Browsing by Author "Milaney, Katrina"
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- ItemOpen AccessAdverse childhood experiences and health among indigenous persons experiencing homelessness(2021-01-07) Smith, Eric; Milaney, Katrina; Henderson, Rita I; Crowshoe, LyndonAbstract Background Current literature has established that adverse childhood experiences (ACEs) are associated with the onset of a variety of physical, mental, and behavioural illnesses. However, there are few studies that have thoroughly examined this association in low-income or marginalized groups. Methods To address this knowledge gap, this study used self-reported data on childhood experiences and adult health outcomes in a sample of 91 Indigenous persons experiencing homelessness. While the primary focus of the study was to assess the relationship between ACEs and health status, we also assessed reports on use and perceptions of health care services to test for potential illness-mitigating factors. Results Results indicated that reported number of ACEs was significantly associated with reported levels of mental illness (p < .001, d = 1.12). Significant associations were not observed for physical illness or patterns of substance use. We also found that the number of reported ACEs was significantly correlated with the number of formal health care services that an individual used (r = 0.32). Conclusions Our results reveal that the relationship between ACEs and adult illness is not as deterministic as the current literature suggests. Access to formal health care services may allow individuals to mitigate their adverse health, thereby eliminating some of the effects of ACEs. Conversely, current tools used to measure ACEs may not translate to an Indigenous population, which speaks to a need to revise ACE related surveys to include additional adversity categories.
- ItemOpen AccessBeing a member of a novel transitional case management team for patients with unstable housing: an ethnographic study(2022-02-19) Garcia-Jorda, Dailys; Fabreau, Gabriel E.; Li, Queenie K. W.; Polachek, Alicia; Milaney, Katrina; McLane, Patrick; McBrien, Kerry A.Abstract Background Homeless and unstably housed individuals face barriers in accessing healthcare despite experiencing greater health needs than the general population. Case management programs are effectively used to provide care for this population. However, little is known about the experiences of providers, their needs, and the ways they can be supported in their roles. Connect 2 Care (C2C) is a mobile outreach team that provides transitional case management for vulnerable individuals in a major Canadian city. Using an ethnographic approach, we aimed to describe the experiences of C2C team members and explore their perceptions and challenges. Methods We conducted participant observations and semi-structured interviews with C2C team members. Data analysis consisted of inductive thematic analysis to identify themes that were iteratively discussed. Results From 36 h of field observations with eight team members and 15 semi-structured interviews with 12 team members, we identified five overarching themes: 1) Hiring the right people & onboarding: becoming part of C2C; 2) Working as a team member: from experience to expertise; 3) Proud but unsupported: adding value but undervalued; 4) Team-initiated coping: satisfaction in the face of emotional strain, and; 5) Likes and dislikes: committed to challenges. Conclusions A cohesive team of providers with suitable personal and professional characteristics is essential to care for this complex population. Emotional support and inclusion of frontline workers in operational decisions are important considerations for optimal care and program sustainability.
- ItemOpen AccessCaring for People on the Margins: An Institutional Ethnographic Exploration of Community Palliative Care Work for People who are Precariously Housed(2023-09-15) Petruik, Courtney Rae; Ducey, Ariel; McCoy, Liza ( Associate Professor Emerita); Milaney, Katrina; Tezli, Annette; Marshall, Zachary; Stajduhar, KelliPeople experiencing homelessness have more barriers accessing healthcare than the general population. Challenges are worsened when people become ill and require end-of-life care (EOLC). Some barriers to EOLC for this population include discrimination, service providers who lack knowledge about homelessness, and fewer opportunities to voice care preferences. As part of a developing palliative equity movement, small teams have been created to provide better EOLC for people experiencing homelessness. While much research explores homelessness and healthcare, to date, none investigates the social organization of these teams amidst the mainstream system. This research addresses this gap by exploring how one of these small teams, the Community Allied Mobile Palliative Partnership (CAMPP), interacts with clients, structures their work, hooks into the mainstream healthcare system, and is institutionally accountable to a broader philanthropic funding structure in Calgary, Canada. This project uses institutional ethnography (IE) as its guiding mode of inquiry. From the standpoint of CAMPP clients, IE promotes understanding of how this team’s work is put together, produced, legitimized, and challenged while operating in the interstices of the mainstream healthcare system. With over 100 hours of observations, document reviews, and 21 client and service provider interviews, this research recasts the reader’s view from taken for granted medical models of palliative care toward the social realities of people at society’s margins and how the CAMPP team embeds these needs into their care model. Grounded in client accounts, this project illustrates how the mainstream system is structured to create challenges for people facing economic marginalization warranting a service like the CAMPP team. Paying close attention to language, this study shows how CAMPP is shaped by and reshapes the palliative care discourse to include social factors, mobilizing the widely recognized model of “harm reduction”. Lastly, this project describes how the CAMPP team is funded and their perceptions of the sustainability of their program. This study has implications for policymakers, community programs, researchers, and people experiencing homelessness by making visible how teams like CAMPP provide care “at the margins” of dissolution while caring for people “at the margins” of society.
