Valuing All Voices: refining a trauma-informed, intersectional and critical reflexive framework for patient engagement in health research using a qualitative descriptive approach.

BACKGROUND: Critical stakeholder-identified gaps in current health research engagement strategies include the exclusion of voices traditionally less heard and a lack of consideration for the role of trauma in lived experience. Previous work has advocated for a trauma-informed, intersectional, and critical reflexive approach to patient and public involvement in health research. The Valuing All Voices Framework embodies these theoretical concepts through four key components: trust, self-awareness, empathy, and relationship building. The goal of this framework is to provide the context for research teams to conduct patient engagement through the use of a social justice and health equity lens, to improve safety and inclusivity in health research. The aim of this study was to revise the proposed Valuing All Voices Framework with members of groups whose voices are traditionally less heard in health research. METHODS: A qualitative descriptive approach was used to conduct a thematic analysis of participant input on the proposed framework. Methods were co-developed with a patient co-researcher and community organizations. RESULTS: Group and individual interviews were held with 18 participants identifying as Inuit; refugee, immigrant, and/or newcomer; and/or as a person with lived experience of a mental health condition. Participants supported the proposed framework and underlying theory. Participant definitions of framework components included characterizations, behaviours, feelings, motivations, and ways to put components into action during engagement. Emphasis was placed on the need for a holistic approach to engagement; focusing on open and honest communication; building trusting relationships that extend beyond the research process; and capacity development for both researchers and patient partners. Participants suggested changes that incorporated some of their definitions; simplified and contextualized proposed component definitions; added a component of "education and communication"; and added a 'how to' section for each component. The framework was revised according to participant suggestions and validated through member checking. CONCLUSIONS: The revised Valuing All Voices Framework provides guidance for teams looking to employ trauma-informed approaches, intersectional analysis, and critical reflexive practice in the co-development of meaningful, inclusive, and safe engagement strategies. PLAIN ENGLISH SUMMARY: Patient engagement in health research continues to exclude many people who face challenges in accessing healthcare, including (but not limited to) First Nations, Inuit, and Metis people; immigrants, refugees, and newcomers; and people with lived experience of a mental health condition. We proposed a new guide to help researchers engage with patients and members of the public in research decision-making in a meaningful, inclusive, and safe way. We called this the Valuing All Voices Framework, and met with people who identify as members of some of these groups to help define the key parts of the framework (trust; self-awareness; empathy; and relationship building), to tell us what they liked and disliked about the proposed framework, and what needed to be changed. Input from participants was used to change the framework, including clarifying definitions of the key parts, adding another key part called "education and communication", and providing action items so teams can put these key parts into practice.

Responding to health inequities: Indigenous health system innovations.

Over the past decades, Indigenous communities around the world have become more vocal and mobilized to address the health inequities they experience. Many Indigenous communities we work with in Canada, Australia, Latin America, the USA, New Zealand and to a lesser extent Scandinavia have developed their own culturally-informed services, focusing on the needs of their own community members. This paper discusses Indigenous healthcare innovations from an international perspective, and showcases Indigenous health system innovations that emerged in Canada (the First Nation Health Authority) and Colombia (Anas Wayúu). These case studies serve as examples of Indigenous-led innovations that might serve as models to other communities. The analysis we present suggests that when opportunities arise, Indigenous communities can and will mobilize to develop Indigenous-led primary healthcare services that are well managed and effective at addressing health inequities. Sustainable funding and supportive policy frameworks that are harmonized across international, national and local levels are required for these organizations to achieve their full potential. In conclusion, this paper demonstrates the value of supporting Indigenous health system innovations.

[Psychosomatic disorder, psychosis and object relations]. / Somatose, psychose et relations d'objet.

This paper presents a case who successively suffered from regional ileitis followed by a reactive psychosis. The author looks at the object relations of a patient afflicted by a narcissistic defect. The fundamental narcissistic disorder models the object relations of the somatic patient and of the psychotic patient. Less differentiation is found in the object representation of the psychotic patient. A comparison is suggested for the two modes of relating to objects.

[An individual approach for the schizophrenic.]. / L'approche individuelle pour le schizophrène aussi!

Community care fore thesever mentally handicapped today fosters a wide <>. Furthermore, the variety of people concerned calls for a coherent and complementary definition of the roles played by everyone involved. This article reviews the particular issues surrounding the schizophrenic's psychic environment, which leaves the subject highly vulnerable in his interpersonal relations. His status as subject is constantly threatened. The specific rewards of an individual relation are illustrated in order to emphasize the need for a significant and constant dual rapport within the entire assortment of measures offering care and social support.

[Manic decompensation]. / Autour des décompensations maniaques.

The author stresses early detection of the premonitory signs of a manic breakdown with a view towards an efficient therapeutic intervention. Some of the most typical signs are described with their corresponding dynamic implication. The manic-depressive's lack of impulse control often forces a member of the patient's circle to take control. After a review of the main personality traits belonging to the manic-depressive patient, the author gives a description of the patient's spouse in whom appear similar and complementary elements of the patient's personality. Finally, some steps are suggested to rationalize treatment. Emphasis is on educational methods combined with lithium therapy within the framework of a therapeutic relationship where the interactive dynamic forces are acknowledged.

[The care-givers, the psychiatric team and the sick.]. / Le soignant, l'équipe psychiatrique et le malade.

The psychiatrie approach has been modified by the advent of community psychiatry. The maintenance of the psychotic in his natural community requires significant resources. The team approach is one which can respond to this need. The challenger to be met persist in the care of the psychotic: respect of the individuality, of the attributes of the subject, the maintenance of the affective ties of the patient. The individual approach attempts to personalize care. But psychosis is a challenge to the care-giver. By its very nature this psychopathology tends to overflow onto the life of the team, to impede its functioning and to sow confusion, thus harming all therapeutic effort. Caregivers react by disorderly activity, affective outbursts... The team must, however, take care to maintain its caregiving function. Two clinical cases will illustrate certain of the difficulties encountered.