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Background: Stress, depression, and anxiety affect 15% to 25% of pregnant women. However, substantial barriers to psychosocial assessment exist, resulting in less than 20% of prenatal care providers assessing and treating mental health problems. Moreover, pregnant women are often reluctant to disclose their mental health concerns to a healthcare provider. Identifying screening and assessment tools and procedures that are acceptable to both women and service providers, cost-effective, and clinically useful is needed., Methods/design: The primary objective of this randomized, parallel-group, superiority trial is to evaluate the feasibility and acceptability of a computer tablet-based prenatal psychosocial assessment (e-screening) compared to paper-based screening. Secondary objectives are to compare the two modes of screening on: (1) the level of detection of prenatal depression and anxiety symptoms and psychosocial risk; (2) the level of disclosure of symptoms; (3) the factors associated with feasibility, acceptability, and disclosure; (4) the psychometric properties of the e-version of the assessment tools; and (5) cost-effectiveness. A sample of 542 women will be recruited from large, primary care maternity clinics and a high-risk antenatal unit in an urban Canadian city. Pregnant women are eligible to participate if they: (1) receive care at one of the recruitment sites; (2) are able to speak/read English; (3) are willing to be randomized to e-screening; and (4) are willing to participate in a follow-up diagnostic interview within 1 week of recruitment. Allocation is by computer-generated randomization. Women in the intervention group will complete an online psychosocial assessment on a computer tablet, while those in the control group will complete the same assessment in paper-based form. All women will complete baseline questionnaires at the time of recruitment and will participate in a diagnostic interview within 1 week of recruitment. Research assistants conducting diagnostic interviews and physicians will be blinded. A qualitative descriptive study involving healthcare providers from the recruitment sites and women will provide data on feasibility and acceptability of the intervention. We hypothesize that mental health e-screening in primary care maternity settings and high-risk antenatal units will be as or more feasible, acceptable, and capable of detecting depression, anxiety, and psychosocial risk compared to paper-based screening., Trial Registration: ClinicalTrials.gov Identifier: NCT01899534.

This paper examines the attributes of culturally responsive teaching (CRT) as well as its theoretical foundations. Gay's (2018) work describes the eight attributes of CRT as validating, comprehensive and inclusive, multidimensional, empowering, transformative, emancipatory, humanistic, and normative and ethical. After unpacking each attribute, I present and discuss four dimensions of Gay's (2018) theoretical foundations of CRT which include culturally diverse curriculum, teacher caring, home and school connection, and academic achievement. Further, I write about how CRT and the epistemologies of Indigenous education can lead to healthy and transformative spaces for Indigenous students in Saskatchewan public schools. For the purposes of this paper, I define healthy and transformative spaces as spaces where students have their needs met in the four dimensions of spirit, mental, physical, and emotional health.

Campuses are becoming increasingly aware of the issues with mental health and well-being among students. This paper explores the context of mental health on campuses and examines the urgent issue of how to address this growing phenomenon. Institutions need to use a holistic perspective to view wellness, and the framework of multiple, interrelated dimensions of wellness may provide a structure to examine the strengths of services and programs provided on individual campuses, as well as help in the process of identifying gaps. In designing a holistic strategy, though, it is imperative that student voice is a fundamentally important piece of planning for the necessary supports for student well-being, including academic and non-academic programs and initiatives.

Despite the potential instructional benefits of integrating devices such as cell phones into schools and classrooms, research reveals that their improper use can negatively impact student behaviour, learning, and well-being. This paper reviews the literature and litigation on cell phone use in schools due to controversies over cheating, cyberbullying, sexting, and searches of student cell phones. Recent studies suggested that the presence of cell phones and related technologies in classrooms could detract from students' academic performances while contributing to higher rates of academic dishonesty and cyberbullying. The growing prevalence of cyberbullying is especially concerning because it can have severely negative, even tragic, effects on student mental health and safety. However, given the relatively discreet nature of cell phone use, regulations about their use can be difficult to enforce. After reviewing literature and litigation on the potential risks associated with inappropriate cell phone use in schools, this paper offers suggestions for educators to consider when devising or revising policies balancing students' individual rights with their safety and well-being before ending with a brief conclusion.

The COVID-19 pandemic created an unprecedented disruption to education and schooling at the end of the 2019-20 school year. Operating in a context of great uncertainty, education leaders were tasked with making key decisions with potentially far-reaching impacts on the educational and mental and physical health of students and families. Drawing on 9 cross-sectoral focus groups with school board administrators, representatives from education industry partners, and K-12 educational policy research organizations, this paper provides a historical record of the evolution of decision-making and points to promising lines of inquiry and lessons that can be learned from this moment in education.

