Public Health Research Improves Outcomes for All

Among our researchers in the field of substance use is Dr Emily Jenkins, who joined the School of Nursing in 2016 as an Assistant Professor. Her research sets as its goal, “optimizing mental health and substance use for populations – from the individual to whole communities – while privileging the voice of the patient/community to make sure that the knowledge generated resonates with the user and is responsive to diverse lived experiences.”

Dr Jenkins’ research encompasses the whole spectrum of healthcare. It covers health promotion to improve health outcomes for everyone; prevention for those who are at risk; and treatment offering intensive health interventions for those who are dealing with more extensive challenges.

Health Promotion

Dr Jenkins co-leads with Dr Alison Gerlach, a research project funded by Vancouver Foundation known as FAIRPLAY. It centres on creating opportunities for
meaningful play among residents of Vancouver’s inner city community. Enhancing play among children is one of the earliest opportunities for supporting health among all family members. It isn’t just about new playgrounds and greenspace. Creating healthy environments means creating connections and opportunities to engage with members of the community, creating healthy networks and learning about programs and policies that are in place to enhance health. All of this promotes a quality of life that is supportive of wellness and contributes to resilience, which helps to combat some of the risks that people experience when living in a neighbourhood where child and family poverty and other forms of marginalization are common.

Carrying on with that idea, Dr Jenkins has initiated the PUBLIC POLICY FOR YOUTH MENTAL HEALTH PROJECT, a study funded by the Michael Smith Foundation for Health Research (MSFHR) and the Canadian Institutes for Health Research (CIHR). The study provides the opportunity for youth to determine what factors influence their mental health and substance use practices and to become engaged in contributing to public policy that is responsive to their needs. “When individuals are operating in a mode of reaction, intervention can be overwhelming,” says Dr Jenkins. “It is helpful to build the resources that assist people before they reach that stage.”

Prevention

While health promotion aims to create healthy environments that optimize health, prevention offers another tool to help populations remain in control of and improve their health. Dr Jenkins and colleagues have been using prevention approaches to respond to adolescent substance use. The TRACE projects, which originated with Dr Joy Johnson, continue to serve youth under the co-leadership of Dr Jenkins and Dr Rebecca Haines-Saah of the University of Calgary. Since no intervention can be completely effective against a curious mind or peer pressure, and since cannabis use isn’t without risks, TRACE looks at ways of minimizing potential harms, especially in terms of reducing stigma, making it easier for youth to seek help when necessary. Youth may be tempted to look to the internet for answers to their questions and stumble upon information that is less than reliable. The TRACE project meets youth where they are and counters misconceptions with open dialogue that is not constrained by an abstinence goal, instead seeking to minimize harms through acknowledgement of their experiences and reliable information.

TRACE focuses on providing parents and teachers with the education, evidence-based information, and resources for creating dialogue with their children and students. Among the resources for students is a film (Cycles) and public health messaging created by and for youth. Rather than expecting self-discipline and restraint from this population, the resources offer level-headed recommendations for students such as not driving under the influence, knowing your source, being aware of your level of usage, and delaying experimentation for as long as possible. Their current focus on parents as a resource utilizes creative, youth driven ways of communicating, such as digital storytelling, help underscore the message.

Treatment

Treatment is the final element of Dr Jenkins’ health research triad. MSFHR funding was awarded in 2017 and is supporting a partnership with nurses at St. Paul’s Hospital who have identified a knowledge gap in caring for people with “concurrent disorders” – cooccurring mental illness and substance use disorder. These patients have poorer health outcomes in part because enhancing health care for this population is a complex problem for which clinicians have little training or experience. The ENHANCING CONCURRENT DISORDER CARE Project is getting underway, driven by the desire expressed by clinicians for resources to use in practice. The project holds patients up as partners in shaping responses to health care, which meets the needs of staff and makes sense for the patients receiving that care.

Dr. Jenkins is a co-investigator on another project exploring the impact of comprehensive interventions aimed at providing more effective services for patients with concurrent disorders. HUB at St Paul’s and Vancouver Coastal Health’s Vancouver Access & Assessment Centre (ACC) are two such platforms that have emerged. HUB provides treatment and followup for people who are living with mental health or substance use concerns. Conveniently located next to St Paul’s Emergency unit, the two private settings opened in the spring of 2017 to offer care for patients from the time that they are admitted until they transition back into their communities. Specialized staff are on hand every step of the way, providing “culturally appropriate, trauma-informed care.” Specialized staff are also located at the ACC to offer short term, on-site treatment during non-life threatening mental health or substance use episodes. This drop-in centre is open and staffed every hour of every day of the year as an alternative to the Emergency department for non-life-threatening care, and is the “single point of access to VCH mental health and/or substance use services in Vancouver.”

Together these systems may add some stability as clients navigate the slippery slopes of the mental health and/or substance use cycle in Vancouver.

The MOMS STUDY is a project that has been developed in partnership with mothers who have lost a child to overdose. Three of these “Moms”, who have established advocacy groups with the mission to change drug policy and prevent further loss, have partnered with the research team. In recognizing that policy is often not based on evidence and that stories are powerful, the Mom’s Study works to harness the power of lived experience supported by evidence. Using personal stories, research, and the strength of their numbers, these women advocate for policy change at a provincial and federal level to make a difference that will benefit everyone.

This research arising from the perspective of health promotion, prevention, and treatment attempts to address several points of entry in the mental health/ substance use cycle in the hopes that it will halt or reduce harm. It may also have positive side effects. Watch for a reduction in stigma and improvement of quality of life for vulnerable populations.

Emily Jenkins with Heather Swallow