A cocreation process of a cultural adaptation of an integrated youth services in Québec (Canada).

PTH 6: Health Policy and Health Services 1, B307 (FCSH), September 4, 2025, 16:30 - 17:30AimsYouth who identify as im·migrants, refugees, racialized and/or belonging to a cultural minority group face significant physical and mental health challenges in Global North countries like Canada. This presentation showcases the preliminary evaluation results of a co-creation process aiming at culturally adapting youth services to the needs and aspirations of these youth. It focuses on the co-initiation and co-design phases of an intersectoral process involving multiple stakeholders - youth, parents, community leaders, practitioners, as well as researchers – in Quebec, Canada.MethodsThis study consists of a process evaluation method designed to analyse how co-created interventions are implemented and how they can be improved. Its main stages are co-initiation (ideation and launching), co-design (conception) and co-implementation (implementation of the co-creation process).It is anchored in critical and anti-racist approached to service and knowledge co-creation.ResultsPreliminary results show the potential of involving all concerned stakeholders in the co-creation of culturally adapted services. They highlight specific institutional challenges in engaging all concerned stakeholders in the co-initiation phase of the co-creation process. They also underline how the co-design phase of the co-creation process has potential to benefit stakeholders at the individual and organizational level.ConclusionsDespite facing additional challenges, youth who identify as im·migrants, refugees, racialized and/or belonging to a cultural minority group are underrepresented in youth services. In order to address this situation, better understanding and adapting services to their needs and aspirations is crucial. Co-creation appears as a promising process and methods to reach the goal of culturally adapting services.

Positive adaptation of immigrant youth in receiving societies is consequential for the well-being of the youth and for the prosperity of the receiving societies. Yet there is significant diversity in the adaptation of immigrant youth. The central question addressed in this chapter is this: “Who among immigrant youth does well and why?” To address this question, the resilience of immigrant youth is examined in the context of development, through the lens of culture, integrating acculturation and social psychological perspectives. For many years, culture was largely neglected in the study of resilience. Now there is growing recognition in research and practice of the pervasive influences culture has on concepts, measures, processes, and indicators crucial to understanding how people overcome challenges or risk to survive, recover, or thrive in life. Particularly in the context of migration, cultural perspectives are essential. Immigrant youth often navigate among conflicting values and developmental goals of home and receiving cultures, with the added challenges of discrimination. For immigrant youth, processes of development, acculturation, and cultural adaptation are highly intertwined. Thus, an integrated cultural and developmental science approach is vital to advancing knowledge on immigrant youth adaptation and its applications to support youth resilience.

Immigrant youth face heightened risks of substance use due to the stress associated with immigration and acculturation. While parental intervention can have a preventative impact on substance use, parents need to be well-informed about substance use and effective interventions that can prevent substance use among immigrant youth. Such interventions ought to be culturally sensitive, family-based, and targeted at the specific substances that are prevalent in a given context. Identifying and curating interventions that can empower parents in addressing substance use can help mitigate the risks that immigrant youth may face. This scoping review aimed to identify the types, characteristics, and effectiveness of family-based substance use intervention programs. Based on Arksay and O'Malley's guidelines, interventions included in the review must have met the following criteria: (a) was a family-based intervention aiming to prevent substance use; (b) targeted immigrant teens aged 12 to 17 years old; (c) was published in English; (d) originated from Australia, Canada, New Zealand, or the United States. The pinch table was used to synthesize included articles, after which studies were compared and categorized, and cross-cutting categories were identified. After screening 4551 searched literature, 13 studies that utilized family-based interventions were included in the review. All interventions were face-to-face programs, and most interventions involved parents and youth as participants. Eco-developmental theory and active learning strategies were used by multiple interventions. Given immigrant families were target stakeholders, both deep structure and surface structure cultural adaptations were utilized. Interventions increased parents' knowledge and skills regarding substance use prevention and delayed substance use initiation among youth. From the review, it was evident that parents are an essential element in any program aiming to prevent or reduce children's substance use. Besides information about substance use prevention, the curriculum also involves parenting and communication skills for parents to understand the protective effects of family. Effective family-based interventions for immigrant youth require attention to parenting and immigration stress, while also considering cultural adaptation. Future directions and limitations are also discussed.

