Review: System transformation to enhance transitional age youth mental health - a scoping review.

BACKGROUND: Youth mental health challenges are an emerging and persistent global public health issue despite efforts for improvement. As part of a broader social innovation study to transform youth mental health systems, this scoping review assesses interventions that aim for systems-level changes to improve the mental well-being of transitional age youth (TAY) (15-25 years) in high-income countries. METHODS: The scoping review method of Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) was used. Seven health and social service databases were utilized with study inclusion criteria applied. Titles and abstracts were screened by two independent reviewers, and four members of the research team were involved in the review and thematic analysis of selected studies. RESULTS: A total of 5652 peer-reviewed articles were screened at the title and abstract level, of which 65 were assessed in full for eligibility, and 29 were included for final analysis. The peer-reviewed articles and gray literature were based in seven different high-income countries and published between 2008 and 2019. Four major themes to support youth mental health were identified in the literature: (a) improving transitions from youth to adult mental healthcare services; (b) moving care from institutions to the community; (c) general empowerment of youth in society; and (d) youth voice within the system. Inconsistent or limited systems-level approaches to TAY mental health care were noted. CONCLUSIONS: There remains a need for innovative, evidence-based approaches to improve TAY mental health care.

What do we mean by critical and ethical global engagement? Questions from a research partnership between universities in Canada and Rwanda.

Language - the words we use - can play a key role in enabling or limiting transformation of inequalities in the field of global health. At the same time, given the interdisciplinary, intersectoral, and international nature of much global health work, intended meanings, commitments, and underlying values for words used cannot be taken for granted. This commentary sets out to clarify, and in this manner render available for further discussion and debate, the phrase 'critical and ethical global engagement' (CEGE). It derives from discussions between scholars and partners in research, education, and healthcare practice based at one Canadian and two Rwanda institutions. Initially, our aim was to conceptualise the term 'critical and ethical global engagement' in order to guide our own practices. As the complexity of the values, commitments, and considerations underlying our use of this phrase emerged, however, we realised these discussions merited being captured and shared, to facilitate further exploration and exchange on this phrase.

Our roles are not at ease: The work of engaging a youth advisory council in a mental health services delivery organization.

OBJECTIVES: There is growing policy impetus for including youth voices in health services research and health system reform. This article examines the perspectives of professionals in a mental healthcare organization charged with engaging young people as advisors in service transformation. METHODS: An institutional ethnography of a youth mental health services organization in Ontario, Canada, was conducted. Fieldwork consisted of twelve months of observation of meetings, interviews with youth advisors and adult service providers, with subsequent text analysis of engagement training and policy materials. The present article reports data from six adult professionals and related field observations. RESULTS: Service providers' efforts to engage youth were observed in three areas: a) supporting youth's development as advisors, b) retaining and deepening youth participation while waiting for organizational change and c) embedding relationships between youth and adults at various levels within the system of care. This work denotes existing tensions between the values and ideals of youth engagement and the everyday demands of services delivery. CONCLUSION: In this setting, a fundamental dimension of this work consisted of negotiating tensions between the policy enthusiasm for engagement and its realization in a health services context. In describing these contextual challenges, we outline implications for consideration by other youth mental health services. Engagement efforts that are authentic and sustained require resources and flexibility, and leadership commitment to instil service users' perspectives throughout multiple levels within the organization.

Informing 'good' global health research partnerships: A scoping review of guiding principles.

Background: Several sets of principles have been proposed to guide global health research partnerships and mitigate inequities inadvertently caused by them. The existence of multiple sets of principles poses a challenge for those seeking to critically engage with and develop their practice. Which of these is best to use, and why? To what extent, if any, is there agreement across proposed principles?Objective: The objectives of this review were to: (1) identify and consolidate existing documents and principles to guide global health research partnerships; (2) identify areas of overlapping consensus, if any, regarding which principles are fundamental in these partnerships; (3) identify any lack of consensus in the literature on core principles to support these partnerships.Methods: A scoping review was conducted to gather documents outlining 'principles' of good global health research partnerships. A broad search of academic databases to gather peerreviewed literature was conducted, complemented by a hand-search of key global health funding institutions for grey literature guidelines.Results: Our search yielded nine sets of principles designed to guide and support global health research partnerships. No single principle recurred across all documents reviewed. Most frequently cited were concerns with mutual benefits between partners (n = 6) and equity (n = 4). Despite a lack of consistency in the inclusion and definition of principles, all sources highlighted principles that identified attention to fairness, equity, or justice as an integral part of good global health research partnerships.Conclusions: Lack of consensus regarding how principles are defined suggests a need for further discussion on what global health researchers mean by 'core' principles. Research partnerships should seek to interpret the practical meanings and requirements of these principles through international consultation. Finally, a need exists for tools to assist with implementation of these principles to ensure their application in research practice.

