Improving language awareness in mental health care by engaging clinicians of language diverse patients

Background: Despite the diverse linguistic profiles of patients at inner city hospitals, language barrier between patients and clinical staff remains neglected. Reasons may include lack of awareness of language barrier by clinicians and silencing of barriers by organizational practices and management priorities. From prior research, inpatient psychiatry nurses and medical students are least likely to seek the help of interpreters when faced with patients that don’t speak English or French. Reasons for these practice patterns are unknown.

Objectives: Developing previous work, this study aims to clarify the quality of language barriers in clinical settings, focusing especially, but not uniquely, on the work of nurses and medical students, to (1) document clinician awareness of language barriers in their patients; (2) explore how awareness of language barriers can be enhanced professionally and institutionally; (3) evaluate the discourses reinforcing language barrier in clinical practice; and (4) assess whether promoting awareness of language barrier results in a measurable increase in documentation of language dynamics in patient charts and a corresponding increase in clinician satisfaction working with language diverse patients in clinical mental health settings.

Hypotheses: We hypothesize that after focus groups on language barrier over one year on psychiatric services, measurements at Time 1 compared to Time 2 will show (1) a statistically significant increase of clinician awareness of language barriers as measured by mentions of language issues in patient charts and (2) greater clinical satisfaction working with language diverse patients.

Research Methodology and Study Population: The study is divided into two phases, each of one-year duration. Phase 1 will consist of Time 1 ratings during the first year of mentions of language issues in 250 hospital charts of patients with diverse mother languages. A baseline clinician satisfaction survey of working with language diverse patients will be administered to 50 clinicians. After these ratings have been completed, a series of focus groups will be conducted in the last six months of year 1 with clinicians and hospital managers to explore experiences, perspectives and suggestions to improve clinical communication. Phase 2 will consist of follow up focus groups during the first six months of the second year to investigate whether clinician awareness of language barriers has affected individual and team practice i.e. to determine if any change has taken place. After the focus groups are complete, Time 2 ratings of mentions of language issues in 250 patient charts will be conducted, and a follow up clinician satisfaction survey of the same 50 clinicians will be administered, both as in Phase 1.

Data Analysis: Descriptive statistics will be calculated for each study variable. Measures that are scored dimensionally (i.e., clinician satisfaction ratings) will be assessed using Analysis of Variance (ANOVA). Measures that are scored categorically (i.e., language mentioned in chart yes/no) will be assessed using standard Chi-Square tests. Where power considerations allow, analyses will control for confounders that show influence on the pattern of results. Potential confounders include clinician type, clinician experience (years), language ability of patients and clinicians, and duration of time of patients in Québec. Focus groups will be audiotaped and transcribed, then analyzed using the qualitative software MAXQDA for constant emerging themes. This will provide a comprehensive understanding of the construct of language awareness and its associated elements in clinical mental health settings.

Relevance: Linguistic diversity is a fact in clinical care settings. This study will help to bridge the gap between patients who are linguistically diverse and their clinicians’ lack of awareness of linguistic diversity and how it may compromise quality of care.

Clinical Measurement of Verbal Language Proficiency in Patients Referred to a Cultural Consultation Service (CCS)

Background: The CCS of the Jewish General Hospital has been evaluating the mental health of immigrants and refugees since 1999. As may be expected, CCS patients from linguistically diverse backgrounds need interpreter services, but how clinical decisions are made to assign interpreters to a given patient are unknown. Furthermore, there are no clinical language proficiency tools available for use in health care settings. Health care literacy tools exist, but before they can be administered to patients of diverse backgrounds, basic verbal language proficiency in English must first be evaluated.

Objectives: Using a retrospective sample of CCS referrals, this study will demonstrate that clinicians overestimate language proficiency in linguistically diverse patients. Then, a simple tool to measure verbal language proficiency, which can be administered quickly and efficiently in clinical settings, will be piloted on a prospective sample of CCS referrals to address this problem.

Hypotheses: 1) The language proficiency of patients will be overestimated by referring clinicians compared to CCS clinicians; 2) The extent to which referring clinicians differ on their estimation of patients’ language proficiency will depend on several variables, including type of referring clinician and institution, patient age (older versus younger), status in Canada (refugee versus immigrant) and level of formal education; 3) The pilot language proficiency questionnaire will, on average, take less than 10 minutes per patient (clinical utility, feasibility) and will be completed by more than 80% of the approached patients who give their consent to participate in the project (clinical acceptability).

Research Methodology and Study Population: Step 1: Retrospective language data on 150 CCS referrals (over approximately five years, 2013-2017) whose mother language is other than English will be gathered by a research assistant from patient charts. Step 2: Prospective language data on approximately 50 CCS referrals (over one year, 2018-19, with anticipated increasing referral rates due to the recent influx of refugees) whose mother language is other than English will be gathered by a research assistant as per Step 1 above. In addition to comparisons of rated language proficiency between referring clinicians and the CCS clinicians, a participant observer will note the dynamics of language use during the consultation: predominant language spoken, language preferences, and how interpreters negotiate clinical communication. Step 3: Based on input from data gathered during Steps 1&2, a pilot language proficiency questionnaire, clinician-rated, brief (less than 10 minutes), and focusing on verbal language, will be drafted by the CCS researchers and administered prior to cultural consultations by a research assistant to 25 CCS referrals (over six months in 2018-19) to estimate feasibility, clinical utility and acceptability of the instrument.