Purpose – This chapter discusses the promise of and challenges to providing effective and culturally responsive trauma-focused mental health services to immigrant and refugee youth and their families within school settings. Design/methodology/approach – This chapter utilizes “practice-based evidence” to outline successes and address the barriers associated with the implementation of school-based, trauma-focused, evidence-based interventions in four immigrant or refugee-dense cities: Los Angeles, Chicago, Minneapolis, and Boston. Findings – Making cultural adaptations to identified trauma interventions that were consistent with community priorities, cultural norms, and values resulted in more accessible programs and greater engagement in treatment services. Practical implications – The strategies tested in these real-world settings contribute to the development of culturally competent trauma-informed services for immigrant and refugee youth and their families. Mental health providers and program developers will better understand the need for multilevel engagement strategies and for culturally driven modifications when employing evidence-based programs with immigrant and refugee youth. Originality/value – This chapter adds to the scarce evidence about useful methods to engage immigrant and refugee youth and families in treatment and to increase the likelihood of positive outcomes.

The purpose of this research study was to analyze therapeutic interventions offered to immigrant youth from an ecological perspective.The following questions were examined: (a) what therapeutic interventions are offered in ORR facilities for immigrant youth; (b) what therapeutic interventions are offered in school-based settings for immigrant youth; (c) what therapeutic interventions are offered in religious institutions for immigrant youth; (d) what factors (e.g., cultural competence, language barriers, staff training, facility resources) are associated with the accessibility and effectiveness of therapeutic interventions for immigrant youth; (e) are there significant differences in effectiveness of therapeutic interventions depending on the setting.This study employed a systemic review methodology that reviewed literature from the years 2000 through 2024.The databases used for this study were: ProQuest Social Services, JSTOR, Google Scholar, and EBSCO Information Services.Results concluded that school-based, trauma-informed cognitive behavioral therapy (CBT) programs are particularly effective due to their high rates of accessibility, cultural adaptation and integration in youth's daily environment.Religious institutions and family involvement in services also play unique and impactful roles.However, structural barriers like language access, institutional preparedness, and lack of culturally humble care persist, especially in settings like Office of Refugee Resettlement (ORR) facilities.This review calls for systemic reforms in social work policy, practice, and research to ensure immigrant youth receive equitable, holistic, and culturally grounded mental health support.

Social studies education is designed to provide a foundation for civic society. In this study we consider immigrant optimism theory within the context of U.S. secondary social studies to examine the civic potential of immigrant youth. Using a mixed-methods approach, we complement analyses of teacher and immigrant young adult interviews with national survey data to explore how adults’ expectations shape immigrant youths’ civic identity formation. Although immigrant parents consistently express high academic expectations of their children, teachers’ civic expectations emerged as a critical factor in immigrant youths’ civic development. While teachers and immigrant youth reported rich civic discourse in advanced social studies classes, we counter that limited social studies course taking may restrict exposure to teachers’ civic expectations, and result in the unrealized civic potential of immigrant youth. We close with a cautionary note regarding the limits of social studies to develop a transformative, emancipatory citizenry, especially among the increasingly diverse immigrant youth population.

