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This paper examines embedded counseling programs across ten Post-Secondary Canadian counseling centers. We highlight common drivers for developing embedded counseling programs, commonalities and differences across programs, successes and challenges in implementation, and recommend a common set of metrics. Our overview demonstrates variability in program structure that reflects the host faculty or department and the culture, expectations, and realities they each face. Based on lessons learned, we highlight emerging and promising practices for university counseling centers.

This paper examines issues that Yazidi refugee students face upon arrival to Canada, and interventions that schools can implement to support these students. Due to traumatic experiences, Yazidi students suffer from post-traumatic stress disorder (PTSD). Therefore, school staff need training to recognize the symptoms of PTSD, and schools must provide targeted counselling services and connections to community-based services. Yazidi students are often illiterate or have gaps in education, so schools need to incorporate inclusive practices to increase engagement, and provide instruction that focuses on emergent literacy and functional language. Teachers require specific training that addresses the academic needs of Yazidi students.

This paper explores the connections between parental nonsupport of a young person's trans or gender diverse identity and young trans people's experiences of justiciable legal problems1 as well as access to the legal system to address these issues. Qualitative youth data were drawn from the TRANSforming JUSTICE: Trans Legal Needs Assessment Ontario (TFJ) study. The narratives of 16 young trans people (16-29 years) were analyzed to identify parental factors in relation to encountering legal problems and accessing the legal system. Five themes emerged: parental nonsupport of gender identity, identity documentation issues, accessing medical care, employment legal problems, and housing legal problems. Results indicate that parental nonsupport of a young person's trans or gender diverse identity may render a young person more vulnerable to experiencing justiciable legal problems and may also create barriers to accessing the legal system to address these issues.

Trans and non-binary youth (TNBY) face high levels of interpersonal and social adversity as well as disproportionate rates of mental health issues such as depression, self-harm and suicidal ideation. Among protective factors, context plays a key role. In addition to parental support, access to gender-affirming medical care begins to emerge as crucial for young people needed them. This paper compares, through thematic analysis, the experiences of TNBY with regard to access and experiences to care in Canada, Switzerland, England, and Australia. It identifies similarities and differences in barriers to access to care, as well as impacts of gender affirming care on young people and their well-being. The article concludes with a discussion on the importance of prompt and easier access to gender-affirming medical care, of training of professionals, and a hypothesis about the role of context in TNBY well-being.

In response to provincial and national calls for whole school approaches, and in the hope to support new teacher competencies aimed at promoting mental health, this paper considers the changing dynamics within the current classroom through elements and implications of a participatory study conducted in an Alberta urban elementary school. Specifics from this research with young "girls," who engaged in ritual, ceremony, arts-integrated, contemplative, and somatic practices, target the on-going conversation on mental health and best practices in schools. Images of and from their life-size body maps are imbedded into the discussion, promoting the inclusion of body-centred, emotional, and imaginal dynamics to be integrated throughout teaching and learning. The discussion calls for the conscious shift of teachers, counselors, and leaders into more integral and ecological paradigms that understand health through the multifold relations with others and the environment. This argument is supported by trauma literature that calls for affective embodied experience, greater inclusion of right hemispheric activities, relational ethics, and teacher professional learning.

Introduction: There is growing interest in the role and use of patient navigators within the health care system. Currently, qualifications and training expectations documented in the literature vary tremendously depending on context and patient population. This paper details the theoretical and pedagogical principles used to develop, implement and evaluate a training programme for lay patient navigators working in a primary care setting. Methods: The planning process involved (a) conducting an educational needs assessment, (b) identifying the theory underpinning the curriculum, (c) developing learning objectives and teaching strategies, (d) formulating evaluation methods, (e) implementing the programme and (f) refining the curriculum based on evaluation feedback and lessons learned. The training programme was first implemented in May 2017 and has evolved over the past 3 years based on our observations and feedback from the programme participants. Results: The training programme involves a total of 25 hours of online and face-to-face education sessions, and ongoing community mentorship from experienced navigators. All training components are rooted in theoretical principles and proven pedagogical approaches. The knowledge, skills and abilities acquired are also tied to core competencies of the role of lay patient navigator. Conclusion: The development of this lay navigator training programme was carefully designed with evidence-based competencies and practical realities to ensure rigour in preparing and supporting navigators' work in primary care settings.

