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.

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.

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.

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

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

Culturally Adapted Education Materials for Families of English-Speaking Minority Patients with Early Psychosis

Psychosis is a serious mental illness that usually begins in adolescence or young adulthood and is characterized by distressing symptoms like hallucinations and paranoia. Psychosis ranks in the top 3 most disabling conditions worldwide. Educating the families of affected individuals is known to make patients feel better, yet many family members of minority patients don’t participate in the education sessions that are offered. Reasons for the lack of participation include not trusting medical authorities and not feeling comfortable to bring up cultural issues like religion, spirituality, and racism. There have been no early psychosis programs that have addressed these problems, so the current study is doing just that.

Over the last two years, researchers have met with leaders and members of English-speaking minority communities, families of English-speaking minority patients with psychosis, patients, and clinicians to understand what changes are needed to make family education about psychosis more acceptable and helpful to people of diverse backgrounds. While it is true that research efforts to date have produced a large and growing body of data, these findings and results need to be prepared for presentation to communities and families. Our knowledge translation activities will include writing plain language summaries of meetings with community and family members to explain what kinds of topics and discussions will facilitate effective care for their loved ones with early psychosis and better collaboration with the clinical team. We will also present statistical findings in a non-threatening and easy-to-access format that will be easy for everyone to understand.

The potential impact of these activities will give community and family members a greater understanding of psychosis, will improve their participation in education seminars, and will contribute to healthier and happier lives of young people with early psychosis.

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Outputs:

• Jarvis, E. G., Desmarais, C., Lang, E., Zimanyi, L., & Leroux-Goyet, S. (March 2023). Family Psychoeducation series [Virtual workshop].

• Khan, S. (March 2023). Looking after our and our Youth's Mental Health. A presentation on caring for our mind, body, and spirit [Presentation]. Amal Center for Women, Montreal, Canada.

• Paquin, V., Pow, R. (March 2023). Training of workers on first episode psychosis L’Annexe is a community organization engaged in the socialization of multicultural young adults with intersectional vulnerabilities [Presentation]. L’Annexe – Ometz Drop-in centre for young adults 16-35, Montreal, Canada.

• Unknown. (Februrary 2023). Exploring the Mental Health Stigma Within the Black Community [Virtual event].

Project extension | Assessment and Implementation of the MedComm Online Interpretation Platform into the Clinical Setting

One-year project extension for a previously funded project. See here.

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Outcomes:

• Unknown. (March, 2023). Role of Medical Students as Interpreters in Bridging Language Barriers in Healthcare Centers: A Scoping Review [Poster presentation]. 19th Annual Crossroads Interdisciplinary Health Research Conference.

Project Extension | Language minorities and the risk of depression among individuals suffering from a chronic disease: a retrospective study of the Canadian Longitudinal Study on Aging

One-year project extension for a previously funded project. See here.

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Outcomes:

• Farid, D., Li, P., Dasgupta, K., & Rahme, E. (2022). Determinants of loss to follow-up in the Canadian Longitudinal Study on Aging: a retrospective cohort study. Journal of epidemiology and community health, 76(12), 1011–1018. https://doi.org/10.1136/jech-2022-219307

• Farid, D., Li, P., Dasgupta, K., & Rahme, E. (2022). Determinants of loss to follow-up in the Canadian Longitudinal Study on Aging: a retrospective cohort study. Journal of epidemiology and community health, 76(12), 1011–1018. https://doi.org/10.1136/jech-2022-219307

• Farid, D., Li, P., Da Costa, D., Afif, W., Szabo, J., Dasgupta, K., & Rahme, E. (2020). Undiagnosed depression, persistent depressive symptoms and seeking mental health care: analysis of immigrant and non-immigrant participants of the Canadian Longitudinal Study of Aging. Epidemiology and psychiatric sciences, 29, e158. https://doi.org/10.1017/S2045796020000670

Project Extension | Are language and motivational barriers limiting healthcare access for Black young adults during the COVID-19 pandemic?

One-year extension of a previously funded project. See here.

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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., Leboeuf, J., Holding, A.C. et al. Better Together: Family and Peer Support for Black Young Adults During the COVID-19 Pandemic and the Black Lives Matter Movement. Trends in Psychology. 1-18, 688–705 (2022). https://doi.org/10.1007/s43076-022-00157-8

• 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

Language and psychosocial factors associated with post-graduate retention of anglophone health and social services students in Quebec

Language minorities often encounter language barriers when accessing health and social services. Specifically, anglophones in Quebec are a growing population but often report difficulties accessing these services and receiving personalized care due to language barriers. Many studies have explored the retention of healthcare and social service workers capable of delivering services in English. Results have shown that many anglophone students in these sectors choose to leave the province post-graduation. Thus, this study will investigate various key factors that may predict the retention of anglophone health and social service graduating students in Quebec. The results will enhance our understanding of why anglophone students choose to stay or leave the province. This knowledge will help develop programs aimed to incentivise anglophones to remain and work in the health and social services sectors in Quebec.