International students in Canada make enormous contribution to the Canadian economy. As domestic students' enrolment has declined, international students' admissions have compensated for economic losses that Canadian universities incur from the decline of domestic students' enrolment. The COVID-19 pandemic is impacting international students' admissions to Canadian universities. Drawing on various secondary data sources, this article argues that international students in Canada are vulnerable due to their temporary immigration status. They are excluded from most governments' relief programs aimed at supporting Canadians during this pandemic. Most international students experience psychological and financial difficulties amid the pandemic. The situation is triggering a further decline in international students' admission, creating economic implications for Canadian universities. By exploring the challenges facing international students and the strategies required to strengthen international students' resilience and universities' capacities, the paper contributes to our understanding of the plights of international students and educational institutions amid the COVID-19 pandemic.

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.

The COVID-19 pandemic brings to the fore strengths and weaknesses in many public policies, including higher education. There are at least three separate but related areas where institutions of higher learning have been stressed by COVID-19: financing, issues related to the logistics of learning, and inequality. These problems are especially pronounced in countries that suffer from high levels of inequality, such as Chile. This editorial offers a review of some of these challenges and their implication for long-term education policy, touching on the cases of Chile, Canada, and the United States.

International students leave their countries to pursue their educational goals in a different country and must adapt to succeed. However, they may face challenges when adapting to and learning a new culture. This study investigates the challenges common to international students in their host countries and summarizes the publishing trends. A literature search of peer-reviewed articles published in Scopus, Taylor & Francis, EBSCO Host, Web of Science, Springer, PubMed, and Wiley Online over 21 years (2002-2022) was done for data collection. After the screening, a total of 175 articles were included in this review and analyzed with content analysis. The findings show that the top four destinations for international students (USA, UK, Australia, and Canada) produced the most articles about international students' challenges. Additionally, most papers investigated more than one challenge, and sociocultural (82.9%) and academic challenges (82.3%) were the most researched, with language issues as the primary cause. The results also show no changes or improvement in the challenges of international students in 21 years, and areas such as psychological and economic challenges need more research. These challenges and other trends found in the articles are discussed and directions for future research are suggested.

Objective: The aim of this study was to investigate whether family income and education have a causal effect on psychological distress among Canadian adults., Methods: We executed fixed-effects regression analyses using data from the Longitudinal and International Study of Adults (LISA). We investigated whether changes in family income and education from wave 2 (2014) to wave 3 (2016) corresponded with changes in psychological distress during this same time period. We also investigated whether changes in these socio-economic resources from wave 1 (2012) to wave 2 (2014) corresponded with lagged changes in psychological distress from wave 2 (2014) to wave 3 (2016). These models controlled for all time-invariant confounders with time-invariant effects, as well as the time-varying factors age, marital status, household size, and employment status., Results: Obtaining a postsecondary degree corresponded with lagged decreases in psychological distress among women ages 18 to 32 (b = -1.97; 95% CI = -3.53, -0.42) and men over the age of 32 (b = -1.86; 95% CI = -3.57, -0.15). The effect of postsecondary education was stronger when considering adults who stayed married throughout the three waves (b = -2.29; 95% CI = -4.37, -0.21)., Conclusion: Completing postsecondary education may have a lagged causal effect on psychological distress, and the life course timing for when postsecondary completion reduces distress is different for women and men., (© 2021. The Canadian Public Health Association.)

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.

This paper reports on food insecurity among students attending a university in rural Nova Scotia. In 2015, 1,030 students completed an online, 38-item cross-sectional survey. The results report that 38.1% of students experienced food insecurity during the previous 12 months. Food insecurity was statistically associated with living arrangements, source of funds for schooling, meal plans, and year of study. Poor overall health, poor mental health, high stress, and poor academic performance were significantly higher for food-insecure students. Students employed multiple coping strategies, with implications for academic success and long-term debt. Qualitative analysis revealed four themes related to insufficient money for food: inability to cover basic needs, health-related outcomes of persistent worry, loss of time from learning, and impacts on social life. This research demonstrates the need to re-evaluate funding policies for post-secondary education in Canada to ensure students can afford the costs of basic needs and educational costs.

