Grant Charles

Youth of parents experiencing mental illness are overrepresented amongst homeless and street-involved youth. Understanding the relationship between parental mental illness and youth wellbeing within this population is vital to providing support. This study had two objectives. The first was to describe the lives of youth experiencing this crossover of homelessness and parental mental illness. The second was to determine the relationship between the number of parents experiencing mental illness that a youth has and their wellbeing. Youth with parents experiencing mental illness were at higher risk for relational, environmental, physical and mental health challenges than their street-involved peers who did not have parents with mental illness. Youth who reported both parents as having mental illness experienced the greatest difficulty, followed by youth with one parent with mental illness, then by youth with neither parent with mental illness, suggesting that the challenge experienced was incremental to the number of parents with mental illness. The only area of wellbeing where youth of parents with mental illness did not differ from their peers without parents with mental illness was in their school attendance and aspirations, as well as their thoughts on where they would be in the future, which were largely hopeful. As this population becomes known to front line workers, policy influencers, and policy makers, there is a need for further support that fits with their unique needs. The resources that the youth identified as needed in communities across British Columbia were safe and affordable housing, job training, food, mental health supports, and more. Acknowledging this population of youth experiencing the intersection of both homelessness and parental mental illness means bringing to light their prevalence as well as addressing their difficulties with appropriate and wanted services.

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Often, international engagement efforts are set in vulnerable communities where there is great potential to do good, but a significant potential to do harm, and there has been a call for higher attention to the many effects of volunteer presence and efforts when engaging with such communities. Recent attempts have been made to have honest discussions about the ethical implications for service abroad, but rarely are these discussions and resulting policy decisions directly informed by the nuanced, contextual perspectives of host communities themselves. When they do, often the conception of “community” does not adequately represent the diversity of stakeholders that form the community in question.This mixed methodological work explores how various stakeholders in one such community in Eldoret, Kenya respond to the question of what it is like to host young international volunteers. These perspectives were gathered over a three month period through interviews and a focus group.Findings 1) A need exists for a broader conception of “host”; 2) The voices of hosts and host communities are underrepresented throughout the literature and the volunteering process; 3) Current language used to describe the role of volunteers is the product of inequitable historical relationships, has adverse effects on process and outcomes, and needs to be adjusted; 4) Host fatigue is a significant factor in adversely affecting outcomes of volunteer placements; 5) Resistance and dissent in volunteer encounters present differently than volunteers might expect; in Kenya, they often present as withdrawal, silence, slowness to respond, bearing the hardship, and much less commonly as direct confrontation, and; 6) Volunteer activity must be factored into what constitutes the social determinants of health of a host community when we try to learn about that community and the issues it faces. Suggestions are made for improving outcomes for volunteers, hosts, and sending organizations.

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Background:While the health system in Canada recognizes the need for comprehensive cancer care, barriersmust be overcome to achieve this goal. One is improving how professionals work together. Thisstudy explores social workers’ and counsellors’ experiences offering psychosocial cancer care aspart of a cancer system that prioritizes medically related cancer care. My study objective is toincrease understanding on how the health care system can better support team-basedapproaches in providing psychosocial cancer care for families faced with cancer.Methods:I explored, through a generic qualitative research methodology, the experiences of eight socialworkers or counsellors who utilize team-based approaches in psychosocial cancer care. Using asemi-structured interview approach, I asked each participant to describe their experiences withteam-based approaches in cancer care.Findings:Findings are presented using the ecological systems perspective, with the themes representingmicro, mezzo, and macro level facilitators and barriers to psychosocial cancer care within ateam-based approach. The overarching theme identified by participants was the need forbuilding authentic and close working relationships with their colleagues. At a micro level,relationships between cancer care providers was identified as an asset when working in anoncology setting facing larger system influences that detract from offering psychosocial cancer care. Within this overarching theme participants described the following mezzo and macrofactors in facilitating or detracting from team-based approaches in offering psychosocial care:flexible infrastructure and resources, space, staff availability, medical dominance, and limitedtime and resources.Implications:Exploring team-based approaches in psychosocial cancer care is understudied in oncologyand health system research. This study may fill some of this knowledge gap, specifically byhighlighting the need for authentic and close relationships with colleagues especially in times of high and demanding workloads within an emotionally fatiguing work environment such asoncology. The participants’ experiences mirror the challenges identified in psychosocialoncology in Canada and future research may expand this study by developing theoreticalframeworks for team-based approaches within a psychosocial oncology context, and bytranslating theory into cancer care practice that addresses the needs of mind, body, and soul.

