Running header: IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 1 It Matters to Me: Informing Youth Service Delivery for Surrey, BC By Heather O’Connor Lynch BA (Criminology), Simon Fraser University, 2009
An Engaged Leadership Project in partial fulfillment of the requirements for the degree of
Master of Arts In Leadership
We accept this Final Report as conforming to the required standard
Susan Thackeray, MA, Academic Supervisor Catherine Etmanski, PhD, School Director
Royal Roads University January 2020 ©Heather O’Connor Lynch, 2020
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Executive Summary The purpose of my ELP was for my project partner, Options Community Services Society (OCS), and myself to engage in an action-oriented initiative with adults who identify as youth allies for the purpose of informing a systemic change in how young people, ages 12–24, access youth services. Evidence in this study has demonstrated a need to encourage an overhaul in services delivery in order to better support young people of Surrey, BC. The goal of this project was to inform the design of a Youth Integrated Services Hub (YISH) through the lens of youth allies, which will eventually support a Foundry site(s) in Surrey. My engaged inquiry question was: How might OCS support youth allies in informing the vision of a youth integrated services hub for Surrey, BC? The subquestions were guided by Beckhard and Harris’s (2009) states of change that explored the current state, ideal state, and possible steps to creating change in the area of improving experiences for young people. My sub questions were: 1. What are the current conditions for youth accessing health services in Surrey? 2. How might a Surrey YISH improve young people’s accessibility to services? 3. What role might allies take to support a Surrey YISH? Research literature revealed that Surrey houses the largest youth population in the province, yet youth’s ability to access services when required proves to be a challenge for youth. Literature examined in my research supports a YISH as the preferred framework to supporting youth to experiencing healthy outcomes. Two methods were used in my research to gather information on designing a YISH for Surrey. The methods were a survey and focus group, which led to the research findings, conclusions, and recommendations. The findings, conclusions, and recommendation extracted from this research are listed in this table.
Findings 1. A warm, welcoming, safe, and
Conclusions 1. There is a need for a radical overhaul to the youth service delivery in Surrey, BC. 2. There is a need to support youth to access health services when they need it. 3. Inclusion of outdoor space is integral when planning spaces for Surrey youth. 4. People with lived experience have evidence-based knowledge that can inform the redesign of youth services for Surrey.
Recommendations 1. OCS to advocate for implementing quiet spaces in the design of a Surrey YISH to support mental and spiritual well-being. 2. OCS to continue supporting the Surrey White Rock Youth Integrated Services Collaborative and other steering tables that promote collaboration amongst service providers by encouraging the establishment of memorandums of understandings that eradicate agency competition. 3. OCS to inform community partners of the SWRYISC on the concept of a grandparent-in-resident program as an effective and efficient attribute to supporting youth. 4. OCS to share with SWRYISC the benefits of incorporating outdoor programs in the delivery of services.
nurturing, home-like environment that is inclusive to all youth, young adults, and their families of Surrey; 2. An integrated service site where providers genuinely collaborate and not compete; 3. A site where young people and their families can receive relevant, timely, and accessible services when they need it; 4. A need for trained staff that have experience working with youth; 5. A holistic environment where basic needs are met that incorporate social gatherings and recreational activities; and 6. A site that includes outside programing space.
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 3 The project partner and I discussed the recommendations, and we have established a strategy on translating the knowledge to key service providers including members of the Surrey White Rock Youth Integrated Services Collaborative. Knowledge will be shared through a PowerPoint presentation that includes a three-dimension design model of a Surrey YISH, based on the findings from project participants. Although f o ur recommendations came out of this project, many other ideas also surfaced, but due to project constraints I was not able to address those concepts in this paper. I have provided the encouragement for other researchers to conduct further exploration in the area of incorporating Indigenous culture, including housing, running a fine arts program, and having youth with lived experience inform and influence the delivery of youth services. My research project captured many design ideas for a Surrey YISH, but my project also experienced limitations and implications that should be taken into consideration if researchers are contemplating conducting studies using the suggestions put forward in this report. References Beckhard, R., & Harris, R. T. (2009). The change process: Why change? In W. W. Burke, D. G. Lake, & J. W. Paine (Eds.), Organization change: A comprehensive reader (pp. 687–698). San Francisco, CA: Jossey-Bass.