Consideration of risk and liability in outdoor educative practice has normally been limited to the narrow risks, usually to physical health, of incidents that can cause a particular injury. In this view of risk management, the more readily controlled the circumstance, the less likelihood of risk and consequent liability. Thus, to reduce risk, learning in the natural world is often avoided because it occurs in far more complex and less controllable contexts than human-created ones. However, wider and more grave risks to physical, emotional and mental health that may accrue through a life that is lived in separation from the natural world are not often considered or evaluated. In part, this may be because these kinds of risks are less immediately evident, and liability for negative outcomes may be more difficult to measure. Thus, there is less incentive to consider them. However, delayed outcomes are still outcomes. To consider easily discerned "narrow risk" alone, while ignoring more complex and longer-term "wide risk," is no excuse for avoiding the ethical responsibility that public education carries to provide both the safest "and" most fecund context for learning. This paper introduces the concept of wide risk as a counterpoint to the narrow risk calculations now performed, and argues that in incorporating an understanding of wide risk in educative practice, at least two results are likely. The first is that learning outdoors will frequently be discovered to be a less risky alternative, if a broad range of outcomes over time are considered. The second is that the value of embracing risk in all aspects of learning ought to become a part of the learning process, and part of what is taught in public schools.

This paper offers a review of the research literature on the experiences of young children and their families who left Syria as refugees and resettled in Canada. We identify five key factors that influence Syrian refugees' experience of social inclusion within the context of the public-school systems as well as unveil the silences in and across the current studies. The five factors are pre-arrival experiences, mental health, social supports, acquisition of English language skills, and lack of preparedness of teachers and schools. Based on limited availability of research, we outline needed research to better understand social inclusion of Syrian refugee families with young children in Canada. There is a call to pay particular attention to their educational and social encounters.

This paper is a response to the language, learning, and life needs of the increasing number of international students studying in Canada. In addition to introducing two "real-life" international students who chose to live in Canada to learn English and otherwise study, the paper presents what the literature tells us about: international students in general; culture shock and acculturation; the struggle of international students for identity, based on the International Student Identity model; and mental health issues among this learner group. It then juxtaposes key themes found in the literature with the life experiences of the aforementioned students. Implications for students, extracurricular and preparatory program planners, and classroom instructors are shared. Given the role of many continuing education centres in providing ESL instruction and supports, the paper holds particular value for educators and administrators in the continuing education sector.

Despite marked improvements, intervention for students with a mental health problem or illness in Canadian higher education settings remains not yet successful, mature, or sustainable. A number of challenges have been identified as contributory to the shortcomings surrounding student mental health in colleges and universities. In this paper, I explore some of the more common barriers that currently limit the development, implementation, and sustainability of student mental health support practices. The barriers of focus include, prevailing stigma and stereotypes, underdeveloped policies, and minimal opportunities for professional development and training. I specifically highlight how these barriers frame the challenges for teaching faculty and academic staff in promoting or supporting student mental health and well-being. Following an identification and discussion of barriers, I offer suggestions on how they can be overcome, or at the very least minimized, and what this would mean for teaching and learning in relation to post-secondary student mental health. For example, in an attempt to clarify current policies surrounding mental health, I suggest and explore how institutions can assign particular individuals (i.e., a designated "task force") as responsible for the development, implementation, and evaluation of mental health policies. Ultimately, the first step to better mental health support practices is to acknowledge how they are challenged.

Background: This manuscript is coauthored by 15 young adult Patient RESearch partners (PARES) with lived and living mental health experiences and three institutional researchers across Canada involved in a patient-oriented research (POR) study called the HEARTS Study: Helping Enable Access and Remove Barriers To Support for Young Adults with Mental Health-Related Disabilities. We share our reflections, experiences and lessons learned as we grapple with the field of POR for its lack of clarity, hierarchical structures, internalized ableism, and accessibility challenges, among others. To mitigate the difficulties of POR, we started by laying the groundwork for equality by embracing the principle of Primus Inter Pares: First Among Equals as the foundation of our approach. In this way, we began with what we know for certain: the inherent worth and dignity of young adults as equal partners, recognizing their expertise, worldviews, creativity, and capacity to contribute meaningfully and intentionally to the research that affects their lives and futures. Main Body: The manuscript underscores the need to reconceptualize meaningful engagement in POR, advocating a shift from traditional, biased paradigms that fail to address the complexities faced by young adults with mental illness. It introduces what we have termed Adaptive and Differential Engagement, underscoring the necessity of tailoring participation to individual preferences and circumstances alongside a Tripartite Compensation model that promotes fair and holistic remuneration in research collaborations. Then we discuss the approaches we have conceptualized, such as Equitable Dialogue, Trust Architecture, Community Continuum, Unity in Diversity, Shared Stewardship, and Agile Frameworks that collectively aim to overcome barriers like language intimidation, power imbalances, framework fatigue, consultation burnout, trust deficits, and systemic discrimination and exclusion. The manuscript does not seek to prescribe any universal or standardized solutions; in fact, it seeks the opposite. Instead, it offers a thoughtful and transparent contribution to the POR canon, providing resources for young adults eager to engage in research and institutional researchers aspiring to collaborate with them. Conclusion: This manuscript is a product of our collective learning and critical self-evaluation. By integrating theoretical insights with practical strategies, we present a justice-oriented blueprint for an inclusive and egalitarian approach to POR. We advocate for applications of POR that are responsive to the individualized contexts of young adult PARES, ensuring their perspectives are central to the research with the resources to take the lead should they choose. Plain Language Summary: Together with a graduate student, co-supervisors, and 15 young people from across Canada who have experience with mental health challenges, this paper looks at how research involving young adults as patient research partners can be better. We feel that the types of research that are supposed to include us are often not clear enough and make it hard to join, especially those with unique life situations and health issues. So, in this paper, we suggest a few new ways of doing things where everyone is treated equally. We call it Primus Inter PARES: First Among Equals. This means young people are just as important as anyone else in research. We want to change the old ways that do not consider our unique experiences as young people with mental health issues. We came up with new ideas like 'Equitable Dialogue' and 'Trust Architecture' to ensure everyone understands the research and feels that they can trust the process. We also suggest ways to make sure different voices are heard and that everyone has a fair chance to contribute. We do not just offer a one-size-fits-all solution; instead, we share many ways to improve research to help young adults who want to be part of research and for the researchers who want to work with us. Our paper is about making research fair and including everyone's point of view. We hope this will make the research better for everyone, especially for young adults. [ABSTRACT FROM AUTHOR]

