Portfolio

Research Publications

Participation of Children and Youth in Mental Health Policymaking: A Scoping Review [Part I]

Yamaguchi, S., Bentayeb, N., Holtom, A. S., Molnar, P., Constantinescu, T., Tisdall, E. K. M., Tuong, J., Iyer, S. N., & Ruiz-Casares, M. (2022). Administration and Policy in Mental Health and Mental Health Services Research.

Abstract

Purpose: Although youth participation is oft-acknowledged as underpinning mental health policy and service reform, little robust evidence exists about the participation of children and youth in mental health policymaking. A scoping review based on Arksey and O’Malley’s framework was conducted to identify and synthesize available information on children and youth’s participation in mental health policymaking.

Method: Published studies up to November 30, 2020 were searched in Medline (OVID), PsycINFO (OVID), Scopus, and Applied Social Sciences Index and Abstracts (PROQUEST). Further studies were identified through Google Scholar and a grey literature search was conducted using Google and targeted web searches from October to December, 2020. Three reviewers performed screening and data extraction relevant to the review objective, followed by an online consultation. From 2,981 records, 25 publications were included.

Results: A lack of diversity among the youth involved was found. Youth were often involved in situational analysis and policy design, but seldom in policy implementation and evaluation. Both the facilitators of and barriers to participation were multifaceted and interconnected. Despite a range of expected outcomes of participation for youth, adults, organizations, and communities, perceived and actual effects were neither substantially explored nor reported.

Conclusions: Our recommendations for mental health policymaking highlight the inclusion of children and youth from diverse groups, and the creation of relational spaces that ensure safety, inclusiveness, and diversity. Identified future research directions are: the outcomes of youth participation in mental health policymaking, the role of adults, and more generally, how the mental health of children and youth shapes and is shaped by the policymaking process.

Keywords: Children and youth; Diversity; Mental health; Participation; Policymaking; Review.

"Youth as accessories": Stakeholder Perspectives on Youth Participation in Mental Health Policymaking [Part II]

Yamaguchi, S., Tuong, J., Tisdall, E. K. M., Bentayeb, N., Holtom, A. S., Iyer, S. N., & Ruiz-Casares, M. (2022). Administration and Policy in Mental Health and Mental Health Services Research.

Abstract

Purpose: To elicit stakeholder perspectives on the findings from our scoping review on youth participation in mental health policymaking, we conducted a global consultation with young people and adults directly involved in mental health policymaking.

Method: Forty-four stakeholders from 16 countries, including 15 young people, 9 policymakers and 20 facilitators of youth participation, took part in individual interviews and/or focus groups. They were asked about how the review findings contrasted with their own experiences in mental health policymaking. The transcribed data were thematically analyzed.

Results: All participants viewed lived experience as valuable in identifying policy gaps. Youth pointed out that children and youth with disabilities, diverse sexual orientations, and/or gender identities were often excluded, and spoke about feelings of being an "accessory", illustrating a lack of power-sharing in a tokenized policymaking process. Adult participants' accounts highlighted the challenges inherent in policymaking such as the need for political knowledge and institutional time constraints. A range of cultural, socio-economic, and political barriers to youth participation, that were often context-specific, were identified.

Conclusions: The diverse perspectives of stakeholders extended the review results. Based on our findings, we recommend that adults and institutions: (1) recognize lived experience as expertise in shaping mental health policies; (2) include diverse groups; (3) reduce tokenistic relationships through the creation of safer spaces, adult feedback, co-production, and social accountability; and (4) adopt an intersectional approach to address cultural, socio-economic, and political barriers to participation. Methodologically, our work demonstrates why stakeholder consultations are an essential component of scoping reviews.

Keywords: Children and youth; Consultation; Lived experience; Mental health; Participation; Policymaking.

Risky environments or risky business?: Health and substance use among street-involved youth and their experiences with harm reduction services in Victoria, BC

Holtom, A. S. (2014). University of Victoria.

Abstract

Purpose: The purpose of this thesis is to analyze changes over time in the interactions of street-involved youth with their risk environments and to investigate how their integration into local, provincial, and federal systems and services impacts their lives, health, and substance use.

Method: This thesis employs a sequential explanatory mixed methods design and uses closed and open-ended questions collected over five waves of interviews during the longitudinal study Risky Business? Experiences of Street-Involved Youth. Quantitative (n = 50) methods of analysis include descriptive statistics and bivariate comparisons complemented by a qualitative (n = 15) thematic analysis comprised of open-ended interview questions. The risk environment framework proposed by Tim Rhodes is used to highlight structural and systemic forces informing the lives of street-involved youth, allowing for an analysis on three levels of influence (micro, meso, macro) and four types of environment (economic, physical, social, policy).

Results: Results indicate that comparatively high substance use and harms of substance use among street-involved youth decrease as they become integrated into local, provincial, and federal systems and services. Intersecting demographic and structural factors correspond with higher substance use for male youth and youth who had been involved with the foster care system during their life. Given the diversity of backgrounds and risk environment experiences, street-involved youth expressed diverse opinions and perspectives regarding the effectiveness of healthcare, harm reduction, and outreach services.

Conclusions: Policy recommendations and suggestions for future research are suggested, with the aim of developing safer environments and environment interventions for street-involved youth that reduce substance use-related harms.

Keywords: Harm reduction; Mixed methods; Risk environments; Street-involved youth; Substance use.

Published Writing

“As People Who Use Drugs, We Are the Safer Supply Experts—Not Physicians”

Beck McGreevy, P., Celinski, A., Di Giorgio, G., Kaminski, N., & Holtom, A. S. (2022, February 14). Filter.

“You’ve Done Your Time in the Trenches.”

Holtom, A. S. (2021, August 16). The Drug Hub.