Adaptation des pratiques / accès aux services

Malgré le nombre important d’immigrants de sexe masculin accueillis au Québec chaque année, il existe peu  d’études québécoises portant sur les enjeux rencontrés par les pères immigrants ou sur les services qui leur sont  offerts. Depuis dix ans, certains travaux ont tenté de combler cette lacune. Parmi eux, l’un porte sur un programme  de soutien aux pères immigrants offert par un organisme montréalais d’accueil et d’intégration des nouveaux  arrivants, un autre sur la relation père-enfant, la relation conjugale, l’identité paternelle et l’exercice de la  discipline, avec une attention particulière accordée à la période périnatale.

Cet article propose une synthèse de ces  travaux, inspirée par le modèle bioécologique du développement humain, avec comme objectif de faire ressortir  les convergences à propos des enjeux auxquels font face les pères immigrants dans leurs relations avec leur enfant,  leur conjointe et leur travail, puis de dégager quelques pistes pour l’amélioration des services offerts dans les  milieux institutionnels et communautaires.

Researchers are beginning to document the experiences of lesbian, gay, bisexual and transgender (LGBT) forced migrants in settlement. However, studies exploring the perceptions of service providers working with this vulnerable population are limited. These may shed light on the challenges of meeting the needs of LGBT forced migrants, especially mental health issues and problems.

This qualitative study elicited the views of 22 Canadian service providers, including advocates, lawyers and mental health practitioners, who serve LGBT forced migrants. Grounded theory analysis revealed the following four themes: facilitating safety, buffering rejection; tracking avoidance patterns; interpreting mental health; and negotiating identity paradigms.

Participants’ accounts suggest that LGBT forced migrants may be best served by providers who understand the exigencies of establishing trust and safety for their clients; recognise their clients’ nuanced social support needs; facilitate the refugee claims process; grasp the complexity of their clients’ mental health challenges; and interrogate their own cultural biases regarding sexual orientations and gender identities.

Québec’s labour market has changed significantly in the past few years, notably with the slower growth of the labour force, an aging population, higher education levels among workers and an increasing proportion of immigrants in the workforce.
In its recent work on occupational rehabilitation, the IRSST has taken a particular interest in workers in vulnerable situations, including immigrant workers. Immigrant workers are considered a more vulnerable population due to, among other things, their proportionately higher-than-average presence in sectors characterized by less favourable working conditions and higher exposure to the risk of occupational injuries. Language and cultural barriers sometimes compound these factors.
The content of this document derives from a study titled The Notion of Ethnocultural Belonging in Rehabilitation Research and Intervention: Knowledge Summaries (published in 2012) and a study (completed in 2017) on the rehabilitation and return-to-work trajectories of immigrant workers with an occupational injury. This study highlighted the role of the health professionals and OHS practitioners involved, their intervention strategies and interactions, and the issues specific to intercultural encounters, while underscoring the impact of the organizational context on these aspects

Pour intervenir auprès des travailleurs immigrants, les professionnels de la santé et les intervenants en santé et en sécurité du travail ont des contacts directs avec eux, soit en personne, soit par téléphone. Ces interlocuteurs étant issus d’horizons culturels variés, leurs rencontres, dites interculturelles, peuvent mettre en relief des perspectives très différentes. Or, on ne peut traiter un travailleur ayant subi une lésion professionnelle sans tenir compte d’une multitude de facteurs qui influencent ses valeurs et la représentation qu’il se fait de lui-même (identité personnelle, organisation sociale, éducation, classe sociale, genre, religion ou idéologie, etc.). Ces variables peuvent présenter d’importants écarts de représentations culturelles entre les individus et être une source de malentendus, d’incompréhension ou de désaccords qui doivent absolument être pris en considération. Pour que ces rencontres favorisent un retour réussi au travail, il importe d’encourager le développement de la compétence interculturelle des intervenants dans les organisations. Ce document a été conçu pour servir d’instrument de réflexion visant à favoriser le développement de telles compétences.