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Acknowledgement My engaged leadership project would not have been possible without the contribution of my project partner, Christine Mohr, Chief Executive Officer of Options Community Services (OCS). Christine’s dedication to modeling collaborative partnership and encouraging community initiatives that promote shared leadership amongst Surrey service providers was a key component to this research. I would also like to thank Tammy, Deputy Executive Director, my direct supervisor, for also supporting me through this journey. Youth, too, kindly created the space and resources for me to conduct research and also carved time out of their busy schedules to support my project. I would like to thank the inquiry team that supported my research, the OCS Youth Services team, that ensured my research tools would not incur harm on project participants; my Royal Roads colleague, Vanessa Lesprance, who assisted my project by vetting research inquiries; Diane Laverdure, a highly skilled facilitator, who created a safe and welcoming space for a focus group; and Cody Jaques, an amazing youth practitioner and community youth mentor, who supported the recruitment of research participants. I further would like to thank the amazing Royal Roads University faculty and all of my Royal Roads family, especially the Peacocks, for providing timely encouragement and also modeling the way of great leadership. Forgunity! Finally, I must create space to thank my incredible family and dedicated friends for supporting me through my research journey. I especially would like to express my love and acknowledgement for the patience of my husband during the long study nights and weekends, the cheerleading of my daughter Alexis and niece Tisha, and the comic relief and kind listening ears of life teams.
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Table of Contents Executive Summary .........................................................................................................................2 Acknowledgement ...........................................................................................................................4 List of Figures ..................................................................................................................................7 Section One: Focus and Framing.....................................................................................................8 Systems Analysis .......................................................................................................................9 Section Two: Significance .............................................................................................................11 Summary ..................................................................................................................................13 Section Three: Literature Review ..................................................................................................14 Youth Integrated Services Hub Approach ...............................................................................14 Youth with Government Care Connection ..............................................................................20 Summary ..................................................................................................................................23 Section Four: Engaged Approach, Implementation, and Knowledge Translation ........................24 Methods....................................................................................................................................24 Data Analysis ...........................................................................................................................28 Ethical Considerations .............................................................................................................28 Summary ..................................................................................................................................29 Section Five: Findings, Conclusions, and Limitations ..................................................................30 Findings....................................................................................................................................30 Conclusions..............................................................................................................................40 Limitations ...............................................................................................................................45 Summary ..................................................................................................................................45 Section Six: Next Steps: Recommendations and Implications ......................................................46 Recommendations....................................................................................................................46 Implications..............................................................................................................................48 Section Seven: Summary ...............................................................................................................50 References......................................................................................................................................52 Appendix A: E-Mail Invitation......................................................................................................59 Appendix B: Invitation Card..........................................................................................................61 Appendix C: Research Information Letter.....................................................................................62 Appendix D: Survey Preamble ......................................................................................................66
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 6 Appendix E: Online Survey Questions ..........................................................................................68 Appendix F: Inquiry Team Member Letter of Agreement ............................................................71 Appendix G: Focus Group Invitation Card....................................................................................73 Appendix H: Informed Consent Form ...........................................................................................74 Appendix I: Focus Group Guide....................................................................................................75 Appendix J: Focus Group Participant Surrey YISH Designs ........................................................77
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List of Figures Figure 1. Poor experiences accessing support in the last six months (N = 30)................................ 32 Figure 2. Current experiences of survey research participants within the last six months of either personally accessing youth services or supporting others in accessing youth services (N = 30). ............................................................................................................. 33 Figure 3. Desired location for a Surrey YISH as identified by survey respondents (N = 30). ........ 35 Figure 4. Services to be included in a Surrey YISH (N = 30). ........................................................ 37