Data Analysis: Descriptive statistics will be calculated for each demographic and study variable. Analysis of Variance (ANOVA) will be used to determine group differences on estimation of language proficiency. Where power considerations allow, variables from Hypothesis 2 that may influence the pattern of results will be analyzed. Measures that are scored categorically (i.e., patient’s need of an interpreter, yes/no) will be assessed using Chi-Square tests. Thematic analysis of qualitative data, gathered from participant observation, will be used to inform the development of the language proficiency questionnaire and to comment on its feasibility, clinical utility and acceptability in preparation for formal empirical testing.

Relevance: Language barriers are linked to poor mental health outcomes that are preventable if clinicians recognize which patients need interpreter services and plan ahead to provide them. A clinical tool to determine basic verbal language proficiency in English, the first of its kind, would make such interventions possible.

Utilization of Psychosocial Oncology Services by Oral Cancer Patients According to their Minority Language Profile in Montreal area.

Several patients with oral cancer experience psychosocial distress during their care trajectory, and even afterwards. In recent years, psychosocial oncology services (SOP) have been implemented in many hospital centers to support cancer patients with emotional, psychological, or social support needs. The use of SOP by patients with oral cancer has not yet been documented, which hinders monitoring and continuous improvement of care. In Quebec, shortages of healthcare personnel, persistent barriers to distress screening, and stigma surrounding the use of mental health services may influence the use of SOP in oral oncology, especially among the anglophone minority where difficulties accessing healthcare and mental health services have been reported. Our objective is to generate surveillance data on the use of SOP by patients and survivors of oral cancer, according to their official linguistic status in Quebec. Therefore, we are conducting a retrospective study based on data from real patients with oral cancer who are followed in one of the major hospital centers in Montreal. In addition to sociodemographic and clinical data, francophone and anglophone patients will be compared on the rate of referral to the psychosocial oncology department, the delay and response rate to these requests, and the type of SOP received. Analyses will be conducted to explore factors related to potential differences in SOP utilization between francophone and anglophone patients. Communicating our data to healthcare providers and policymakers will help them review their policies and strategies to promote comprehensive care for patients in oral oncology while ensuring equitable access to services between linguistic minorities and majorities.

Bilingual Simulations in Nursing: Virtual Reality, Interlinguistic Pairing, and Authentic Reinforcement

In recent years, researchers in computer-assisted language learning have been exploring the potential of immersive technologies to support second language (L2) acquisition. Virtual reality (VR), defined as the computer-generated simulation of an environment in which users experience a sense of presence (Sadler et al., 2013), can immerse L2 learners in interactive scenarios where they practice communication in real-life situations. Such learning environments can reduce L2 anxiety (Gruber & Kaplan-Rakowski, 2022) while increasing willingness to communicate (Papin, 2018, 2022). However, little is known about the impact of participation in immersive interactive simulations on L2 self-efficacy (i.e., learners' belief in their ability to use the L2 to perform linguistic and non-linguistic tasks (Mills, 2014)). Given the positive impact of self-efficacy on L2 learning (Bai & Wang, 2022), the research objective of this exploratory study is to examine the impact of conducting VR simulations on L2 self-efficacy. The participants will be 48 intermediate French L2 learners enrolled in a nursing education program at two post-secondary institutions, one English-speaking and the other French-speaking. Before participating in an in-person internship at a hospital, they will be asked to individually conduct two simulations on ImmerseMe. During these simulations, which mimic daily conversations in a professional setting, learners will be individually immersed in a virtual environment. This environment will place them in a virtual hospital room using 360-degree videos, and they will have to orally interact with pre-programmed virtual agents. The simulations are based on scenarios depicting authentic interactions encountered in a hospital setting: 1) assessing a patient's level of pain; and 2) interacting with a patient as part of a postoperative protocol. Through ImmerseMe's voice recognition capabilities, the utterances of L2 learners will be compared to a pre-established script, allowing the simulations to progress if the produced sentence matches one of the possible responses.

Integrating French second-language experiences into clinical psychology training to enhance retention of English-speaking trainees

Context: Minority communities need access to linguistically/culturally sensitive mental health services. In this respect, Québec Anglophones face a retention challenge: Many English-speaking clinical psychology trainee students leave Québec upon graduation, thereby reducing the available pool of English-speaking mental health practitioners. Reasons include linguistic challenges in establishing a sustainable clinical practice in Québec, such as inability to meet French-language requirements of the Ordre des psychologues du Québec and/or inability to build a practice that includes Francophone clients. Concordia's Psychology Department is instituting a novel approach to addressing this challenge by integrating French-language experiences for English-speaking trainees into its program. This provides the project setting; we will closely study Concordia's experience and conduct a systematic review of literature on relevant best practices.

