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.

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

There is a high prevalence of mental health challenges among immigrant-origin youth (IOY) as a consequence of unique stressors and risk factors, disparities in access to mental health services, and distress associated with the COVID-19 pandemic. Educators and school staff are in need of effective, accessible, and culturally relevant mental health literacy (MHL) training to accurately recognize and appropriately respond to these mental health concerns. The main goal of this pilot study was to examine initial evidence on the effectiveness, utility, acceptability, and cultural fit of the virtual format of the Youth Mental Health First Aid (YMHFA) training program among educators who work with IOY. A mixed-methods approach was employed through quantitative online surveys at pre-training, post-training, and three-month follow-up as well as qualitative virtual focus groups querying educator and school staff’s perspectives. Descriptive and inferential analyses were used to quantitatively analyze survey data. Thematic analysis was used to analyze qualitative data. Findings obtained from a total of 36 educators and school staff working predominantly IOY revealed significant improvements in participants’ mental health knowledge, confidence to help, and attitudes towards mental illness that were sustained at three-month follow-up, with some variability based on race, prior mental health training experience, and professional role. The content and format of the virtual YMHFA was also found to be highly rated in its utility and acceptability. Themes related to utility included (a) crisis response skills and knowledge and (b) flexible scope of use of the training. Themes related to acceptability included the (a) presentation of information, (b) accessibility and convenience, (c) interactive nature of the training, (d) timing and scheduling, and (e) limited content. Themes highlighting the strengths and weaknesses associated with the cultural relevance of the training included (a) inclusivity and specificity and (b) cultural sensitivity and awareness. Themes related to recommendations to improve the cultural relevance of the training included (a) additional knowledge and resources, (b) improving representation in scenarios and videos, and (c) tailoring content to a target audience. Based on these initial findings, several implications for implementation of YMHFA training in schools, improving the cultural relevance of YMHFA for IOY, and future directions in research are discussed.

Disparities in mental health service use among People of Color (POC) adolescents with depression is a serious public health concern. Engaging and retaining POC adolescents in treatment is imperative to improving mental health outcomes. Parents/caregivers play a critical role in POC adolescent engagement in the therapeutic process, yet POC adolescents’ and parents’/caregivers’ preferences for parental participation engagement (PPE) in depression treatment are unknown. The goal of this dissertation was to investigate POC adolescents’ and parents’/caregivers’ preferences for PPE in adolescent depression treatment. A qualitative approach was used through individual semi-structured interviews with POC adolescents and parents/caregivers. A brief quantitative preferences questionnaire was also administered. Questionnaire data were analyzed via descriptive statistics. Qualitative data were analyzed via thematic analysis procedures. Results indicated that teen and parent/caregiver preferences for PPE included: (a) direct parental involvement, (b) indirect parental involvement, and/or (c) limited involvement. The quality of the teen-parent relationship and logistical factors informed teen and parent/caregiver preferences for PPE, with therapists having a key role in influencing these preferences and facilitating the initiation and continuation of PPE. Factors associated with the quality of the teen-parent relationship included: (a) parent mindsets and behaviors, (b) teen and parent perceptions of adolescent development, and (c) severity of teen symptoms. Themes related to the perceived outcomes of PPE included: (a) improved teen-parent communication, (b) improved parental support behaviors, (c) improved teen-parent connection and trust, (d) negative outcomes, and, (e) treatment retention. Based on these findings, implications for clinical practice and future research are discussed.

An autism spectrum disorder (ASD) diagnosis in childhood comes with inherent vulnerability to adverse experiences. For some, the developmental process of adolescence overwhelms their altered neural system, exacerbating this vulnerability. Adolescence presents an opportunity to mitigate the negative effects of adverse childhood experiences (ACEs) on the developing brain. However, little is known about children who have both ASD and a history of ACEs. This study, first sought to understand the prevalence of ACEs among adolescents with ASD and whether those who have experienced ACEs are placed at further risk for other social and emotional challenges, impacting their transition into adulthood. With adolescents being highly sensitized to their environment, opportunities for intervention in their environments may mitigate the long-term consequences of ACEs. Due to adolescents spending a great deal of their time in school, developing interventions to support those with ASD that can be implemented within the school would be beneficial. Thus, the second aim of this study was to understand how schools can serve as a place for trauma-informed intervention. The Whole School, Whole Community, Whole Child (WSCC) model served as the conceptual framework for this mixed-methods study. Data from the 2020 National Survey of Children’s Health (NSCH) were examined to determine the prevalence of ACEs and further risk for social-emotional issues in adolescents with ASD. Focus groups and semi-structured interviews were conducted with school personnel in public schools to understand how they respond to typically developing and ASD students who have experienced ACEs. The findings showed that 60% of adolescents with ASD had experienced ACEs. Additionally, significant associations were found between the experience of ACEs and a diagnosis of anxiety, depression and ADHD. Furthermore, the experience of ACEs was associated with being bullied, however, no significant association was found with their ability to make friends. Great variability exists in the way schools respond to ACEs, if at all, and lack consistency and clarity in their SEL practices. Therefore, there is a need to identify the school climate components that are needed to provide trauma-informed interventions and determine how to scale these interventions. Further, with the heterogeneity of the ASD profile, identifying which factors are associated with this risk will be helpful in providing tailored interventions, specifically in the school environment.

Virtual group therapy offers multiple unique advantages to improving access to mental health care for Canadian youth and families. However, virtual environments may hinder the development of the type of relationships within groups that promote positive treatment outcomes. The present study explores the extent to, and ways in which, service providers working in the youth and family mental health sector in Eastern Ontario adapt to the unique characteristics of virtual environments in order to communicate effectively and develop therapeutic relationships. Secondary quantitative and qualitative data were analyzed using a mixed-methods design. Survey responses (n = 58) and interview recordings (n =12) collected from service providers involved in the delivery of virtual groups for youth and families in response to COVID-19 were analyzed using a concurrent triangulation design. Descriptive statistics indicate service providers achieved moderate satisfaction regarding their ability to communicate and develop relationships within virtual groups, and that this ability was perceived as approximating in-person processes. Thematic analysis suggests that while virtual group environments involve unique challenges and and elevated complexity, facilitators adapt to virtual delivery by both employing diverse strategies and accepting certain limitations. The present study suggests that the unique challenges and complexities involved in virtual group-based therapy need not deter the implementation of virtual groups as a means of better addressing the mental health needs of Canadian youth and families.