Charles James Frankish

Professor

Relevant Degree Programs

 

Graduate Student Supervision

Doctoral Student Supervision (Jan 2008 - May 2019)
Substance use and school connectedness among street-involved youth in British Columbia : a mixed-methods study (2018)

Street-involved youth face difficulties due to their precarious living situation. Substance use is higher among these youth compared to the general youth population. This study examines the relationship between street-involved youth and school connection on their problem substance use. Problem substance use was defined as using marijuana 20 or more times a month, binge drinking alcohol three or more times a month, and facing consequences from severe substance use.The study design was a two-step sequential mixed-methods approach, beginning with a quantitative analysis using probability profiling via logistic regression with 762 street-involved youth ages 12 to 18 who responded to the province wide 2006 British Columbia Street-Involved Youth Survey in Canada. The second step used qualitative interviews to collect qualitative data with street-involved youth enrolled in school the previous year and identified using substances. Themes were identified from their experiences with substance use while in school. The probability profiling analyses uncovered school connectedness influenced problem substance use differently for young women and men. The presence of school connectedness decreased the probability of Problem Alcohol Use from 32% to 17% for young men and provided a 25% overall reduction in probability among known risk factors. The probability of Problem Marijuana Use decreased from 33% to 18% for young women as school connectedness increased; school connectedness reduced risk factors by 18%. Consequences from Substance Use was marginally protected against for young women, but school attendance protected against consequences for young men by 12%, in the presence of known risk factors. The second step examined qualitative data collected from interviews with four young women and seven young men who were street-involved in Vancouver, Canada at the time of the study. The age for youth participation was 16 to 24; they must been in school for a month over the past year and used substances while attending school. The recruited youth were between ages 16 and 21. They said having one caring adult in school, participating in extracurricular activities, and attending schools with zero tolerance policies toward substance use were ineffective in reducing substance use or creating stronger connections to school.

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Planning for healthy and equitable communities in British Columbia : a critical analysis of the implementation of an equity lens in Healthy Built Environments initiatives (2016)

British Columbia’s communities, as settings in which we work, learn, and play, have a significant role in shaping our health and well-being. Recently, the provincial government has encouraged health authorities to join with local government planners to create local Healthy Built Environment (HBE) teams, so that they can work together for healthier communities. Within our communities, there are significant differences in health status that are unjust or unfair, and are rooted in underlying socio-political processes. International research suggests that we must reduce those inequities if we are to improve health for all. To help address health inequities, researchers have suggested that public health practitioners use an ‘equity lens’ in their day-to-day work. Yet implementing such a lens is challenging. This case study explored the implementation of an equity lens in HBE work in BC. The project examined the work of intersectoral HBE teams at the provincial and local levels, through an in-depth examination of HBE projects within three different BC communities. Data was collected through interviews, participant observation, and the collection of key documents, maps, and photographs. The main research question was: How is an ‘equity lens’ being implemented in association with Healthy Built Environments work in British Columbia? Influenced by the shifting strategic direction of the provincial government, HBE teams reported only limited progress in actively considering equity as integral to their work. The key elements of the implementation of an equity lens included targeting specific, ‘vulnerable’ populations and using community health data to monitor key outcomes. In general, however, the political will to more fully consider equity as integral to HBE work was just not present at either local or provincial levels. There was hope, however, in the form of champions, who worked to re-frame equity issues in more palatable ways, and the desire to explore new tools to better understand equity issues at the local level. There is also evidence of a growing desire within HBE teams to build meaningful, authentic, partnerships, consistent with a broad Healthy Communities approach. The development of those partnerships will be key to collectively building more just, inclusive, and healthier communities.