This paper examines geographic variations in sense of community belonging in Hamilton, Ontario. It also identifies the most significant health and social factors associated with belonging in the city. The research employs data from the 2007/08 Canadian Community Health Survey for respondents aged 18 or over living in the Hamilton Census Metropolitan Area. The primary unit of geography is the forward sortation area (FSA), which correspond with the boundaries comprising the first three digits of the postal code. The paper found that, overall, residents of Hamilton enjoy a strong sense of belonging to their community, one of the highest rates in Canada. Consistent with research at the national level, the paper revealed a strong and clear association between lower sense of belonging and lower self-perceived mental health. Age (45-64) and household type (couples with children) were associated with higher sense of belonging. The mapping analysis revealed that sense of belonging was generally strongest among residents of rural Hamilton and became weaker moving towards the city centre, with particularly low levels evident in the Lower City. The presence of lower sense of belonging and lower mental health was clearly visible in three FSAs comprising the central portion of the Lower City.

The concept of sense of place has received considerable attention by social scientists in recent years. Research has indicated that a person's sense of place is influenced by a number of factors including the built environment, socio-economic status (SES), well-being and health. Relatively few studies have examined sense of place at the neighbourhood level, particularly among communities exhibiting different levels of SES. This article investigates sense of place among three neighbourhood groups in Hamilton, Ontario representing areas of low, mixed and high SES. It analyses data from a 16-point sense of place scale derived from the Hamilton Household Quality of Life Survey carried out in 2010-2011 among 1,002 respondents. The paper found that sense of place was highest among residents of the high SES neighbourhood group as well as among home owners, people residing in single-detached homes, retired residents and those living in their neighbourhood for more than 10 years. From a health perspective, the paper found that a strong association existed between sense of place and self-perceived mental health across the three neighbourhood groups. Furthermore, by way of regression modeling, the paper examined the factors influencing health-related sense of place. Among the sample of respondents, a strong connection was found between housing, particularly home ownership, and high levels of health-related sense of place. (Contains 5 tables and 1 footnote.)

Social capital has been studied by academics for more than 20 years and within the past decade there has been an explosion of growth in research linking social capital to health. This paper investigates social capital in Hamilton, Ontario by way of a telephone survey of 1,002 households in three neighbourhood groups representing high, mixed and low socio-economic status (SES). A Social Capital Measurement Tool is proposed as a straightforward way to account for differences in social capital perceptions and actions among residents. Consistent with the literature, the paper found that there was a strong association between social capital perceptions and health, particularly mental health and life stress. Social capital was greater in the high and mixed SES neighbourhoods and much weaker in the low SES neighbourhoods. With respect to social capital actions, both volunteering and voting was associated with positive overall health and mental health. Finally, the paper identified the social capital "elite"--respondents with high or above average perceptions and who participated in the two social capital actions--voting and volunteering. Prominent among the social capital elite in Hamilton is the "health wealthy" senior, a positive development for the continued social well-being of the city.

