The consequences of substance use have had a devastating impact on British Columbia’s (BC) healthcare system. Since the declaration of the province’s public health emergency in 2016, over 10,000 British Columbians have died from an overdose. The lack of a coordinated addiction treatment system provincially is a significant contributor to BC’s present state. To address this, Providence Health Care is implementing the Road to Recovery Initiative (R2RI), an innovate model of care to address two aspects of BC’s addiction treatment crisis through: 1) increasing access to on-demand addiction care; and 2) reorganizing existing clinical services to support patients at every phase of recovery. The proposed Program of Research seeks to evaluate key health and social outcomes associated with the implementation of R2RI. Participants of this program will be followed for 5 years with data collection focused on: substance use, illness trajectory, community engagement, health care utilization, health risk behaviours, quality of life, overdose, and death. Knowledge gained through this research will identify outcomes associated with the provision of a coordinated addiction treatment system and will inform successful scale-up of this new approach.
Research Pillar: Health Services Research
Co-Developing a Learning Health System with People with Lived/Living Experience of Substance Use: a response to the toxic drug poisoning crisis
Walk With Me was developed by Dr. Karsten and her research team throughout the past four years with intent to combat stigma and create systems change in relation to the toxic drug poisoning crisis – a public health emergency that has enacted more deaths in BC than suicides, car accidents and homicides combined. This team has been working in Vancouver Island communities of various sizes, and within Island Health acute care facilities, to better understand the ways in which the drug poisoning crisis is impacting communities and systems. Through deep listening, peer engagement and leadership, and collaborative design, the team has developed recommendations designed to close service gaps and reduce stigma. In the summer of 2022, Island Health released its first Harm Reduction Policy. Stemming from this release is an opportunity to deepen this existing partnership, through the co-creation of a Harm Reduction Learning Health System. This system, developed through patient/peer insights and leadership, and alongside clinicians, management and staff, will enable Island Health to respond effectively to a rapidly-evolving public health crisis.
Transforming health services following traumatic brain injury through peer-support
Traumatic brain injury affects approximately 450 people every day in Canada and is a leading cause of disability nationally and globally. These injuries can lead to life-long disability and health problems, and people who sustain them often experience decreased quality of life, poor mental health, and long-term unemployment.
There is a critical gap in the development and delivery of programs and services that help people with traumatic brain injury to improve their health. Current health services focus on areas of impairment rather than personally-important priorities for rehabilitation. In addition, participatory research, which engages people with traumatic brain injury and community organizations as active partners, is underused in the development of rehabilitation programs.
My goal is to implement a peer support program for people with traumatic brain injury. I will use a partnered approach, in which people with traumatic brain injury and members of their community are leaders in the project. This will ensure that the research answers to their needs and values. Ultimately, this research will improve the access to services, health, and quality of life of people with traumatic brain injury in Canada.
Nini nanaghintsan ?anh (is your mind tired?): The Healing Journeys of Indigenous Adolescents Navigating Pathways to Urban and Online Wellness Supports
Due to the historical and ongoing effects of colonization, Indigenous youth experience higher rates of mental illness. As Indigenous youth, it is particularly difficult to access mental health care in Canada. Many Indigenous youth are reluctant to seek help when they are in crisis. Indigenous youth and families advocate it would be better if more culturally-responsive wellness supports were available. This research project will use oral traditions and storytelling to ask Indigenous youth (aged 12 to 24) about their healing journeys when accessing wellness supports in urban and online spaces. This project will work in partnership with Foundry BC to collaborate with local Indigenous communities. In Phase 1, Indigenous youth will join Sharing Circles to create collective stories about what holistic wellbeing means to them and how they access wellness supports in community and online settings. In Phase 2, Indigenous youth will be asked to complete a survey about their mental health care access, cultural identity, technology use, and holistic wellbeing. The findings from this study can inform culturally-resurgent practices to help transform the way Indigenous youth are engaged in wellness supports across urban and online spaces.
Promoting integrated mental health care services and supports for refugees in BC
Approximately 84 million people worldwide were forcibly displaced during 2021, including refugees, who have been forcibly displaced by conflict. It is estimated that 1 in 5 people in settings affected by conflict have a mental disorder. Evidence shows that many refugees require mental health support post migration as a result of trauma, and post migration stress. Mental health conditions such as depression, anxiety, Post Traumatic Stress Disorder, and psychosis are much more prevalent among refugees than among host populations. Post migration, refugee mental health is determined by stressors of acculturation such as employment, housing and access to health care.
Limited knowledge exists on how mental health services work to promote refugee mental health in high income countries like Canada. Barriers to mental health care include service fragmentation and provider knowledge about the determinants of refugee mental health. The goal of my research is to develop and conduct an evaluation of existing mental health services and supports for refugees in BC. Findings will inform primary health care services, mental health services and settlement services about what promotes integrated mental health care for refugees in BC.