- ItemOpen AccessDenied Boarding in Health Care: A Critical Understanding of the Lived Experiences of Patients with Lyme Disease in Alberta(2022-04) Schroeder, Lindsay; Milaney, Katrina; Hawkins, Ralph; Wilson, Maureen; Sperling, FelixPatients with late-stage Lyme disease often express their feeling of being excluded from the benefits of Canada’s universal health care system. In Alberta, as elsewhere, patients struggle to access the health care system for diagnosis and treatment for late-stage Lyme disease. Little is known about the lived experiences of late-stage Lyme disease patients navigating Alberta’s health care system. This project gives patients with late-stage Lyme disease a voice to share their lived experience accessing health care within the provincial health authority in Alberta. No such study has been conducted within the Canadian context, and I hope to shed light on why doing so is imperative to help inform our publicly-funded health care system about the specific needs of patients with this diagnosis. The main objective of this study is to inform policy and practice that will optimize patient experience in trying to access health care. Through the critical examination of lived experiences of patients with diagnosed late-stage Lyme disease in Alberta, this research aims to provide a deeper understanding of the complex late-stage Lyme patient experience and how it is related to dominant medical policies and practices within an Alberta health care authority..Using hermeneutic philosophy and a modified version of Ricoeur’s theory of interpretation within a caring science paradigm, I explore meaning through an interpretive metaphor of a train journey to approach nine in-depth interviews with late-stage Lyme disease patients seeking access to care in Alberta. Using a critical social theory lens in my interpretation, I ask the question “What is the lived experience of patients diagnosed with late-stage Lyme disease in their attempts to access appropriate health care?” This qualitative study included participants iii from an Alberta-based General Internal Medicine Clinic who have been diagnosed and treated for late-stage Lyme disease by an Internist, experienced in diagnosing and treating Lyme disease. There are many public myths that surround late-stage Lyme disease, a contested diagnosis in present day discourse. Realizing that the reality of tomorrow can be formed based on the findings of today, I believe it’s necessary to contribute to the literature through a shared patient narrative that speaks the truth of lived experience. In my attempt to contribute to future historical resolution, I used a qualitative research methodology to help me reflect on a particular moment in time that represents truth for a group of marginalized patients. The findings of this research demonstrates how a sampling of patients with late-stage Lyme disease have faced barriers in communicating with health care professionals in Alberta, Canada, on their journey with this debilitating disease. Through a shared patient voice, I have identified ways in which this group of patients is blocked from access to appropriate health care despite their many attempts to do so within the healthcare system. I examine the political landscape of Lyme disease in Canada to identify sources of the barriers they face in communicating with health care professionals and posit some alternative approaches. Findings of this interpretive investigation offer insights into the traumatic journey experienced by late-stage Lyme disease patients in Alberta Health Services and provides suggestions for improved policy and practice initiatives that ensure inclusive health care for all Albertans.
- ItemOpen AccessDrug use, homelessness and health: responding to the opioid overdose crisis with housing and harm reduction services(2021-08-26) Milaney, Katrina; Passi, Jenna; Zaretsky, Lisa; Liu, Tong; O’Gorman, Claire M.; Hill, Leslie; Dutton, DanielAbstract Background Canada is in the midst of an opioid overdose crisis and Alberta has one of the highest opioid use rates across the country. Populations made vulnerable through structural inequities who also use opioids, such as those who are unstably housed, are at an increased risk of experiencing harms associated with opioid use. The main purpose of this study was to explore if there was an association between unstable housing and hospital use for people who use opioids. Methods Analysis utilized self-reported data from the Alberta Health and Drug Use Survey which surveyed 813 Albertans in three cities. Hospital use was modeled using a logistic regression with our primary variable of interest being housing unstable status. Chi square tests were conducted between hospital use and variables associated with demographics, characteristics of drug use, health characteristics, and experiences of receiving services to establish model inclusion. Results Results revealed a significant association between housing instability and hospital use with unstably housed individuals twice as likely torequire hospital care. Conclusions Results highlight the importance of concurrently addressing housing instability alongside the provision of harm reduction services such as safe supply and supervised consumption sites. These findings have significant implications for policy and policymakers during the opioid overdose epidemic, and provide a foundation for future areas of research.