This article investigates the association between sense of community belonging and health among settlements of different size and across the urban to rural continuum in Canada. Using data from the recent 2007/08 Canadian Community Health Survey (CCHS), the objective is to identify the major health, social and geographic determinants of sense of community belonging and to consider policy options aimed at improving sense of belonging among certain segments of the population. The research found a significant and consistent association between sense of belonging and health, particularly mental health, even when controlling for geography and socio-economic status. At the same time, sense of community belonging improved progressively across the urban to rural continuum with remarkably high levels of belonging evident in the outer most regions of Canada. Despite the health deficit that exists in rural and small-town Canada, the paper postulates that these communities are able to overcome health challenges to create conditions conducive to a positive sense of belonging. Overall, sense of belonging was also found to be highest among seniors, people residing in single-detached homes and among couples with children and was lowest among youth, residents of high-rise apartments and among single-parents. Finally, in the context of addressing deficiencies in sense of belonging, the paper examines several recent policy developments aimed at improving mental health services in Canada.

The number of students on university and college campuses that are struggling with depression, anxiety, suicidal thoughts, and psychosis across North America is rising (Gallagher, 2008). This intensification of students' psychological needs has become a mental health crisis. The age at which many mental disorders manifest themselves is between 18 and 24, which coincides directly with the average age of student enrollment in higher education (Kessler et al., 2005). Adolescent suicide rates have tripled over the past 60 years, making suicide the second leading cause of death for that age group (Vastag, 2001). Studies conducted by the American College Health Association (2005) suggest that 12 to 18 percent of college students are being treated for a mental disorder. Canadian statistics mirror the tragic rate of mental disorders in American university students. Studies have also shown that there are more students seeking psychological care than in previous decades (Watkins, Hunt, & Eisenberg, 2011). The mental health crisis faced by North American institutions of higher education is relevant to institutional funding challenges, as the crisis is creating a growing need for financial and human resources to address this serious problem. Counselling centres in post-secondary educational institutions have difficulty meeting the growing needs of students as they are underfunded and understaffed. Resources are required to increase staffing, improve training, and increase physical space on campus for counselling centres (Kadison & DiGeronimo, 2004). There is evidence to support the reality of the mental health crisis, and the serious challenge it poses for post-secondary educational institutions. What are the factors behind this crisis? This paper identifies six factors that recent research has implicated as contributing to the mental health crisis: academic pressure, financial burden, increased accessibility of higher education, increased female to male student ratio, increased use of technology, and dramatic change in the lifestyle of university and college students. All of these factors play an important role in the mental health crisis.

In the age of the human Genome Project wide spread prodigious information technology, our system of education is unable to keep pace with and meet the demands for knowledge, skills, and identification and treatment of academic, emotional, social, mental and health concerns of our youth. As the Saskatchewan task force on the state of education in Saskatchewan, Canada (1999) noted, the educational system's problems mirror those problems found in society in general. Increasingly, these societal problems are being deferred to the educational institutions for identification, treatment and prevention. While all parties tend to agree that prevention of problems is desirable, there is not general agreement about the efficacy of prevention programs rather than deficit models, nor the means by which to develop resilient students. The purpose of this paper is to identify risk factors and their potency, to identify protective or resilient factors and their potency, to identify the relationship and relevancy of these two concepts for students, and to identify family, community and school practices that foster resiliency.

Melba Vasquez (1992), educator, and ethicist, and the President Elect of the American Psychological Association wrote, "Professionals concerned with the problems of unethical behavior believe that the strongest weapon against professional misconduct may be the education of trainees" (p. 196). It is this statement, my professional experience as both a clinician and educator in a graduate psychology-training program, and my membership on a State Examining Board of Psychology that serves as the inspiration for this paper. Every state in the Union and Province in Canada has an Examining Board of Psychology that regulates the practice of psychology. In addition clinicians are responsible to the codes of ethics as members of their respective professional organizations. These groups set the standards for ethical practice that are defined by the various governing laws and ethical standards. These may vary somewhat, but all are designed to define professional practice and safeguard the public. Two of the criteria that define a profession are both the establishment of an ethics code and the capacity to work meaningfully within this code. Nowhere is this more important than in the delivery of mental health care in general and clinical psychology in particular. When problems arise resulting from an ethical violation in the course of treatment, the clinician may be faced with a disciplinary complaint to a licensing or regulatory board or the ethics committee of their professional organization. It is estimated that one in four psychologists will have a disciplinary complaint sometime in their career. In addition, certain specialties with in psychology are at a higher risk due to the nature of their practice.

In 2016, 235,000 Canadians experienced homelessness, and on any given night, there are 35,000 Canadians who are homeless. Many have significant mental-health needs. This article describes a series of storytelling workshops offered at a shelter and medical clinic to provide a space for homeless people to reflect, share their voices, gain communication skills, and connect within a peer group. Fourteen self-selected homeless men participated. The staff and participant experiences shared in this paper point to how narratives and storytelling provide a rich ground for better understanding and empowering people experiencing homelessness.

