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Background: Youth experiencing homelessness (YEH) suffer from poorer physical and mental health outcomes than stably housed youth. Additionally, YEH are forced to navigate fragmented health and social service systems on their own, where they often get lost between systems when transitioning or post-discharge. Inevitably, YEH require support with health system navigation and healthcare coordination. The aim of this study is to understand interactions within and between the emergency youth shelter (EYS) and health systems that affect healthcare coordination for YEH in Toronto, Canada, and how these interactions can be targeted to improve healthcare coordination for YEH. Methods: This study is part of a larger qualitative case study informed by the framework for transformative systems change. To understand interactions in healthcare coordination for YEH within and between the EYS and health systems, we developed a causal loop diagram (CLD) using in-depth interview data from 24 key informants at various levels of both systems. Open and focused codes developed during analysis using Charmaz's constructivist grounded theory methodology were re-analysed to identify key variables, and links between them to create the CLD. The CLD was then validated by six stakeholders through a stakeholder forum. Results: The CLD illustrates six balancing and one reinforcing feedback loop in current healthcare coordination efforts within the EYS and health systems, respectively. Increasing EYS funding, building human resource capacity, strengthening inter and intra-systemic communication channels, and establishing strategic partnerships and formal referral pathways were identified among several other variables to be targeted to spiral positive change in healthcare coordination for YEH both within and between the EYS and health systems. Conclusions: The CLD provides a conceptual overview of the independent and integrated systems through which decision-makers can prioritize and guide interventions to strengthen healthcare coordination within and between the EYS and health systems. Overall, our research findings suggest that key variables such as streamlining communication and improving staff–youth relationships be prioritized, as each of these acts interdependently and influences YEH's access, quality and coordination of healthcare. [ABSTRACT FROM AUTHOR]

Indigenous youth who experience homelessness are faced with multilevel challenges related to family, health, service access and support, employment and education. Navigating racism, ageism and other forms of discrimination complicates the search for pathways out of homelessness, especially without adult support. In this study, the educational experiences of homeless youth across the York Region of Toronto were explored in depth. The narratives shared by 11 Indigenous youth convey their perspectives on education, health and mental health, and other life contexts affected by homelessness. Analyses of their dialogues can assist educators, researchers and service providers to gain a better understanding of their health and mental health challenges. Despite strong desires to continue their education, homeless youth are often forced to drop out of school prematurely. Their perspectives, especially about mental health and education, can raise awareness about youth homelessness in suburban areas surrounding Toronto. [ABSTRACT FROM AUTHOR]

Celling Sex was a community-based participatory research project that used a strengths-based approach to explore the agentic harm reduction practices employed by young women who trade sex and learn about their experience accessing health and social services. Fifteen racially diverse young women participated in interviews. They described how they tried to stay safe and advice for others. Each participant also individually made a brief digital video (cellphilm) to tell their story. Participants were invited to a private screening at which cellphilms were screened and common themes identified. The interviews and cellphilms were subsequently coded according to these themes. Participants identified a number of trading risks including: physical risks (unwanted pregnancy, STIs, and violence), social risks (racism and fetishisation), and mental health risks. To mitigate these concerns, participants detailed the harm reduction strategies they used which included use of technology, screening measures, boundary setting, and actively incorporating sexual health protections. Young women who trade sex are keenly aware of the risks inherent in transactional relationships and proactively negotiate and navigate harm reduction strategies in the context of deep systemic barriers. Further intervention may be necessary for them to actualise these strategies and access important forms of health and social support. [ABSTRACT FROM AUTHOR]

