Applying experience-based co-design with vulnerable populations: Lessons from a systematic review of methods to involve patients, families and service providers in child and youth mental health service improvement

The objective was to identify methods used to involve patients, family and service providers in child and youth mental health service improvement research. We analyzed the alignment of methods used with Experience-Based Co-Design (EBCD) methodology, and how power imbalances among participants were addressed. A systematic review of the English-language peer review literature since 2004 was carried out. The EMBASE, Scholar’s Portal, PubMed, Web of Science databases and the Ontario College of Art and Design University libraries were searched electronically for variations of ‘child’, ‘mental health’, ‘experience-based co-design’, ‘participatory research’ and ‘health care services’. Textual data was systematically extracted and analyzed. The electronic search identified 1468 articles; 13 remained following full text review and reference checking. Many participatory research studies in child and youth mental health were consistent with core elements of the EBCD methodology, but few focused on experiences and incorporated the perspectives of all participants throughout the research process. Story telling and visual media, employing youth as researcher partners, establishing equal status among participants, offering counseling support, paying particular attention to confidentiality, scheduling frequent breaks, and having skilled interviewers and facilitators were suggested methods to address power imbalances for this vulnerable population. Conclusion-The existing child and youth mental health participatory research literature aligns considerably with many elements of EBCD methodology and suggests diverse approaches to address power imbalances. More systematic application of the full range of elements will help to achieve patient centeredness and recovery in mental health and for other vulnerable populations

From Psychologism to Psychologization: Beyond the Boundaries of the Discipline and Practice of Psychology

This thesis provides a descriptive account of three waves of critiques of psychologism and psychologization that appeared throughout the 20th century from philosophers and sociologists. I examine these arguments chronologically to show that psychology has repeatedly been criticized for going beyond its disciplinary boundaries and permeating other academic and cultural realms. Although the critiques focus on different forms of psychologism and psychologization, they all demonstrate how psychological approaches to subjectivity have precluded important knowledge about human mental life that can be gained from philosophy and sociology. By incorporating philosophical and sociological findings into psychological thinking, a more holistic understanding of human mental life can be achieved. Philosophers and sociologists illuminate the systemic roots of individual problems by focusing on the relation between individuals and social structures, and they encourage the development of critical thinking and political engagement as a means to achieving the psychological aim of mental well-being

Next Steps on the Road to Basic Income in Canada

Canada has had recurring debates about guaranteed or basic income over several decades. This article outlines reasons for implementing basic income in the Canadian context—reducing poverty and inequality, addressing precarious employment, and building an ecologically sustainable economy. Recently there has been a strong renewal of interest in basic income in Canada. Expressions of interest have come from the Liberal federal government elected in 2015, from provincial governments, from political parties not in power, and from municipal governments. Support for basic income also is found in a growing range of prominent individuals and organizations. While basic income advocates are encouraged by recent developments, several large and complex questions remain on how this approach can be implemented in Canada. These questions encompass the specifics of design, delivery, funding, and political support. How can basic income build on existing income security programs and leave Canadians better off in the end? How can we ensure that basic income is not used as an excuse to cut vital services such health care, social housing, early childhood care and development, and social services for those with disabilities and other challenges? How can basic income be set in place in Canada, given its complicated federal-provincial nexus of responsibility for, delivery of, and funding for social programs? The article concludes with principles that might help guide the implementation of authentically universal, adequate, and feasible basic income architecture in Canada

Possibilities and Prospects: The Debate Over a Guaranteed Income

The idea of a guaranteed income has a long and respectable history in Canadian political and economic thought. Recently, in the face of both wide criticism of the Canadian income security system and growing recognition of the unacceptability of current poverty rates, there has been a resurgence in calls for implementation of a Canadian guaranteed income. But the idea is a controversial one; progressive activists, academics, and politicians disagree about the desirability and the practicality of a guaranteed income. This report: Traces the history of guaranteed income proposals in Canada; Catalogues both the most common reasons supporting advocacy of a guaranteed income and the most telling concerns raised by the notion; Provides an overview of basic dimensions along which proposals for a guaranteed income differ and sets out models that capture much of the range of proposals in the current debate; and Suggests a number of other social welfare measures that should be central elements of any reform program, but that guaranteed income debates often ignore. The term “guaranteed income” refers to a specific although broad category of social reform. As a starting place for discussion, the idea of a guaranteed income is used to signal reform proposals that advocate some variant of an income benefit scheme in which the state provides a minimum level of basic income on a continuing basis to every adult, irrespective of personal circumstances or need, with no or very few conditions attached. Proponents of a guaranteed income cite a range of reasons supporting the idea: A fix to poverty; Liberty and individual opportunity; Social and democratic citizenship; Gender equality; Shared social ownership; A flexible and just labour market; and Environmental sustainability

