al., 2003) can be useful for improving services at the individual client, program, organization, and system levels. Yet, emerging research suggests that such measures are often not used consistently or effectively (Mellor-Clark, Cross, Macdonald, & Skjulsvik, 2016), and that poor use of these measures can be in part attributed to how they were put into practice (de Jong, 2016). Systematically conducted, empirical research on the effective implementation of such tools is scarce (Boswell, Kraus, Miller, & Lambert, 2015). Thus, the current study examined the factors and processes that contribute to the effective implementation of clinically relevant measures, specifically the CANS and GAIN, in community-based mental health agencies serving children and adolescents. A second objective was to examine the role of staff participation in the implementation process. Three general research questions guided the study, including: (1) How can clinically relevant measures such as the CANS be implemented effectively? (2) What are the perceived consequences of staff participation in adapting and implementing a version of the CANS and how do these consequences come about? and (3) How does the implementation context affect the process and its outcomes? The study employed qualitative, multiple-case study methods. Four child and youth mental health agencies in Ontario participated, including a total of 44 staff with varying roles (e.g., frontline and management). Several cross-case and within case comparisons were made to examine the contribution of staff participation and tool features, such as tool adaptability, to implementation outcomes. Data was analyzed using guidelines developed by Yin (2009), Miles and Huberman (1994), and Thomas (2006). Results suggest that staff participation in the process of putting clinically relevant measures into practice contributes to effective implementation and increased uptake and use of the measures. When staff are engaged in the process, they have reasons and opportunities to interact, talk about the use of the measure, and “co-create fit” between the measure and their work context. This improved fit then facilitates increased staff commitment and ability to use the measure effectively. Agency leaders play a key role in enabling this fit-making process through: encouraging and supporting a participatory approach to implementation, creating implementation structures, following through with planned activities, and being open and responsive to staff feedback. Findings suggest that the implementation context provides incentives or reasons for implementing a measure, affects the initial fit between the measure and staff members’ work, and affects the feasibility of engaging staff in the fit making process. In conclusion, this study is one of the few empirical studies to examine implementation of clinically relevant measures. The findings have important implications for research and practice, which will be discussed.

No description available.

New generations of youth are coming of age at a time when digital technology is omnipresent, where devices are our constant companions, extensions of ourselves. It is not yet fully known what effect this mass consumption of digital technology will have on current and future generations. Although not entirely negative, dramatic shifts in human interaction and well-being have already presented themselves, begging understanding. Among these shifts are rising rates of youth struggling with mental health – especially since the COVID-19 pandemic. Various international and domestic governing bodies highlight the importance of this burgeoning field of research, turning in part to our technology-loaded ecosystems for answers. Early research has established associations between increased digital screen usage and youth mental ill-health. Questions remain, however and there exist large gaps in counselling psychology research as to how we can best support youth in the digital age. Situated within this debate, the current study establishes a theoretical basis as to the role digital technology plays in youth mental health. The study employs a qualitative methodology, including semi-structured interviewing and thematic analysis. Eight youth were interviewed and asked to share their experiences of the relationship between their devices and their well-being. Thematic findings highlight a conflictual relationship between digital technology use and youth mental health, affecting their relationships with others, themselves, and the world around them. Because digital technology consumption on this scale is so new, this is one of the first available cohorts of youth to actively participate in the exploration of this topic, offering their unique voices in ways that will benefit broader societal understandings of technology and mental health. / Graduate