Skye Barbic

Background. Seventy-five percent of people with mental health disorders have an onset of illness between 12 and 24 years old. Many in this age group report significant obstacles to receiving quality youth-centred mental health care services. With the rapid development of technology and the advent of the COVID-19 pandemic, mobile health (mHealth) presents new opportunities for youth mental health research, practice, and policy. Methods. This multi-methods research project includes a scoping review that assesses the current landscape of mHealth intervention in the field of youth mental health. To understand mHealth usage in the real world, I used a quantitative approach to analyze service access and utilization data across three delivery modality groups at a local integrated youth services (IYS) setting over a 4-year period (2020–2023). This quantitative analysis informed two qualitative studies guided by both inductive and deductive approaches. We investigated the perspectives of stakeholders on mHealth integration and meaningful youth engagement in its design. Data were gathered through semi-structured interviews. Results from all studies informed recommendations for mHealth practices and policies.Results. The scoping review revealed rapid growth in mHealth interventions but highlighted significant gaps in youth-centred design, equity, and engagement. Quantitative findings demonstrated patterns of service utilization across three modalities, with hybrid models showing potential for increased accessibility. Qualitative analyses identified critical facilitators and barriers to mHealth integration. Youth engagement emerged as a pivotal factor for sustainable mHealth development, the key to its implementation was identified using the consolidated framework of implementation research. In my summary chapter, I synthesize the findings from all studies and propose next steps for research, practice, and policy.Significance. For youth navigating mental health challenges and technology reforms, mHealth spaces can be exciting but have potential risks. There is an imminent need to understand how to engage youth to design safe and effective tools to deliver high quality care. The goal of this work is to generate new knowledge that provides evidence to support youth mHealth best practices, standards, and health policies in Canada and beyond.

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Mental health challenges are the leading cause of disability in youth worldwide. In Canada, mental health challenges affect one in five youth by age 24. When youth activate mental health services, they reduce their likelihood of experiencing problems later in life, yet less than 20% of youth with mental health challenges are accessing these services. This gap is largely attributed to a lack of comprehensive, well-designed health care services to meet the needs of this age group effectively. Canada’s mental health strategy identifies peer support as an essential component of mental health services. However, the majority of peer support research has focused on adult populations. Largely missing from the literature is an understanding of peer support in a youth mental health context. The purpose of this research was to learn from experiences of peer support at an integrated youth services (IYS) organization in British Columbia (BC), Canada. This study utilized interpretive description methodology and a research community partnership model. Data were collected from IYS centers across BC in urban, rural, and Northern settings. Qualitative, semi-structured interviews were conducted and analyzed to examine how peer support is experienced by: youth peer support workers (YPSWs), service providers, and youth recipients of peer support. Findings are presented within each group of participants. A discussion of similarities and differences across groups illustrates key priorities to advance youth peer support in a meaningful way. Four recommendations to guide IYS organizations in strengthening their youth peer support services are provided: 1) Standardize YPSW hiring and onboarding processes across the IYS network; 2) Establish senior peer support roles and regional peer support practice leads; 3) Implement an evidence-based model of supervision for YPSWs; and 4) Increase the availability and accessibility of YPSWs across BC. Strategies to achieve each recommendation are discussed. As the need for mental health services for youth continues to rise, developing and implementing recovery-oriented and evidence-based interventions is crucial. This study aimed to generate new knowledge to optimize and scale peer support at IYS organizations and to guide broader policies for mental health services offered to youth and by youth in BC, and beyond.

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Background: The co-occurrence of opioid use disorder (OUD) and mental illness is common and may lead to poor negative health and social outcomes, as compared with having either illness alone. The body of evidence pertaining to best practices in person-centred care for those with concurrent OUD and mental illness remains in its infancy. The objective of this project is to generate evidence to guide improvements in the provision of concurrent OUD and mental health care for this population.Methods: This mixed-methods project begins with a rapid review which assesses the current landscape of health-related measurement for this population and provides recommendations for empirical work. For the empirical work, first, data were derived from two longstanding prospective cohort studies of people who use unregulated drugs. The impact of various factors on receipt of concurrent OUD and mental health care from a single provider were examined using generalized estimating equations. Second, guided by an interpretive descriptive methodology, data were collected via semi-structured interviews with physicians and persons with lived experience (PWLE). Findings were derived in a series of iterative steps including thematic analysis, as well as theme interrogation, and reflection on plausible associations or affiliations. Results: This project highlighted key concerns with current health-related measurement practices and identified strategies to improve the quality of and opportunities for health-related measurement among this population. It identified factors which may delay or inhibit receipt of concurrent OUD and mental health care from a single provider including daily non-injection opioid use and experience of a non-fatal overdose. It then drew attention to various concerns with the present quality of care currently being provided to individuals with a concurrent OUD and mental illness. This thesis also identified strategies that may ensure the provision of high quality, evidence-informed care for this population. Conclusion: Amidst North America’s worsening overdose crisis, a coronavirus pandemic, and an era where mental health has been increasingly threatened, findings from this project offer critical insights to help guide future research, policy, and practice decisions in an optimal way to support improvements in outcomes of persons living with concurrent OUD and mental illness.

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