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Resilience in youth recently diagnosed with psychosis : a qualitative inquiry (2012)

BACKGROUND: Psychotic disorders are among the most disabling health issues affecting young people today. Clinical and psychosocial interventions are considered to have the most potential for preventing the disabling consequences of this illness during the first two to five years following the onset of a psychotic disorder. The development of interventions for this stage of the illness is partially dependent upon understanding how young people build resilience within the context of their daily lives. Yet, little research has been conducted on resilience particularly based on the narrative accounts of youth themselves.OBJECTIVE: To better understand how youth recently diagnosed with a psychotic disorder restore, sustain, and enhance their resilience (capacity to cope with adversity), and how aspects of the environment, and the activities they engage in, support and/or hinder this process.METHODS: Using a qualitative approach, combining grounded theory, narrative, and arts-based methods at different stages of the research process, 17 young people, between the ages of 18 to 24, diagnosed with psychosis within the past three years, were recruited from two Canadian mental health care settings: a specialized early psychosis intervention program and a general psychiatric service for street youth. Over the duration of 1 year, 36 individual interviews and three focus group meetings were conducted, supplemented by participants’ creation of biographical, literary and visual accounts. Prolonged engagement, methodological crystallization, transparency, and reflexivity enhance the rigour and trustworthiness of the findings. RESULTS: Data analysis led to the explication of normalizing-identity work, a psychosocial process that involves navigation towards and engagement in narrative practices and highly valued activities to enhance one’s normal sense of self and identity, in conjunction with the social, structural, and technological environment’s capacity to facilitate access to this process in meaningful ways. CONCLUSION: The findings illustrate that a key pathway through which participants sustain, restore, and enhance their resilience is engagement in identity work. The findings contribute to theoretical and empirical knowledge that further understanding of the phenomena of resilience, well-being, and psychosocial recovery in relation to youth recently diagnosed with psychosis, as well as offer practical implications for the specialized field of early psychosis intervention.

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An examination of the ethical decision-making processes used in decisions to fund, reduce or cease funding tailored health services (2009)

Health authority administrators were interviewed for their perspectives on what makes a good health care system; on tailored population-specific services as a way to address health inequities; and on how they perceive themselves to be making good funding decisions on the public’s behalf. The qualitative descriptive research dataset includes 24 hour-and-a-half long interviews with administrators from four BC health authorities, health region documents, memos, and field notes. Participants support the continuation of a public health care system and all participants acknowledge using tailored services as a route towards reducing health inequities. However, these identified services have not been evaluated for their overall effectiveness. When it comes to decision-making, participants describe using a series of governance and bioethical principles that help them frame what and how issues can be considered. Decision situations are framed in a way that informs them whether they need to use formal or informal processes. In both cases participants collect information that allows others to understand that they have made wise decisions. The Recognition-Primed Decision Model accurately reflects the intuitive processes that participants describe using during informal decision-making and portions of formal decision-making. However, in relation to formal decision situations, there is less alignment with existing Decision-Analysis literature. Seven practice and future research recommendations are provided:1. Increase health authority participation in intersectoral partnerships that address non-medical determinants of health.2. Develop new strategies for addressing health inequities. 3. Evaluate the efficacy of using tailored services beyond their ability to remove barriers to access. In addition, increase focus on testing new strategies for reducing the inequities gap.4. Enhance existing decision-making processes by including the explicit review of decision tradeoffs, value weighting, and mechanisms for requesting revisions. 5. Focus future research on developing and evaluating the usefulness of formal decision-making tools in health authority structures and their relation to decision latitude.6. Launch a longitudinal research study that examines how health authority expert decision-makers use judgmental heuristics and how they avoid the negative effects of bias.7. Commission public dialogue on shifting the current illness-based system to one that is wellness based.