Main objective: Deliver a report on best practices for French second-language training and assessment for trainees in clinical psychology with a focus on potential implications for trainee retention.

Procedures: Procedures include (1) Examining the literature worldwide on best practices for language-training of mental health clinicians; (2) Interviewing 30 Concordia clinical psychology trainees; (3) Interviewing participating clinical supervisors; (4) Consulting community-based practicing clinicians about experiences using their secondlanguage-French with Francophone clients.

Data analyses: Systematic Reviews of the literature; Qualitative Analyses of interview data.

Potential contributions:

• enhancing retention of English-speaking clinical psychology trainees in Québec, thereby increasing support for the Anglophones community; laying foundations for future mixed-methods assessments of such second-language training support;

• providing support for similar English-language experiences for Francophone trainees, thereby further increasing the availability of practitioners for Anglophones.

Linguistically- and Culturally-Sensitive Psychotherapy: Improving Communications to Improve Outcomes

Context: Linguistic mismatch can lead to communication problems that interfere with psychological treatments for mental health problems. Cultural misunderstandings can exacerbate these problems. Past research funded by Dialogue McGill has identified ways in which psychotherapists can effectively intervene to overcome linguistic and cultural barriers. The current research proposes to directly evaluate these interventions.

Main Objectives: We will: (1) carry out a systematic review of psychotherapy effectiveness in cross-linguistic and cross-cultural settings; use (2) use qualitative inquiry to study linguistic/cultural misunderstandings between clients and their therapists; and (3) use quantitative techniques to study the impact of interventions designed to mitigate these misunderstandings.

Research Procedures: Participants will be 12 anxiety and/or depression patients from a migrant and/or minority background, all of whom speak English as a second language and prefer English as their first official language. Half will be in a situation of language match with their therapist, and half will have a mismatch, in terms of preferred official language.

Data Analysis:  Qualitative inquiry will give us a close reading on best practices when working with linguistic and cultural diversity. Quantitative modeling will allow us to study the impact of change over time through daily self-report assessments. Some models will include participants from previous Dialogue McGill-funded projects, enhancing statistical power.

Potential Contributions: We anticipate this project will improve mental health care for English-speaking patients in Quebec, as well as improving training of mental health professionals. Results will be relevant to other settings characterized by linguistic and cultural complexity.

Remotely-Delivered CBT for English-Speaking Psychiatric Outpatients across Quebec: An Evaluation of Treatment Effectiveness, Treatment Acceptability and Barriers to Accessing Care

Cognitive behavioural therapy (CBT) is the ‘gold standard’ psychological intervention for most mental health problems, however, access to CBT is often challenging due to long clinic waitlists and limited availability of trained professionals in all communities. In Quebec, English-speaking Quebecers are faced with additional challenges in accessing care due to their status as a linguistic minority. One method of increasing access to CBT is using a model of remote service delivery whereby clinics that specialize in CBT can provide services in English to patients located anywhere in the province. Using a non-randomized design, we aim to examine whether providing remotely-delivered CBT to English-speaking Quebecers from across the province will lead to similar improvements in symptoms and functioning compared to patients receiving in-person treatment. We will also examine questionnaire results and identify themes in patients’ written feedback to assess their treatment satisfaction and to better understand their experiences of receiving remotely-delivered CBT. This study will be conducted in the Centre for CBT Research, Training and Intervention (Centre for CBT-RTI), a clinic located in the McGill University Health Centre. The Centre for CBT-RTI is a non-sectorized clinic staffed by bilingual mental health professionals with expertise in CBT who provide in person and remotely-delivered CBT for patients from across Quebec. The findings from this research are anticipated to increase awareness among mental health professionals and key stakeholders in government and hospital administration about the benefits of remote-delivered CBT and patient preferences for service-delivery.

Sustainable human resource management of healthcare personnel working in a minority linguistic context – comparative phase in border regions

This project aims to address strategic human resources management (HRM) issues faced by the part of the healthcare system serving the English-speaking population and other cultural minorities in regions of Quebec outside the Montreal metropolitan area. Its initial phase took place in the Quebec City region at Jeffery Hale - Saint Brigid's Hospital (JHSB), grouped as part of CIUSSS de la Capitale-Nationale, and then has proceeded to a comparative analysis of recruitment processes between CIUSSS de la Capitale-Nationale and CISSS des Laurentides. The present project aims to conduct further comparative analysis between these two establishments and regions of Quebec bordering the English-speaking provinces: Outaouais, Montérégie-Ouest and Côte-Nord. The first objective of the project is to report on the current bilingual staffing process (recruitment, selection, on-boarding and integration) for four job categories in high demand in the Quebec healthcare system, in designated English-speaking facilities. Its aim is to establish the degree of adequacy between published language requirements, initial assessment of candidates and upgrading measures offered to newcomers. Secondly, the project aims to identify HRM practices that can help retain staff working in a bilingual healthcare context. The entire non-agreement-based HRM process will be covered (staff appraisal, skills development, non-monetary recognition), while investigating the potential strategic contribution of the surrounding English-speaking community in this respect.