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Section One: Focus and Framing The purpose of my ELP was for my project partner, Options Community Services Society (OCS), and me to engage in an action-oriented initiative with adults who identify as youth allies for the purpose of informing a systemic change in how young people access youth services. This shift in service delivery could lead to an improved experience for vulnerable young people transitioning to adulthood. For the purpose of this study, youth allies were identified as adults 19 and older who bring the lenses of former government care experiences, young people ages 19 to 24 who would be eligible to access the proposed youth service, parents and/or caregivers who have loved ones under the age of 25, youth service providers, and other youth-invested adults. The information and recommendation gathered in this research will be able to inform the development of a Youth Integrated Services Hub (YISH) initiative in response to Foundry BC’s call for applications. A YISH is a collaborative, integrated services approach that supports young people between the ages of 12 to 24 with a one-stop-shop, “no door is the wrong door” initiative to providing young people with primary care, mental health services, addictions support, life skills training, and other applicable services. Foundry BC (n.d.) is British Columbia’s (BC’s) preferred model of a YISH; it includes an integrated approach that is informed by youth, supported by families, delivered by community partners, and evaluated externally by an outside resource. In preparation to respond to Foundry’s anticipated call for proposals, OCS initiated the establishment of the Surrey White Rock Youth Integrated Services Collaborative (SWRYIC) in 2018. This collaborative table has 14 community agencies, including several-not-for profits, Fraser Health Authority, the Aboriginal Health Authority, the Surrey North Delta Division of Practice, the Ministry for Child and Families Development (MCFD), youth, and families. The leadership of this table includes four co-leads: (a) OCS’s Executive Director; (b) MCFD’s Director of
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 9 Operations; and (c) two youth, one with government care experience and one with mental health lived experience. The purpose of this table was to develop a strategy that would welcome at least one Foundry site for Surrey. My engaged inquiry question was: How might OCS support youth allies in informing the vision of a youth integrated services hub for Surrey, BC? The subquestions were guided by Beckhard and Harris’s (2009) states of change that explored the current state, ideal state, and possible steps to creating change in the area of improving experiences for young people. My sub questions were: 1. What are the current conditions for youth accessing health services in Surrey? 2. How might a Surrey YISH improve young people’s accessibility to services? 3. What role might allies take to support a SYISH? This ELP was focused on bringing youth allies together to inform the design of a Surrey YISH. I strongly feel that the findings in this project have contributed to a systemic shift movement on how young people, ages 12–24, access health services in Surrey. The hope was that this shift in service delivery would lead to better outcomes for young people, especially those with government care experience. Systems Analysis I currently manage the Youth Services department for my agency, and the youth teams I oversee offer key services to support youth and young adults in Surrey. Last fiscal, we provided approximately 100 youth with Youth Transitioning services (i.e., preparing youth for adulthood), 128 young people with youth justice support, 11 youth with subsidized housing, 38 young people with Life Skills services, and 1,100 children in our in-school and out-of-school prevention programming. We offer “GenWhy?” a youth TV program produced by youth and aired on Shaw
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 10 Cable (longest running Shaw cable show in Canada). We partner with the Federation for BC Youth in Care Network, a peer youth-led provincial organization, that supports government care connected young people (Youth in Care Canada, n.d.). In addition, we provide gang prevention and intervention services to youth and their families. This ELP was important to me because improving systems so young people can increase access to much needed services is a personal life-long mission of mine. Having a YISH in Surrey, such as Foundry, that is informed by community members such as youth allies would promote improved health support for youth and their families with seamless transitions to accessing services, safe and supported environments, and relationship-based care.
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Section Two: Significance In this section, I discuss the significance of how this ELP contributed to a systems change to the Surrey youth services system. The impact this project had on the Surrey community members, my project partner, and myself are also outlined in this section. The purpose of this ELP was to support a transformative system change for young people accessing youth support in Surrey, BC. Shifting to an integrated youth service delivery model encourages better experiences for young people between the ages 12–24 as they transition into adulthood (Graham Boeckh Foundation, 2019). Currently, Surrey has the largest youth population in the province, with 45% of its residents being under the age of 24 (Statistics Canada, 2017). There is a worldwide renown trend that adolescence are the most underserved group when it comes to accessing required services to support their health (National Research Council and Institute of Medicine, 2009). BC is not immune to this issue; it is estimated that 84,000 (70%) of our young people struggled with a mental disorder, such as anxiety, depression, suicide ideation, and others, yet were not able to receive required mental health support (Waddell, Shepherd, Schwartz, & Barican, 2014). In their strategic priority plan for 2018–2021, the Fraser Health Authority (2018) identified their commitment to supporting a more developed strategy in Surrey to support youth accessing health services. The combination of all this evidence led me to working with my project partner to explore the redesign of our current youth services system. The literature supporting this ELP and the data gathered through both the online survey and the focus group revealed an urgent need to implement a strategy that would significantly improve the current state of how young people access services in Surrey. Evidence informed the current state for our youth as bleak and hopeless if nothing changes (Nguyen et al., 2019). Evidence presented that the mental health crisis amongst youth continues is on a steady rise, with the highest
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 12 risked being government connected young people, youth who are involved in youth justice, LGBTQSS young people, and homeless youth (National Research Council and Institute of Medicine, 2009). This project supported a call for action that required a collaborative approach, which included the investment of influencers engaging in a community impact initiative. This project to project participants, myself, and the broader community. Project participants reported the benefits of coming together to support a cause that supported youth individually and impacted the improved health of our community. They also expressed that the project allowed them to forge new relationships with like-minded community members. The project was beneficial to OCS, for it allowed the agency to demonstrate effective systems-changed leadership by bringing together community agencies for the purpose of working collaboratively on a shared initiative. This resulted in strengthened relationships and trust amongst partners that historically competed for funding. Having a group of champions in one room for a few hours to engage in a knowledge exchange process through the sharing of experiences, offering wisdom, and developing recommendation on the design of a Surrey YISH was an honour and privilege for me to witness. To be privileged to contribute to global change has been an incredible experience that will forever be remembered. For the broader community, this ELP encouraged individuals with various lenses to contribute to a systems-change project. The information gleaned from this project supported Surrey with four Foundry applications by bringing the voice of youth allies to inform the design of a system that best supports young people to successful health outcomes. The change legacy formula that was captured in this project can be duplicated in other communities if they are
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 13 interested in engaging in a project that leads to systemic change for youth service delivery. Establishing a YISH in Surrey will support the transformational change movement in service delivery for youth 12–24 that is prevalent worldwide (Graham Boeckh Foundation, 2019). Summary In this section, I discussed the significance of how this ELP contributed to encouraging a redesign of services for youth. I also expressed the benefits that this project had on my project partner, me, and the community of Surrey.