This chapter brings to the forefront various challenges of engaging in both critical and participatory forms of knowledge building, in particular with queer and trans migrants with precarious status. Two scholars trace their previous experiences of engaging in participatory and critical research as well as their shift toward reflexive ways of knowing. This shift elicits the ways in which Critical Participatory Action Research (CPAR) may be used to build reflexive knowledge with and about queer and trans migrant communities, and in particular, LGBTQ refugees and MSM Latino migrants.

Camp Cosmos was founded in 1971 in Montreal to provide children from diverse social, economic and cultural backgrounds with a safe and fun environment to play, learn and grow. The summer camp is grounded on an anti-oppression philosophy that drives its enriching intercultural, accessibility, environmental, youth leadership and athletic programs. After 47 summers of empowering children, building communities with families, and fostering support networks with partner organizations, Camp Cosmos continues to be a vehicle of social transformation in Montreal. Since 1971, more than 2000 children have participated in the Camp Cosmos summer camp program. In response to the Syrian refugee crises, Camp Cosmos expanded in 2016 to create a second camp on Montreal’s West Island. That year, 23 Syrian children were welcomed at both the West Island and Downtown locations. In summer 2017, numbers rose, with 28 Syrian children and 12 children whose families had recently crossed the Canadian/USA border for a total of 40 (camp fees waived). The total number of campers in 2017 was 121 (up from 50 in 2014). In addition to welcoming Syrian campers, there were also 3 young Syrian counselors-in- training who had their first Canadian job experience. In 2018, with the aim to continue adapting to the Montreal society’s needs, Camp Cosmos welcomed 158 campers from diverse backgrounds, introduced a sliding scale payment system to welcome a greater diversity of campers, and extended the hours of care to improve access to camp. The camp adapted their 5-day staff training to include a greater focus on their anti- oppression mandate and a focus on accessibility by collaborating with Montreal-based organizations. For the first time, the camp welcomed 12 and 13-year-old campers, filling the previously existing age gap, to participate in a new program that included both activities with the whole camp as well as volunteer opportunities at community organizations.

Background: Many Canadian adolescents and young adults with mental health problems face delayed detection, long waiting lists, poorly accessible services, care of inconsistent quality and abrupt or absent inter-service transitions. To address these issues, ACCESS Open Minds, a multi-stakeholder network, is implementing and systematically evaluating a transformation of mental health services for youth aged 11 to 25 at 14 sites across Canada. The transformation plan has five key foci: early identification, rapid access, appropriate care, the elimination of age-based transitions between services, and the engagement of youth and families.

Methods: The ACCESS Open Minds Research Protocol has multiple components including a minimum evaluation protocol and a stepped-wedge cluster randomized trial, that are detailed in this paper. Additional components include qualitative methods and cost-effectiveness analyses. The services transformation is being evaluated at all sites via a minimum evaluation protocol. Six sites are participating in the stepped-wedge trial whereby the intervention (a service transformation along the key foci) was rolled out in three waves, each commencing six months apart. Two sites, one high-population and one low-population, were randomly assigned to each of the three waves, i.e., randomization was stratified by population size. Our primary hypotheses pertain to increased referral numbers, and reduced wait times to initial assessment and to the commencement of appropriate care. Secondary hypotheses pertain to simplified pathways to care; improved clinical, functional and subjective outcomes; and increased satisfaction among youth and families. Quantitative measures addressing these hypotheses are being used to determine the effectiveness of the intervention

Although collaborative care was adopted in several countries, including Canada, to improve the health and social services system, partnerships are often experienced as challenging. In many cases, transformative partnership remains a political rhetoric rather than a practical reality. This article presents an analysis of partnership relationships in youth mental health (YMH) using insights from game theory and a qualitative analysis of interactions during transcultural interinstitutional and interdisciplinary case discussion seminars (TIICDSs).

Drawing on the analysis of 40 seminar sessions and six focus groups with seminar participants conducted in Montréal (Canada) between October 2013 and April 2015, this article interrogates the conditions and processes present in TIICDSs that contribute to building and strengthening YMH partnerships, examining how tensions among TIICDS participants are attended to.