A review of migration patterns of English-speaking healthcare workers in Québec and existing French-language supports

In 2022, PERT published a report titled “French-language support for Québec’s English-speaking professionals.” This report examined the role of French language policies in professional orders and the language supports available to English-speaking prospective and current members of professional orders. We concluded that there is no comprehensive framework for supporting individuals who need to improve their French. Additionally, we found that most institutional stakeholders were not mandated nor had adequate capacity to provide French-language support to English-speaking health professionals. Since the publication of this report, the situation for English speakers within Québec’s healthcare system has become more complex. There are acute shortages of healthcare professionals, concerns about reduced access for English speakers, outmigration of healthcare workers, and the implementation of new French-language policies that may impact the hiring and retention of English-speaking healthcare workers.

In this project, we will expand on the findings of the report. The objectives are to:

• Understand the immigration and out-migration of English-speaking healthcare professionals in order to identify the impacts of outmigration and immigration and analyze the existing capacity of English-speaking workers to fill existing labour shortages and healthcare needs

• Identify the government-funded French-language training programs targeted at healthcare professionals in Québec

• Formulate policy recommendations to support English speakers’ entry into and retention in Québec’s healthcare industry

This will be accomplished in two ways: an inventory of existing government-funded French-language training for healthcare workers, and analysis of education and migration patterns of English-speaking healthcare professionals through 2016 and 2021 census data.

Pregnancy outcomes of Anglophones compared with Francophones in Québec

A growing number of studies suggest that Anglophones may be at risk of preterm birth and stillbirth in Québec. However, pregnancy outcomes such as gestational diabetes and preeclampsia have not been studied. These two pregnancy complications are major causes of morbidity in pregnant women and have potential to explain why some Anglophones have a greater risk of preterm birth and stillbirth. Gestational diabetes is a type of hyperglycemia that develops specifically during pregnancy, and can lead to complications in infants and mothers. Preeclampsia is a life-threatening pregnancy complication that can lead to severe hypertension, seizures, and maternal death. The objective of this research proposal is to investigate if Anglophones have a higher risk of gestational diabetes and preeclampsia, compared with Francophones. We will perform population-based studies using linked data that include birth characteristics and medico-administrative information in Québec from 2008 to 2020. The main exposure will be English or French maternal mother tongue. The main outcomes will be gestational diabetes and preeclampsia. We will measure the association between maternal mother tongue and the risk of gestational diabetes and preeclampsia using regression models. We will also determine if maternal characteristics such as age, country of origin, education, and socioeconomic status influence the relationships of interest. Our findings will help assess the extent to which Anglophones have high risk pregnancies that may benefit from enhanced obstetric care to prevent adverse outcomes.

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Outcomes:

• Auger N, Bilodeau-Bertrand M, Ayoub A, Lafleur N, Wei SQ. (2024; submitted). Increasing risk of gestational diabetes in the Anglophone minority of Quebec. Canadian Journal of Diabetes.

• Auger, N., Bilodeau-Bertrand, M., Lafleur, N., & Lewin, A. (2024). Underlying Causes of Ethnocultural Inequality in Pregnancy Outcomes: Role of Hospital Proximity. Journal of immigrant and minority health, 26(1), 54–62. https://doi.org/10.1007/s10903-023-01545-7

• Auger N, Bilodeau-Bertrand M, Lafleur N. (2023). Access to perinatal healthcare: Risk of adverse birth outcomes among minority Anglophones in Montreal, Canada [Poster presentation]. Colloquium 2023 on the Health of OLMCs, Health Canada, Ottawa, Ontario, Canada.

• Auger N, Bilodeau-Bertrand M, Lafleur N, Lewin, A. (2023). Ethnocultural inequality in pregnancy outcomes: Comparison of Francophones and Anglophones in Montreal [Poster presentation]. Colloquium 2023 on the Health of OLMCs, Health Canada, Ottawa, Ontario, Canada.

• Auger N. Pregnancy outcomes of Quebec Anglophones: recent research results. (unknown). QUESCREN Concordia Lunch and Learn. Montreal, Québec, Canada.

Digital cognitive assessments for Quebec English-speaking older adults and patients on the Alzheimer’s disease spectrum

About 1 in 9 people above 65 years old has Alzheimer’s disease (AD). Timely and precise diagnosis, along with comprehensive cognitive assessment, play crucial roles in managing this disease effectively. A precise evaluation of cognition is essential for making accurate diagnoses, including the identification of the prodromal phase of AD known as mild cognitive impairment (MCI). However, conventional cognitive tests come with significant limitations, especially for the English-speaking population in Quebec. These issues encompass the absence of tests tailored to English speakers in Canada or Quebec, outdated norms exceeding 20 years, a lack of contemporary digital assessment tools, and the failure to consider social determinants of health (SDOH) in normative data. Our project has two primary goals:

1. to validate and standardize a cognitive battery incorporating digital adaptive tests for English-speaking older adults in Quebec, while accounting for SDOH;

2. to compare the diagnostic accuracy of a traditional paper-pencil cognitive battery with a digital counterpart for MCI. Our study will involve 150 cognitively unimpaired older adults and 20 MCI patients, who will undergo both traditional and novel digital cognitive assessments.

