فرزندپروری نوجوانان از زمینه های قومی و فرهنگی: اسکن برنامه های مبتنی بر جامعه در کانادا برای ارتقاء بهداشت روانی نوجوانان

Objectives To i) describe current community-based programs across Canada to support parents for the promotion of adolescent mental health, with special attention to ethno-cultural populations; and ii) identify needs, gaps, and opportunities for the development of a framework to support parents for the promotion of adolescent mental health. Methods We conducted an internet-based cross Canada scan of community-based parenting programs that promote adolescent mental health in ethno-culturally diverse populations, followed by structured phone interviews with program staff. Findings were categorized according to audience (ethnicity/culture and age group), geographical distribution and coverage, and program type. Barriers to access and outreach mentioned by interviewees were documented. Results We found a total of 47 programs that met our search criteria. The greatest numbers were found in the provinces of Ontario, British Columbia and Alberta, particularly in the Greater Toronto and Vancouver Areas. Most programs consisted of psycho-educational, information-based workshops, support groups, or used innovative approaches (e.g., arts, alternative medicine, mentorship, and skillsdevelopment courses). Five programs (11%) had parent and youth components. From the perspective of service providers, cultural distrust, stigma, financial constraints and language barriers pose challenges to outreach. Program evaluations are limited and often not publicly available. Conclusion There are gaps in geographic coverage and types of programs available to parents for the promotion of adolescent mental health in ethno-cultural communities. Inconsistent and insufficient funding [and other forms of institutional support] detract from the capacity of community-based organizations to adequately support families and conduct, publicize, and evaluate their programs.