Lesbian, gay, bisexual and transgender (LGBT) people have historically, and continue today to encounter barriers to accessing health services. This has been attributed to the well-documented heterosexism, homophobia, biphobia, and transphobia that shape all health and social institutions. In this paper, invitational theory offers insight into the challenges faced by a childbearing lesbian couple to access supportive health care, and sheds light on inequities faced by LGBT people when accessing health care in Canada. The author draws on critical feminist research and invitational concepts to build an understanding of four dimensions of this couple's access to supportive care. The invitational approach is combined with an explicitly critical stance to highlight gender and other relations of power, and to provide a theoretical rationale for incorporating invitational concepts into equity-related research, including a current application focused on improving LGBT home care access in the Canadian context. Given the deeply embedded structural inequities that hinder the creation of intentionally inviting environments for diverse groups, this research has implications both for shedding light on areas in need of health care access research, as well as for integrating invitational approaches that align with critical pedagogies into health care education.

The need to attend to terminally ill persons and provide improved quality of living and dying should be a national priority in Canada. Hospice palliative care (HPC), a person-centered approach that addresses the needs of the whole person, improves the quality of living and dying of persons facing a life-threatening illness. To ensure Canadians are able to benefit from HPC, we propose that it should be enshrined as a human right in Canada with access guaranteed to all terminally ill persons under the Canada Health Act (CHA). This paper describes numerous barriers that currently exist including, but not limited to, barriers from geographic location, prognosis, ageism, and constraints from the Canadian medical system that have resulted in unequal access to of a patchwork of services. This paper proposes if HPC is formally recognized as a human right, then financial allocation specifically for HPC will require provincial governments to address the substantial inequalities in access to HPC.

Telehealth is a wide range of health services delivered across distance through technology. In this technology-supported health world, sometimes, the client and his or her family can get lost as clinical consultations are counted for reporting purposes and new technologies are implemented. As a response to this situation and building on the increasing importance that narrative has assumed in health, this paper describes a practice-based education initiative called the Storyboard Project. Importantly, the term storyboard is used here in a literal sense as a place where stories are posted; it does not refer to the crafting or designing of a story for a focused purpose. Through the stories of patients, families, and telehealth professionals considered in this paper, the reader is reminded that people--rather than technology--are the heart of the telehealth experience. Additionally, health practitioners, educators, and policy makers may experience these narratives as statements of the multi-dimensional benefits of telehealth. These benefits include not only physical benefits but also emotional, psychological, and familial benefits. Special appreciation is expressed to the story tellers who agreed to share their experiences through the Storyboard Project and in this paper.

Child and youth care (CYC) professionals often provide care to children, youth and families in conjunction with professionals from other disciplines. How CYC professionals engage other service providers in the provision of care for suicidal adolescents requires examination. The purpose of the overall study was to understand and explain the process of CYC professionals' mental health literacy practices with suicidal adolescents. Findings presented here provide insight into the process of CYC professionals' practice with other service providers in the context of their encounters with suicidal adolescents. Using a constructivist grounded theory method, data were collected and analysed from interviews with CYC professionals, supervisors within youth-serving community agencies, educators within Schools of Child and Youth Care, and extant texts of relevance to suicide, such as organisational policies, assessment tools, and suicide education curricula. One practice identified during analysis, flooding the zone, is the focus of the present paper. Flooding refers to the process of contacting and informing a myriad of professionals or services of the adolescent's suicidality, and was comprised of making decisions as to whom to contact, informing the adolescent, and negotiating with services. Professionals' perceptions of their role and the availability and accessibility of mental health services influenced the practice of flooding. Based on analysis of the data, flooding the zone has the potential to disrupt CYC professionals' relational proximity to the adolescent and may reinforce a devalued role for CYC professionals in suicide intervention within the larger mental health system of care.

Background: This paper reports on some of the findings of a large-scale survey (n = 852) of family members and support staff of adults with intellectual disabilities receiving community living services in British Columbia, Canada, concentrating on comparison of outcomes across four types of community residential settings: group homes, family model homes, independent home or apartment, and family home. Method: Comparisons were conducted on six domains: "information and planning"; "access to and delivery of supports"; "choice and control"; "community connections"; "satisfaction"; and, "overall perception of outcomes". Where applicable, further multivariate analyses were undertaken to determine the effect of the degree of help required by the residents and the respondent type. Results: Findings indicate that on all measures other than choice and control, group homes and family model homes showed better outcomes than either independent settings or family homes. Conclusion: The findings may indicate that the move to more independent living settings is not being accompanied by appropriate supports.