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Background: Unsafe injection practices remain a significant source of morbidity and mortality among people who inject drugs (IDU), this thesis sought to: review the literature outlining the ways in which people inject unsafely, the health consequences associated with unsafe practices, the factors that influence injection practices, and the interventions that have been designed to address these problems; describe a drug user-led safer injecting education campaign; and finally, examine the facilitators’ and participants’ perceptions of a unique user-led intervention.Methods: Qualitative data was derived from semi-structured qualitative interviews conducted with eight members of the Injection Support (IS) Team who developed and facilitated a series of safer injecting education workshops and 20 individuals who participated in these workshops. Interviews were transcribed verbatim and a thematic analysis was conducted.Results: A literature review identified numerous specific unsafe injection practices, which are associated with negative health outcomes, including HIV, hepatitis C, bacterial infections, and venous damage. Research demonstrates that various individual, physical, social, and structural factors influence injection practices, and has identified a number of interventions (e.g. syringe distribution, education) that reduce negative health consequences. Results indicate that IDU typically learn about injecting by watching or sharing experiences with other IDU and that significant gaps in knowledge regarding safer injecting practices persist. Accounts of IDU suggest that the unique process and structure of IS Team workshops enabled effective communication of information about safer injecting practices, while targeting the unsafe practices of workshop participants. Facilitators’ identity as IDU enhanced their ability to relate to workshop participants, most of whom expressed that they prefer user-led interventions to other approaches. Facilitators reported gaining knowledge, skills, and positive feelings about themselves from their involvement in the campaign, while many participants reported that they acquired new knowledge that would alter their future injecting practices.Discussion: The IS Team education campaign focuses on health issues relevant to IDU that are not being adequately addressed by existing public health programs. This study demonstrates the feasibility and benefits of involving IDU in educational initiatives targeting unsafe injecting. Increased involvement of IDU in interventions designed to address unsafe injecting is urgently required.

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According to a 2009 Canadian national health survey approximately 12% of children under the age of 12 live in a household were the survey respondent reported one or more mood, anxiety or substance use disorder (Bassani, Padoin, Philipp & Veldhiuzen, 2009). In fact, one out of every five individuals will experience a mental illness during their lifetime. It is widely accepted that people who experience mental illness parent at the same rate as the general population. Numerous studies have explored the topic of children of parents with a mental illness. Early research focused on understanding the adverse effects on children and specifically on identifying risk for childhood psychopathy. More recently researchers have begun to explore the positive aspects of growing up with parental mental illness in light of children who are seen as demonstrating considerable resiliency. Strength-based aspects to the experiences of growing up as a child of parental mental illness have been included in some studies. The goal of this exploratory qualitative study was to explore the experiences of adults, who as children, grew up with a mentally ill mother and/or father. The method used included recruiting study participants using purposive sampling. The data collection and analysis was informed by grounded theory including a constant comparison of interview data and data analysis. Findings in this study supported previous research related to growing up with parental mental illness. Experiences of study participants were also similar to findings in existing research. Unique findings that would be worthy of further exploration included experiences of growing up in a two parent family with a father with a mental illness. Significant challenges with transitioning from adolescence to young adulthood were found across many of the interviews. The process of making meaning of experiences growing up in a family with parental mental illness as study participants experience their own significant life events was also found. These findings can inform policy and practice working with individuals and families who experience parental mental illness.

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