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IntroductionMental health problems are common globally, and typically have their onset in adolescence and early adulthood—making youth (aged 11–25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth mental health (YMH) initiatives are now underway, thus far few have been subject to economic evaluations. Here we describe an approach to determining the return on investment of YMH service transformation via the pan-Canadian ACCESS Open Minds (AOM) project, for which a key focus is on improving access to mental health care and reducing unmet need in community settings.ApproachAs a complex intervention package, it is hoped that the AOM transformation will: (i) enable early intervention through accessible, community-based services; (ii) shift care away toward these primary/community settings and away from acute hospital and emergency services; and (iii) offset at least some of the increased costs of primary care/community-based mental health services with reductions in the volume of more resource-intensive acute, emergency, hospital or specialist services utilized. Co-designed with three diverse sites that represent different Canadian contexts, a return on investment analysis will (separately at each site) compare the costs generated by the intervention, including volumes and expenditures associated with the AOM service transformation and any contemporaneous changes in acute, emergency, hospital or service utilization (vs. historical or parallel comparators). Available data from health system partners are being mobilized to assess these hypotheses.Anticipated resultsAcross urban, semi-urban and Indigenous sites, the additional costs of the AOM transformation and its implementation in community settings are expected to be at least partially offset by a reduction in the need for acute, emergency, hospital or specialist care.DiscussionComplex interventions such as AOM aim to shift care “upstream”: away from acute, emergency, hospital and specialist services and toward community-based programming which is more easily accessible, often more appropriate for early-stage presentations, and more resource-efficient. Carrying out economic evaluations of such interventions is challenging given the constraints of available data and health system organization. Nonetheless, such analyses can advance knowledge, strengthen stakeholder engagement, and further implementation of this public health priority.

Abstract To achieve health, Indigenous people seek a life that balances mental, spiritual, emotional, and physical wellness, yet the scope of these four dimensions is not typically considered in the Western‐based health system. Indigenous people experience ongoing pain and hurt in all these dimensions as a result of a colonial legacy that persists in current‐day policy and care contexts. Exploring ways to support Indigenous people to embrace ways of being well and reducing chronic pain has not been a priority area in health research. This community‐based, qualitative study in four First Nations communities involved conversation sessions with 188 First Nations children, youth, parents, and Elders and 32 professionals who practice in those communities. The purpose was to gather perspectives related to pain expression, care experiences, and the strategies to improve the healthcare encounter. Thematic analysis was used to identify a more culturally thoughtful approach for clinicians to consider when First Nations people seek care. Two‐Eyed Seeing consisting of four iterative steps was used to co‐create the FIRST approach validating for community members that their perspectives were heard and providing a clinical approach for culturally safe practices with children, youth, and families. An overarching theme in the results was a clearer understanding about how pain and hurt translate into participants' health experiences and their desire to have their knowledge reflected in their health care. Participants describe experiencing pain and hurt in all four dimensions of health and from a historical, cultural, and spiritual identity, as well as from a community, family, and individual perspective. The FIRST approach captures Indigenous knowledge relating to Family, Information, Relationship, Safe‐Space, and Two‐Eyed treatment in the healthcare encounter. Considerations of this approach in clinical practice could enhance respectful and trusting relationships, knowledge exchange for better care experiences, and potentially improvement of culturally sensitive outcomes for Indigenous people.

Abstract. Introduction:. Indigenous children and youth may be quiet about the way they express their pain and hurt which is in contrast to how health professionals are trained to assess it. Objectives:. The aim was to understand how youth from 4 First Nation communities express pain using narratives and art-based methods to inform culturally appropriate assessment and treatment. Methods:. This qualitative investigation used a community-based participatory action methodology to recruit 42 youth between 8 and 17 years of age to share their perspectives of pain using ethnographic techniques including a Talking Circle followed by a painting workshop. Physical pain perspectives were prominent in circle conversations, but emotional pain, overlapping with physical, mental, and spiritual pain perspectives, was more evident through paintings. Art themes include causes of pain and coping strategies, providing a view into the pain and hurt youth may experience. Youth were more comfortable expressing emotional and mental pain through their artwork, not sharing verbally in conversation. Results:. Circle sessions and artwork data were themed using the Indigenous Medicine Wheel. Content of the circle conversations centered on physical pain, whereas paintings depicted mainly emotional pain (eg, crying or loneliness; 74% n = 31) with some overlap with physical pain (eg, injuries; 54%), mental pain (eg, coping strategies; 31%), and spiritual pain (eg, cultural symbols; 30%). Common threads included hiding pain, resilience, tribal consciousness, persistent pain, and loneliness. Conclusion:. Once a safe space was created for First Nation youth, they provided a complex, culturally based understanding of the pain and coping experience from both an individual and community perspective. These engaging, culturally sensitive research methods provide direction for health providers regarding the importance of creating a safe space for young people to share their perspectives.