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Final framework from narrative interviews to explore the needs of youth in
remote/northern Canada
Youth in rural Canada fa...
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(2016) NorthBEAT: Final framework from narrative interviews to explore the needs of youth in remote/northern Canada [IEPA Poster A136]

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2016 International Early Psychosis Association (IEPA) 10th Biennial Conference: Milan, Italy. October 2016.
Poster Presentation

CHENG C, NADIN S, KATT M, LEM C, DEWA CS, MINORE B

Acknowledgements: The NorthBEAT Project was funded by the Sick Kids Foundation in partnership with CIHR. Attendance at this conference is supported by St. Joseph’s Care Group Thunder Bay.

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(2016) NorthBEAT: Final framework from narrative interviews to explore the needs of youth in remote/northern Canada [IEPA Poster A136]

  1. 1. Final framework from narrative interviews to explore the needs of youth in remote/northern Canada Youth in rural Canada face similar barriers to EPI as their urban counterparts (e.g., lack of knowledge about psychosis and psychosis services). They share many of the needs perceived by urban youth (e.g., psychosis education, reduced stigma, shorter wait times, EPI specific services).§ The analysis resulted in two global themes: “North: Barriers to Early Assessment and Treatment” (Figure 1) and “What Rural Youth Need” (Figure 2). QUALITATIVE APPROACH RESULTS CONCLUSIONS Cheng, C.1,2,3 ; Nadin, S.1,3 ; Katt, M.3 ; Lem, C.1 ; Dewa C.S.4 ; Minore, B.3 1. 2. 3. 4. Youth (n=18) Family caregivers (n=11) Service providers (n=14) Rural youth face additional barriers that are unique to their geographical contexts (e.g., travelling far to services, lack of resources in rural/remote communities). Indigenous youth in rural areas face additional barriers of double stigma and mistrust of the healthcare system due to colonialization and racism. The thematic analysis and frameworks represents initial steps to understanding how to decrease the barriers to early assessment and treatment, and meet the service needs of youth who experience psychosis in rural areas. Acknowledgements: The NorthBEAT Project was funded by the Sick Kids Foundation in partnership with CIHR. Attendance at this conference is supported by St. Joseph’s Care Group Thunder Bay. References: *: Statistics Canada. 2013. North West (Health Region), Ontario, North East (Health Region), Ontario and Ontario (table). Health Profile. Catalogue no. 82-228-XWE 2007. North East Health Integration Network, Ontario (Code3513) (table) and North West Health Integration Network, Ontario (Code3514) (table). Catalogue no. 92-591-XWE. +: Attride-Sterling, 2001 §: Anderson et al.,2013 Next steps for NorthBEAT include the development, implementation, and evaluation of online learning modules to educate non-specialist service providers about psychosis and psychosis services. For more information, visit: www.chicheng.ca Semi-structured telephone interviews were conducted with youth ≤18 years old who have experienced psychosis, their family care- givers, and rural mental health service providers. 1: Purposive sampling: convenience (youth & caregivers) and maximum variation (service providers) techniques. 2: Verbatim transcripts were content analyzed using a thematic networks approach.+ Thematic maps were drawn to illustrate the inductively derived themes. The results were validated through workshops with project participants and stakeholders. 3: Aims: • To understand how youth in Northern Ontario experience early psychosis and services for psychosis; • To understand what are the barriers to receiving appropriate EPI; • To examine Indigenous youth as a significant and vulnerable population in Northern Ontario. BACKGROUND NORTHERN ONTARIO Northern Ontario (rural Canada) is an area with a vast geography, scarce population and many Indigenous communities, and where EPI programs struggle to understand and meet service needs. * Research Question: What are the perceived service needs of Indigenous and non-Indigenous youth in Northern Ontario who experience first episode psychosis? (Barriers to Early Assessment and Treatment) is a 3-year, descriptive, mixed-method project that explored the service needs of youth in Northern Ontario. Population: 786 290 Land mass: 802 396.28 km2 6% of Ontario’s population 90% of Ontario’s landmass 32% of Northern Ontario’s population is rural, vs 14% in Ontario overall 2 out of 50 of Ontario’s EPI programs service the entire region 6x the Indigenous population, as compared to the rest of Ontario (15% vs 2%) View related presentations: www.slideshare.net/drcheng Indigenous Cultural Context Lack of Knowledge about Psychosis An Isolating and Disconnected System Geographical Context “Help” Not Wanted (Youth/ Family refuse/ disengage from EPI services) NORTH Barriers to Early Assessment & Treatment Psychosis Signs/ Symptoms “Missed” (denied/ ignored/not recognized by youth or family) Psychosis Signs/ Symptoms “Missed” (denied/ ignored/not recognized by youth or family) Need for Psychosis Education The “system” is disconnected and incomprehensible Isolating Service Mandates and Eligibility Criteria Lengthy Referral Processes & Wait Times Lead to Longer DUP’s Mistrust of Healthcare Providers Double Stigma (Indigenous - Mental Illness) Rural/Remote: Few Resources Distance is a Barrier Social Determinants of Health The “Right” Door Family Suport Reduced Stigma Intervention before Crisis What Rural Youth Need Emergency Department is not the Right Place A Connected and Knowledgeable System Access to Child & Adolescent Services The Important Role of Family Family Need Support in Their 3-Pronged Fight To Belong & Be Believed A Safe, Welcoming, Comfortable Environment EPI Approach Psychiatry (Medication) Recovery Focus Providing EPI isn’t a Solo Sport Trusting & Engaged Clinical Relationship Psychosis Education Intense Case Management Getting to an early intervention worker is not always possible depending where you live. Service Provider I probably could have used the help when I was 13 years old. Youth, 16 You’re looking at a bunch of white people who don’t know what you’ve been through and don’t care. Family Member It’s a slow system, really slow… Like she’s [my daughter] asking for help right now. They should seize the moment and say: Yes, we will help you. Family Member Sometimes I feel like I’m doing it all alone. So sometimes it would be nice just to have somebody to talk to. Family Member

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