- ItemOpen AccessExperience of Young Stroke Survivors in a Community-Based Peer Support Group(2023-04-28) Morin, Tiffany Danette; Milaney, Katrina; Rankin, Joanna; Dukelow, SeanPurpose: The purpose of this study was to explore the experiences of young stroke survivors (YSS) participating in a community-based peer support program in Calgary, Alberta. There is a lack of research on peer support groups facilitated by YSS themselves, and on the impact of peer support on the health and wellbeing of stroke survivors under the age of 50. Methods: This qualitative case study project was guided by Critical Disability Studies and included five semi-structured interviews with YSS in Calgary, Alberta. Participants were between the ages of 18-50 and had attended at least two YSS peer support activities in the past three years. Following the principles of community-based research, support for this research was provided by the Stroke Recovery Association of Calgary to co-create the research question, methods, recruitment, and analysis of results, along with guiding the development of the implications and recommendations. Results: Three main themes and six sub-themes were identified from the interviews as follows: 1) Feeling normal; 1a) What is normal anyways?; 1b) Why does there need to be a new normal?; 2) Connection through lived experience; 2a) Shared life and stroke experiences; 2b) Mixed feelings when meeting with other survivors; and 3) Perceived benefits of attending the peer support group; 3a) Being accepted by others; 3b) Opportunities for social interaction. Conclusion: This case study demonstrated that there continues to be value in recommending peer support to YSS, especially grassroots groups that are led and facilitated by those with lived experience. Participants experienced connection through shared experiences, as well as supported each other to navigate a world that caters to people who fit societal norms and often leaves them feeling isolated and alone. Keywords: young stroke survivors, stroke, peer support, community engagement
- ItemOpen AccessExperiences and Perceived Outcomes of Low-Income Adults During and After Participating in the British Columbia Farmers' Market Nutrition Coupon Program: A Longitudinal Qualitative Study(Elsevier, 2022-03-28) Caron-Roy, Stéphanie; Lee, Yun Yun; Sayed, Sayeeda Amber; Lashewicz, Bonnie; Milaney, Katrina; Dunn, Sharlette; O'Hara, Heather; Leblanc, Peter; Prowse, Rachel J L; Fournier, Bonnie; Raine, Kim D; Elliott, Charlene; Olstad, Dana LeeThe British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) is a farmers' market food subsidy program that provides low-income households with coupons valued at $21/wk for 16 weeks to purchase healthy foods at participating BC Association of Farmers' Markets members' markets.
- ItemOpen AccessParadoxical Mothers - Examining the complexities of being the mother of a disabled child and a deceased child(2021-09) DesJardine, Patricia; Hughson, E.Anne; Milaney, Katrina; Badry, Dorothy; Nelson, Fiona; Dimitropoulis, Georgina; Fuchs, DonaldMothers of disabled children can be silenced by stereotypical depictions of their heroism, bravery, divine purpose or own pathology. Born from a medical model perspective that sets disability as a type of death, these depictions have the power to elevate or denigrate a woman’s maternal identity. When disability is set as a metaphorical death, mothers are expected to grieve the loss of their imagined perfect child as a process for accepting their disabled child. Her resolution with that grief then serves as a determinant of her ability to love and care for that child. In turn, this same silencing serves to negate mothers’ voices in their process of providing love and care, even while they are being rhetorically elevated by human service professionals (HSPs) as ‘experts’ of their disabled children. The stories of six mothers of disabled children who have also buried a child speak of their understanding of grief, death, disability and expertise, as disruptive acts of resistance to such silencing. Their stories reflect a desire to challenge the notion that being the mother of a disabled child demands they adopt said stereotypes.