Research results indicate that TIICDSs can be seen as a game operating under different rules than real-life clinical work. They are characterized by the establishment of a climate of trust and respect, a high value placed on diversity and creativity, a concern for affects and power dynamics, a process of inclusive dialogue and negotiation, and a consideration for continuity. The game rules allow participants to safely apprehend a situation from a different perspective, a key competence in intercultural and collaborative YMH care. Results also indicate that participants complexify their representations by playing with divergent perceptions of people and situations and that enhanced case formulations are collective game outcomes. In light of our findings, tensions in collaborations can be seen as constituting both obstacles that can be counterproductive if not attended to, as well as powerful and useful learning tools that, under certain conditions, can support the clinical process and contribute to partnership building. Some clinical and partnership impasses may be overcome through clinical case discussions that allow partners to address these tensions and negotiate power relationships.

À la suite de l’arrivée de nombreux réfugiés syriens en 2015-2016 et dans le but de les accueillir, plusieurs mesures  extraordinaires et ressources supplémentaires ont été déployées par le gouvernement du Canada. En considérant  que près de la moitié des nouveaux arrivants étaient mineurs, l’école québécoise s’est retrouvée devant de  nombreux défis relatifs à l’accueil et à l’organisation des pratiques scolaires. Dans ce contexte, nous avons mené  une recherche-action visant à évaluer une intervention mise en place en contexte scolaire pour favoriser le bienêtre et le sentiment d’appartenance des élèves réfugiés syriens.

L’action comportait deux volets distincts : des  groupes de parole menés en classe sur des sujets sensibles (ex. : la migration, les deuils et les pertes, la famille) et  un accompagnement psychosocial proposé à des élèves identifiés par les acteurs scolaires comme étant  potentiellement en mal-être. Cinq classes, provenant de deux écoles secondaires et une école primaire, ont  participé à la recherche.

Cet article reprend des données secondaires collectées dans ce cadre pour mettre en  lumière des résultats de recherche qui soulignent l’importance de la compréhension et de la prise en compte de  l’expérience pré-, péri- et post-migratoire des élèves réfugiés en vue de favoriser leur accueil et leur expérience  socioscolaire. Nous discutons, entre autres, de l’écart important entre la perception des acteurs scolaires du  parcours migratoire et du vécu de leurs élèves réfugiés d’une part et de l’expérience réelle de ceux-ci d’autre part.

La Maison Bleue is a community-based perinatal health and social centre in Montreal that provides services during pregnancy up to age five to families living in vulnerable contexts. The study aimed to describe: 1) the challenges and protective factors that affect the well-being of migrant families receiving care at La Maison Bleue; and 2) how La Maison Bleue strengthens resilience among these families.

Synthèse du symposium du 28 novembre 2018.

Abstract

Introduction. Despite greater father participation in child care/rearing nowadays and the challenge of involving fathers in nursing interventions, no instrument exists to measure professional attitudes toward father involvement in family interventions. Objectives. The aim of this study was to adapt an existing measure that assesses nurse attitudes regarding the importance of including families in nursing care into a measure that assesses professionals’ attitudes towards the importance of involving fathers in interventions with families. Method. The Professionals’ Attitudes towards Father Involvement (PAFI) scale was adapted from the Families’ Importance in Nursing Care – Nurse Attitudes (FINC-NA) scale. A total of 297 professionals in family care completed the 26 items of the PAFI. Results. Items analysis indicated three items had low variability and abnormal distribution. Principal component analysis was conducted with the 23 remaining items. Results revealed a solution with four factors reproducing the structure of the original scale: Father as conversational partner, Father as resource, Father as burden, and Father as own resource. Most items loaded on their original factor. The four subscales and the global scale showed good internal consistency. Discussion and conclusion. Even though further studies are needed, this adapted scale now enables researchers and practitioners to assess professionals’ attitudes towards the importance of involving fathers in interventions with families.