Objectives: Indigenous youth who identify themselves as First Nations, Métis or Inuit living in Canada between the ages of 12-25 experience higher rates of depression and suicide than non-Indigenous youth. Using narrative review, this paper provides a critical analysis of the scholarly literature to explore the current delivery and accessibility of mental health services among Indigenous youth and suggests areas for improvements in system recovery. Research Design and Methods: The narrative review selected papers from databases including Google Scholar, PubMed, APA PsychInfo, and Indigenous Peoples Atlas of Canada to capture literature from several academic disciplines between August 2020 to May 2022. Data was then synthesized to deliver broad perspectives on this topic. Results: Three categories describe how the accessibility of mental health services for Indigenous youth is impacted by (1) research, (2) current mental health practice, and (3) the location of care services. The medicalization of mental health services, and its emphasis on individual causation and intervention, grounded this discussion. Intersectionality and cultural safety offered a counterpoint to medicalization since these ideas encourage the consideration of social, political, economic, and historical forces. These concepts inform possibilities for change at the micro, mezzo, and macro system levels to address this growing issue. Conclusion: Future implications for improving mental health services and mental health recovery among Indigenous youth include advancing research and implementing innovative solutions that promote intersectionality and culturally safe care across multiple system levels. [ABSTRACT FROM AUTHOR]

This article integrates story and the form of qualitative methodology known as arts-based inquiry. The authors use this approach to provide a case study of Kal, a 15-year-old boy who had unsuccessfully attempted to end his life by "flying" off his apartment balcony. The paper begins with orientation to the background of this case and to arts-based inquiry and case history and then proceeds with an imaginative re-creation of the involvement of Margie, Kal's caregiver, in this case in the form of a letter written in role by her as Kal to his mother. Finally, the authors discuss how arts-based representations can be used to positively affect mental health and to generate creative healing energy. In this presentation Kal is the leading character, and Margie, Kal's real-life teacher in a hospital-based mental health unit in Ontario, Canada, is the supporting actress. Through dramatic fictionalization of her work with Kal, Margie found that "human learning can be renewed when teacher researchers use arts-based textual strategies to reflect on experience and invite others to respond to these inquiries" (Diamond & Mullen, 1999, p. 18).

Background: Withdrawal management and opioid agonist treatment (OAT) programs help to reduce some of the harms experienced by people who use substances (PWUS). There is literature on how features of drug treatment programs (e.g., policies and practices) are helpful, or not helpful, to PWUS when seeking access to, or in, treatment. There is, however, relatively little literature based on the perspectives of family members/family of choice of PWUS and community-based organization staff within the context of Atlantic Canada. This paper explored the perspectives of these two groups on what was helpful, or not, about drug treatment programs in Atlantic Canada in terms of supporting access to, and retention in, treatment., Methods: One-on-one qualitative telephone interviews were conducted in 2020 with the two groups. Interviews focused on government-funded withdrawal management and OAT programs. Data were coded using a qualitative data management program (ATLAS.ti) and analyzed inductively for key themes/subthemes using grounded theory techniques., Results: Fifteen family members/family of choice and 16 community-based organization staff members participated (n = 31). Participants spoke about features of drug treatment programs in various places, and noted features that were perceived as helpful (e.g., quick access), as well as not helpful (e.g., wait times, programs located far from where PWUS live). Some participants provided their perceptions of how PWUS felt when seeking or accessing treatment. A number of participants reported taking various actions to help support access to treatment, including providing transportation to programs. A few participants also provided suggestions for change to help support access and retention such as better alignment of mental health and addiction systems., Conclusions: Participants highlighted several helpful and not helpful features of drug treatment programs in terms of supporting treatment access and retention. Previous studies with PWUS and in other places have reported similar features, some of which (e.g., wait times) have been reported for many years. Changes are needed to reduce barriers to access and retention including the changes recommended by study participants. It is critical that the voices of key groups, (including PWUS) are heard to ensure treatment programs in all places support access and retention., (© 2024. The Author(s).)

Globally and historically, Indigenous healthcare is efficacious, being rooted in Traditional Healing (TH) practices derived from cosmology and place-based knowledge and practiced on the land. Across Turtle Island, processes of environmental dispossession and colonial oppression have replaced TH practices with a colonial, hospital-based system found to cause added harm to Indigenous Peoples. Growing Indigenous health inequities are compounded by a mental health crisis, which begs reform of healthcare institutions. The implementation of Indigenous knowledge systems in hospital environments has been validated as a critical source of healing for Indigenous patients and communities, prompting many hospitals in Canada to create Traditional Healing Spaces (THSs). After ten years, however, there has been no evaluation of the effectiveness of THSs in Canadian hospitals in supporting healing among Indigenous Peoples. In this paper, our team describes THSs within the Center for Addiction and Mental Health (CAMH), Canada's oldest and largest mental health hospital. Analyses of 22 interviews with hospital staff and physicians describe CAMH's THSs, including what they look like, how they are used, and by whom. The results emphasize the importance of designating spaces with and for Indigenous patients, and they highlight the wholistic benefits of land-based treatment for both clients and staff alike. Transforming hospital spaces by implementing and valuing Indigenous knowledge sparks curiosity, increases education, affirms the efficacy of traditional healing treatments as a standard of care, and enhances the capacity of leaders to support reconciliation efforts.