This project holds immense significance for clinical practice and Quebec's English-speaking communities, as it will provide novel open-access digital tools for researchers and clinicians. These tools will offer a more accurate, efficient and engaging experience for patients and clinicians.

Virtual Reality Exposure Therapy for Severe Anxiety Disorders: Effectiveness and Acceptability in English-Speaking Quebeckers

Exposure therapy consists in approaching one’s fears without avoidance. It is known to be the best psychological intervention for anxiety disorders, which are some of the most common, debilitating mental health problems in Quebec. Recently, virtual reality exposure therapy (VRET) has been developed to address some of the accessibility and acceptability concerns of traditional exposure therapy conducted in “real life”—one of these being the need for consistently clear communication between therapists and patients. Through computer-generated, language-free environments, VRET helps individuals confront the virtual counterparts of their fears, without extensive therapeutic discussions. VRET’s potential to increase access to a first-line anxiety treatment for English-speaking Quebec residents is thus promising. Although the efficacy of VRET has been shown to be comparable to traditional exposure therapy, most of this research has been conducted in well-controlled laboratories focusing on subclinical anxiety. This project aims to examine the effectiveness and acceptability of VRET for severe symptoms of anxiety disorders in a non-sectorized mental health clinic, accessible to all Quebec residents. English-speaking Quebeckers with an anxiety disorder will receive twelve sessions of VRET and will complete symptom measures pre- and post-intervention. Results will be compared to symptoms of individuals who have already undergone traditional exposure therapy at the clinic. Demonstrating that VRET is as effective as traditional exposure therapy in a real-life and language minority context will help increase access to a gold standard intervention, using approachable, language-free technology. Lastly, themes will be extracted from participants’ feedback to compare the treatments’ perceived accessibility and acceptability

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Outcomes:

• Gagné, J. P. (2023, April). Using virtual reality in exposure therapy for a specific phobia of flying: Two case studies. Talk presented at the First Annual McGill University Health Centre Mental Health Mission Research Day, Montreal, QC.

Increasing access to pediatric sleep care for youths in the English-speaking community in Quebec.

Abundant evidence indicates that the negative impacts of sleep disorders can be significantly reduced by effective treatment. However, interventional opportunities that would improve the sleep and overall health of children and adolescents in the English-speaking community in Quebec are currently being missed because healthcare providers serving this community are either unaware of the tools available or do not know how to use the tools effectively. Significant progress towards increasing access to pediatric sleep services could be made if healthcare professionals serving the English-speaking community in Quebec be provided with knowledge and skills in pediatric sleep medicine. Thus, the objective of the proposed activities is to disseminate pediatric sleep training to healthcare professionals who treat youths in the English-speaking community. This is important as it is expected to facilitate increased access to pediatric sleep care for youths with sleep problems and disorders in the English-speaking community in Quebec.

Catalyzing Capacity Building in Rehabilitation Post-Solid Organ Transplant

Solid organ transplant (SOT) patients have low levels of physical activity before and after transplantation which has a negative impact on their health and survival. Despite this, in Quebec, there is limited availability of rehabilitation and physical activity programming for transplant candidates and recipients. Importantly, many healthcare professionals do not feel confident in counselling SOT recipients about physical activity that is appropriate for them due to lack of specific education about transplantation in their training.

Our objective is to develop a free online continuing education course on exercise prescription in SOT recipients for English-speaking exercise professionals in Quebec that will include interactive lectures, case studies and evaluation materials. This will ultimately improve the confidence of exercise professionals when they deal with SOT recipients and the quality of rehabilitation that they are able to offer.

The development of the course will involve 4 steps:

1. A scientific committee, including both professionals and patient partners, will participate in a video conference call to define the learning objectives and the most relevant content (theory, case studies, evaluations) to be included in the course.

2. The Co-PIs, the coordinator, a trainee, patient partners, Maria Sedeno (RESPIPLUS) and Becky Zucco (Wilkin) will draft the first version of the online course including the learning objectives, content, case studies, evaluation materials as well as visual aspects and interactive components of the module.

3. Feedback from the scientific committee will be sought via email. At least two rounds of revision are planned.

4. Feedback will be integrated into the module. This initiative was made possible through a financial contribution by Health Canada. 7 By providing English-speaking exercise professionals in Quebec with the knowledge and tools to effectively prescribe exercise to SOT recipients, the availability of rehabilitation services and physical activity programming for SOT recipients in Quebec may increase.

Linguistically- and Culturally-Sensitive Psychotherapy: Training and Retaining Migrant & Minority Therapists

Mental health care in multicultural communities is enhanced when local therapists represent the population and when these therapists are trained in linguistically- and culturally-sensitive psychotherapy. Unfortunately, many trainees do not feel well-prepared for diversity and migrants/minorities face barriers to building a career in Québec.

