Youth Connectedness & Vital Signs

coverThe theme for the Victoria Foundation’s 2016 Vital Signs report (launched today!) is Belonging.

The report focuses on 4 profiles of belonging:

  1. Aboriginal Peoples;
  2. Newcomer;
  3. Youth; &
  4. Seniors.

Unsurprisingly, we had something to say when it came to youth belonging and connectedness. The following is an excerpt from the report:

As social animals, humans evolved to grow up and live in community. All the evidence points to increasing connectedness for youth as resulting in improved outcomes in all the important areas of life. “Youth who feel more connected to their community have lower rates of stress, feel less despair and are less likely to have self-harmed or attempted suicide,” says Petra ChambersSinclair, coordinator of the Child and Youth Health Network (CYHN) of the Capital Region.

Getting youth connected to place and community bolsters that sense of belonging, confers advantages in terms of educational outcomes and carries over long into their adult lives. But not all our children and youth experience that beneficial sense of social connectedness. “The experience of belonging varies enormously for children and youth in the Capital Region,” says Chambers-Sinclair. “All people need to feel that they belong, but there are enormous disparities in the degree of healthy social supports available to youth in our region.”

Young people need mentorship from adults, she asserts, because the health and resilience of the entire community depends on successful transition to adulthood by its young people. Chambers-Sinclair states, however, that nowadays mentors are scarce for many children and youth—and in many communities, the mentors they do have are overworked and burning out.

“Ultimately, we all need to work together to support the successful transition to adulthood for the next generation, and I believe creating resilient networks of social connectedness for young people is one of the best ways to approach that.” Adults increasingly feel that they don’t know how to support young people through the process of becoming successful adults, says Chambers-Sinclair. “We end up with a situation where adults feel alienated from youth, youth feel disconnected and abandoned by adults, and the successful transition to adulthood remains incomplete for many young people through their 20s, 30s and even longer,” she says. “All of these factors create fragmented and weak systems that lack resilience at the individual, family and community levels. At a time when we are facing some of the most complex challenges in human history. We need to wade into this space and work with young people to figure out how to help them.”

leverageThe CYHN has a mission of increasing connectedness to improve the wellbeing of young people in the Capital Region. In 2016, the CYHN began developing an Index of Connectedness as part of its shared measurement system. The index comprises a comprehensive review of indicators for measuring connectedness in young people, with the aim of creating a single composite index that will then identify gaps to be addressed as well as recommendations for using the results. 

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The Impacts of Hetero-normativity & Cis-normativity on Youth Mental Health

This week our youth partners presented at the CYMHSU Collaborative Learning Session in Vancouver.

Their presentation was titled The Impacts of Hetero-normativity & Cis-normativity on Youth Mental Health.

First question:

Q: What’s Cis?

A: Identifying as the gender you were assigned at birth.

The youth were speaking from experience. About the impacts of prejudice and discrimination on the mental health of LGBTQ+ youth.

CYMHSU2016

Hetero-normativity & Cis-normativity: What’s the problem?

Here’s what the youth told the doctors, clinicians, practitioners and parents in their workshop:

LGBTQ+ identity doesn’t cause mental health problems, yet LGBTQ+ youth have extraordinarily high rates of depression, anxiety, self-harm, suicide and substance use.

Why?

This video helps to answer that question:

https://vimeo.com/17101589%20

The youth explained that LGBTQ+ youth face increased vulnerability due to:

  • Loss of supports: rejection by family, friends and community;
  • Burden of keeping their a secret identity;
  • Bullying and violence;
  • Discrimination/hetero-normatavity/genderism;
  • The coming out process;
  • Internalized homophobia;
  • Being confused/not knowing how they identify/feeling uncomfortable in their gender; &
  • Pathologization by the medical/psychiatric community.

They shared fresh (2015) statistics from the Canada-wide Transgender Youth Health Survey:

  • Almost half of trans youth reported feeling stressed to the point that they could not do their work or deal with things during the last 30 days;
  • More than half of trans youth reported they had hurt themselves on purpose in the last year; &
  • 65% of trans youth had seriously considered suicide, more than a third had attempted suicide at least once, and nearly 1 in 10 had attempted suicide 4 or more times.

They asked us: Does it make sense that they, as LGBTQ+ youth, face approximately 14 times the risk of suicide and substance abuse than their heterosexual and cisgender peers, when mental health problems, substance use and suicide are not side-effects of having a minority sexual identity or gender orientation?

They are side-effects of prejudice and discrimination.

What’s the Solution?

Our youth partners are saying that it would be really helpful if we could start by making space for who they are.

Sounds like a reasonable request!

They offered an initial strategy:

Start with Language

Youth who have a non-binary gender identity may prefer different pronouns than he or she, but most of us are unfamiliar with gender-neutral pronouns and feel awkward using them.