Making room at the table: Understanding the mealtime experiences of racialized residents and their families in long-term care
Mealtimes in long-term care (LTC) homes are important for visible minority (e.g. Chinese, South Asian) residents’ well-being and keeps them connected with their families who help at mealtimes. Visiting restrictions during the COVID-19 pandemic meant that some families could not provide mealtime care which had negative effects on residents and families. There is very little research on the mealtime experience for visible minority residents and families and even less on their experiences during the pandemic, even though almost one-quarter of Canadians are from a visible minority group. It is important to understand these experiences to improve mealtimes in LTC homes. This qualitative study will answer the question: what are the mealtime experiences of visible minority residents and their families in LTC? The objectives of this study are to: 1) understand the mealtime experiences of visible minority residents and their families; 2) understand how these mealtime experiences are impacted by social, political, and economic factors; 3) identify ways to improve mealtime care for visible minority residents and families; and 4) share the research findings with stakeholders to improve mealtime care in LTC homes.
Improving access to breastfeeding support in British Columbia: Needs assessment of a virtual health intervention
Breastfeeding has numerous benefits for parents and infants. However, many parents encounter challenges with breastfeeding that can lead to early breastfeeding cessation. In addition, persons across British Columbia (BC), especially those in rural or remote regions, cannot access breastfeeding support. This has been especially true during the COVID-19 pandemic, as social distancing protocols and anxiety over personal safety have decreased opportunities for face-to-face interactions. My postdoctoral work will identify effective telehealth strategies and interventions to deliver breastfeeding support to persons living in BC. This study will have three phases: a literature review of effective virtual breastfeeding support; interviews to understand the support needs and acceptance of virtual breastfeeding support among healthcare providers and persons; and development of a clinical guideline for virtual breastfeeding support. Knowledge gained from this study will be used to develop a framework for the provision of virtual breastfeeding support. In addition, it will inform health policy, research, and practice for new parents living in rural BC or those who experience challenges in receiving face-to-face breastfeeding support.
Advancing anti-colonial implementation science and knowledge translation with the xacqanaǂ itkiniǂ (Many Ways of Working on the Same Thing) research team
xacqanaǂ itkiniǂ (Many Ways of Working on the Same Thing) is a long-term working relationship between Ktunaxa First Nation, Interior Health, University of Victoria, and University of British Columbia – Okanagan. Over the last three years, the xacqanal itkinil team developed a new approach to research that is led by Ktunaxa peoples and reflects Ktunaxa culture. We tested this approach in Ktunaxa communities by hosting a series of gatherings and land-based activities, where community members shared their vision for a healthy community. The team recently received a five-year CIHR Project Grant to build off the first phase of the partnership to work towards Ktunaxa Nation’s vision for a healthy community. We will work with community partners to co-design and implement interventions (i.e. programs, policies, practices), with the aim of transforming the culture of the health system to better serve Indigenous peoples and the wider population. This fellowship will directly contribute to monitoring and evaluating the interventions and their implementation to understand what is working well, what challenges are encountered along the way and how they are addressed, as well as how this work can be carried forward into the future.
Transforming prisons and improving health outcomes for people who use drugs: An evaluation of BC’s prison-based therapeutic community
People with substance use disorders (SUD) are more likely than those without SUD to be sent to prison and to experience negative outcomes after release. Prisons are not typically ideal environments to treat complex health issues including SUD. Therapeutic communities (TCs) offer an alternative to traditional forms of punishment, providing the environment for belonging and relationship-building, through activities such as group-based therapy, education/work, and community participation. The proposed study will evaluate Guthrie House, BC’s first and only prison-based TC which opened in 2007 at Nanaimo Correctional Centre. The study aims to identify the TC-related mechanisms of change associated with health and criminal justice outcomes, and will involve three main components: a survey with TC clients, interviews with TC and correctional staff, and linked administrative data analyses. This study has the potential to identify promising approaches to supporting people with SUD who experience incarceration. This work will add meaningfully to the policy initiatives in BC focused on reducing overdose and increasing access to SUD care.
The impact of the COVID-19 pandemic on access to adequate care for serious mental disorders in British Columbia
The Covid-19 pandemic has created new challenges for the treatment of serious mental disorders such as schizophrenia and bipolar disorder. Patient avoidance of health services and the rapid switch from in-person to virtual delivery of services may have created barriers to accessing specialist services. The aim of the current study is to evaluate whether access to adequate psychiatric care for serious mental disorders changed between 2015 and 2022, and particularly after the onset of the pandemic. In addition, we will examine whether any disparities in access by demographic (age, sex, neighbourhood income quintile, geographic location) clinical (diagnosis and presence of substance use disorder) and health system factors have increased or decreased over this time period. Findings from this study will have important implications for the provision of mental health services for serious mental disorders in British Columbia.