We will: (1) use qualitative inquiry to study perceived training deficits and career barriers in psychologists trained at anglophone institutions; (2) use quantitative techniques to establish a consensus model of the changes needed to retain multicultural expertise in Québec. 

Participants will be 40 clinical psychology trainees and 40 licensed clinical psychologists. This project will use a cultural consensus design, a mixed methods approach with four sequential steps: (1) qualitative interviews (in this case, analysis of previously collected interviews); (2) free listing responses to open-ended questions; (3) sorting the most common responses while thinking aloud; and (4) survey design based on the consensual sorts.

The qualitative interview and think-aloud transcripts will be studied using qualitative inquiry, specifically thematic analysis. The free listing, sorting, and survey components will be studied using quantitative analysis; frequency analysis, multidimensional scaling, and cultural-consensus analysis, respectively.

We anticipate this project will improve training of mental health professionals and will yield steps to boost retention of migrant/minority psychologists in Québec. We will develop recommendations for the two anglophone training programs, and for the professional order. Our results will be relevant to other cultural settings characterized by linguistic and cultural complexity.

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Outputs:

• Zhao, Y., Segalowitz, N., Voloshyn, A., Chamoux, E., & Ryder, A. G. (2021). Language Barriers to Healthcare for Linguistic Minorities: The Case of Second Language-specific Health Communication Anxiety. Health communication, 36(3), 334–346. https://doi.org/10.1080/10410236.2019.1692488

• Ryder, A. G., Doucerain, M. M., Dere, J., Jurick, T., Zhou, B., & Zhou, X. (2021). On dynamic contexts and unstable categories: Steps towards a cultural-clinical psychology. In M. Gelfand, C.-Y. Chiu, & Y.-Y. Hong (Eds), Advances in culture and psychology, volume 8 (pp. 195-245). OUP.

• Voloshyn, A., Dussault, È., Segalowitz, N., Ryder, A. G. (2022, September). A qualitative study of clinical psychologists’ reflections on their work with linguistically- and culturally-diverse clients [Paper session]. Presentation at the 6th World Congress of the World Association of Cultural Psychiatry, Rotterdam, Netherlands.

Thinking social: Examining the efficacy of a social skills training group for young adults on the autism spectrum

Social skills are challenging for individuals on the autism spectrum (AS). Such deficits make everyday living difficult, and can lead to mental health difficulties, most notably anxiety and depression. Social skills training programs have been shown to improve social abilities adolescents and adults on the AS. However, little is known regarding their efficacy to improve mental health issues.

In Québec, few programs aimed at improving social skills in young adults are offered within the public healthcare system, and even fewer are offered to English speakers. Additionally, clinicians rarely receive training to intervene with ASD young adults.

Thus, this study aims to a) assess the efficacy of a program aimed at improving social skills young adults on the AS, b) examine whether increased social abilities and connection with peers lead to improved mental health in these adults, c) increase the availability of English-language intervention for adults on the AS within the public healthcare system and d) increase clinical capacity of English-speaking clinicians in Québec to deliver social skills interventions.

For this project, 12 young adults on the AS will participate in a 24-week social skills training program. Each participant will be paired with a peer social coach who will be recruited from clinical departments at McGill University (psychology, SCSD, etc.). Participants will undergo testing to assess social skills and mental health at baseline (T0), immediately after completing the program (T1), and six-month post-treatment (T2). ANCOVAs will be used to compare test scores at T0 to those at, T1 and T2.

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Outputs:

• Beauchamp, M. L. H., Amorim, K., Wunderlich, S. N., Lai, J., Scorah, J., & Elsabbagh, M. (2022). Barriers to access and utilization of healthcare services for minority-language speakers with neurodevelopmental disorders: A scoping review. Frontiers in psychiatry, 13, 915999. https://doi.org/10.3389/fpsyt.2022.915999

• Beauchamp, M. L. H., Rezzonico, S., Bennett, T., Duku, E., Georgiades, S., Kerns, C., Mirenda, P., Richard, A., Smith, I. M., Szatmari, P., Vaillancourt, T., Waddell, C., Zaidman-Zait, A., Zwaigenbaum, L., & Elsabbagh, M. (2023). The Influence of Bilingual Language Exposure on the Narrative, Social and Pragmatic Abilities of School-Aged Children on the Autism Spectrum. Journal of autism and developmental disorders, 53(12), 4577–4590. https://doi.org/10.1007/s10803-022-05678-w

• Beauchamp MLH, Rezzonico S, Elsabbagh M, Mirenda P, Bennett T, Duku E, Georgiades S, Kerns CM, Smith IM, Szatmari P, Ungar WJ, Vaillancourt T, Zaidman-Zait A, Zwaigenbaum L. (May 11-14, 2022). Examining the Influence of Bilingualism on the Narrative, Social and Pragmatic Abilities of School-Aged Children on the Autism Spectrum. International Society for Autism Research (INSAR) Conference, Austin, USA, hybrid format,

• Beauchamp MLH, Rezzonico S, Smith I, Duku E, Georgiades S, Kerns C, Mirenda P, Richard A, Szatmari P, Vaillancourt T, Waddell C, Zwaigenbaum L, Zaidman-Zait A, Elsabbagh M. (Nov 17–19, 2022). Narrative, Social and Pragmatic Abilities in Bilingual and Monolingual School-Aged Children on the Autism Spectrum. The American Speech-Language-Hearing Association (ASHA) Convention 2022, New Orleans USA.

