2016 International Early Psychosis Association (IEPA) 10th Biennial Conference: Milan, Italy. October 2016. Poster Presentation CHENG C, NADIN S, KATT M, LEM C, DEWA CS, MINORE B Acknowledgements: The NorthBEAT Project was funded by the Sick Kids Foundation in partnership with CIHR. Attendance at this conference is supported by St. Joseph’s Care Group Thunder Bay.

1. Final framework from narrative interviews to explore the needs of youth in
remote/northern Canada
Youth in rural Canada face similar barriers to EPI as their urban
counterparts (e.g., lack of knowledge about psychosis and
psychosis services). They share many of the needs perceived by
urban youth (e.g., psychosis education, reduced stigma, shorter
wait times, EPI specific services).§
The analysis resulted in two global themes:
“North: Barriers to Early Assessment and Treatment” (Figure 1) and “What Rural Youth Need” (Figure 2).
QUALITATIVE APPROACH
RESULTS
CONCLUSIONS
Cheng, C.1,2,3
; Nadin, S.1,3
; Katt, M.3
; Lem, C.1
; Dewa C.S.4
; Minore, B.3 1. 2. 3. 4.
Youth
(n=18)
Family
caregivers
(n=11)
Service
providers
(n=14)
Rural youth face additional barriers that are unique to their
geographical contexts (e.g., travelling far to services, lack of
resources in rural/remote communities). Indigenous youth in rural
areas face additional barriers of double stigma and mistrust of
the healthcare system due to colonialization and racism.
The thematic analysis and frameworks represents initial steps to understanding how
to decrease the barriers to early assessment and treatment, and meet the service
needs of youth who experience psychosis in rural areas.
Acknowledgements:
The NorthBEAT Project was funded by the Sick Kids Foundation in partnership with CIHR. Attendance at this conference is supported by St. Joseph’s Care Group Thunder Bay.
References:
*: Statistics Canada. 2013. North West (Health Region), Ontario, North East (Health Region), Ontario and Ontario (table). Health Profile. Catalogue no. 82-228-XWE
2007. North East Health Integration Network, Ontario (Code3513) (table) and North West Health Integration Network, Ontario (Code3514) (table). Catalogue no. 92-591-XWE.
+: Attride-Sterling, 2001
§: Anderson et al.,2013
Next steps for NorthBEAT include
the development, implementation, and
evaluation of online learning modules to
educate non-specialist service providers
about psychosis and psychosis services.
For more information, visit: www.chicheng.ca
Semi-structured telephone
interviews were conducted
with youth ≤18 years old
who have experienced
psychosis, their family care-
givers, and rural mental
health service providers.
1:
Purposive sampling:
convenience (youth
& caregivers) and
maximum variation
(service providers)
techniques.
2:
Verbatim transcripts were content
analyzed using a thematic networks
approach.+
Thematic maps were drawn
to illustrate the inductively derived
themes. The results were validated
through workshops with project
participants and stakeholders.
3:
Aims:
• To understand how youth in Northern Ontario
experience early psychosis and services for psychosis;
• To understand what are the barriers to receiving
appropriate EPI;
• To examine Indigenous youth as a significant and
vulnerable population in Northern Ontario.
BACKGROUND
NORTHERN
ONTARIO
Northern Ontario (rural Canada) is an area with a vast geography, scarce
population and many Indigenous communities, and where EPI programs
struggle to understand and meet service needs. *
Research Question:
What are the perceived service needs of Indigenous and
non-Indigenous youth in Northern Ontario who experience
first episode psychosis?
(Barriers to Early Assessment and
Treatment) is a 3-year, descriptive, mixed-method project
that explored the service needs of youth in Northern Ontario.
Population:
786 290
Land mass:
802 396.28 km2
6%
of Ontario’s
population
90%
of Ontario’s
landmass
32%
of Northern Ontario’s
population is rural, vs
14% in Ontario overall
2 out of 50
of Ontario’s EPI programs
service the entire region
6x
the Indigenous population, as
compared to the rest of Ontario
(15% vs 2%)
View related presentations:
www.slideshare.net/drcheng
Indigenous
Cultural
Context
Lack of
Knowledge
about Psychosis
An Isolating and
Disconnected
System
Geographical
Context
“Help” Not
Wanted (Youth/
Family refuse/
disengage from
EPI services)
NORTH
Barriers to Early Assessment & Treatment
Psychosis
Signs/
Symptoms
“Missed”
(denied/
ignored/not
recognized by
youth or family)
Psychosis
Signs/
Symptoms
“Missed”
(denied/
ignored/not
recognized by
youth or family)
Need for
Psychosis
Education
The “system” is
disconnected and
incomprehensible
Isolating Service
Mandates and
Eligibility Criteria
Lengthy Referral
Processes & Wait Times
Lead to Longer DUP’s
Mistrust of
Healthcare
Providers
Double Stigma
(Indigenous -
Mental Illness)
Rural/Remote:
Few
Resources
Distance is a
Barrier
Social
Determinants
of Health
The “Right”
Door
Family
Suport
Reduced
Stigma
Intervention
before Crisis
What Rural Youth Need
Emergency
Department is
not the Right
Place
A Connected
and
Knowledgeable
System
Access
to Child &
Adolescent
Services
The
Important
Role of
Family
Family Need
Support
in Their
3-Pronged
Fight
To Belong &
Be Believed
A Safe,
Welcoming,
Comfortable
Environment
EPI
Approach
Psychiatry
(Medication)
Recovery
Focus
Providing EPI
isn’t a Solo
Sport
Trusting &
Engaged
Clinical
Relationship
Psychosis
Education
Intense Case
Management
Getting to an early
intervention worker
is not always
possible depending
where you live.
Service Provider
I probably could
have used the
help when I was
13 years old.
Youth, 16
You’re looking at
a bunch of white
people who don’t
know what you’ve
been through and
don’t care.
Family Member
It’s a slow system,
really slow… Like
she’s [my daughter]
asking for help right
now. They should
seize the moment
and say:
Yes, we will help you.
Family Member
Sometimes I feel like
I’m doing it all alone.
So sometimes it
would be nice just to
have somebody to
talk to.
Family Member