Résumé

Introduction. Les pères sont de plus en plus engagés auprès de leurs enfants. Plusieurs professionnels, dont les infirmières, peinent à s’adapter à cette nouvelle réalité. Aucune échelle n’existe pour mesurer l’attitude des professionnels par rapport à l’importance d’inclure les pères dans leurs interventions. Objectifs. Le but de cette étude est d’adapter une échelle qui mesure les attitudes des infirmières quant à l’importance d’inclure les familles dans leurs soins pour en faire un instrument permettant de mesurer les attitudes des professionnels envers l’importance d’inclure les pères dans leurs interventions auprès des familles. Méthodes. L’échelle Attitudes des professionnels envers l’inclusion des pères (APIP) a été adaptée à partir de l’échelle Importance des familles dans les soins infirmiers – Attitudes des infirmières. Au total, 297 professionnels ont répondu aux 26 items de l’échelle APIP. Résultats. L’analyse des items révèle que trois d’entre eux présentaient une faible variabilité et une distribution anormale. L’analyse à composantes principales a été effectuée avec les 23 items restants. Les résultats confirment quatre facteurs, reproduisant la structure de l’échelle originale : le père comme partenaire de conversation, le père comme ressource, le père comme fardeau et le père comme ayant ses propres ressources. Les quatre sous-échelles et l’échelle globale ont montré une bonne cohérence interne. Discussion et conclusion. Même si d’autres études sont nécessaires, cette échelle adaptée permet maintenant aux chercheurs et aux praticiens de mesurer les attitudes des professionnels quant à l’importance d’impliquer les pères dans leurs interventions auprès des familles.

In this article, we question the unilateral discourse of benefit of participation in participatory refugee theatre in the context of a growing socio-political climate of polarisation and stigmatisation of refugees in European countries of resettlement. By integrating critical voices from the fields of applied theatre and refugee research, we analyse the micro and macro dramaturgy of a Berlin-based participatory refugee theatre project. Through this analysis, we explore how refugees’ participation entails opportunities for empowerment, agency and giving voice, but also risks disempowerment and silencing in the interconnected relations between the participant, theatre maker, audience and the broader socio-political context.

Le contre-transfert culturel est un concept qui souligne la dimension socioculturelle, et donc collective, du contre-transfert. Dans ce texte, nous analysons, au moyen de cinq histoires cliniques présentées dans le cadre de séminaires de discussion de cas transculturels et interinstitutionnels menés à Montréal, Canada, les diverses formes que peut prendre le contre-transfert culturel pour des cliniciens en situation d’impasse thérapeutique face à la prise en charge de familles migrantes. Nous examinons ensuite le rôle éventuel de ces séminaires dans la transformation de ce contre-transfert et dans la formulation de pistes permettant de relancer ou de soutenir le processus thérapeutique. Les résultats indiquent que les séminaires transculturels et interinstitutionnels de discussion de cas facilitent un travail d’élaboration sur les représentations collectives des cliniciens et que ce travail groupal permet de contenir et parfois de dépasser certaines situations d’échec thérapeutique.

Ce manuscrit propose une première description d’un travail clinique spécialisé au regard de la radicalisation menant à la violence au Canada. Une équipe clinique multidisciplinaire rattachée à un programme de santé mentale et de soins de première ligne à Montréal offre depuis juillet 2016 un service de consultation spécialisée pour soutenir des partenaires sur l’ensemble du territoire du Québec. Cet article décrit l’approche de l’équipe, l’organisation de l’offre de service et documente à travers des vignettes cliniques les principales catégories de problèmes sociaux et cliniques pour lesquels l’équipe fut sollicitée durant sa première année de fonctionnement. Nos observations préliminaires confirment la pertinence d’une évaluation pluridisciplinaire fondée sur une approche systémique du phénomène de la radicalisation violente, pour appréhender les différents facteurs sociaux, familiaux et individuels qui influencent les manifestations de ce phénomène, et déterminer la nature des interventions psychosociales et/ou psychiatriques pertinentes. La présentation des cas cliniques propose aux intervenants sociaux, communautaires et en santé mentale des pistes d’intervention et une compréhension du phénomène de radicalisation violente tel qu’il se présente dans les réseaux de la santé, de la protection de la jeunesse et de l’éducation au Québec.

