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BackgroundIn schizophrenia spectrum populations, adherence to treatment is poor, community-based supports are limited, and efforts to foster illness self-management have had limited success. These challenges contribute to frequent, lengthy, and costly hospital readmissions and poor functional outcomes. Digital health strategies, in turn, hold considerable promise in the effort to address these problems. ObjectiveThis feasibility trial will examine a digital health platform called App4Independence (A4i), which was designed to enhance illness self-management and treatment engagement for individuals with schizophrenia. MethodsFeasibility metrics in this single-blind, randomized trial include study recruitment and retention, rate of technology use, safety, and utility in clinical interactions. Other outcome metrics include symptomatology, treatment adherence, patient-provider alliance, and quality of life. In this trial, 160 study participants with schizophrenia spectrum diagnoses will be randomized to either treatment or control conditions, with pretest-posttest outcomes measured over a 6-month period. ResultsThis study was funded by the Canadian Institutes of Health Research in January 2020 and received Institutional Review Board approval on August 13, 2020. This study plans to begin recruiting in January 2021 and will be completed within 3 years. Data collection is projected to begin in January 2021. ConclusionsThis research will provide critical information for the development of this new technology in the larger effort to address a key problem in the schizophrenia field—how to leverage technology to enhance illness self-management and care engagement in resource-limited service contexts. International Registered Report Identifier (IRRID)PRR1-10.2196/24736

Youth homelessness represents a persistent and significant challenge for service sectors with limited best practice guidance. Housing supports, in particular, are widely deployed, with the practice-oriented literature providing little detail regarding service design beyond broad domains such as employment support and life skills coaching. The present multiple case study investigation was designed to develop a preliminary understanding of the guiding principles that attend the development of interventions that support youth exiting homelessness in the Canadian context. These case studies were conducted with a diverse group of five organizations recognized as sector leaders, with findings considered in light of practice standards from the better-established adult housing literature. Key findings with respect to service models included the strategies used to provide flexible, culturally responsive, tailored services with an emphasis on specialist support. Implementation factors included the navigation of strategic partnerships, the use of data in capacity-building, and the benefits and drawbacks of larger, centralized service environments versus smaller, dispersed environments. Youth-specific considerations in housing stabilization models are highlighted. This work contributes to a growing body of literature that seeks to articulate best practices in the effort to address and prevent youth homelessness. [ABSTRACT FROM AUTHOR]

This paper describes how various community partners collaborated to design and implement a student-centred, trauma-informed educational program that addresses the personal and systemic barriers identified by refugees who are survivors of trauma as obstacles to accessing higher education, and consequently social inclusion, in Canada. This 14-week program created a safe space where participants could rebuild identities, agency, and confidence and develop healthy relationships of trust and mutual respect. Measures of well-being and qualitative interviews conducted at entry, mid, and exit points showed statistically significant improvements on measures of self-esteem, resilience, and life satisfaction and overall satisfaction with the program.

Background: The expansion of the Patient-Centred Medical Home model presents a valuable opportunity to enhance the integration of team-based mental health services in primary care settings, thereby meeting the growing demand for such services. Understanding the organizational context of a Patient-Centred Medical Home is crucial for identifying the facilitators and barriers to integrating mental health care within primary care. The main objective of this paper is to present the findings related to the following research question: "What organizational features shape Family Health Teams' capacity to provide mental health services for depression and anxiety across Ontario, Canada?" Methods: Adopting a constructivist grounded theory approach, we conducted interviews with various mental health care providers, and administrators within Ontario's Family Health Teams, in addition to engaging provincial policy informants and community stakeholders. Data analysis involved a team-based approach, including code comparison and labelling, with a dedicated data analysis subcommittee convening monthly to explore coded concepts influencing contextual factors. Results: From the 96 interviews conducted, involving 82 participants, key insights emerged on the organizational contextual features considered vital in facilitating team-based mental health care in primary care settings. Five prominent themes were identified: i) mental health explicit in the organizational vision, ii) leadership driving mental health care, iii) developing a mature and stable team, iv) adequate physical space that facilitates team interaction, and v) electronic medical records to facilitate team communication. Conclusions: This study underscores the often-neglected organizational elements that influence primary care teams' capacity to deliver quality mental health care services. It highlights the significance of strong leadership complemented by effective communication and collaboration within teams to enhance their ability to provide mental health care. Strengthening relationships within primary care teams lies at the core of effective healthcare delivery and should be leveraged to improve the integration of mental health care. [ABSTRACT FROM AUTHOR]