• Beauchamp, M. L. H., Blanco Gomez, G., Rezzonico, S.,...Elsabbagh, M (2023). The Validity of the Narrative Scoring Scheme in School-Aged Children on the Autism Spectrum. International Society for Autism Research.

• Scorah, J; Beauchamp, M. L. H.; Amorim, K; Elsabbagh, M. (2022). Examining the Characteristics of Clinicians in an ECHO (Extension for Community Health Outcomes) Autism Program

• Beauchamp, M. L. H., Amorim, K., Wunderlich, S. N., Lai, J., Scorah, J., Elsabbagh, M. (2022, submitted). Identifying Barriers to Healthcare Access and Use for Minority-Language Speakers with Neurodevelopment Disorder

• Beauchamp, M. L. H., Blanco Gomez, G., Rezzonico, S.,...Elsabbagh, M (2023, submitted). The Narrative Scoring Scheme’s Validity with Bilingual and Monolingual Children on the Autism Spectrum

Linguistically- and Culturally-Sensitive Psychotherapy: Improving Communication to Improve Outcomes

Context: Linguistic mismatch can lead to communication problems that interfere with psychological treatments for mental health problems—not least, because these are linguistic interventions. Cultural misunderstandings can exacerbate these problems. Yet there ways in which psychotherapists can engage in positive ways with linguistic and cultural diversity. Studying how this is best done is particularly relevant to the Quebec situation.

Main Objectives: We will: (1) use quantitative techniques to study the impact of linguistically- and culturally-sensitive therapy on outcomes; and (2) use qualitative inquiry to study the conversations that unfold between clients and their therapists.

Research Procedures: Participants will be 12 anxiety and/or depression patients from a migrant and/or minority background, all bilingual but half who prefer English as their first official language, half who prefer French. Within each subgroup, half will be in a situation of language match with their therapist, half mismatch, in terms of their preferred language.

Data Analysis: Quantitative modeling will allow us to study the impact of change over time through daily self-report assessments. We will be able to see how specific therapeutic interventions benefit specific patients. Qualitative inquiry will give us a close reading on what works—and what does not work—when working with linguistic and cultural diversity.

Potential Contributions: We anticipate this project will improve mental health care for English-speaking patients in Quebec suffering from mental health problems, as well as improving training of mental health professionals. Our results will be relevant to other cultural settings characterized by linguistic and cultural complexity.

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Outputs:

• Zhao, Y., Segalowitz, N., Voloshyn, A., Chamoux, E., & Ryder, A. G. (2021). Language Barriers to Healthcare for Linguistic Minorities: The Case of Second Language-specific Health Communication Anxiety. Health communication, 36(3), 334–346. https://doi.org/10.1080/10410236.2019.1692488

• Ryder, A. G., Doucerain, M. M., Zhou, B., Dere, J., Jurcik, T., & Zhou, X. (2021). On dynamic contexts and unstable categories: Steps toward a cultural-clinical psychology. In M. J. Gelfand, C.-y. Chiu, & Y.-y. Hong (Eds.), Handbook of advances in culture and psychology (pp. 195–243). Oxford University Press. https://doi.org/10.1093/oso/9780190079741.003.0005

• De Oliveira Jr., O., Hammami, S., Quadrio, J., & Ryder, A. G. (2022, May). Creating a front-line transcultural mental health clinic for Montreal-Nord youth. Poster presented at the 2022 Summer Institute for School Psychology, Montréal, QC.

• Ryder, A. G., Quadrio, J., Stora, L., Taing, J., Yampolsky, M., Tao, D., & Segalowitz, N. (2022, May). La culture, la langue et la santé mentale: La « Acculturation Toolbox » pour les chercheurs et les cliniciens. Paper presented at the 44th Annual Congress of the SQRP, Saint-Sauveur, QC.

• Voloshyn, A., Segalowitz, N., Zhao, Y., Ryder, A. G. (2021, July). Linguistic minorities and access to mental healthcare: The case of second language health communication anxiety. Paper presented at the 25th conference of the IACCP, Olomouc, Czechia.

Sustainable Human Resource Management of Health Care Personnel Working in Minority Language Contexts | Comparative phase, Laurentians and Outaouais regions

This project is integrated into another larger one aimed at responding to strategic issues of human resource management (HRM) faced by our health systems serving English-speaking communities and other cultural minorities in Quebec, but outside the Montreal area. Its initial phase takes place in Quebec at Jeffery Hale St. Brigid's Hospital (JHSB; financing obtained from MITACS and pending ethics approval from the CIUSSS de la Capital-Nationale). The present request aims to finance the comparative phase for two regions west of Quebec: the Laurentians and Outaouais. First, the project aims to comparatively report the current endowment processes of bilingual personnel (recruitment, selection, onboarding, and integration) for certain employment categories that are in high demand in Quebec, which include nurses.