The hospital is a place of encounter between health care providers, patients and family members, the healthy and the suffering, migrants and non-migrants, as well as social and cultural minorities, and majorities of various backgrounds. It is also a space where multiple conceptions of care, life, quality of life, and death are enacted, sometimes inhibiting mutual understanding between caregivers and the cared for, a scenario that in turn may provoke conflict. Through the lens of conflict, we explore in this article the theme of Otherness within the clinic, basing analysis on an ethnographic study conducted in recent years in three cosmopolitan Canadian cities. Daily practices and—on a larger scale—the social space of the clinic become material here for reflecting on recognition (and non-recognition) of the Other as actors in the clinical encounter. The examination of structural and situational conditions that contribute to the emergence of conflict offers an understanding of the diversity of values that pervade the clinic. By way of conclusion, we argue that recognition of diversity, at least on the part of practitioners, is a key condition for the emergence of a pluralist normativity in the social space of the clinic.

Stemming from a study with families of migrant & non-migrant backgrounds in Montréal on children’s stomach pains, this paper questions how ways of dealing with medical uncertainty has bearing on pathways to care. These pathways are enacted within and beyond the family space as well as in medical settings. While acknowledging that group practices call for nuance, non-migrant children lead a greater quest for legitimacy of their pain while most migrant families place stomach aches in the range of normality.

Abstract Background

The objective of this article is to present an overview of the burden, spectrum of diseases, and risk factors for mental illness among subgroups of migrants, namely immigrants, refugees, and individuals with precarious legal status. This expert review summarizes some of the implications for primary care services in migrant receiving countries in the global North.

Methods

A broad literature review was conducted on the epidemiology of mental health disorder in migrants and refugee and on the available evidence on mental health services for this population focusing on key issues for primary care practitioners in high income countries.

Results

Although most migrants are resilient, migration is associated with an overrepresentation of mental disorder in specific subpopulations. There is general consensus that stress related disorders are more prevalent among refugee populations of all ages compared to the general population. Relative to refugees, migrants with precarious legal status may be at even higher risk for depression and anxiety disorders. Persistence and severity of psychiatric disorders among migrant populations can be attributed to a combination of factors, including severity of trauma exposures during the migration process. Exposure to stressors after resettlement, such as poverty and limited social support, also impact mental illness. Services for migrants are affected by restricted accessibility, and should address cultural and linguistic barriers and issues in the larger social environment that impact psychosocial functioning.

Conclusion

There is substantial burden of mental illness among some migrant populations. Primary care providers seeking to assist individuals need to be cognizant of language barriers and challenges of working with interpreters as well as sensitive to cultural and social contexts within the diagnosis and service delivery process. In addition, best practices in screening migrants and providing intervention services for mental disorders need to be sensitive to where individuals and families are in the resettlement trajectory.

Aim

Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes.

Method

We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post‐secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation.

Results

Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study.

Conclusions

Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.

This article describes how autism spectrum disorder is experienced in the context of immigrant families and how the meaning of this condition, proposed by professionals in the host country, is negotiated between families and healthcare providers. The study sample consists of 44 parents of different nationalities and their 35 children with autism spectrum disorder (ASD) living in a socioeconomically deprived neighborhood of Montreal, Canada. Individual parent interviews were audiotaped and transcribed for subsequent analysis. Results suggest that – although they may sometimes be a source of anxiety – the uncertainties regarding the etiology of ASD, as well as the gap between the explanatory models (EMs) proposed by host country professionals and the impressions of parents, seem to increase the capacity of families to resist the imposition of what they perceive as external categories. Parents perceived the day-to-day difficulties associated with their child’s condition as a form of social exclusion that compromised their child’s future and independence. These day-to-day difficulties were also described as directly affecting the parents’ social life, constituting an important emotional and physical burden. When talking about their children, parents described the painfulness of their experiences, but also discussed how their autistic child had transformed and shaped their lives. Overall, these results show how the disease is “enacted” in the day-to-day life of parents; and suggest that such an embodied understanding of ASD may sometimes represent a form of re-appropriation of power by families faced with adversity.