Many Indigenous peoples around the world are disproportionately affected by mental health challenges, due to intergenerational and collective trauma stemming from historical losses and ongoing colonialism. A growing body of literature suggests that mental wellness initiatives are more culturally safe and result in more successful and sustainable outcomes when they are developed by, for and with Indigenous communities using community-driven approaches that prioritize and privilege Indigenous leadership, knowledge systems, beliefs and practices. However, knowledge has not been synthesized on mental wellness initiatives and the extent of community engagement during the development, implementation, and evaluation stages of these initiatives. The authors conducted a scoping review of studies on Indigenous community-based mental wellness initiatives to identify the (1) characteristics of these initiatives, (2) types of evaluation approaches (specific measures and assessment tools), (3) level of community engagement from inception to the evaluation stage of the initiative, and (4) lessons learned as identified by the authors. Published and grey literature were searched across several electronic databases. Inclusion criteria required that each study was published between January 2008 and June 2018, focused on Indigenous peoples and their communities in Canada, USA, Australia, and/or New Zealand, focused on a community-based mental wellness initiative, was meaningfully co-led or co-designed by the community, described the initiative and how it was evaluated, and was printed in English. The search yielded 1491 unique articles, and 22 of these articles met all of the inclusion criteria. All included studies took place in Canada, the USA, or Australia. Most mental wellness initiatives addressed general mental wellness, substance use, suicide prevention, and/or co-occurring conditions, and many were tailored for Indigenous youth. Culture-based initiatives were emphasized in most studies, with cultural adaptation and relevance prioritized in all initiatives. Approaches to evaluation ranged from process evaluations to outcome evaluations. Most studies used a mixed methods approach and a wide range of assessment tools, including questionnaires and indicators of community capacity building. Many evaluations used a shared leadership model between community leaders and researchers and had combinations of community members, families, Elders, Knowledge Keepers, and leaders involved in the development, implementation, and evaluation of the mental wellness initiative. Common challenges in conducting evaluation research included limitations of funding structures and the burden on community staff and leaders during the project. Overall, across all studies, culture stood out as a major theme for community-based mental wellness initiatives among rural and remote Indigenous communities, with cultural teachings, cultural activities, appropriate use of culture, land-based programming and knowledge sharing integrated into community programming. However, culture and Indigenous leadership throughout were lacking in many of the research studies. Thus, as more Indigenous communities and leaders govern and guide the development of evidence-based mental wellness programming, culture as a form of healing needs to be incorporated into the development of the program, and culture should be a core competency in any evaluation research.

INTRODUCTION Many Indigenous peoples around the world are disproportionately affected by mental health challenges, due to intergenerational and collective trauma stemming from historical losses and ongoing colonialism. A growing body of literature suggests that mental wellness initiatives are more culturally safe and result in more successful and sustainable outcomes when they are developed by, for and with Indigenous communities using community-driven approaches that prioritize and privilege Indigenous leadership, knowledge systems, beliefs and practices. However, knowledge has not been synthesized on mental wellness initiatives and the extent of community engagement during the development, implementation, and evaluation stages of these initiatives. METHODS The authors conducted a scoping review of studies on Indigenous community-based mental wellness initiatives to identify the (1) characteristics of these initiatives, (2) types of evaluation approaches (specific measures and assessment tools), (3) level of community engagement from inception to the evaluation stage of the initiative, and (4) lessons learned as identified by the authors. Published and grey literature were searched across several electronic databases. Inclusion criteria required that each study was published between January 2008 and June 2018, focused on Indigenous peoples and their communities in Canada, USA, Australia, and/or New Zealand, focused on a community-based mental wellness initiative, was meaningfully co-led or co-designed by the community, described the initiative and how it was evaluated, and was printed in English. RESULTS The search yielded 1491 unique articles, and 22 of these articles met all of the inclusion criteria. All included studies took place in Canada, the USA, or Australia. Most mental wellness initiatives addressed general mental wellness, substance use, suicide prevention, and/or co-occurring conditions, and many were tailored for Indigenous youth. Culture-based initiatives were emphasized in most studies, with cultural adaptation and relevance prioritized in all initiatives. Approaches to evaluation ranged from process evaluations to outcome evaluations. Most studies used a mixed methods approach and a wide range of assessment tools, including questionnaires and indicators of community capacity building. Many evaluations used a shared leadership model between community leaders and researchers and had combinations of community members, families, Elders, Knowledge Keepers, and leaders involved in the development, implementation, and evaluation of the mental wellness initiative. Common challenges in conducting evaluation research included limitations of funding structures and the burden on community staff and leaders during the project. CONCLUSION Overall, across all studies, culture stood out as a major theme for community-based mental wellness initiatives among rural and remote Indigenous communities, with cultural teachings, cultural activities, appropriate use of culture, land-based programming and knowledge sharing integrated into community programming. However, culture and Indigenous leadership throughout were lacking in many of the research studies. Thus, as more Indigenous communities and leaders govern and guide the development of evidence-based mental wellness programming, culture as a form of healing needs to be incorporated into the development of the program, and culture should be a core competency in any evaluation research.