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The COVID-19 pandemic has exacerbated pre-existing health inequities in vulnerable and marginalized patient populations. Continuing professional development (CPD) can be a critical driver of change to improve quality of care, health inequities, and system change. In order for CPD to address these disparities in care for patient populations most affected in the health care system, CPD programs must first address issues of equity and inclusion in their education development and delivery. Despite the need for equitable and inclusive CPD programs, there remains a paucity of tools and frameworks available in the literature to guide CPD and broader education providers on how best to develop and deliver equitable and inclusive education programs. In this article, we describe the development and application of a Health Equity and Inclusion (HEI) Framework for education and training grounded in the Analyze, Design, Develop, Implement, and Evaluate model for instructional design. Using a case example, specifically a hospital-wide trauma-informed de-escalation for safety program, we demonstrate how the HEI Framework can be applied practically to CPD programs to support equity and inclusion in the planning, development, implementation, and evaluation phases of education program delivery. The case example illustrates how the HEI Framework can be used by CPD providers to respect learner diversity, improve accessibility for all learners, foster inclusion, and address biases and stereotypes. We suggest that the HEI Framework can serve as an educational resource for CPD providers and health professions educators aiming to create equitable and inclusive CPD programs. [ABSTRACT FROM AUTHOR]

Background: Evidence shows that mindfulness-based programs reduce levels of stress, anxiety, and depression. Yet, web-based mindfulness has been less studied, especially among university students. We developed a student-centered web-based mindfulness virtual community (MVC) intervention informed by cognitive-behavioral-therapy constructs. MVC comprised of (1) 12 online video-based modules (psychoeducation and practice), (2) anonymous peer-to-peer discussion forums, and (3) anonymous, group-based, 20-min live video conferences by a trained moderator. While the intervention was found effective in reducing anxiety and depression in a randomized controlled trial (RCT), the impact on students' quality of life remained to be examined. The reported study examined the impact of 8-week long web-based MVC intervention on the quality of life of undergraduate students compared to those in the control group. Participants were recruited from a large Canadian university into a two-arm RCT (N = 160) and randomly allocated to the web-based MVC intervention (n = 80) or to the control (n = 80) group. Participants completed online survey at baseline (T1) and at 8-week (T2). The outcome of quality of life was measured by 16-item Quality of Life Scale (QOLS). The generalized estimation equation (GEE) method with AR(1) covariance structures was used, adjusting for potential covariates. Results: At the baseline 159 students completed the survey. Participants (32 males, 125 females, 2 other gender) had a mean age of 22.6 years, 57.2% were born in Canada. Participants in MVC (n = 79) and control (n = 80) groups were similar in sociodemographic characteristics except hours of volunteer work. At T2 that coincided with students' exam period, QOLS score for the control group declined while MVC group had a slight increase. Between-group analysis for QOLS score-change showed a significantly higher score at T2 for MVC group compared to the control (81.64, SD = 14.63 vs. 72.9, SD = 17.26, P < 0.001). Per adjusted GEE analysis, the higher QOLS score in MVC compared to the control group was statistically significant (β = -2.24, P =.03). Conclusions: Web-based MVC intervention helped the students to have better quality of life, compared to the control group, at 8-week follow-up despite exam stress. Future research with a longer follow-up would advance understanding. Trial registration: https://doi.org/10.1186/ISRCTN12249616 Registration Date: 21/06/2017. [ABSTRACT FROM AUTHOR]

Disease-based models of health often fail to consider socio-economic models that perpetuate optimal health. The promotion of human thriving, rather than merely surviving, can be achieved by promoting optimal health indicators that facilitate overall wellbeing. Such interventions are those that promote a high quality of life, otherwise conceptualized as a "life worth living," and can consist of life activities that exist outside of traditional health care intervention. Despite the continuous rise of health outcomes in Canada, it is likely that the cost associated with thriving may reduce the likelihood that optimal health will be achieved by many. Previous studies have generated the cost of thriving calculated for a single individual living in the Greater Toronto Area and have found that the cost of thriving is below the median annual income for this region. In the current study, this framework has been applied to three additional communities in Northwestern Ontario. Results indicated that when costs of thriving in Thunder Bay, Sioux Lookout, and a small remote community were compared, costs of thriving were highest in more rural and remote areas. Given the limited availability of regional data, it was not possible to generate specific total costs for all communities in this review. Overall, health promotion and wellbeing approaches can be diversified by using evidence-based, strength-based health interventions. Such approaches can be offered in conjunction with traditional public health initiatives, to better foster individual-level health (through disease reduction) and wellbeing (such as promoting hope, belonging, meaning, and purpose) within community. [ABSTRACT FROM AUTHOR]