The prevalence of adverse mental health conditions among children and adolescents in Canada is estimated at 14%, representing over one million young people (Waddell, Offord, Shepherd, Hua, & McEwan, 2002). Anxiety, depression, behavioral disorders, and substance use are among the most common mental concerns (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003). Four-in-five psychiatric disorders emerge in adolescence (Leitch, 2007). Despite the prevalence and socio-economic cost of mental health conditions among young people in Canada (Leitch, 2007 and Waddell et al., 2002), only one-in-five children who need mental health services currently receives them (Morgan, Charalambides, Hutchinson, & Murray, 2010) and wait times are longer than proposed standards of care (Kowalewski, McLennan, & McGrath, 2011). It has long been established in research that parents can be crucial mediators of adolescent distress experienced in a community context (Brown et al., 2007, Powell, 1983 and Shochet et al., 2001). Parents play a key role in help-seeking for adolescent mental health, as well as supporting young people during treatment (Pineda and Dadds, 2013, Sayal et al., 2010, Viner et al., 2012 and Wahlin and Deane, 2012). Thus, recommendations from the Evergreen Child and Youth Mental Health Framework for Canada identify parents and caregivers as key stakeholders in the development and receipt of prevention and intervention campaigns (Kutcher & McLuckie, 2010). In addition, Canada is home to an increasingly diverse population. Twenty-four percent of the total population aged 15 and over were born outside of Canada and visible minorities constitute 16% of the total population. An estimated 23% of the latter are children aged 14 years and under, a higher proportion than the same age group for the total population (Statistics Canada, 2008). The migratory process and social determinants of health raise concerns about the possible mental health outcomes of child migrants (Beiser et al., 2010). A longitudinal study using the National Population Health Survey in Canada identified immigration status (foreign born versus Canadian born) as one of the factors that mediate the relationship between ethnicity and mental distress, and documented the highest risk of reporting moderate/high mental distress among those aged 15 to 24 years and in the low-income group (Pahwa, Karunanayake, McCrosky, & Thorpe, 2012). Studies with displaced and refugee youth, including those settled in Canada, have also documented socio-economic and mental health needs that require further attention (Kirmayer et al., 2011, Rousseau et al., 2000 and Tousignant et al., 1999). Social dislocation and isolation together with minority language, cultural and racial differences may compound the challenges of adjustment for these youths (Beiser et al., 2011 and Reed et al., 2012). A parallel may exist in the experiences of children adopted across national, cultural and racial lines. In Canada, Westhues and Cohen (1994) cautioned twenty years ago that while children in inter-country adoption generally benefited from the more advantaged social location of most of their parents, for some the experience of racism complicated their transition through adolescence. Similarly, in the U.S., where more of such research has been completed, some adolescents, particularly ethnic minority adolescents, bear the burden of additional chronic stressors that are inextricably linked to their social, cultural, and structural positions. Where poverty, neighborhood disorder, community violence, and racial/ethnic discrimination pervade daily life, the buffering effects of family may be compromised (Copeland-Linder et al., 2011 and Garbarino, 1985). In their study of contextual stress and health risk behaviors among African American adolescents, Copeland-Linder and her colleagues (2011) concluded that the more dangerous the neighborhood, the more common the symptoms of depression, anxiety, conduct disorder and other significant distress. Minority youths are disproportionately likely to reside in neighborhoods where stressors are pervasive and community assets including supports for mental health and family development are not (Acevedo-Garcia et al., 2008 and Shonkoff and Phillips, 2000). Whether the concern has been with aggressive and other externalizing social problem behaviors (Bannon and McKay, 2007, Obsuth et al., 2006 and Pepler et al., 2010), high risk activities including substance use (Srebnik, Kovalchick, & Elliott, 2002), adjustment to divorce and family reconfiguration (Zhou et al., 2008) or challenging parent–child communication, community-based services are noted for their contribution to parent engagement, normalization and de-stigmatization. The provision of services within communities of like others enables self-help and social integration as a component of clinical outreach and community development. Access to mental health services may be nonetheless complicated for immigrant and refugee youth due to language, stigma of mental health services, and lack of awareness of appropriate health and community resources (Ellis et al., 2011 and Saechao et al., 2012). There is accumulating evidence that caring, supportive parent–child relationships in childhood and adolescence protect against poor mental health and intimate relationships later in life (Elgar et al., 2013, Johnson and Galambos, 2014, Raudino et al., 2013 and Repetti et al., 2002). Interventions aimed at improving parent–child communication and quality relationships are also showing promising results in the promotion of mental health and the prevention of behavioral issues in children and adolescents (Morgan, Brugha, Fryers, & Stewart-Brown, 2012). Despite the critical role of strong parent–adolescent relationships in mental health promotion and prevention during adolescence, little is known about parental mental health education and support programs in Canada that address the parenting of adolescents particularly in ethno-cultural populations. Assuming therefore a relationship between community service development and the emerging needs of ethno-cultural youth and families, an environmental scan of agency practices was conducted to partially fill this knowledge gap. The scan was designed to profile community based, parent-involved programs currently available for the promotion of adolescent mental health in ethno-cultural communities in Canada, with attention to different types of programs, geographical location and coverage, ethno-cultural communities served, and barriers experienced by community-based agencies in supporting parents to that end. The central question was whether existing services had the capacity to achieve the objective of promoting adolescent mental health now and in the near future, from the perspective of service providers, given the context of diversification within Canadian society.

Some innovative programs exist in Canada to support parents for the promotion of adolescent mental health. Nonetheless, considering the increasing ethno-cultural diversity of the Canadian population, there is a lag in the provision of culturally safe and appropriate services to meet the needs of immigrant and refugee parents and their adolescents. Consequently, there are many who are not utilizing the mainstream services available even though they may require assistance with a variety of issues that affect their wellbeing and successful adaptation. Findings from this study revealed geographic gaps in service provision as well as limitations in the types of programs available to parents for the promotion of adolescent mental health. Our results call attention to the increasing need for funding and other forms of institutional support for the continued provision of services to an increasingly diverse population. More studies are needed to better understand the needs and resources of different ethno-cultural and migrant groups and to assess the effectiveness of existing interventions in supporting parents for the promotion of adolescent mental health within this population. Considering that adolescence is a period when many mental health problems and illnesses present themselves for the first time, parental support and mental health promotion initiatives during this life stage are crucial.