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Section Three: Literature Review In this section, I review relevant literature on two topics that supported this ELP. Topics explored include a youth integrated services hub approach and also the outcome experiences of a vulnerable population: former youth who had government experience. Youth Integrated Services Hub Approach How and why a YISH would contribute to a transformational change initiative is the first topic explored. Surrey has become the fastest developing city in North America and the second largest city in the province, with close to 518,000 people calling Surrey their home (Statistics Canada, 2017). Included in this population are young people under the age of 24, which has contributed to 45% of Surrey’s population, making it the largest youth population in the province accounting for 13% of the youth population in BC (Statistics Canada, 2017). According to the research gathered by the Graham Boeckh Foundation (Ziemann, 2019), health issues increased amongst adolescents resulting in up to 21% of Canadian’s being diagnosed with at least one mental health illness. Over a span of 10 years, Canada has witnessed a significant increase of young people, between the ages of 5-24, reporting mental health issues (Frayme, n.d.). There was a 70% jump in Canadian youth reporting that they struggled with mental health challenges, and there was an increase of 56% in hospital admittance due to mental health related issues (Ziemann, 2019). Although evidence demonstrated a significant increase of health challenges amongst young people, there is a worldwide trend that the majority of adolescence do not access support (Canadian Institute for Health information, 2015). It is estimated that 84,000 (70%) of young people in BC have a diagnosed mental health issue, yet less than one third of this population accessed support (Ziemann, 2019). Also, reports have shown that 35% of young people between
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 15 the ages of 10 to 19 accessed the hospital as their first contact for addressing their mental health issues, which demonstrated that young people waited until there was a crisis before they accessed support (Nguyen et al., 2019). This delay of accessing services has led to an ineffective and costly health system (Canadian Institute for Health Information, 2015). Explanations as to why young people refused to engage in services has been attributed to issues related to accessibility of services, siloed systems, timely support, and a continuum of services through key transitions periods (Canadian Institute for Health Information, 2015). The combination of Surrey’s expanded population, increased mental health amongst young people, and a system that is riddled with barriers illuminated the need for me to examine Surrey’s youth health landscape and explore approaches that promoted ultimate youth health. One innovative way of supporting young people in receiving timely support is through the concept of including retired individuals in the youth service delivery. The outcome of an American study that examined five intergenerational programs that matched retired seniors who had experience working with at-risk youth, proved beneficial to both youth and elders (Freedman & Jaffe, 1993). Another study that came out of the United States examined another “grandparent” program that proved equally successful by demonstrating enriched connections to trusting adults, cost-efficient service delivery, increased resiliency and self-worth, improved developmental assets, and enhanced social skills (VanderVen, 2004). A team of UBC undergrad doctors acknowledged a need for a universal change in BC’s approach to supporting youth based on a coordinated service delivery model (Nguyen et al., 2019). Currently in Surrey, the approach has young people referred to scattered locations where family members (or care providers) are not incorporated in the service plans, and patients experienced long wait times to access urgent care support (Nguyen et al., 2019). Solutions tended to be solely
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 16 focussed on the child, where the primary care service provider rarely included the youth or their family in the care plan (Chovil, 2009). Focussed groups on the topic of Informing the Design of a YISH, that included 140 school- aged Surrey youth, reported challenges for youth accessing health supports were contributed to issues related to transportation, cost, the lack of awareness on how to access help, limited hours of services, stigma of engaging in services, and long waitlist (City of Surrey, in press). As a result, these young people shared that they are struggling with debilitating issues associated with depression, anxiety, and other mental health challenges. The implementation of a coordinated, one-stop-shop approach to supporting young people, where families are included as experts in the decision making, is the preferred evidence-based model that has been shifting the practices of youth service delivery in communities within BC, across Canada, and throughout the world (Ziemann, 2019). This worldwide system-change movement is based on the premise that services for youth are delivered in an integrated approach by multi-community service providers while empowering youth and their families to inform service plans (Chovil, 2009). This approach has also significantly impacted the issue of young people waiting long periods of time to access required (BC-IYSI Working Group, 2015). This approach has been practiced in various communities all over the world, such as Australia’s Headspace, Frances’ les des Adolescents, Ireland’s Jigsaw, New Zealand’s Youth One Stop Shops, United States’ Allcove Centres, Ontario’s Youth Wellness Hubs, and Foundry BC (Ziemann, 2019). All of these initiatives are categorized as youth integrated services hubs (YISH), which are guided by a universal framework. According to the BC-IYSI Working Group (2015), this framework includes:
