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Isabelle Abdul-Rahman, MA
Background: In Canada, immigrants make up 20% of the population, of whom 4% are newly settled (Statistiques Canada, 2013). Faced with systemic barriers, some immigrant families are more at risk of experiencing parental challenges that can have a detrimental impact on their children’s development (Vatz-Laaroussi & Bessong, 2008). In 2004, a home visitation program was implemented by the government of the province of Quebec to support the healthy development of children aged 0 to 5 years from vulnerable families (MSSS, 2004). To take part in the program 1) the mother has to be 19 years or younger or 2) she must have a low socio-economic status (poverty and low educational level). Transcultural clinical literature however shows that these criteria may not apply to immigrant families (Hassan et al., 2011) and thus may constitute barriers to access care. Objectives: The aim of the current study is to identify factors of vulnerability specific to immigrant families and potentially revise the program eligibility criteria. Methods: A sequential mixed-method research design was developed in order to identify vulnerability profiles among immigrant families enrolled in the program in 2011-2012 in two Centres de Santé et de Services Sociaux in multiethnic neighborhoods in Montreal. In step 1, descriptive statistical analyses were conducted on a sample of 287 cases of immigrant families. In Step 2, a qualitative thematic analysis was carried out on 30 randomly selected cases of immigrant families. Results: Both the quantitative and qualitative data obtained indicate that the following elements are salient aspects of the vulnerability profile for immigrant families: recent immigration, a first pregnancy in the host country, lack of material social support, isolation, and language barriers are factors that impair parental skills and children’s development. Our results suggest that the current eligibility criteria must be revised in light of the settlement conditions and vulnerability factors specific to immigrant families. Conclusions: This study thus informs on the necessity to address problems of unequal access to health care for vulnerable immigrant populations in order to improve their overall well-being.
Tania Israel, Ph.D.
Many rural mental health and substance abuse (MH/SU) providers are ill-prepared to provide lesbian, gay, bisexual, transgender, and queer (LGBTQ) people with well-informed, quality services (Willging, Cacari-Stone, Lewis, Lamphere, & Duran, 2007; Willging, Salvador, & Kano, 2006). This project addressed this challenge by training lay people who were members of the LGBTQ community as peer advocates (PAs). Use of peer-based approaches to enhance service utilization and social support draws upon established Community Health Worker (CHW) models (Giblin, 1989; Nemcek & Sabatier, 2003; Witmer, Seifer, Finocchio, Leslie, & O’Neil, 1995) and represents a growing practice in MH/SU treatment (The President's New Freedom Commission on Mental Health, 2003; Waitzkin, Getrich, Heying, et al., 2010; Weeks, Convey, Dickson-Gomez, et al., 2009). The PAs engaged in community-based activities intended to: (1) facilitate initial and ongoing contact between help seekers and MH/SU services; (2) promote advocacy behaviors among help seekers; and (3) assist help seekers in developing social support outside of MH/SU services. To obtain the knowledge and skills needed to implement this protocol, PAs took part in four days of didactic and interactive training exercises over two weekends. The current study is the evaluation of this training.
The training included material that could be useful to all LGBTQ community members, such as information about LGBTQ populations, including distinctions among sex, gender identity/expression, and sexual orientation; societal messages, and information about LGBTQ subpopulations; LGBTQ mental health, substance use, and mental health services. Participants had opportunities to learn and practice helping skills by applying them within the context of the topical material. The second half of the training entailed more specific information and skill development for the PA program. This weekend was structured around the three primary activities in which the PAs would engage: 1) individual work with LGBTQ community members, 2) working with service providers, family members, and others, and 3) outreach, advocacy, presentations, and social support. Participants took part in activities to develop their understanding, problem-solving, and implementation skills in each area. Specific skills included solution-focused approaches, needs assessment, negotiating communication conflicts, and conducting presentations. Participants were prepared for their paraprofessional role with material and activities related to ethical decision-making, boundaries, and self-care. Self-awareness was encouraged through activities on privilege and leadership roles in LGBTQ communities.
Thirty-six participants took part in either the pilot or final training. Participants completed a demographic questionnaire and pre- and post-test measures of self-efficacy and knowledge. In addition, participants in the pilot training provided anonymous responses to