There is a high prevalence of Indigenous youth experiencing either precarious housing or homelessness in northwestern Ontario. Given that Indigenous pathways to homelessness can differ from non-Indigenous youth, interventions that address homelessness must also adapt to meet diverse needs. The Housing Outreach Program Collaborative (HOP-C) is a tertiary prevention intervention designed to provide congruent housing and peer and mental health supports for youth experiencing homelessness in Toronto, Ontario. Less is known regarding its adaptability to adequately serve Indigenous youth in northwestern Ontario. This study assessed the preliminary effectiveness and feasibility of an adaptation of the HOP-C North program for transitional aged Indigenous youth exiting homelessness in Thunder Bay, Ontario. Participants completed premeasures (n = 15) and postmeasures (n = 8) as well as qualitative interviews regarding their experiences in the program. Qualitative interviews were also conducted with staff (n = 14) engaged in implementing the program. After completing the HOP-C North program, participants reported improvements in a number of outcomes, including increased educational enrollment, attainment of employment, reduced hospitalizations, and increased engagement in clinical mental health services. Specific program aspects that participants found helpful included increased program flexibility, accessibility, emphasis on relationships, relevance of programming, fostering participant autonomy, and an adaptive approach to program implementation. These findings suggest that the HOP-C North model, when adapted, is a helpful program for Indigenous youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Objective. The process of patient navigation involves system resource experts matching patients to the most appropriate services. Patient navigation within the mental health and/or addictions (MHA) system is only a recent development and has not undergone extensive research. This study examines trends regarding clients of a family navigation service in Toronto, Canada, which supports families of youth ages 13-26 with MHA concerns. Method. A retrospective chart review was conducted using a sample of 200 cases from the first 989 clients of the navigation service. Descriptive statistics were performed to examine the general characteristics and demographics of navigation clients, the MHA profiles of navigation clients, and the characteristics of navigation. To predict the service needs and goals of navigation clients, four forward likelihood ratio multinomial logistic regression analyses were performed. Results. Female caregivers were the most frequent point of contact, and families most commonly requested psychiatric assessments, counselling services, and parent support programs. Families who were seeking help for a female youth were less likely to request psychiatric treatment compared to families seeking help for a male youth (p= .04) and families with a youth who already had a formal psychiatric diagnosis were more likely to request a counselling or therapy referral (p= .04) compared to families with a youth who had not received a formal psychiatric diagnosis. Conclusion. The findings contribute to an understanding of family navigation within the MHA field, and may support the development of targeted navigation programs that meet youth and families' needs. [ABSTRACT FROM AUTHOR]

There is limited empirical evidence documenting the magnitude and correlates of area-level variability in unmet need for children's mental health services. Research is needed that identifies area-level characteristics that can inform strategies for reducing unmet need in the population. The study purpose is to: (1) estimate area-level variation in children's unmet need for mental health services (using Service Areas as defined by the Ontario Ministry of Children and Youth Services), and (2) identify area-level service arrangements, and geographic and population characteristics associated with unmet need. Using individual-level general population data, area-level government administrative data and Census data from Ontario, Canada, we use multilevel regression models to analyze unmet need for mental health services among children (level 1) nested within Service Areas (level 2). The study finds that 1.64% of the reliable variance in unmet need for mental health services is attributable to between-area differences. Across areas, we find that Service Areas with more agencies had a lower likelihood of unmet need for mental health services. Compared to other Service Areas, Toronto had much lower likelihood of unmet need compared to the rest of Ontario. Rural areas, areas with unsatisfactory public transport, and areas with higher levels of socio-economic disadvantage had a higher likelihood of unmet need for mental health services. These findings identify challenges in service provision that researchers, policymakers and administrators in children's mental health services need to better understand. Policy implications and potential Service Area strategies that could address equitable access to mental health services are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Opioid misuse among youth is a significant concern given its potential negative consequences; yet youth who use opioids continue to face challenges in seeking treatment. The goal of this study was to understand the demographics, mental health, and substance use and co-occurring concerns of service-seeking youth with opioid use to inform future services and research.Methods: This study characterized 1769 youth between 14 and 24 years old seeking services at an urban treatment facility in Toronto, Ontario (ON) between 2008 and 2019. Youth who could adequately read English, had no immediate psychiatric service needs, provided research consent, and responded to a question about opioid use history were eligible. Participants provided information on demographics, substance use, mental health, and treatment motivation.Results: Youth who use opioids were more likely to report challenges with social determinants of health, use more substances, initiate substance use earlier, and use some substances at a higher frequency than youth who do not use opioids. Youth with opioid use reported more co-occurring mental health and substance use concerns than youth with no opioid use. They also endorsed more trauma and a likely PTSD diagnosis. Not being in employment, education, or training and using a higher number of substances positively predicted youth opioid use. In terms of treatment motivation, youth who use opioids endorsed more internal forms of motivation than youth who do not use opioids.Conclusions: Youth who use opioids have complex social and co-occurring mental health and substance use needs that may be addressed with integrated community-based services. Future research should focus on developing evidence-based opioid treatment programs in this context and other innovative platforms. [ABSTRACT FROM AUTHOR]

Drawing on our study with newcomer youth from four communities in Toronto, this article discusses post-migration determinants of mental health for newcomer youth in Toronto and reflects on policy implications. Preliminary study findings indicate that settlement challenges and discrimination/exclusions are salient risks to the mental wellbeing of newcomer youth and their families. [ABSTRACT FROM AUTHOR]