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Understanding insight development in early psychosis : a narrative approach (2008)

Intervening early in the course of psychotic illness (e.g. schizophrenia) may significantly improve prospects for the recovery, both in medical and psychosocial terms, of the individuals who experience these conditions. Engaging such individuals in care, however, remains a challenge. One barrier to engagement is lack of insight, or the low illness awareness that is considered to be a typical characteristic of people who experience psychotic illnesses, particularly in their early phases.The dominant view of this phenomenon is that it is primarily related to the illness itself and thus is biologically based. There is reason to believe, however, that understanding the psychosis experience is also an interpretive process, and that the meaning of this experience for the individual arises out of dialogue between the person, mental health professionals and significant others. There is also reason to believe that the relationship between insight and recovery may not be as straightforward as presumed. While the dominant view sees insight as a crucial condition for recovery, emerging evidence suggests that insight once gained may lead to depression and demoralization. Insight thus may be understood as an interpretive, dialogical process that is fundamentally narrative in nature, the consequences of which may be divergent. Using qualitative methods (constructivist grounded theory complemented by narrative analysis), the present study sought to understand the process by which insight developed in early psychosis, and sought to explore the relationship between insight and the early stages of illness management and recovery, as reflected by the written and oral accounts of twelve individuals who were within the first three years of illness.Overall, the results suggest that insight development in early psychosis can be conceptualized as the process of coming to an acceptable, adaptive explanation. More specifically, the results first of all suggest that insight development involves finding or negotiating an account of illness that fits or can be accommodated with the individual’s own story of the psychosis experience. The process also involves finding an account of illness and its treatment that can be envisioned as a helpful rather than disruptive aspect of the individual’s future biography.

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Master's Student Supervision (2010 - 2018)
Oral health care related perceptions and experiences of homeless adults in Vancouver's downtown east-side (2016)

Background: Oral health problems are particularly prevalent among homeless adults in Vancouver. The extensive unmet oral health care needs (both clinically evaluated and self-reported) indicate the importance to understand homeless adults’ perceptions and attitudes towards use of oral health care to improve their oral health. The purpose of this research was to explore homeless adults’ perspectives on oral health and oral health care services through their experiences with the access to and use of oral health care services.Methods: A qualitative approach was taken and 25 semi-structured interviews were conducted with homeless adults in Vancouver in regards to their self-perceived oral health status and to their experiences of access to and use of oral health care services.Results: For the majority of the homeless participants, maintaining good oral health was important while they perceived their oral health to be poor. Participants reported a high need in oral health care and that many past experiences with oral health services were disappointing. As such, they described their unwillingness to visit dentists regularly because they feared that they would not receive appropriate oral health care services. In addition to the cost of care and lack of adequate public oral health services, the main concern of homeless adults’ were the indifferent attitude by dentists, and lack of information about the available oral health care resources.Conclusion: The study participants ranked oral health as important and perceived high need of oral health care services. The past experiences with dentists influence the participants’ behavior towards future use of oral health services. The study results suggest that the current state of affairs between oral health service providers and homeless adults is a divisive one filled with distrust, disrespect, and at times professional irresponsibility.

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Changing early child communities (2013)

Changes in the proportion of children vulnerable on the Early Development Instrument (EDI) over timecan be used to identify communities with an improvement or decline in its ability to foster healthychildren. Positive change communities had a significant reduction in the proportion of children in acommunity deemed vulnerable. Negative change communities had a significant increase in theproportion of children in a community deemed vulnerable. Communities exhibiting positive change fellabove the 83rd percentile on a composite of those SES variables found to correlate with EDIvulnerability, while negative change communities all fell below the 83rd percentile. Stable communitieswere those with no significant change in the proportion of children deemed vulnerable, and meaningfuldifferences were found between stable high and stable low vulnerability communities. This communitytypology provides a priority setting lens for where early child interventions may be most effective. Amethodology for identifying and analyzing a group of Early Child Development (ECD) communities ispresented. A heat map tool is created to synthesize all data relevant to community ECD. Communitystakeholders have to choose and evaluate best practices for providing a stimulating cognitive and socialenvironment for all children before they reach kindergarten. This includes universally targeted variationsof pre-kindergarten programs. New Investments would be required, but there would be a financialreturn to governments in future health, labor, and crime outcomes.