While the COVID-19 pandemic has greatly exacerbated the mental health challenges of transition-aged youth (TAY) between 17 and 29 years old, it has also led to the rapid adoption of digital tools for mental health help-seeking and treatment. However, to date, there has been limited work focusing on how this shift has impacted perceptions, needs and challenges of this population in using digital tools. The current study aims to understand their perspectives on mental health help-seeking during the pandemic and emerging issues related to digital tools (e.g., digital health equity, inclusivity). A total of 16 TAY were invited from three post-secondary institutions in the Greater Toronto Area. A total of two streams of focus groups were held and participants were invited to share their perceptions, needs and experiences. Five main themes were identified: 1) Helpfulness of a centralized resource encompassing a variety of diverse mental health supports help-seeking; 2) The impact of the shift to online mental health support on the use of informal supports; 3) Digital tool affordability and availability; 4) Importance of inclusivity for digital tools; and 5) Need for additional support for mental health seeking and digital tool navigation. Future work should examine how these needs can be addressed through new and existing digital mental health help-seeking tools for TAY., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Mental health issues continue to present barriers for Canadian children, in terms of both psychological and academic outcomes. Growing numbers of students are placed "at risk" as a result. A mental health promotion approach suggests that students can develop a number of skills and competencies, namely those related to social-emotional learning (SEL), which can reduce their chance of developing mental health difficulties. In Canada, a wide range of curricula, frameworks, initiatives, and programs have been put in place that address elements of SEL. In this paper, a sampling of these drawn from across the country is described. The emphasis on SEL apparent in many provinces and territories is evidence of the shared understanding of its importance with respect to improving student outcomes. However, a lack of evidence to support these approaches, inconsistencies in terms of terminology and practices, the lack of alignment between SEL and academics, and the piecemeal approach adopted within some provinces leave SEL and mental health promotion approaches vulnerable to being labelled "add-ons" and becoming transient initiatives.

In its final report, the At-risk Working Group, which reported to the Ontario Minister of Education, described at-risk secondary students as performing significantly below the provincial standard, failing to meet curriculum expectations, and being disengaged from school (O'Connor, 2003, p. 5). In this special issue, authors examine this topic, supporting at-risk learners, from many perspectives and report on recent research conducted across the country. Contributors to this issue address questions concerning the following: (a) motivational issues that both contribute to and result from at-risk status; (b) mental health issues that may arise as students experience low achievement and disengagement and that may also cause students to experience poor achievement and disinterest in school; and (c) challenges associated with the transition from adolescence to adulthood, from school to work. This issue of "Exceptionality Education International" offers seven papers that challenges the shift of the focus away from what "these learners are not doing" and onto "what we can" do to make schools better contexts for disenfranchised youth in Canada.

The COVID-19 pandemic caused a global health crisis directly impacting the healthcare system. Healthcare leaders influence and shape the ability of an organization to cope with and recover from a crisis such as the COVID-19 pandemic. Their actions serve to guide and support nurses' actions through unpredictable health service demands. The purpose of this paper was to examine frontline managers' experiences and organizational leadership responses that activated organizational resilience during the COVID-19 pandemic, and to learn for ongoing and future responses to healthcare crises. Fourteen managers participated in semi-structured interviews. We found that: (1) leadership challenges (physical resources and emotional burden), (2) the influence of senior leader decision-making on managers (constant change, shortage of human resources, adapting care delivery, and cooperation and collaboration), and (3) lessons learned (managerial caring behaviours and role modelling, adaptive leadership, education and training, culture of care for self, and others) were evidence of managers' responses to the crisis. Overall, the study provides evidence of managers experiences during the early waves of the pandemic in supporting nurses and fostering organizational resilience. Knowing manager's experiences can facilitate planning, preparing, and strengthening their leadership strategies to improve work conditions is a high priority to manage and sustain nurses' mental health and wellbeing. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic disproportionately affected those who face historical and ongoing marginalization. In centering pandemic experience of recent immigrant women in the accommodation and food services sector in Canada, we examine how their precarious work translated to experiences of work precarity and wellbeing. This paper illuminates how pre-existing and ongoing marginalization are reproduced during a health crisis for those at the intersection of gender, race, migration, and labour inequities. Using semi-structured interviews and systematic analysis using the Work Precarity Framework, we found that the pandemic exacerbated pre-existing socio-economic marginalization and resulted in unique experiences of work precarity. The latter was experienced as precarity of work (unpredictable work hours and job or employment insecurity), precarity from work (inadequate incomes), and precarity at work (physical, psychological, and relational unsafety). Work precarity stood out as a social determinant of health in relation to its outcome of degraded mental health and wellbeing. Recognizing the role of policies in producing, reproducing, and distributing precarity, we recommend policy directions to reduce social inequities in pandemic recovery. [ABSTRACT FROM AUTHOR]