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 17 1. Youth and family are involved in service delivery and inform the development of the hub. 2. There is an integration of community services that includes addictions, mental health, primary care, and social services. 3. Services are offered to young people ages 12–24, capturing significant life transition points (i.e., childhood to adolescence and adolescence to adulthood). 4. All sites have an evaluation component that measures progress and success of programming. A key component of the YISH is that it is a coordinated approach that includes traditional service providers (e.g., physicians, therapist, etc.), social service providers, and most importantly, youth participants with lived experience and their families informing the service design and delivery. A YISH model encourages community partners to work collaboratively and have a sense of investment in supporting the delivery of youth services (Guthrie & Guthrie, 1991). The key component of BC’s preferred model is to remove the competition amongst youth service providers by creating a process that encourages the ongoing development of relationship building (Foundry BC, 2018). Creating an environment where one agency takes ownership of an integrated process can result in other YISH agency team members removing their involvement in the project and directing their interest and time back to their home agency (Gardner, 1992). Creating a system change initiative that re-designs the delivery of youth services must include the engagement of youth with lived experience as a key ingredient to witnessing social change (Blanchet-Cohen, Mack, & Cook, 2011). This approach encourages a number of benefits, such as improved program effectiveness (Zeldin, 2000), increased sense of belonging amongst
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 18 young people (Shaw, Brady, McGrath, Brennan, & Dolan, 2014), and enhanced service plan outcomes (Carlson, 2006). Researchers have recommended several strategies to encourage youth and family engagement. Some of these strategies include: 1. Engaging young people and their families in service design and implementation to encourage services effectiveness. This includes the implementation of creative and innovative outside-the-box strategies in planning for the future (Ziemann, 2019). 2. Including young people and their families in decision making by incorporating them in all levels of the governance structure while creating safe place polices that do not incur harm. This would be achieved through sufficient mentorship and training that enhances inclusion (Shaw et al., 2014). 3. Engaging young people in participatory research that is ethically sound increases validity and relevancy (Zinck et al., 2013). 4. Creating partnership opportunities that promote equality between youth and adults who have a shared vision strengthens group dynamics (Carlson, 2006). Surrey youth have expressed that having a safe, barrier-free, welcoming site that includes quick response to services that support mental health, physical health, and spiritual health, delivered by caring professionals, is what Surrey youth require (City of Surrey, in press). These youth advocates further expressed that the design of this space should promote diversity, include outdoor spaces for gathering and sports activities, have quiet places that may include a waterfall, aromatherapy, and relaxing music to help young people destress. These sites must support young people with life skills and housing services to set them up for successful outcomes. In addition, youth shared that this space should welcome free training for parents to help support family
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 19 dynamics. Finally, youth in Surrey have expressed that developing services for youth should be established with them involved (City of Surrey, in press). Implementing a holistic approach encourages the focusing on a person’s strength and building resiliency amongst youth and their families (Clark, 2001). This could be established by supporting young people and their families with developing a fitness plan, establishing nutritional goals, addressing environmental issues, supporting positive relationships, discovering peace, finding purpose for life, instituting a consistent belief system, and promoting self-care (Clark, 2001). Evidence has demonstrated that there are benefits to including quiet spaces in youth service program designs (Spalding, 2003). The Quiet Place Project was implemented in several schools in England, and results demonstrated improved mental, physical, and spiritual health in at-risk young people. Also, libraries, known for offering quiet spaces, are still a popular resource accessed by young people today for they provide quiet environments that often cannot be found in their homes (Regalado & Smale, 2015). In addition to quiet spaces, incorporating the outdoor programing into youth services delivery can provide young people with positive outcomes on their mental and physical health (Eigenschenk et al., 2019). Connecting to natural land environment experiences not only increased physical and mental health benefits, it also promoted social benefits such as interpersonal development and reduction in criminal recidivism. Additionally, Metzgar (2012) supported that outdoor activity provides young people with “unique psychological and physical benefits” (para. 1) when compared to “traditional indoor” activities (para. 1).