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Housing first and emergency department utilization among homeless individuals with mental illness in Vancouver (2013)

BACKGROUND: The purpose of this study was to evaluate the impact of Housing First at 12 months on emergency department (ED) use among homeless individuals with mental illness in Vancouver. METHODS: Homeless individuals with mental illness enrolled in the At Home/Chez Soi study were randomly assigned to a Housing First model of housing and support or Usual Care. ED data from St. Paul’s Hospital and Mount Saint Joseph Hospital were linked for 382 participants in Vancouver. Negative binomial regression was used to compare the Rate of Visits and logistic regression was used to compare the Presenting Complaints, Discharge Diagnosis, and Disposition for visits from participants in Housing First or Usual Care. RESULTS: 60% of all participants visited the ED at least once at 12 months and the annual Rate of Visits was 3.32 (SD=6.21). After adjusting for the baseline rate and other potential confounders, the Rate of Visits at 12 months was 0.66 times less (95% CI: 0.47-0.93) for Housing First participants compared to Usual Care. For all participants at 12 months, mental health and substance use-related reasons accounted for 30% of Presenting Complaints and 34% of Discharge Diagnoses. The majority of visits (87%) resulted in discharge from the ED, including 9% left against medical advice or without being seen, and 13% resulted in care advance. For Housing First participants compared to Usual Care at 12 months, the odds ratio for a mental health and substance use-related Presenting Complaint (OR=0.98, 95% CI: 0.64-1.51) or Discharge Diagnosis (OR=1.18, 95% CI: 0.75-1.86) was not statistically significant, nor was the odds ratio for a care advance Disposition (OR=1.21, 95% CI: 0.68-2.15). CONCLUSION: This study observed lower ED utilization for Housing First, consistent with findings from previous evaluations in other settings, which suggests that this model should be expanded for homeless individuals with mental illness similar to those recruited in this study.This study also observed that many participants experienced acute mental health issues resulting in visits to the ED, and visited the ED without receiving care, which suggests there are opportunities to improve care for this population in the ED and other settings.

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Urban revitalization and healthy public spaces, a critical discourse analysis (2011)

In the past decade, Vancouver’s Downtown Eastside (DTES) has been the target of the Vancouver Agreement and the DTES Revitalization Program – two programs aiming to revitalize the neighbourhood and create a healthy community. Planning interventions in public spaces have a unique position in this environment. Public spaces should be accessible to all; however, in the process of revitalization, low-income or otherwise marginalized residents are frequently excluded. The purpose of my thesis was to critically assess the way revitalization efforts in the DTES envision healthy public spaces and contribute to (in)equitable conditions in the area. I have done this by describing how the language used in urban revitalization planning compares to the dialogue of low-income residents in representing public spaces in the DTES. The use of language (i.e., discourse) contributes to understandings of places and their inhabitants. Features such as grammar and sentence structure reveal what issues are highlighted or suppressed, what assumptions are made, and how actions are justified. I used critical discourse analysis to analyze two sets of texts: 1) planning documents from the Vancouver Agreement and DTES Revitalization Program and 2) 6 interviews and 1 focus group with local residents on healthy and unhealthy places in their neighbourhood. My results show that while the planning texts present revitalization outcomes as uniformly positive (e.g., economic revitalization, participation, and visibility of public spaces), resident interviews highlight aspects that serve to marginalize individuals (e.g., displacing homeless people) or eliminate activities that currently fulfill everyday needs (e.g., buying goods from street vendors). The planning texts combine the goals of community health and increased economic activity in the DTES; however, interviewees separate these goals and identify ways they are incompatible. In this way, the planning texts do not acknowledge inequality, and low-income residents do not recognize revitalization’s purported benefits. Community health and local planning are connected, but the goal of improving health may not be compatible with some planning imperatives. This highlights the need to exercise caution in integrating health and planning efforts and ensure that community improvements are equitable, prioritizing people who need them most.

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