For many patients throughout the world, access to healthcare depends on the patients" and healthcare providers' ability to communicate efficiently in each other's language. One way to reduce linguistic barriers to healthcare access is to increase the number of linguistically and culturally competent healthcare professionals. Conspicuously absent in the literature on second language (L2) training of healthcare professionals, however, is the use of technology that combines meaningful interaction, feedback, simulation, and asynchronous access. The goal of this paper is to fill this gap by describing and evaluating the "Virtual Language Patient," a computer-based L2 training module for healthcare professionals. The module employs automatic speech recognition technology, pronunciation assessment, and video clips of a simulated medical history interview with a minority language patient. Five nurses-in-training at a French-language nursing college in Quebec reported that the module was easy to operate and that it addressed their anticipated language learning needs. More importantly, analysis of the data file automatically generated by the module revealed improvements in acceptability of the nurses' pronunciation of the medical interview questions. These findings suggest that the module can be effective in language training for healthcare professionals. Implications for the improvement of virtual dialogue systems are discussed. (Contains 5 figures.)

Background: There is an increasing interest in the notion of health disparities, inequities and inequalities in Canada and elsewhere. In Canada, individuals with disabilities represent one of six groups identified as particularly vulnerable to health disparities. Method: This paper combines the literature related to the concepts of inequity and inequality with the body of knowledge on health disparities faced by individuals with intellectual disabilities. Results: The value of distinguishing inequity from inequality, particularly as it relates to the experience of individuals with intellectual disabilities, is highlighted. Conclusions: A framework for the study of health inequities based on intellectual impairment is proposed.

To produce more rural physicians, the College of Family Physicians of Canada recommends providing earlier and more extensive rural medicine experience for all undergraduate medical students, developing rural postgraduate training programs, providing third-year optional special and advanced rural family-medicine skills training, and making advanced family medicine skills training competency-based and nationally accredited. Contains 24 references. (Author/TD)

This paper used a structural perspective to examine unmet healthcare needs in women at risk for eating disorders in Canada utilizing the Canadian Community Health Survey. The results revealed that body dissatisfied women had reported significantly higher unmet needs compared to body satisfied women (χ 2(1) =29.31, p <.05). Body dissatisfied women were also more likely to identify structural reasons for unmet needs. Considering the high costs associated with eating disorders, barriers creating inequitable health services need to be addressed in clinical practice, organizational structures, policy, and in research to improve treatment pathways. [ABSTRACT FROM AUTHOR]

Migration is increasing at unprecedented rates worldwide, but inadequate mechanisms for granting citizenship or permanent residence have rendered many immigrants without legal status. We study the health of people without immigration status in Canada, building on a 2010 review on being without status and health. We employ an expanded definition of health, guided by the WHO Social Determinants of Health (SDoH) framework. Using a scoping review methodology, we reviewed literature from 2008 to 2018 on the SDoH of people without legal immigration status in Canada, selecting 33 articles for analysis. We found that structural determinants of health, such as stigmatization and criminalization, and intermediary determinants, such as fear of deportation and healthcare avoidance, produce ill health. We show how different social positions are produced by SDoH, finding immigration status to be the foundational determinant of health for people without status in Canada. We argue that lack of immigration status as a SDoH is missing from the WHO framework. [ABSTRACT FROM AUTHOR]

Social workers have been critical in the response to HIV from its inception, in HIV prevention, support, and advocacy for stigmatized populations including gay, bisexual, and other men who have sex with men (GBM). Recently, social workers have been tasked with working in an era of increasingly biomedicalized HIV prevention, including pre-exposure prophylaxis (PrEP), a safe and highly effective new prevention technology. However, disparities in PrEP access due to structural barriers, including lack of health insurance coverage, and complex decision-making pathways and processes of engagement present substantial challenges for PrEP implementation. Ensuring equitable access to resources and supporting informed decision making are paramount to social work values, yet scant published literature has considered PrEP social work intervention. This article draws on qualitative data from 29 GBM respondents to highlight gaps in PrEP decision-making support and access that may be amenable to social work intervention. Authors describe opportunities for individual, interpersonal, organizational, and structural social work interventions to address multilevel gaps in PrEP implementation. Findings illuminate the complexity of individual experiences and social discourses regarding PrEP and their impact on GBM and raise important issues for social workers to consider in working with GBM clients, service providers, and administrators. [ABSTRACT FROM AUTHOR]