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Youth with Government Care Connection The second topic supported respectfully including the voice of government-connected youth in this project. I gathered literature that described the realities of former youth in care (FYIC) and compared their experiences to their non-government-connected peers. Youth with government care experiences had poorer outcomes when they transitioned into adulthood compared to their non-government-cared peers (Healey, 2017). This phenomenon is not only exclusive to BC, but was a common theme experienced by FYIC across Canada and other places in the world (Healey, 2017). This stage in life, also coined as “quarter-life crisis” (Dewar & Goodman, 2014, p. 1), brought a reality of homelessness, poverty, addictions, parenting alone at a young age, dependence on the welfare system, conflict with the law, and health challenges. These realities are true to FYIC throughout the world (Dewar & Goodman, 2014). Evidence of this phenomena can be seen in Ontario (Tweddle, 2005), Europe (Dewar & Goodman, 2014), Australia (Mendes, Saunders, & Baidawi, 2016), and the United States (Hilliard, 2011). Tweddle (2005) shared that poor outcomes were contributed to a lack of family support, limited financial resources, underdeveloped life skills, non-completion of school, and a history of trauma. Due to these outcomes, it was imperative that government-connected youth inform the design of Surrey’s YISH (Hilliard, 2011). The experience of youth transitioning to adulthood, also known as “emerging adulthood” (British Columbia Representative for Children and Youth, 2014, p. 50), has been a milestone often greeted with excitement and optimism, especially if one has a strong support network. A newer trend in Canadian society finds that young adults have become more dependent on their parents and have been staying home until their late 20s (Vancouver Foundation, 2013). Parents have supported their children with food, rent-free living arrangements, transportation, and the
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 21 transference of wisdom to assist in their success during this transition period (McCreary Centre Society, 2016). According to Statistics Canada (2012, p. 3), 84.5% of young people stay at home well into their 20s, with 59.3% being between the ages of 20 to 24, and 25.2% of young people remaining at home between the ages of 25 to 29 years of age. Parallel to Canada, European young adults have been remaining at home up to the age 32 (Dewar & Goodman, 2014). This phenomenon of young people being supported by family seems to be a new normal, which may have been contributed to society’s high cost of living (Vancouver Foundation, 2013). Comparing non-government-connected young people to the 700 young people in BC who annually age out of government care, and for their 5,000 FYIC predecessors, was unparalleled. For FYIC between the ages of 19 to 24, life is often greeted with a sense of uncertainty, anxiety, and dreary outcomes (McCreary Centre Society, 2016). Evidence has shown that FYIC expect to earn $329,000 less than their peers over a lifespan (McCreary, Centre Society 2016). Researchers have described this transition as a “cliff edge” (Campo & Commerford, 2016, p. 22), where a young person who was raised in the care of the government was suddenly expected to be an adult who must manage their life independently with none or little preparation, training, or support (Healey, 2017; McCreary Centre Society, 2016). FYIC share a common thread across the world in comparison to their non-government- raised peers. These experiences include exposure to trauma before entering government care, mental health issues, and multiple disruptions such as multiple social workers and foster placements (British Columbia Representative for Children and Youth, 2014). In BC, researchers reported that young people with care experience averaged 9.5 housing placements as they grow-up in the care of the Ministry of Children and Family Development (British Columbia Representative for Children and Youth, 2014). Understanding that youth in care are at high risk of health issues
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 22 lends for an approach that supports this vulnerable population (Campo & Commerford, 2016). Researchers have recommended an integrated approach as the best model to supporting government-connected young people (Hilliard, 2011). Ashton (2017) explained that there is a need for the mental health system to provide targeted interventions that address more vulnerable populations. Currently, young people with care experience do not have catered mental health services that address their complex trauma and adverse childhood experiences (Ziemann, 2019). Adverse childhood experiences comprise a framework that predicts adult risk factors based on early childhood experiences. Researchers have identified young people with adverse care experiences as at risk based on their adverse childhood experiences score, which have contributed to poor health outcomes due to historic trauma (Felitti et al., 1998). Forty to 60% of young people had at least one psychiatric disorder combined with issues of depression and post-traumatic stress disorder, which is a rate double that of non-foster cared youth (Ziemann, 2019). Ziemann (2019) suggested (a) a coordinated continuum of care system that supports young people with complex issues past the age of 19; and (b) implementing non-government, community-based programing that supports young people with long-term positive adult mentorship that encourages a sense of belonging. In my ELP, I have encouraged a process that welcomed all community members, over the age of 19, to inform the design of a YISH for Surrey, yet intentionally recruited young people with former government care experience to ensure that their voice was present in the design. Evidence has determined that there is a crisis amongst the health of youth. There is a call for action for a system-wide change that supports young people to experience increased health outcomes. This shift in service delivery moves from a traditional siloed approach to a new design