The youth recommended that we embrace the awkwardness and practice: “because you know what? It’s way more awkward to have people ignore your gender identity. It’s so awkward it causes self-harm and suicide. So really, embracing a little awkwardness while you get used to using some new words is worth it!

They shared some of the pronouns that transgender people may prefer including: They/them; Xe/xir; Ze/Mer; Ve; Ney and Yo.

If that list is overwhelming, they said that most transgender people are fine with ‘they/them’ as gender-neutral pronouns. The key is to ask: “Is there a gender pronoun you prefer?“.

Just ask!

They also offered two tips for pronoun usage:

  1. Never make assumptions about a person’s gender identity; &
  2. If you slip up and use the wrong pronoun, just correct yourself & move on.

Our Bad

Comprehensive Children’s Mental Health Indicators

It’s a wonderful thing when you find a paper that proactively answers your specific research question!

Creating Comprehensive Children’s Mental Health Indicators for British Columbia is a paper like that.

Our Question

What data sources are available and what criteria should we use to select comprehensive indicators to track the mental health of young people in the capital region over time?

This Paper Answers:

The Data Sources used to select indicators for this study can be found on pages 16-18 and the indicators on pages 19-22.

But the whole paper is worth a read. Or two.

Here’s just a little of what this paper offers:

“Mental health—or social and emotional well-being—is fundamental to human development and essential for all children to flourish. Yet at any given time, an estimated 14% of children (or 800,000 in Canada) experience mental disorders causing significant symptoms and impairment, exacerbating matters, clinical treatment services still reach fewer than 25% of these children despite substantial public investments in health care. Meanwhile, there are almost no investments in programs that could address determinants and prevent problems. Consequently, mental disorders unnecessarily persist throughout the lifespan, with adverse outcomes ranging from reduced educational and occupational chances to increased mortality. The associated economic burden is now estimated to exceed $51 billion in Canada annually, urgently underscoring the need to better address mental health starting in childhood. To address children’s mental health adequately, a new comprehensive population health approach is needed—promoting healthy development for all children and preventing disorders in children at risk, in addition to providing effective treatment for children with established problems and disorders.”

“Canada urgently requires a population health approach to children’s mental health—promoting health and preventing disorders, in addition to providing treatment. Underpinning this approach, indicators could enable population monitoring, thereby informing ongoing public investments.”

“Strategically, monitoring could also raise public awareness about the importance of children’s mental health—understanding that ‘what gets counted, counts.'”

“A population health approach for children’s mental health—promoting health and preventing disorders, in addition to providing treatment—requires a correspondingly broad framework encompassing concepts central to the social and emotional well-being of the entire population of children. Therefore we propose a comprehensive framework that covers: major developmental stages; determinants and contexts; mental health status and related developmental domains; and a wide range of intervention approaches.”

Population Health Framework for Children's Mental Health
Gratitude to Charlotte Waddell, Cody A. Shepherd, and Alice Chen from Simon Fraser and Michael H. Boyle from McMaster for all the work that went into this project and for reporting the results so we could learn from them.

12 Evidence-based Protective Factors for Youth

In 2013, almost 30,000 students in Grades 7–12 completed the BC Adolescent Health Survey (BC AHS) in schools across British Columbia.

The survey was conducted previously in 1992, 1998, 2003 and 2008.

As in previous years, all four Southern Vancouver Island school districts participated.
The survey is designed to consider emerging youth health issues and to track trends over time.
Over the years, the following factors have been identified as protective for youth:

1. SCHOOL CONNECTEDNESS

The more connected students felt to their school, the better their mental health ratings.

In addition, students who had been teased, excluded, and/or assaulted in the past year who reported higher school connectedness were more likely to have only positive aspirations for the future than those with lower feelings of connectedness.

2. POSITIVE FAMILY RELATIONSHIPS

Most students in South Vancouver Island felt their family had fun together (68%), understood them (60%), and paid attention to them (76%). These youth made safer decisions. For example, students who felt they and their family had fun together were less likely to have self-harmed in the past year (9% vs. 33% of those who did not feel they and their family had fun together). And students who felt that their family understood them were half as likely to report binge drinking in the past month (15% vs. 30% who did not feel their family understood them).

Youth who ate their evening meals with their parents most of all of the time reported better nutrition. For instance they were more likely to have fruit or vegetables three or more times the previous day (67% vs. 47% of those who never or rarely ate with their parents). They also reported greater self confidence, such as more likely to feel good about themselves (85% vs. 63%) and their abilities (89% vs. 79%).

Students whose parents were aware of what they were doing in their free time were less likely to be texting or chatting on their phone after they were expected to be asleep (55% vs. 69% of those whose parents were not monitoring their spare time). They were also more likely to have slept for eight or more hours on the night before taking the survey (60% vs. 35%).

