Adolescent Mental Health
Basic Research Projects - Program Development:
The purpose of this line of research was to better understand the determinants of help-seeking for mental health difficulties in adolescents and to develop and validate more effective help-seeking interventions for young people with mental health difficulties. This line of work was initiated following three suicides in Nova Scotia, at which time the family of affect schools approached myself and a colleague, Dr. Vivek Kusumakar, to develop a program of research aimed at addressing mental health difficulties, suicidal behaviour and barriers to help-seeking in youth. These projects were initially funded by the Lloyd Carr Harris Foundation and then by a number of grants from the Social Sciences and Humanities Research Foundation, including a SSHRC Strategic Themes Grant. Several key papers arose from this work, which illustrated the potential and importance of examining and fostering help-seeking behaviour within a specific school-based context, where proximal help-seeking targets (e.g. the guidance counsellor or teen health centre) are targeted directly as opposed to more distal help-seeking target (e.g., the family physician or health clinic).
The controlled trial that was conducted remains one of the few successful school-based help-seeking interventions (Santor, Kusumakar, Poulin & LeBlanc, 2007). These basic studies also established that internet based programs could foster help-seeking for mental health difficulties (Santor, Poulin, Leblanc & Kusumakar, 2007), as well as the (limited) effectiveness of school based health centres (Santor, Poulin, Leblanc & Kusumakar, 2006). Most importantly, this early work demonstrated the potential of an internet based resource for both (a) the early detection of difficulty and fostering help-seeking and (b) knowledge mobilization. Yet, upon completion of the research studies, the ideal outcome, namely to implement ad establish a long-standing program designed (a) to improve health literacy and decision making in young people and (b) to facilitate help seeking in young people who have or are at risk for developing a mental illness remained unfulfilled.
Applied Research Projects -- Moving from basic research to program development and implementation
Despite decades of development and enormous expense, and the near unanimous acknowledgement of the benefit of school based mental health promotion programs1, the fact remains that few programs have been implemented en masse and that the majority of schools do not provide students with these types of programs. Overcoming these obstacles facing school based program is arguably one of the most important challenges facing researchers, practitioners and policy makers, which was the goal of this second phases of work.
However, the challenges to implementing this or any type of school based mental health program on a very broad scale are not easily addressed. In her presidential address at the Canadian Psychological Association, , Leadbeater (2010), summarizes a number of well documented obstacles that range from the inadequacy of short term grants, to the new challenges researchers are often required to take on when implementing a program of research (e.g., functioning as advocate, marketer, trainer, quality assurance manager and continued evaluator of the program). Although she like others emphasizes the need for further research, she also acknowledged that the challenges to the transportability of programs that will not easily be solved by research, alone.
Online Health Promotion:
It was on the basis of this initial work that the concept for an interactive mental health literacy magazine (seeMyHealth Magazine description) was developed with my collaborators and partners. The goal was to develop a program would cost about $1 per student per year and to implement the program on a very large scale (e.g., all schools in Canada). Providing the program over the internet allowed us to achieve several important goals that were judged early on to be essential to build a sustainable and widely sought after program. These benefits have been discussed previously (Santor & Bagnell, 2008; 2011) but the key benefits are summarized here as follows.
Increased accessibility. One of the main benefits of developing an internet based application is that the program or resource can be accessed by most people almost anywhere. At present, approximately 45 million youth have access to information on the internet in North America and studies suggest that as many as half of all young people may prefer to obtain health information online as opposed to other media. As such, this represents the single most important opportunity to engage a large number of youth. Estimates suggest that as many as 75 percent of adolescents have used the internet to locate health information online, slightly more than the numbers downloading music and playing games (Henry J. Kaiser Family Foundation, 2001; Borzekowski & Rickert, 2001a, 2001b). A recent report by the Media Awareness Network estimated that some 94 percent of young people in Canada access the Internet from home (http://www.media-awareness.ca/english/research/YCWW/phaseII/). This underscores the importance of developing programs that can be accessed on-line and the enormous potential that these programs offered.
Customizable. One other main benefit is that internet-based programs can be customized to meet the needs of unique users and diverse local communities, whether in Canada or the US, or whether in French, English or Spanish. Accordingly, I developed the magazine so that it can be completely customized by local communities and school groups (a) by allowing groups to limit the number of on-line modules or features that ware available to young people and (b) by allowing groups to modify any of the content on the magazine, including info sheets, magazine issues, or Q&As. This was essential not only to address the needs of different linguistic or cultural groups, but also to address the different levels of readiness among stakeholders and school groups. Our experience in implementing the program in Missouri was that some schools were initially comfortable only with rendering information sheets on line. They subsequently "turned on" more interactive features of the magazine, but only after they were comfortable with the response of students and parents. We are about to launch a bi-lingual version of the magazine (http://college.yoomagazine.net click on EN or FR at the top right corner to view the multilingual capacity).
Embedded Evaluation Tools. Program evaluation is typically an intensive and frequently onerous exercise. We have integrated our program evaluation tools within the structure of the website, allowing stakeholders to evaluate the uptake of the program from the very first day that the program is implemented. Periodic satisfaction questionnaires and year-end evaluation surveys allow stakeholders to begin understanding the relationship between website utilization and a variety of health and mental health status indicators. When completed annually these surveys can serve as a snapshot of student health and mental needs, stigma, school climate and motivation for learning, but can also be used to examine the effectiveness of local bullying initiatives. We now have the capacity to "force" participants to complete baseline surveys which allows us to now conduct true randomized controlled trials.