BackgroundAlthough high quality mental health care for children and youth is a goal of many health systems, little is known about the dimensions of quality mental health care from users’ perspectives. We engaged young people, caregivers and service providers to share experiences, which shed light on quality dimensions for youth mental health care.MethodsUsing experience‐based co‐design, we collected qualitative data from young people aged 16‐24 with a mental disorder (n = 19), identified caregivers (n = 12) and service providers (n = 14) about their experiences with respect to youth mental health services. Experience data were collected using multiple approaches including interviews, a suite of online and smartphone applications (n = 22), and a co‐design event (n = 16) and analysed to extract touch points. These touch points were used to prioritize and co‐design a user‐driven prototype of a questionnaire to provide feedback to service providers.FindingsYoung people, caregiver and service provider reports of service experiences were used to identify aspects of care quality at eight mental health service contact points: Access to mental health care; Transfer to/from hospital; Intake into hospital; Services provided; Assessment and treatment; Treatment environment; and Caregiver involvement in care. In some cases, low quality care was harmful to users and their caregivers. Young people co‐designed a prototype of a user‐driven feedback questionnaire to improve quality of service experiences that was supported by service providers and caregivers at the co‐design event.ConclusionBy using EBCD to capture in‐depth data regarding experiences of young people, their caregivers and service providers, study participants have begun to establish a baseline for acceptable quality of mental health care for young people.

The objective was to identify methods used to involve patients, family and service providers in child and youth mental health service improvement research. We analyzed the alignment of methods used with Experience-Based Co-Design (EBCD) methodology, and how power imbalances among participants were addressed. A systematic review of the English-language peer review literature since 2004 was carried out. The EMBASE, Scholar's Portal, PubMed, Web of Science databases and the Ontario College of Art and Design University libraries were searched electronically for variations of 'child', 'mental health', 'experience-based co-design', 'participatory research' and 'health care services'. Textual data was systematically extracted and analyzed. The electronic search identified 1468 articles; 13 remained following full text review and reference checking. Many participatory research studies in child and youth mental health were consistent with core elements of the EBCD methodology, but few focused on experiences and incorporated the perspectives of all participants throughout the research process. Story telling and visual media, employing youth as researcher partners, establishing equal status among participants, offering counseling support, paying particular attention to confidentiality, scheduling frequent breaks, and having skilled interviewers and facilitators were suggested methods to address power imbalances for this vulnerable population. Conclusion-The existing child and youth mental health participatory research literature aligns considerably with many elements of EBCD methodology and suggests diverse approaches to address power imbalances. More systematic application of the full range of elements will help to achieve patient centeredness and recovery in mental health and for other vulnerable populations.

Health disparities exist between indigenous and non-indigenous Canadians, an important source of which is a family history of RS attendance. This has implications for clinical practice and Canadian public health, as well as countries with similar historical legacies.

Photoelectron angular distributions (PADs) are obtained for a pair of 4s(1)4p(6)6p(1) (a singlet and a triplet) autoionizing states in atomic krypton. A high-order harmonic pulse is used to excite the pair of states and a time-delayed 801 nm ionization pulse probes the PADs to the final 4s(1)4p(6) continuum with femtosecond time resolution. The ejected electrons are detected with velocity map imaging to retrieve the time-resolved photoelectron spectrum and PADs. The PAD for the triplet state is inherently separable by virtue of its longer autoionization lifetime. Measuring the total signal over time allows for the PADs to be extracted for both the singlet state and the triplet state. Anisotropy parameters for the triplet state are measured to be β(2)=0.55 ± 0.17 and β(4)=-0.01 ± 0.10, while the singlet state yields β(2)=2.19 ± 0.18 and β(4)=1.84 ± 0.14. For the singlet state, the ratio of radial transition dipole matrix elements, X, of outgoing S to D partial waves and total phase shift difference between these waves, Δ, are determined to be X=0.56 ± 0.08 and Δ=2.19 ± 0.11 rad. The continuum quantum defect difference between the S and D electron partial waves is determined to be -0.15 ± 0.03 for the singlet state. Based on previous analyses, the triplet state is expected to have anisotropy parameters independent of electron kinetic energy and equal to β(2)=5∕7 and β(4)=-12∕7. Deviations from the predicted values are thought to be a result of state mixing by spin-orbit and configuration interactions in the intermediate and final states; theoretical calculations are required to quantify these effects.