Objectives: Data documenting the scope of sexual health clinical services offered as public health in Canada are unavailable. This article provides first insights into the scope of STI and clinical sexual health services available nationally. Methods: Data were gathered using an online survey of 113 Canadian public health units. Results: Almost half of the clinics were not providing expedited partner therapy, one third were not providing point of care testing for HIV and one third were not using syndromic management of sexually transmitted infections (STIs). Low rates of physician support were evident. Conclusion: Given the ever-higher rates of STIs, findings from this study identify important challenges to providing comprehensive services. [ABSTRACT FROM AUTHOR]

Background Despite the benefits of Neonatal Follow-Up ( NFU) programs for infants at risk for developmental problems subsequent to preterm birth, non-attendance continues to be a problem within Canada and beyond. This study investigated the barriers and facilitators to attendance at Canadian NFU programs from mothers' and health care providers' ( HCP) perspectives. Methods In this multi-site qualitative descriptive study, we conducted semi-structured individual interviews with 12 mothers, six from each of two NFU programs; and focus groups with 20 HCPs from nine NFU programs. Interviews were audio-recorded and transcribed and then subjected to thematic analysis. Results The predominant barriers represented a complex interplay of cumulative factors: mothers' isolation and feeling overwhelmed, with limited support, experiencing difficulty attending because of limited resources, who viewed NFU as not needed until problems arose for their child. Other barriers included vulnerability and fear of bad news. Mothers reported the need to protect their vulnerable child from risks, whereas HCPs reported creating vulnerability by monitoring the child's development over time. HCPs perceived fear of bad news as a barrier, whereas mothers viewed that impending bad news increased their need to attend to address the issue. The predominant facilitators were support, family centred-care and mothers with adequate resources. Conclusions Attendance is most problematic for mothers with limited support, capacity and resources. First and foremost, targeted approaches to NFU service provision are needed to address the cumulative barriers and improve experiences for mothers who find it difficult to attend NFU. A continuous relationship with a single point of contact is needed and merits further investigation - a provider who works across the traditional silos of neonatal intensive care, NFU and community services, minimizes duplication and navigates transitions. [ABSTRACT FROM AUTHOR]

Research has shown persistent inequalities in access to health care between and within sociodemographic groups and geographic areas. Yet much of what we know about geographical disparities in access comes from studies of regional and urban/rural contrasts, or from studies of intra-urban, neighborhood-level variations. We know relatively little about variations in access to primary health care across different urban areas, and whether such variations translate into differences among residents' health. This study examines how health status and access to primary care vary across five of Canada's largest cities, paying particular attention to populations that may be particularly vulnerable based on age and income. Across all outcomes, there was a consistently strong relationship with individual socioeconomic status. We show that city of residence is important for access to health care but not for health status. Results are discussed in terms of their relevance for urban health-care policy and delivery, and impacts on health and access to care. [ABSTRACT FROM AUTHOR]

Background: In the Canadian context, health care services are governed by the Canada Health Act, which ensures that primary care doctors, specialists, hospitals and dental surgeries are covered through provincial health insurance plans. This ensures access to medically necessary health care services for all Canadians regardless of ability to pay. Despite this important piece of legislation, research has shown persistent inequalities in access between and within socio-demographic groups, and geographic areas. To date, most research has focused on access to primary care, with much less attention paid to specialist care as an important component of the health care continuum. Thus, the objectives of this research are to address this gap in knowledge by examining the factors associated with difficulty accessing specialist services, and the reasons why particular subpopulation groups report experiencing difficulties. Methods: This research uses multivariate logistic regression to analyze data from the Canadian Community Health Surveys' optional content from the province of Ontario (n=21,526) related to accessing specialist health care services. The multivariate logistic regression model identifies several subpopulation groups that are more likely to report difficulty accessing specialist care when required. Cross-tabulations are subsequently used to establish the main reasons why difficulties are faced. Results: Over 26% of respondents required a specialist visit in the 12 months preceding administration of the survey. Of these, 22% reported difficulty accessing specialist care. Those with difficulties were more likely to be immigrants, post-secondary educated, and have one or more chronic conditions. People living in urban health regions were also more likely to report difficulties accessing care. Primarily wait times were cited as reasons for these difficulties, followed by a perceived lack of availability. Conclusions: There are difficulties faced by the general population as a whole (e.g., wait times) as well as particular difficulties experienced more frequently by certain groups (e.g., transportation, language, and cost barriers for newcomers). These issues are important, as they may discourage individuals from using necessary health care services, and may contribute to feelings of dissatisfaction with the health care system. [ABSTRACT FROM AUTHOR]

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