Fostering sustainability by linking co-creation and relationship management concepts

BackgroundeHealth interventions have the potential to address challenges related to access, service engagement, and continuity of care in the delivery of mental health services. However, the initial development and evaluation of such interventions can require substantive amounts of financial and human resource investments to bring them to scale. Therefore, it may be warranted to pay greater attention to policy, services, and research with respect to eHealth platforms that have the potential to be adapted for use across settings. Yet, limited attention has been placed on the methods and processes for adapting eHealth interventions to improve their applicability across cultural, geographical, and contextual boundaries.ObjectiveIn this paper, we describe an adaptation framework and protocol to adapt an eHealth intervention designed to promote recovery and prevent relapses in youth receiving specialized services for first-episode psychosis. The Web-based platform, called Horyzons, was initially developed and tested in Australia and is now being prepared for evaluation in Canada.MethodsService users and service providers from 2 specialized early intervention programs for first-episode psychosis located in different provinces will explore a beta-version of the eHealth intervention through focus group discussions and extended personal explorations to identify the need for, and content of contextual and cultural adaptations. An iterative consultation process will then take place with service providers and users to develop and assess platform adaptations in preparation for a pilot study with a live version of the platform.ResultsData collection was completed in August 2017, and analysis and adaptation are in process. The first results of the study will be submitted for publication in 2018 and will provide preliminary insights into the acceptability of the Web-based platform (eg, perceived use and perceived usefulness) from service provider and service user perspectives. The project will also provide knowledge about the adaptations and process needed to prepare the platform for evaluation in Canada.ConclusionsThis study contributes to an important gap in the literature pertaining to the specific principles, methods, and steps involved in adapting eHealth interventions for implementation and evaluation across a diverse range of cultural, geographical, and health care settings.

BackgroundThree out of ten children in Germany have immigrant backgrounds and this proportion is expected to further increase in subsequent years. While immigrant youth have been found more vulnerable to developing symptoms of depression and anxiety, the underlying mechanisms of how such disparities unfold during youth development are still understudied. Some previous research has found that immigrant youth are at risk of experiencing a less positive self-concept compared to non-immigrant youth. We investigated whether the self-concept mediates mental health disparities and explored variability in such associations from middle childhood to late adolescence.MethodsOverall 1839 children and adolescents aged 6–21 years (M = 14.05 years, SD = 3.03, 49.8% female, n = 782 with immigrant status) participated in a cross-sectional self-report survey in classroom settings using scales from the Beck Youth Inventories II (Beck et al. in Beck Youth Inventories - Second Edition, Psychological Corporation, San Antonio, 2005) to assess self-concept and symptoms of depression and anxiety. Links between immigrant status, age, self-concept and symptom levels of depression as well as anxiety were examined using hierarchical regression and moderated mediation models.ResultsImmigrant youth reported higher symptom levels of depression and anxiety than their non-immigrant peers but did not differ in their self-concepts. Hypothesized moderated mediation models were not fully supported and self-concept neither mediated the link between immigrant status and depression nor immigrant status and anxiety. However, self-concept was a significant predictor for symptom levels of depression as well as anxiety, with stronger associations in adolescents.ConclusionsOur study substantiates previous findings that immigrant youth in Germany have overall increased symptom levels of depression and anxiety compared to non-immigrant youth. Our study however does not support that immigrant youth have a more negative self-concept and that the self-concept mediates such internalizing mental health disparities. Findings match previous evidence that developing a positive attitude towards the self is linked to better mental health. Beyond that, our findings suggest that mental health interventions addressing the self-concept could be especially relevant when targeting adolescents. Further research is needed to deepen the understanding of the mediating processes between migration status and mental health variables.