This paper explores the relative importance of social factors and health measures in predicting educational achievement in early and late adolescence using population-based administrative data. The sample was made up of 41,943 children born in Manitoba, Canada between 1982 and 1989 and remaining in the province until age 18. Multilevel modeling nests each individual (level 1) within a family (level 2) residing within a neighborhood (level 3). Most important in predicting adolescent achievement were a broad socioeconomic status index (and a narrower measure of household income), being on social assistance, mother's age at first birth, gender, residential mobility, the presence of ADHD/Conduct disorders, and measures of family functioning (child taken into care or offered protection services and family structure history). Family size, birth order, and newborn characteristics (birthweight, APGAR, gestational age) were statistically significant but of little importance in explaining the outcomes. Both examining regression coefficients and systematically omitting variables showed social factors (often emphasized by epidemiologists) to have markedly greater effects than the combination of health measures (often stressed by economists) in predicting achievement. However, mental health in childhood is identified as among the important predictors. Record linkage across population datasets from health, education, and family services ministries allowed: tracking health and educational attainment at different times in a child's life, following a large number of cases across childhood, considerable sensitivity testing, controlling for unmeasured family and neighborhood effects, generating an extensive list of predictors, estimating effect sizes, and comparing Manitoba results with those of well-known American studies.

Adolescence is a critical period for the promotion of mental health and the treatment of mental disorders. Schools are well-positioned to address adolescent mental health. This paper describes a school mental health model, "School-Based Pathway to Care," for Canadian secondary schools that links schools with primary care providers and mental health services, enabling them to address youth mental health in a collaborative manner. The model highlights the fundamental role of mental health literacy, gatekeeper training, and education/health system integration in improving adolescent mental health, and enhancing learning environments and academic outcomes. (Contains 1 figure and 1 table.)

There has been recent attention paid to the mental health issues experienced by many children and youth in Canada and internationally. In particular, the role of the school and educational leaders in preventing mental health difficulties and intervening in the case of mental illnesses has been highlighted. This paper presents an overview of several policies, programs, and initiatives related to the prevention of and intervention for mental health difficulties in Canadian schools with a focus on the Ontario context. Following this, literature examining the role of educational leaders in meeting the mental health needs of students will be reviewed and recommendations put forward.

Background: Indigenous children living in high income countries have a consistently high prevalence of mental health problems. We aimed to identify psychosocial risk and protective factors for mental health in this setting. Methods: A systematic review of studies published between 1996 and 2016 that quantitatively evaluated the association between psychosocial variables and mental health among Indigenous children living in high income countries was conducted. Psychosocial variables were grouped into commonly occurring domains. Individual studies were judged to provide evidence for an association between a domain and either good mental health, poor mental health, or a negligible or inconsistent association. The overall quality of evidence across all studies for each domain was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines. Results: Forty-seven papers were eligible (mainland US 30 [64%], Canada 8 [17%], Australia 7 [15%], Hawaii 4 [9%]), including 58,218 participants aged 4-20 years. Most papers were cross-sectional (39, 83%) and measured negative mental health outcomes (41, 87%). Children's negative cohesion with their families and the presence of adverse events appeared the most reliable predictors of increased negative mental health outcomes. Children's substance use, experiences of discrimination, comorbid internalising symptoms, and negative parental behaviour also provided evidence of associations with negative mental health outcomes. Positive family and peer relationships, high self-esteem and optimism were associated with increased positive mental health outcomes. Conclusions: Quantitative research investigating Indigenous children's mental health is largely cross-sectional and focused upon negative outcomes. Indigenous children living in high income countries share many of the same risk and protective factors associated with mental health. The evidence linking children's familial environment, psychological traits, substance use and experiences of discrimination with mental health outcomes highlights key targets for more concerted efforts to develop initiatives to improve the mental health of Indigenous children. [ABSTRACT FROM AUTHOR]