Staff at the centre with youth: An Institutional Ethnology of Staff in Integrated Youth Services

Up to 75% of mental health issues develop during the adolescent period from 12 to 25 years old,yet only an estimated 25% of affected youth in Canada access mental health services. Integrated youth services (IYS) is a model that seeks to improve youth service access and outcomes. IYSdisrupts traditional power structures within youth mental health services by incorporating livedexperience into service development, ensuring direct access by youth in youth-friendly settings,youth and family engagement, providing consideration of a broad range of service needs, andusing peer support models. IYS initiatives are grounded in a commitment to evidence-based practice and knowledge translation, that also constitutes an effort to dislocate power through encouraging knowledge creation and sharing. Institutional ethnography grounds itself in the livedwork experience of individuals and this methodology was supported using poststructural theory. Data collection included ethnographic observations and 19 interviews were used to map the experience of frontline IYS staff in relation to the ruling relations in their institutions. Staffrecounted how they are doing the work of IYS, but they did not connect their workplace actions to the policy commitments of IYS. For example, research participants mentioned the importance of youth engagement, but not in terms of how this can address inequity, and none discussed the impact of family engagement on their work. Participants universally noted that being able to consider diverse challenges facing youth instead of only remaining focused on mental health wasimportant for wellness, but they did not relate these needs to structural oppression or seem totake up the possibility of intersectional reflection. Most participants reported a lack of orientationto the IYS model and a lack of meaningful access to use evaluation and research. As IYScontinues to expand across Canada, there is a need to bridge the gap that persists between theambitious policy commitments of IYS and the experience and engagement of frontline staff inorder to realize better, more accessible services through disrupting the traditional powerstructures in youth mental health services.