Staff at the centre with youth: An Institutional Ethnology of Staff in Integrated Youth Services

Abstract

Up to 75% of mental health issues develop during the adolescent period from 12 to 25 years old, yet only an estimated 25% of affected youth in Canada access mental health services. Integrated youth services (IYS) is a model that seeks to improve youth service access and outcomes. IYS disrupts traditional power structures within youth mental health services by incorporating lived experience into service development, ensuring direct access by youth in youth-friendly settings, youth and family engagement, providing consideration of a broad range of service needs, and using peer support models. IYS initiatives are grounded in a commitment to evidence-based practice and knowledge translation, that also constitutes an effort to dislocate power through encouraging knowledge creation and sharing. Institutional ethnography grounds itself in the lived work experience of individuals and this methodology was supported using poststructural theory. Data collection included ethnographic observations and 19 interviews were used to map the experience of frontline IYS staff in relation to the ruling relations in their institutions. Staff recounted how they are doing the work of IYS, but they did not connect their workplace actions to the policy commitments of IYS. For example, research participants mentioned the importance of youth engagement, but not in terms of how this can address inequity, and none discussed the impact of family engagement on their work. Participants universally noted that being able to consider diverse challenges facing youth instead of only remaining focused on mental health was important for wellness, but they did not relate these needs to structural oppression or seem to take up the possibility of intersectional reflection. Most participants reported a lack of orientation to the IYS model and a lack of meaningful access to use evaluation and research. As IYS continues to expand across Canada, there is a need to bridge the gap that persists between the ambitious policy commitments of IYS and the experience and engagement of frontline staff in order to realize better, more accessible services through disrupting the traditional power structures in youth mental health services.