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Outputs:

• Paquet-Martel, Racin, & Feillou. (May, 2023). La GRH durable pour l’amélioration de la fidélisation et le bien-être des travailleurs, des résidents et de leurs proches dans les établissements regroupés au CIUSSSCN [Oral presentation]. Congrès de l’ACFAS, HEC Montréal

• Racine et Dioh. (June, 2023). Attraction et rétention du personnel bilingue dans les établissements de santé québécois situés en région : résultats préliminaires d’une étude comparative [Oral presentation]. 2e Congrès international de l’ÉDIQ / 19e Congrès de l’ARIC (Association internationale pour la recherche interculturelle)

• Gestion des ressources humaines (GRH) durable du personnel du milieu de la santé œuvrant en contexte linguistique minoritaire. Page présentant le projet de recherche dans son ensemble, y compris le présent projet. Sur la plate-forme web du Centre d’expertise sur l’adaptation aux communautés d’expression anglaise en santé et services sociaux (ACESS)

A Synthesis of Evidence of The Unique Psychosocial Challenges Faced By Quebec’s English Speaking Black Communities During the COVID-19 Pandemic

The McGill Human Motivation Lab and the Black Community Resource Center (BCRC) have collaborated on 8 research studies over the last two years to examine the resilience of Quebec English-speaking Black communities in the face of the greatest public health crisis in a century. Our results uncovered numerous important themes, such as how involvement in the BLM movement allowed Black young adults to recover from the social isolation imposed by the pandemic, how it was particularly Black women who assumed leadership roles despite having been especially burdened by the pandemic, and how social support from both family and friends were importantly related to young adults’ psychological adjustment. More recently, with funding provided by the Health Care Access for Linguistic Minorities Network, we conducted studies that compared members of Quebec’s English and French-speaking Black communities and found significant group differences in important real-life outcomes such as experiences of discrimination, barriers to physical and mental health care, and hesitancy regarding vaccination for the COVID-19 virus.

Across all studies, English-speaking Black communities struggled more than French-speaking Black communities. We propose to synthesize these findings into a single cohesive knowledge translation effort that can be used to prepare workshops, presentations, technical reports, publications, web-based tools, school curricula, and webinars. Our partnership with the BCRC will support the development of these educational and community-building events. Highlighting the unique challenges of English-speaking Black communities is critically important as this community faces a Quebec government that intends to use the not-withstanding clause to pass laws that will restrict English language rights in many spheres of Quebec life. Such language restrictions are likely to have devastating impacts on the health and vitality of English-speaking Black communities. These laws will also weaken the natural alliance that exists between the English and French-speaking Black communities. The purpose of this knowledge translation will be to increase community awareness of unique barriers of accessing health care and social services faced by Quebec’s English-speaking Black communities. It will contribute to improving access to resources and evidence-based information on the status and needs of the English-speaking Black communities.

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Outcomes:

• Lafreniere, B., Audet, É. C., Kachanoff, F., Christophe, N. K., Holding, A. C., Janusauskas, L., & Koestner, R. (2023). Gender differences in perceived racism threat and activism during the Black Lives Matter social justice movement for Black young adults. Journal of community psychology, 51(7), 2741–2757. https://doi.org/10.1002/jcop.23043

• Nweze, N., Davids, J., Fang, X., Holding, A., & Koestner, R. (2023). The Impact of Language on the Mental Health of Black Quebecers. Journal of racial and ethnic health disparities, 10(5), 2327–2337. https://doi.org/10.1007/s40615-022-01412-5

• Audet, É. C., Thai, H., Holding, A. C., Davids, J., Fang, X., & Koestner, R. (2023). The depth of stories: How Black young adults' disclosure of high arousal negative affect in narratives about the COVID-19 pandemic and the BLM protests improved adjustment over the year 2020. Journal of community psychology, 51(4), 1504–1517. https://doi.org/10.1002/jcop.22929

CKOL: Documentation on Health and Social Services in English-Speaking Quebec

The Community Knowledge Open Library (CKOL), created by the Quebec English-Speaking Communities Research Network (QUESCREN), Concordia University, is a growing online repository of documents from groups and stakeholders serving and working with English-speaking communities in Quebec. The objective of the current project for which we are seeking funding is to add material related to health and social services in English-speaking Quebec to the existing CKOL database.

This material will be gathered from existing project partners, and we will establish new partnerships with members of the Community Health and Social Services Network (CHSSN), from whom we will also start obtaining CKOL material. Integrating new documents into this user-friendly one-stop database will increase access to knowledge through an enriched CKOL database. This will make it easier for stakeholders to meet the health care and social service needs of English speakers in Quebec.