Dispossession from social and ecological support systems is a major concern for many Indigenous communities. In response to community health challenges in these settings a number of initiatives such as youth mentorship programs have shown some value in enhancing adaptive capacity. The pilot Going Off, Growing Strong program provides opportunities for at-risk youth to engage in community- and land-based activities and build relationships with positive adult role models in Nain, Nunatsiavut (Labrador, Canada). This paper offers an interpretive description drawing from autobiographical accounts of the development of this innovative program. A collaboratively developed conceptual framework, based on the literature, is used to present and explain program operator’s experiences and rationale for program development. The emergent goals of Going Off, Growing Strong are to strengthen individual youth and collective community resilience through intergenerational exchange of land, social, and cultural skills and knowledge by drawing on social supports, such as a community freezer and experienced harvesters. We found that the process of collaborating over time with multiple stakeholders in creating this conceptual framework was an important one for solidifying the goals of Going Off, Growing Strong and creating context-specific, meaningful evaluation outcomes to enable future measurement of impacts on the community.De nombreuses communautés autochtones redoutent de se voir dépossédées de leurs systèmes de soutiens sociaux et écologiques. En réponse aux défis que pose la santé communautaire dans de tels contextes, un certain nombre d’initiatives, telles que les programmes de mentorat pour les jeunes, ont démontré une certaine valeur sur le plan de l’accroissement des capacités adaptatives. Le programme pilote Going Off, Growing Strong (« Sortir, grandir ») procure aux jeunes à risque des opportunités de s’engager dans des activités communautaires – et enracinées dans le territoire – et de nouer des relations avec des adultes jouant le rôle de modèles à Nain, au Nunatsiavut (Labrador, Canada). Cet article représente une description interprétative de l’élaboration de ce programme novateur à partir de récits autobiographiques. Nous utilisons un cadre conceptuel développé en collaboration et se basant sur de précédents travaux pour présenter et expliquer les expériences des acteurs et la raison d’être du développement de ce programme. Les objectifs émergents de Going Off, Growing Strong sont de renforcer la résilience des jeunes de la communauté au niveau individuel et collectif par l’intermédiaire des échanges intergénérationnels de compétences et de savoirs relatifs au territoire, à la société et à la culture, en se fondant sur des appuis sociaux tels qu’un congélateur communautaire et des chasseurs-pêcheurs...

Going Off, Growing Strong is a program for Inuit youth facing widespread social, cultural, and economic change. The overarching goals of the program are to: (1) enhance resilience and wellness; (2) build social connections for the youth; and (3) transmit traditional knowledge, skills, and values to participating youth.

Background In publicly funded health systems, digital health technologies are strategies that aim to improve the quality and safety of health care service delivery and enhance patient experiences and outcomes. In Canada, governments and health organizations have invested in digital health technologies such as personal health records (PHRs) and other electronic service functionalities and innovation across provincial and territorial health systems. Objective Patients’ access to their own information via secure, Web-based PHRs and integrated virtual care services are promising mechanisms for supporting patient engagement in health care. We draw on current evidence to develop an economic model that estimates the demonstrated and potential value of these digital health initiatives. Methods We first synthesized results from a variety of Canadian and international studies on the outcomes for patients and service providers associated with PHRs across a continuum of services, ranging from viewing information (eg, laboratory results) on the Web to electronic prescription renewal to email or video conferencing with care teams and providers. We then developed a quantitative model of estimated value, grounded in these demonstrated benefits and citizen use (2016-2017). In addition to estimating the costs saved from patient and system perspectives, we used a novel application of a compensating differential approach to assess the value (independent of costs) to society of improved health and well-being resulting from PHR use. Results Patients’ access to a range of digital PHR functions generated value for Canadians and health systems by increasing health system productivity, and improving access to and quality of health care provided. As opportunities increased to interact and engage with health care providers via PHR functions, the marginal value generated by utilization of PHR functionalities also increased. Web-based prescription renewal generated the largest share of the total current value from the patient perspective. From the health systems perspective, Canadians’ ability to view their information on the Web was the largest value share. If PHRs were to be implemented with more integrated virtual care services, the value generated from populations with chronic illnesses such as severe and persistent mental illness and diabetes could amount to between Can $800 million and Can $1 billion per year across Canadian health systems. Conclusions PHRs with higher interactivity could yield substantial potential value from wider implementation in Canada and increased adoption rates in certain target groups—namely, high-frequency health system users and their caregivers. Further research is needed to tie PHR use to health outcomes across PHR functions, care settings, and patient populations.

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