Background There is rising evidence that relationships that bridge between immigrants and long-time residents are critical to immigrant integration and to the overall heath of communities. The processes by which this bridging social capital is built are not well understood. Schools in new immigrant destinations, as spaces in which diverse youth come together, provide a unique opportunity to examine how immigrant and long-time resident youth connect to each other and build relationships. Purpose This article examines the processes of building relationships between immigrant and long-time resident youth and explores the meaning and consequences of these processes for the individuals involved. The article further suggests ways in which schools might adopt strategies to promote personal interaction, cooperative action, and collective identification to aid in the development of these relationships. Setting Lewiston, Maine is the setting of this study. Between February 2001 and May 2003, 1,200 Somalis arrived in Lewiston, a town of 35,690 people, 97.3% of whom were White at the time of the 2000 Census. Research Design Using the methodology of portraiture, this study examines, as an exemplary case, one relationship between two students: a Somali immigrant, and a White longtime resident. Portraiture is a methodology built on relationships, which mirrors the theoretical issues under investigation. Findings/Results This study provides new insights into how bridging relationships are built. The participants capitalized on the common space of their new immigrant destination school to transform casual personal interactions into a bridging relationship based on collective identification. Through dialogue, particularly about race, they challenged each other and themselves, and each came to understand the other in new ways; they also became invested in each other and dependent on each other to grow and to understand themselves and their places in a changing town. Conclusions/Recommendations The research identifies processes of personal interaction, cooperative action, and collective identification as central to the building of bridging relationships. It also reveals the necessity of a focus on race when researching, analyzing, or cultivating these relationships. Lessons for educators and schools seeking to foster relationships between immigrant and long-time resident youth include engaging students in direct dialogue about race and cultivating skills in empathetic storytelling and listening in order to “double-think,” or receive a counter-story.

ObjectiveWhile one in five women may experience mood and anxiety disorders during pregnancy and postpartum, Indigenous identity increases that risk by 62%, especially among younger Indigenous women. The need for evidence-based perinatal mental health interventions that provide culturally relevant well-being perspectives and practices is critical to improving maternal, child, and community outcomes for Indigenous peoples, and reducing health inequities.MethodsThrough a collaboration between community maternal and child health professionals, intervention researchers, and a cultural consultant, our workgroup developed cultural adaptations to Mothers and Babies, an evidence-based perinatal depression prevention intervention. Applying a cultural interface model, the workgroup identified existing intervention content for surface adaptations, as well as deep, conceptual adaptations to incorporate traditional teachings into this evidence-based intervention.ResultsThis collaboration developed a culturally adapted facilitator manual for intervention providers, including guidance for implementation and further adaptation to represent local tribal culture, and a culturally adapted participant workbook for Indigenous perinatal women that reflects cultural teachings and traditional practices to promote well-being for mother and baby.ImplicationsCommitting to a culturally respectful process to adapt Mothers and Babies is likely to increase the reach of the intervention into Indigenous communities, reengage communities with cultural practice, improve health outcomes among parents, children, and the next generation's elders, and reduce disparities among Indigenous groups. Replication of this community-engaged process can further the science and understanding of cultural adaptations to evidence-based interventions, while also further reducing health inequities. Future steps include evaluating implementation of the culturally adapted intervention among tribal home visiting organizations.

There is a pressing need for prevention programs that address increasing rates of epidemics and pandemics, including noncommunicable diseases. However, many populations face substantial systemic barriers to accessing traditional prevention programs. To minimize persistent service utilization gaps for underserved populations, the field requires effective, efficient, and sustainable methods to increase accessibility and cultural relevance of prevention programming to multiple audiences. Cultural adaptation is one such strategy, but it can be daunting for many preventionists. Therefore, this paper presents a step-by-step guide to streamline the cultural adaptation of prevention programs through digitization and use of a novel application of storyboarding methodology, called “blueprint storyboarding.” This innovative approach to cultural adaptation is designed to increase systematicity through manualization, efficiency, cost-effectiveness, and adaptability for multiple cultures and developmental stages. We illustrate this novel method by describing how we applied the blueprint storyboarding approach after digitization to culturally adapt the JUS Media? Programme, a food-focused media literacy program designed to buffer media-related obesity risks for diverse youth.

Human-centred design thinking as a co-creation process: A commentary.