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 23 of services delivery that includes the integration of a community-based, one-stop-shop service delivery that empowers youth and their families by embedding them in the design and includes an evaluative component that assesses the effectiveness of programming. In addition, this improved service delivery must be respectfully inclusive of the complex needs of vulnerable populations such as young people with care experience. Evidence has demonstrated that a YISH is currently the most effective approach to supporting youth to good health (BC-IYSI Working Group, 2015). Summary The two topics explored in this literature review included the experiences of young people who had formal government-care connections and the framework of a YISH. These two topic reviews were instrumental in supporting the findings, conclusions, and recommendations for this ELP.
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 24 Section Four: Engaged Approach, Implementation, and Knowledge Translation In this next section, I discuss the engaged approach, implementation, and knowledge translation of this ELP. Details of each topic are presented in this section. Methods The methodology chosen for this ELP was an engaged action-oriented inquiry, and I used two research methods to gather information. One method was a survey and the other was a focus group. The information gathered through both data collection methods was used to support the design of an arts-based product that would inform the vision of a Surrey YISH. Survey . I chose a survey method, as this approach provided quantitative data to support the study (Fowler, 2009). This method contributed to the triangulation of the research by supporting other methods to verify findings. The survey tool that I used for my ELP was SurveyMonkey (https://www.surveymonkey.com/), for it allowed respondents to remain anonymous while providing the opportunity to share their thoughts freely. SurveyMonkey is a global online survey platform, offered in various languages, where information is hosted in Canada. The survey was distributed to 50 community members on November 12 to individuals identified as adults 19 and over who have a strong interest in supporting Surrey youth. Each was sent an email invitation to participate in the research (Appendix A). A focus group invitation card was sent at the same time (Appendix B) as well as a research information letter (Appendix C). By clicking on the link in the invitation card, participants could access the online survey preamble (Appendix D) and the survey (Appendix E). The survey was closed on December 15, 2019. Thirty participants responded to the survey, resulting in a 60% response rate. The inquiry team reviewed and analyzed the anonymous data collected from SurveyMonkey. Prior to participating in the research, each team member signed a Letter of
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 25 Agreement (see Appendix F). The team organized the information into themes and patterns. I tested my survey on 16 youth service practitioners, which included young people who had care experience, to assist in mitigating any issues of potential harm. This process proved helpful, for a number of amendments brought to my attention strengthened my survey and resulted in a more user-friendly tool. Focus group . A focus group was my second method to gather information. I chose a focus group, as it is a method that brings a group of individual to engage in candid discussion on a topic of interest (Liamputtong, 2011). This method encouraged research participants to work collaboratively to provide an additional layer of data, which was used for triangulation and to increase the validity of the project. The inquiry team identified key individuals in their networks who had a good understanding of youth service needs in Surrey. Invitation letters were distributed to individuals 19 years and older (Appendix G), who had the capacity to sign a consent form (Appendix H). Potential group participants were informed that their goal was to generate data to establish recommendations to support a design product that would illustrate a YISH model product that would be used to support a Foundry application for Surrey. The invitation letter briefly provided an overview of the ELP, shared why they were identified to support this research, and explained that participation in the research was on a volunteer basis. The letter welcomed participants to complete the online survey if they chose. Potential group participants were informed that they had the opportunity to opt out of the group at any time. Letters included that information collected in relation to informing the design of a YISH would be recorded on paper. The letter also informed participants that their contribution in the research project was valued, appreciated, and may contribute to advocating for a change in the service delivery for Surrey youth.