3. SUPPORTIVE AND CARING ADULTS OUTSIDE THE FAMILY

As shown in the AHS before, adults outside the family also have a role to play.

For example, students with a limiting health condition or disability were less likely to miss out on needed mental health care if they had an adult outside their family they could turn to.

4. SOMEONE TO TURN TO FOR HELP

Most youth who were looking for advice or support approached their friends and family, but they also looked to a range of professionals in their lives, including teachers, school counsellors, doctors, and sports coaches.

Most often youth found the assistance helpful, and this again had positive associations.

Youth who had been physically and/or sexually abused and found their teacher to be helpful were more likely to have post-secondary plans and less likely to have attempted suicide in the past year than those who approached their teacher for help but did not find it helpful.

5. PEER RELATIONSHIPS

As youth grow older, their relationships with peers play an increasingly important role in their lives. There were positive associations with having more than just one or two close friends.

For example, students who had three or more close friends were more likely than those with fewer friends to rate their overall health as good or excellent (91% vs. 80%). They were also less likely to have been teased, excluded, or assaulted in the past year (47% vs. 62%).

6. GOOD NUTRITION

Youth who reported eating fruit or vegetables three or more times on the day before taking the survey were more than those who had fewer servings to report good or excellent mental health, and to feel calm (52% vs. 42%) and happy (74% vs. 62%) most or all of the time in the past month.

They were also less likely to report extreme stress (30% vs. 35%) and extreme despair in the past month (14% vs. 22%).

Those who always ate breakfast on school days were more likely than those who ate breakfast less often or not at all to report report good or excellent mental health, better nutrition, and sleeping for 8 or more hours the previous night.

7. FEELING ENGAGED AND VALUED

Feeling listened to and valued in their activities can be protective for youth. Those who felt their ideas were listened to quite a bit or a lot were more likely to rate their overall health as good or excellent.

Similarly, among youth who had been teased, excluded, or assaulted in the past year, those who felt their activities were meaningful were more likely to feel good about themselves.

8. STABLE HOME

Moving can have a negative impact on young people. As shown earlier in presentation, youth who had been in government care who had not moved in the past year were more likely than those who had moved to report feeling calm and at peace all or most of the time in the past month (47%* vs. 27%* who had moved in the past year).

These was also true for students who had never been in government care. For instance, youth who had not moved were more likely to report feeling good about themselves (83% vs. 73% who had moved in the past year) and their abilities (88% vs. 81%).

New protective factors identified through the 2013 Adolescent Health Survey:

9. EIGHT OR MORE HOURS OF SLEEP

The more sleep students got, the more likely they were to rate their mental health as good or excellent.

Among students who had been physically or sexually abused, those who slept for at least eight hours the night before taking the survey were more likely to rate their overall health as good or excellent compared to those who slept fewer hours.

10. NEIGHBOURHOOD SAFETY

Compared to youth who did not feel safe in their neighbourhood during the day, youth who always felt safe were more likely to have only positive aspirations for the future, and were less likely to have missed out on medical care if they thought they needed it.

Feeling safe was also associated with positive mental health among vulnerable youth.

11. COMMUNITY CONNECTEDNESS

There were similar protective associations for community connectedness. Youth who felt like a part of their community were more likely to feel good about themselves and their abilities, compared to youth who felt less connected.

Similarly, the more connected youth who had been socially excluded felt to their community, the less likely they were to have missed out on necessary medical care (9% vs. 20% of those who were very little or not at all connected), or mental health services (13% vs. 32%) in the past year.

12. CULTURAL CONNECTEDNESS

Youth who were involved in traditional activities on a weekly basis were more likely to be engaged in their community in other ways. For instance, they were more likely to be doing weekly volunteering (54%* vs. 13% of youth who never took part in traditional activities).

They were also more likely to plan to continue their education after high school (91% vs. 83%) and to feel good about themselves (89% vs. 79%).

Ecological Determinants of Health

The Canadian Public Health Association has just released a discussion paper on the Ecological Determinants of Health. Find it here.

Wellness WheelThis document relates to the current work of the Shared Measurement constellation of the Child & Youth Health Network. Partners in the Shared Measurement constellation are currently defining each of the 8 domains identified as core to our Common Agenda.

We have wondered about about whether we should include any ecological measures in the ‘environment’ domain.

Though ecological systems are not our target (social systems are) if we really want to ensure that children & youth thrive in the long term, we cannot pretend that ‘ecological determinants of health’ are not going to be increasingly relevant to young people’s well-being.

Not only their future well-being, as ecological impacts became more pervasive, but their current well-being: if young people see adults committing to improving the health of our ecological systems, they may experience less nihilism about the state of the world they are inheriting.