This study of social representations about interpreted medical consultations examines the discourse of French language focus groups (FGs), conducted in Quebec, with 22 third year medical students (4 FGs), 29 family medicine residents (4 FGs) and 47 experienced family physicians (5 FGs). The audio-recorded FGs were transcribed. Each discussed two video vignettes of interpreted consultations. Statistical textual analysis showed that the students’ discourse patterns differed by FG. Residents prioritized access to the patient’s culture via the interpreter, though recognizing the need to respect the patient-physician relationship. Senior physicians organized their discourse differently for each vignette, associating it with a ‘standard’ response: for them, the two main issues were the quest for information, which we relate to the medical socialization process; and the interpreter’s stances, in terms of how s/he is perceived by physicians and the role(s) s/he is seen to play in the consultation. Physicians tend to represent the interpreter as a controllable ‘object’, not a full-fledged healthcare professional.

Cet article rapporte les constats d’une revue de la littérature et d’une consultation d’experts sur la santé de travailleurs cumulant des précarités : ceux embauchés par des agences de location de main-d’œuvre, les petites entreprises non syndiquées et les étrangers temporaires. On constate que : a) il est difficile de dresser un portrait de l’état de santé de ces travailleurs ; b) faute de pouvoir les distinguer au sein des entreprises, ils ne bénéficient d’aucune attention particulière ; c) ils sont souvent embauchés dans des secteurs non prioritaires, où la surveillance n’est pas assidue ; d) ils sont en marge des pratiques de SST parce qu’ils sont de passage dans les entreprises. Ces faits contribuent à les mettre à l’écart, alors qu’il serait possible d’adapter les pratiques préventives aux travailleurs cumulant des précarités en recadrant les obligations scientifiques, administratives, légales et morales de justice sociale des instances de santé et de sécurité au travail (SST).

Cet article présente quelques réflexions critiques issues de la démarche inductive de deux projets de recherche impliquant des enfants. Ces projets portent sur les services publics en santé mentale jeunesse (SMJ), l’un avec des familles réfugiées et l’autre avec une population générale, tous deux intégrant le jeu et le dessin aux entretiens avec les enfants. Après avoir posé les bases critiques et inductives de la recherche « avec » les enfants, nous présentons quelques éléments de notre approche méthodologique. Cette dernière se situe entre les méthodes projectives de la clinique et les méthodes créatives de la recherche, en proposant un usage narratif, expressif et exploratoire de la projection. La démarche inductive de recherche est présentée à travers l’expérience de l’élaboration méthodologique et de la cueillette de données auprès des enfants. Six exemples sont tirés des projets pour illustrer nos questionnements autour de la directivité des entretiens et de leur exigence pour les enfants, de même que des interrogations autour du degré projectif impliqué, qui change le potentiel interprétatif en le rendant plus complexe, mais aussi plus riche. Nous concluons en proposant une conception créative de la projection en recherche comme un espace de jeu participatif. Cet espace de jeu est également envisagé comme contribuant à l’éthique de la recherche. Finalement, nous proposons, pour des recherches ultérieures, de faire participer les enfants à l’élaboration des méthodologies. Nous terminons en soulignant la pertinence d’une démarche inductive pour développer une réflexion critique en recherche.

À partir du cadre théorique de la niche d’activité professionnelle et d’études effectuées au Québec, un portrait des pratiques et représentations du travail avec interprètes dans les soins est dressé. Ce portrait est d’abord fait pour les contextes non sensibles aux dimensions linguistiques et culturelles des soins. Il est ensuite dépeint plus en détail avec deux études menées en contextes sensibles. Cette comparaison permet de mettre en évidence les niveaux de contexte qu’il est nécessaire de prendre en compte pour l’intégration des interprètes dans les équipes de soins et pour établir une collaboration interprète-praticien de qualité : politique, institutionnelle (qui inclut les dimensions structurelle et collaborative), de formation et déontologique. Pour chacun d’eux, les conditions idéales pour établir une collaboration interprète-praticien-usager constructive sont décrites.

Introduction