Promising Points for Intervention in Re-Imagining Partnered Research in Health Services Comment on "Experience of Health Leadership in Partnering with University-Based Researchers in Canada - A Call to 'Re-imagine' Research".

In this commentary, we respond to Bowen and colleagues' empirical study of research partnerships between Canadian health organizations and university-based investigators. We draw on our experiences of university and health-services partnerships to elaborate on some of the misalignments between researchers and health services leaders identified by Bowen et al. We take up Bowen and colleagues' call to re-imagine research by proposing three promising points of intervention in research partnerships. These are: (1) orient towards research relationships rather than project-based partnerships; (2) recognize shared and diverging expectations and objectives; and (3) foster a more nuanced understanding of mutual gains.

Engaging Youth in the Bipolar Youth Action Project: Community-Based Participatory Research.

BACKGROUND: We describe the methodological dimensions of community-based participatory research through a description of study design, youth engagement, and methods/processes in the cocreation of knowledge within a Canadian study, the Bipolar Youth Action Project. This collaborative partnership-carried out by a team composed of academic, community, and youth partners-was designed to investigate self-management and wellness strategies for young adults living with bipolar disorder. OBJECTIVE: The aim is to describe the opportunities and challenges of this collaboration and to reflect upon the process of involving youth with bipolar disorder in health research that concerns them, and share lessons learned. METHODS: The project was conducted in multiple phases over 2 years: (1) grant-writing, with youth contributing to the process; (2) recruitment, in which 12 youth were selected and trained to help shape and conduct two research forums; (3) the first research forum, where more youth were consulted about the strategies they apply to stay well (self-management strategies); (4) data analysis of Forum I findings; (5) research Forum II, which consulted youth with bipolar disorder about knowledge translation of Forum I findings; and (6) data analysis of Forum II findings. Youth peer researchers with bipolar disorder were involved in a significant capacity at every stage in the process. RESULTS: Of the initial 12 youth peer researchers, 7 remained on the project from the recruitment phase until the project ended. They collaborated in the creation of two youth research forums that consulted youth with bipolar disorder on their self-management strategies. CONCLUSIONS: This article shares what was learned from the process of partnering with youth with bipolar disorder in a community-based participatory research study.

What makes for effective, sustainable youth engagement in knowledge mobilization? A perspective for health services.

BACKGROUND: Young people who seek mental health treatment often also seek the services of non-profit organizations to support their well-being. Wisdom2Action (W2A) is a Canadian knowledge mobilization network that focuses on improving the mental health and well-being of children and youth in challenging contexts by increasing the use of evaluation, evidence and engagement in the youth-serving sector. Since 2013, W2A has engaged youth advisors (YAs) to provide input to W2A's Board, lead their own projects and co-design W2A activities. OBJECTIVE: In fall 2017, the YAs, as well as adult Board members and W2A staff, collaborated in a participatory evaluation to better understand the experiences and impacts of youth engagement. This article describes insights derived through this process. DESIGN AND PARTICIPANTS: Board, YAs and staff members participated in a reflective approach to informing, analysing and sharing the findings from this process. Individual interviews and review of documents, as well as iterative cycles of group analysis and synthesis, were conducted. RESULTS: Both YAC members and W2A benefit from YAs' leadership and engagement. The YAs position themselves as members of the youth-serving sector, not merely recipients of its services; as such, their professional development aligns with the mandates of W2A and merits further investment, despite challenges in impact measurement. CONCLUSION: This article identifies challenges and facilitators of implementing an effective and sustainable youth advisory council model of engagement in the context of a pan-Canadian network. The mutual gains and areas of growth for youth, adults and the organization described can inform health services, as well as funders and advocates for youth well-being.