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 26 Three members of my inquiry team were instrumental in organizing the focus group. One member, who had government care experience, was responsible for identifying and inviting up to six community members whom they considered a champion youth ally. Another inquiry team member, who was also an MAL colleague, vetted questions that research participants may have had prior to engaging in the group. Another member, whose training expertise was facilitating groups on Indigenous cultural competency and who was also a trained parent-teen mediator, was responsible for creating a safe and welcoming place for research participants with the inclusion of Indigenous land acknowledgement. As a way to reduce issues of harm, the group-based method was tested by a member of my inquiry team, who was a child and mental health therapist for a government agency. Focus group participants were encouraged to attend one 3-hour session and engage in a knowledge exchange dialogue for the purpose of informing the design of a Surrey YISH. The invitation explained that participants would enjoy a meal together as a way for group members to get to know each other and also to give a gesture of appreciation for their time. Participants were informed that bus tickets would be provided if required. The maximum of seven people rsvp’d to attend the focus group, which ended my recruitment process. Six individuals participated in the session (one confirmed guest did not show). The session was held in a private meeting room. Five focus group participants identified as having some government care experience, and one participant identified as a parent who supported their child who struggled with mental health issues. To remove any power-over issue and to encourage participants to speak freely, I did not participate in the session. To enhance participants’ engagement, several strategies were implemented. I recruited a skilled facilitator, who also had a history of facilitating groups that included vulnerable
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 27 populations. Her role provided added research triangulation and also verified findings. Other ways that encouraged engagement were through the intentional activity of welcoming group members, acknowledging Indigenous lands, and assisting the group in establishing group guidelines to create a safe and respectful session. Included in the initial focus group session was the reviewing of expectations, such as confidentiality, consent, and information storage (Appendix I). Copies of the Information Letter (Appendix C) were distributed so participants who were able to use it for future reference. Prior to commencing the focus group, participants’ signed informed consents were collected (Appendix H). The initial steps took 15 minutes to complete and also honoured the required ethical standards expected for this ELP. The next 10 minutes in the session consisted of the facilitator instructing participants to pair-up, introduce themselves, and respond to the first two questions provided in the Focus Group Guide (Appendix I). The listening partner took notes on the provided paper. After five minutes, the partners exchanged roles. After both completed their five minutes of sharing, all participants joined the larger group, and each participant had 30 seconds to introduce their partner and share their responses to the questions. Core values expressed amongst group participants comprised the only information captured during this part of the session. The facilitator than led the group to the second part of the session, which entailed answering the remaining questions as presented in the Focus Group Guide (Appendix I). Participants contributed their ideas to inform the design of a Surry YISH, which took approximately 2.5 hours to complete. Information was captured by drawings, and comments were recorded on provided paper or on a flip chart (please see Appendix J). The facilitator scheduled a short break for the research participants. For the last 30 minutes, participants were offered a catered meal together as a way to foster group dynamics and to appreciate research participants for
IT MATTERS TO ME: INFORMING YOUTH SERVICES DELIVERY 28 dedicating their time and wisdom for my project. Even though the lunch was scheduled for 30 minutes, participants stayed up to one hour engaging in conversations. Feedback shared from the participants was that they appreciated the aptitude of the facilitator who had created a space where participants felt safe to share experiences and information while she skillfully moved the group along the process of the session. Data Analysis Data from both the survey and the focus group were synthesized and analyzed by members of the inquiry team. This was achieved by me working with them to create themes and patterns from the research data. The enquiry team member, who was instrumental in gathering participants for the focus study, sent the established themes to members of the focus group to verify the accuracy of the established themes. The themes were used to inform research findings and conclusions. Research findings and conclusions were used by my research partner and me to develop research recommendations that informed the knowledge exchange, which is a PowerPoint presentation that includes an illustration of a Surrey YISH, based on the findings of the research. The recommendations established by this research were used by OCS to inform Surrey service providers who sit at the Surrey White Rock Youth Integrated Services Collaborative (SWRYISC) by providing recommendations on how to inform the redesign of services for Surrey youth. Ethical Considerations I ensured that I considered the core principles of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, & Social Sciences, & Humanities Research Council of Canada [Tri-Council], 2014) of “Respect for persons, Concern for welfare, [and] Justice” (p. 6). Project participants involved in this ELP were provided with an overview of
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