- ItemOpen AccessRecognizing and responding to women experiencing homelessness with gendered and trauma-informed care(2020-03-26) Milaney, Katrina; Williams, Nicole; Lockerbie, Stacy L; Dutton, Daniel J; Hyshka, ElaineAbstract Background The purpose of this study is to highlight the experiences of women who are often hidden in what we know and understand about homelessness, and to make policy and practice recommendations for women-centred services including adaptations to current housing interventions. Methods Three hundred survey interviews were conducted with people experiencing homelessness in Calgary, Alberta, Canada. The survey instrument measured socio-demographics, adverse childhood experiences, mental and physical health, and perceived accessibility to resources. Eighty-one women participants were identified as a subsample to be examined in greater depth. Descriptive statistics and logistic regressions were calculated to provide insight into women respondents’ characteristics and experiences of homelessness and how they differed from men’s experiences. Results Women’s experiences of homelessness are different from their male counterparts. Women have greater mental health concerns, higher rates of diagnosed mental health issues, suicidal thoughts and attempts, and adverse childhood trauma. The results should not be considered in isolation, as the literature suggests, because they are highly interconnected. Conclusion In order to ensure that women who are less visible in their experiences of homelessness are able to access appropriate services, it is important that service provision is both gender specific and trauma-informed. Current Housing First interventions should be adapted to ensure women’s safety is protected and their unique needs are addressed.
- ItemOpen AccessRepresentation and Regulation: A Critical Analysis of the Woman in Jail(2014-01-07) Milaney, Katrina; Hughson, E. AnneAbstract Women make up approximately 11% of the total number of incarcerated adults in provincial jails across Canada. While overall crime rates are declining, incarceration rates, particularly at the provincial level, and for women, are growing. Examination of the literature on the experiences of incarcerated women shows complex histories that include physical and sexual violence, poverty, mental health concerns or disabilities and often addictions. The purpose of this study is to understand the complexity of women’s experience and how it is related to the ways in which policies and practices to manage crime emerge within dominant political ideologies. Using institutional ethnography, in-depth interviews and analysis of authorizing and interfacing texts inside the women’s unit of a provincial prison in Alberta, Canada, I examine power and decision making. The following questions guided this study: how specifically do dominant ideologies manifest within the prison experience? Does sustaining a prison system meant to punish and rehabilitate offenders at the same time reduce future crime? How do dominant ideologies construct women offenders? And how do prison processes and decisions rooted in these ideologies impact the women offenders’ experiences in prison? My interdisciplinary approach, using a gendered-disability lens seeks to understand how the ‘woman in jail’ is constructed within the dominant economic philosophy of neoliberalism, as well, how these constructions lead to a particular representation and corresponding regulation of her. The critical analysis reveals that current practices of incarcerating women with histories of trauma has deleterious effects. An alternative approach is theorized
- ItemOpen AccessTeaching Mental Health in the Classroom: A Mixed-Methods Investigation of a Mental Health Literacy Program in Elementary Schools(2023-06) Sadler, Daniel; Ronksley, Paul; McCaughey, Deirdre; Metcalfe, Amy; Milaney, KatrinaBackground: Mental illnesses are the largest disease burden for adolescents, affecting 20% of youth in Canada. As mental health needs arise earlier and with greater prevalence it is essential to work upstream and prepare youth before psychological distress emerges. When implemented in the classroom as part of the educational curriculum, Mental Health Literacy (MHL) fulfills these goals as a universal response to the myriad of societal and development stressors experienced by youth. Aim: The overall aim of this program evaluation was to investigate the experience of educators in delivering the Elementary Mental Health Literacy Resources (EMHLR) program during a 4-month trial. The specific objectives were to identify the individual (educator) and organizational (district) level barriers and facilitators to delivery of the EMHLR to improve future implementation of the program. Design and Setting: An explanatory sequential design collected educator experience through a feedback survey which informed group interviews. Participants were elementary school educators primarily from the provinces of British Columbia and New Brunswick. Methods: The feedback survey collected demographics and feedback on each module taught using five-point Likert scales. The feedback survey also included multiple solicitations for qualitative feedback. Group interviews were held to further explore survey responses. Findings were integrated using the RE-AIM framework to identify barriers and facilitators and develop considerations for implementation. Results: System level barriers included preexisting stigma around mental health, competing priorities for classroom time and access, and cultivating buy-in from educational leadership. Individual level barriers included the time required to teach the EMHLR curriculum and to develop the skills and knowledge to teach MHL. The flexible design of the EMHLR curriculum alongside key implementation strategies of advocacy, practice champions, and professional development were seen as facilitators. Conclusion: Adolescents are ready to engage in their mental health. Mental Health Literacy offers the language to communicate about their experience clearly and accurately. The EMHLR curriculum offers an evidence-based and adaptable means to build the MHL of youth across Canada. This could result in significant improvements in adolescent mental health but requires intentional implementation strategies to be successful.