Including an ecological measure in the Child & Youth Health Network would also be a way to engage all of the people in our community, including those who are passionate about the environment.

But at the same time, if it is not a system we are targeting, is appropriate for us to try to measure it?

Though this document doesn’t provide example indicators, it advocates for their development (the following excerpt is from p. 26):

The Public Health Agency of Canada, the Canadian Institutes for Health Information, and Statistics Canada should develop and test a set of indicators of the ecological determinants of health to be used to monitor and report on these issues across all four orders of government (i.e., federal, provincial, municipal and First Nations) and to guide more comprehensive impact assessments of the ecological, social, health and economic impacts of major public policies and private sector developments.

Specifically, to:

  • Identify health indicators for conditions plausibly related to ecological change for use within impact assessments and as early-warning or sentinel conditions to be monitored;
  • Revise the core set of indicators of health used in Canada to include indicators to measure key ecological determinants of health, the socio-ecological system and sentinel health conditions associated with ecological change;
  • Ensure that public health reports at all levels include indicators of ecological determinants of health in routine reports, and report specifically on them on a regular basis, reflecting local, regional, provincial, national, indigenous and global contexts; and
  • Assure that as much effort and profile are applied to the collection and publication of data on the state of the environment as on the state of the economy.

A Child & Youth Mental Health Epidemic (& a solution~)

beach youth“According to the most recent information from the Mental Health Commission of Canada, more than one million, or 23 per cent of Canadians aged nine to 19, are living with a mental illness. And by some estimates, a staggering three out of four young people who have mental-health issues do not receive the help they need. At almost every turn, they encounter barriers to accessing timely and appropriate care, ranging from a lack of resources to their own reluctance to seek help due to shame, embarrassment or fear of prejudice.”

This quote from an article titled “To improve mental health, tackle problems early” from the Globe & Mail this week.

So what do we do?

A small group of youth age 15-17 who are partners in the Child & Youth Health Network have a vision…

A Youth Resource Hub

Their idea is simple: we come together create a place where youth can go & no matter what they are looking for, they can get support.

A one-stop shop.

From a professional standpoint we would frame this in terms of mental health services. The youth are fine with this, but they are clear that, for them, a resource hub would address the whole person: mind/body/spirit.

So whether a youth is

  • lonely;
  • worried about ‘a friend’s’ suicidal ideation;
  • needs help with creating a resume;
  • has a weird & embarrassing rash;
  • is getting bullied;
  • needs help with coming out;
  • doesn’t know where they will sleep that night;
  • is worried about their parent; or
  • needs time to build trust and relationships before sharing what they are grappling with…

there is a youth-friendly place they can go where youth-friendly people will not leave until the youth is safe & a plan is in place.

That is their vision.

Other features of the hub that are important to these youth:

  • A food garden where youth are welcome, can find fresh food to eat, learn how to grow food and can access indirect, low-pressure counselling from a counsellor~gardener.
  • All kinds of services onsite, including (perhaps) a branch of the youth clinic, a branch of the Victoria Regional Library (designed for youth), a café (where youth can get job & life skills + affordable healthy food), mental health/addictions/counselling services, & a place to offer workshops/groups.
  • Youth- & adult-led groups & workshops for youth on subjects that matter to youth: gender identity, sexuality, spirituality, etc.
  • That the hub be intentionally designed to be safe for all youth, including those that may be young/sheltered. Not just an emphasis on street involved/homeless youth.

Turns out, other communities have already embraced this model. The Globe & Mail article explains:

“Such a big problem requires big solutions, especially as more young people, freed from the discrimination of previous generations, speak out and seek help. While we’ve seen increased attention and funding from various levels of government (from community boards to federal agencies), we will be left with a patchwork of initiatives unless concrete steps are taken to improve access to diagnosis and provide funding for treatment nationwide. A few initiatives under way are worthy of national attention.

Dismantling silos

One of the boldest of these initiatives seeks to radically change how young people receive mental-health treatment with the ambitious goal of driving down waiting times. Modelled after Australia’s Headspace National Youth Mental Health Foundation, the ACCESS Canada project aims to provide one-stop hubs where youth can seek the various services they need.”

What about the cost of not finding a way to effectively support children & youth who are struggling with their mental health?

“Untreated, [children & youth] risk failing at school, floundering at work, getting into trouble with the law, facing homelessness, being repeatedly hospitalized or dying by suicide.

The Mental Health Commission reports the total cost of addressing mental-health problems and illnesses over the next 30 years is expected to exceed $2.5-trillion. Yet some of these costs could be prevented. An estimated 70 per cent of mental-health problems emerge in childhood or adolescence and evidence shows the earlier they’re tackled, the better the chances of positive outcomes.”