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Outputs:

• Loiselle, C.G., Durand, A. B., Monarque, M., Brown, T. L.. (manuscript In preparation). Predictive retention factors of English-speaking health and social service students graduating from an Anglophone Québec university.

• Brown, T. L., Durand, A., Monarque, M., & Loiselle, C. G. (2022, May). Language and psychosocial factors associated with post-graduate retention of anglophone health and social services students in Quebec [Poster Presentation]. Poster presented at the World Conference on Health Promotion, Montreal, Quebec.

• Brown, T. L., Monarque, M., Durand, A., & Loiselle, C. G. (2021, December). Key psychosocial predictors of students' retention. In C. G. Loiselle (Chair), Language matters: Dialogue McGill’s supported initiatives [Symposium]. Dialogue McGill Conference, virtual.

Innovative Practices in Service Provision with Interpreters in Times of Health Crisis: A Qualitative Study of Clinicians, Interpreters, and Service Users’ Perspectives

Language barriers hinder access and quality in health and social services. Attention to cultural and social norms is also key to the provision of good care, especially with migrants and refugees. The benefits of working through interpreters have been documented, yet not in the context of health crises nor from the perspective of service users. Our study explores how practitioners, interpreters, and service users in Quebec provide/receive health and social services during the COVID-19 crisis. Individual semi-structured interviews (n=60) will be conducted with public and community-based health and social service providers, interpreters, and non-francophone users in Montreal and Quebec. Interviews will explore (a) innovative practices in service provision with interpreters used during the COVID-19 crisis and (b) barriers and enablers to the success of these practices. Interviews will be conducted by phone, skype, or in-person following Public Health guidelines, with assistance of an interpreter when necessary. Interviews will be audio recorded with permission of participants, transcribed verbatim, and translated into English or French. Interview transcriptions and interviewers’ fieldnotes will be analyzed thematically using NVivo 12. The perspectives of clinicians, interpreters, and users will be contrasted within and across practices and socio-demographic groups. Innovative practices will be classified using the Innovative Practices Evaluation Framework. Special attention will be paid to ensuring voluntary and respectful participation and confidentiality. Ethics approval will be sought from the CIUSSS West Centre Montreal and researchers’ universities. This study will identify innovative strategies for service provision through interpreters in times of health crisis, including digital innovations.

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Outputs:

• Ruiz-Casares, M. & Bentayeb, N. (March, 2022). Intervenir avec interprètes durant la COVID-19 : le point de vue des intervenant.e.s, des interprètes et des usager.ère.s [webinar]. Sherpa University Institute.

Does language ecology in Québec modulate COVID-19 health access or outcomes?

The COVID19 pandemic suggests that language barriers impact access to health-related information and medical outcomes in Québec at societal and individual levels. The Association for Canadian Studies recently reported that English minority speakers in Québec have greater COVID19-linked anxieties and distrust of Québec Provincial pandemic governmental policies, compared to French majority speakers. Currently unclear is what gives rise to these differences, and how language barriers impact both personal attitudes and societal public health outcomes regarding the pandemic. Guided by sociolinguistic and psychological theory, reseachers will investigate several factors including people’s language experience, interpersonal networks, community contexts, and society-level constraints. We will use cutting edge social network analyses and statistical modelling approaches to analyze large-N, language-tagged, COVID19 questionnaire data from Anglophone and Francophone respondents across Quebec, particularly in Montreal. The team, comprised of language scientists, social psychologists, and big data scientists, is uniquely qualified to address these urgent questions. This work will generate important, timely knowledge and student training opportunities about language barriers faced by English minority speakers that are relevant to COVID19 health access and public health outcomes in Quebec.

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Outputs:

• Hernández-Rivera, E., Gullifer, J. W., & Titone, D. (2022). Socioecological and psycholinguistic approaches to multilingual health literacy. Translational Issues in Psychological Science. https://doi.org/10.1037/tps0000325

• Hernández-Rivera, E., Gullifer, J. W., & Titone, D. (2022). Socioecological and psycholinguistic approaches to multilingual health literacy.Translational Issues in Psychological Science, 8(2), 197–209. https://doi.org/10.1037/tps0000325

• Hernández-Rivera, E., Marco S. G., Ahia, M., Tiv, M., Knäuper, B., Johns, B. T., Doucerain, M., & Titone, D. (In prep). Does language ecology in Québec modulate COVID19 health access or outcomes?

• Ahia, M., Hernandez-Rivera, E., Titone, D. (2021). Do Language Use Affiliations Predict Health Outcomes? COVID-19 Publich Health Outcomes in Linguistic Majority and Minority Populations in Montreal. [poster presentation]. Department of Psychology, McGill University, Montreal, Quebec.

