Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health Information Science

Supervisor

Wathen, N.

2nd Supervisor

Berman, H.

Co-Supervisor

3rd Supervisor

Iyer, S.

Affiliation

McGill University

Abstract

As national system- and research-agendas invest heavily in the improvement of youth mental health services delivery, the discursive and policy impetus for the inclusion of youth as advisors has increased. However, we know little about the work of youth engagement (YE) in the everyday realities of a care-delivery organization. Does the engagement of youth advisors ultimately inform care?

This dissertation addresses the knowledge concerns of YE with a detailed account of the experiences of youth advisors, service providers, and an organization in the process of services reform. I used institutional ethnography to (1) reveal the day-to-day work of engaging young people as advisors to a mental health services delivery site; (2) examine the linkages and tensions between the discourse of YE and its realities in practice; and, (3) understand the processes by which youths’ knowledge is articulated and admitted to organizational decision-making.

Fieldwork consisted of meeting observations and interviews with service providers and youth advisors, and a discourse analysis of YE practice texts to understand how their discursive framings coordinate local work.

Detailing engagement work made visible how service providers negotiate between a ruling discourse of engagement and the realities of mental health services delivery. They adapt to and resist problematic elements in the ideology of engagement, including its individualizing rhetoric and the omission of structural and social considerations. At the same time, they employ a youth-centred orientation made concrete by the youth advisors, using it to alter established organizational processes that have excluded youth as knowers from the institution of healthcare.

Findings from this study were analyzed in light of recent work on epistemic injustice. This proved to be a useful lens, making more precise whether and how YE makes a difference to youth, the organization and the culture of mental healthcare.

My findings underscore the necessity of framing YE as the labour of epistemic inclusion of youth in the design of formal systems of care. In telling this story of YE work at one service site, I suggest a new pathway for the operation and evaluation of engagement, as underpinning appropriate care and, ultimately, health equity.

Summary for Lay Audience

Alongside national investments in the improvement of youth mental health, enthusiasm for youth engagement has increased. However, we know little about what it means to engage youth as advisors of a care-delivery organization. Does the engagement of youth advisors ultimately inform care?

This dissertation addresses the knowledge concerns of YE with a detailed account of the experiences of youth advisors, service providers, and an organization in the process of services reform. I used institutional ethnography to (1) reveal the day-to-day work of engaging young people as advisors to a mental health services delivery site; (2) examine the linkages and tensions between the language and ideals of YE and its realities in practice; and, (3) understand the processes by which youths’ knowledge is admitted to organizational decision-making.

Fieldwork consisted of meeting observations and interviews with service providers and youth advisors, and a discourse analysis of YE practice texts to understand how they influence the local work.

Detailing engagement work made visible how service providers negotiate between the enthusiasm for engagement and the realities of mental health services delivery. They adapt to and resist problematic elements in the ideology of engagement, including its individualizing rhetoric and the omission of structural and social considerations.

Findings from this study were analyzed in light of recent work on epistemic injustice. This proved to be a useful lens, making more precise whether and how YE makes a difference to youth, the organization and the culture of mental healthcare.

My findings underscore the necessity of framing YE as the labour of epistemic inclusion of youth in the design of formal systems of care. In telling this story of YE work at one service site, I suggest a new pathway for the operation and evaluation of engagement, as foundational to appropriate care and, ultimately, health equity.

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