Data elicited through apps for health systems improvement

A promising approach to meeting the need in many jurisdictions for timely, in-depth qualitative health systems experience data, is to elicit feedback through smartphone and web applications (apps). Apps offer an appealing tool to elicit data from patients and family members who may feel stigma when receiving some services and a power imbalance when providing feedback to health-care providers. In this article, we examine the effectiveness of a suite of smartphone and web apps called myExperience (myEXP) that were created to gather care experiences of youth, family members, and service providers as part of an experience-based co-design (EBCD) study in Ontario involving youth with mental disorders. We analyzed data from 12 triads of youth (aged 16–24), family members, and service providers gathered between August 2015 and December 2016. We used qualitative content analysis to understand participant feedback on the myEXP apps and identify thematic categories that emerged from experience data elicited through the myEXP apps. We found overall that the myEXP apps were more effective at eliciting experience data from youth compared with family members and service providers. Rich experience data were gathered from youth about treatment plans in real time through the apps. The apps also showed important promise as reflective tools for all participants. They may offer advantages in research that seeks to improve responsiveness in service delivery and build mutual understanding. The apps also offer choice in how data are elicited, encourage more candid feedback and help to overcome stigma, which are important considerations for some vulnerable populations. For service redesign research using approaches such as EBCD, apps offer real-time data gathering that can complement and enhance traditional approaches such as retrospective interviews and observation

Are you really doing ‘codesign’? Critical reflections when working with vulnerable populations

‘Codesign’ and associated terms such as ‘coproduction’ or ‘patient engagement’, are increasingly common in the health research literature, due to an increased emphasis on the importance of ensuring that research related to service/systems development is meaningful to end-users.  However, there continues to be a lack of clarity regarding the key principles and practices of codesign, and wide variation in the extent to which service users are meaningfully engaged in the process. These issues are particularly acute when end-users include populations who have significant health and healthcare disparities that are linked to a range of intersecting vulnerabilities (eg, poverty, language barriers, age, disability, minority status, stigmatised conditions).  The purpose of this paper is to prompt critical reflection on the nature of codesign research with vulnerable populations, including key issues to consider in the initial planning phases, the implementation process, and final outputs.  Risks and tensions will be identified in each phase of the process, followed by a tool to foster reflexivity in codesign processes to address these issues

Designing as Negotiating Across Logic Multiplicity: The case of mental healthcare transformation toward co-design and co-production

Designing within complex service systems implies navigating across a plurality of norms and beliefs that multiple stakeholder groups uphold, designers included. Transformational processes may be challenged by minimum, moderate or extensive conflict depending on the centrality or compatibility of competing logics. This article reflects on how the complexity inherent in higher level institutional orders of society can support or inhibit the potential and implementation of co-production in the public sector realm where designers operate. Using the context of public mental healthcare transformation as a backdrop, we identified and reflected on four predominant logics: the logic of state; the logic of market; the logic of profession; and the logic of community. We then developed a tool to support reflexivity – the Layers of Logics Map – that can be used to take “project logics snapshots” to represent the perceived strength of project stakeholder logics at the micro, meso and macro levels and their centrality and compatibility. Three co-design project examples were used to retrospectively test the Layers of Logics Map to reveal the role of competing logics in project challenges or triumphs. While we acknowledge that logics are often highly institutionalized and difficult to become aware of, we value as fundamental the creation of tools to better enable designers to consciously adopt adequate strategies to navigate this complexity

Adopting, implementing, and assimilating coproduced health and social care innovations involving structurally vulnerable populations: Findings from a longitudinal, multiple case study design in Canada, Scotland, and Sweden

Background: Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation, and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups.Methods: We conducted a four-year longitudinal multiple case study (2019-2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping region, Sweden involving people with multiple complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the case study protocol, semi-structured interview guides, data extraction, deductive coding, and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model, and Lozeau’s Compatibility Gaps to understand assimilation.Results: The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organisations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change.Conclusions: In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures, and an emphasis on driving transformational change in organisational cultures

Adopting, implementing and assimilating coproduced health and social care innovations involving structurally vulnerable populations: findings from a longitudinal, multiple case study design in Canada, Scotland and Sweden

Background: Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups. Methods: We conducted a 4 year longitudinal multiple case study (2019–2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping Region, Sweden involving people with multiple complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision-makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the case study protocol, semi-structured interview guides, data extraction, deductive coding and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model and Lozeau’s Compatibility Gaps to understand assimilation. Results: The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organizations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change. Conclusions: In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures and an emphasis on driving transformational change in organizational cultures