• Hernández-Rivera, E., Marco S. G., Ahia, M., Tiv, M., Knäuper, B., Johns, B. T., Doucerain, M., & Titone, D. (2021). Language-Use and COVID-19 Outcomes: Exploring Population Data Across Two Canadian Cities. Presentation at the Dialogue McGill Annual Conference of 2021. Montreal, Canada.

• Hernández-Rivera, E. (2021) Invited Speaker: Experiencias en el uso de datos censales para estudiar de la distribución de COVID-19 en Canadá. Segundo Encuentro de Egresados de la Facultad de Medicina y Psicología. Department of Medicine and Psychology, Autonomous University of Baja California, Baja California, México.

Language minorities and the risk of depression among individuals suffering from a chronic disease: a retrospective study of the Canadian Longitudinal Study on Aging

The risk of depression in individuals with diabetes has not been evaluated in relation to language. Communication barriers may lead to isolation and impaired access to health care. This may affect the mental well-being of individuals specially those also suffering from a chronic disease such as diabetes. Researchers will use baseline and 3-year follow-up data of the Canadian Longitudinal Study on Aging Comprehensive cohort (CLSA; 2012-2015 and 2015-2018; ages 45-85 years, N=21,000) to determine, among those with and those without diabetes, the effect of maternal language (French, English or Other) on the risk of depression at three years and on the rate of seeking mental health care for depression.

The cohort will include CLSA participants without baseline depression (Center for Epidemiological Studies Depression-10 score<10 and no depression treatment). These will be separated by baseline diabetes status (HbA1c ≥7% and/or self-reported diabetes). Maternal language will be the ‘language first learnt at home and still understood’ (French, English or Other). English (French) speaking minorities will be those with ‘Other’ native language and English (French) as the language most spoken at home. The associations between maternal language and language minorities and the outcomes of interests will be examined overall and by diabetes status using multivariate logistic regression models.

Findings will help health care providers and program developers tailor their services toward reducing language barriers for minorities to help curb their risk of depression and appropriately manage their diabetes and mental health disorders.

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Outputs:

• Farid, D., Li, P., Dasgupta, K., & Rahme, E. (2022). Determinants of loss to follow-up in the Canadian Longitudinal Study on Aging: a retrospective cohort study. Journal of epidemiology and community health, 76(12), 1011–1018. https://doi.org/10.1136/jech-2022-219307

• Farid, D., Li, P., Dasgupta, K., & Rahme, E. (2022). Determinants of loss to follow-up in the Canadian Longitudinal Study on Aging: a retrospective cohort study. Journal of epidemiology and community health, 76(12), 1011–1018. https://doi.org/10.1136/jech-2022-219307

• Farid, D., Li, P., Da Costa, D., Afif, W., Szabo, J., Dasgupta, K., & Rahme, E. (2020). Undiagnosed depression, persistent depressive symptoms and seeking mental health care: analysis of immigrant and non-immigrant participants of the Canadian Longitudinal Study of Aging. Epidemiology and psychiatric sciences, 29, e158. https://doi.org/10.1017/S2045796020000670

English official language minorities in Quebec who have autism: Healthcare access and developmental outcomes

This project extends research on the healthcare access of official language minorities in Canada to a new population: individuals with Autism Spectrum Disorder (ASD) and their families. Individuals with ASD face significant communication challenges (APA, 2013). There are consequential delays in the access to ASD services in Quebec, to both obtain a diagnosis (Zwaigenbaum et al., 2019), and then wait for provincial services (Rivard et al., 2014). We expect that English speakers in Quebec with ASD will face compounded challenges in access to services due to communication difficulties, delays in ASD services, and minority language status. Official language minorities in Canada (English-speaking people in Quebec, and French-speaking people in other provinces) face multiple barriers to healthcare access, and negative disparities in health outcomes (Bouchard & Desmeules, 2013; de Moissac & Bowen, 2019; Falconer & Quesnel-Vallée, 2014). In the US, language barriers had negative impacts on service access for families with a child with ASD (St. Amant et al., 2018). Researchers aim to 1) evaluate the accessibility of health and social services to English-speaking families with a child with ASD in Quebec, relative to French-speaking families and 2) obtain detailed information from a subset of families with adolescents with ASD, via focus groups, including richer quantitative survey data on the question of service access and language and cognitive measures that serve as indicators of developmental health outcomes. By identifying potential disparities in access, as well as their implications for outcomes, this project furthers the goal of optimal outcomes for English speakers in Quebec.

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Outputs:

• Amantayev, N. & Nadig, A. (2022, May). Healthcare Access of Language Minorities with Autism: The Case of English Official Language Minorities in Quebec, Canada. Poster to be presented at the annual meeting of the International Society for Autism Research, Austin, Texas, USA.