The experience of youth-participatory action research in a social innovation lab: A methodological and organizational approach

Abstract

Based on the theory and quality criteria of Youth-Participatory Action Research (Y-PAR), youth and adult co-researchers at a social innovation lab in Ontario, Canada, have undertaken various knowledge generation and action activities for the purpose of supporting youth mental health and wellbeing among transitional-age youth (ages 16–25). We describe the methodological and organizational approach employed in this undertaking, including aspects of the social innovation model to support the action components of Y-PAR. We draw on Bradbury-Huang’s (2010) seven choice points for quality in action research to structure this collective reflection. Our experiences illustrate the tensions and opportunities arising from housing a Y-PAR project within a large health services institution. We also note how social innovation lab processes can support the emancipatory aims of participatory research. Implications for using Y-PAR in other areas are included.

Keywords

Youth-centred participatory action research youth mental health social innovation and design

Introduction

The Mental Health INcubator for Disruptive Solutions (“MINDS”) is a social innovation lab (SIL) focused on addressing the mental ill-health and addiction challenges experienced by Transitional-Age Youth (ages 16–25) (TAY) in the community of London-Middlesex, Ontario. Bradbury-Huang’s (2010) London is a mid-size city in Ontario, Canada, with a population of 392,000; it is surrounded by the rural county of Middlesex, which has a population of 71,551. Current estimates of persons in this community between ages 10–29 are approximately 118,355. MINDS employs social innovation (Antadze & Westley, 2012) grounded in a youth-centred participatory research (Y-PAR) methodology (Cammarota & Fine, 2008) to engage in the work reported herein. Writing as a collective of youth with lived experience, and emerging and established researchers, we describe how our program is being refined, clarified, and adapted in response to the problems and opportunities encountered, outlining how we operationalize participatory principles in our diverse individual, group and community-wide research activities. We draw on Bradbury (2010) and Bradbury et al.’s (2019) seven choice points for quality in action research to structure our critical reflection, using illustrative examples from our local activities.

Background

MINDS of London-Middlesex

MINDS of London-Middlesex is a social innovation laboratory (SIL) founded to implement cross-sectoral interventions to improve the mental health of TAY. MINDS is a transdisciplinary group of youth research associates, university investigators from 5 different faculties, and 25 service-providers from community organizations. MINDS engages regularly with its larger Community Collective, composed of partners from organizations in health, education, community, and social services for youth (see mindslondon.ca). Consistent with MINDS’ commitment to a Y-PAR approach, youth with lived experience are employed as researchers and co-facilitators in all MINDS activities. The youth MINDS engages may have lived experience of mental illness/poor mental-health, navigating the mental health system, and/or are passionate about addressing mental health issues in the community; the vast majority have direct personal lived experience with mental illness (over 90%). TAY employees and adult team members co-lead engagement activities and consultations with the Community Collective; designing, prototyping, piloting, implementing, and evaluating all interventions generated. All research activities conducted by the MINDS research team have received approval by Western University’s REB.

A full description of all of MINDS activities exceeds the scope of this paper, but is available (Pervez et al., in prep). Here, we offer examples of MINDS prototypes developed out of our consultation with youth, their adult allies, and the community organizations comprising our Collective:

1. A youth-led Safe Storytelling Toolkit to support TAY from various backgrounds to share their experiences with their mental health. The goal is to create awareness, normalize struggles with mental health through personal stories, promote a sense of personal growth and inclusive community, decrease stigma, increase emotional literacy, and support a safer mental health journey.

2. The Youth Mental Health and Addictions Council’s (YMHAC) promotes youth mental health care through advising and guiding hospital and community programs and initiatives with engaged leadership, influence and decision making. All members have some form of lived experience with mental ill-health (either personally or through close others).

3. Repairing Damaged Relationships is a collaborative youth-adult workbook co-created by youth and adult allies focused on the rehabilitation of connections strained by a breach of trust, with the goal of reconstructing close connection and support.

We will use these examples to show how programs are being refined, clarified, and adapted in response to problems and opportunities encountered. In this critical reflection, we hope to convey the impact of the project on participating staff (including youth), regulations/protocols, institutional culture at the hospital, etc.

Social innovation

Social innovation (SI) is “a novel solution to a social problem that is more effective, efficient, just, or sustainable than present solutions, and for which the value created accrues primarily to society as a whole rather than individuals,” (Phills et al., 2008, p. 36). SI seeks to overcome challenging and often systemic social and environmental barriers to social progress (Hean et al., 2015); including new programs, products, laws, institutions, ideas, relationships and/or patterns of interaction (Antadze & Westley, 2012; Westley et al., 2015). The term ‘social innovation’ also describes the process of generating, testing, and adapting these novel solutions, (Preskill & Beer, 2012).

Youth-centred participatory action Research

Participatory Action Research (PAR), and its sub-branch of Youth-centred Participatory Action Research (Y-PAR), has roots in critical and liberation theory, with key contributions from two originating traditions of action research and participatory research (Cornwall & Jewkes, 1995; Healy, 2001). Its theoretical underpinnings include the democratic tradition of collaborative action research promoting social equality and empowerment, where people for whom change is intended are core to decision-making. In this tradition, credit is given to Lewin for coining the term ‘action research’ to link the cycles of theory, practice, and problem-solving (Minkler & Wallerstein, 2003). The Freireian (or Southern) tradition focuses on intentionally creating and opening space to hear voice and expression from marginalized and disempowered individuals, communities, and groups who are (un)intentionally dampened or silenced due to various systemic, societal, and/or institutional factors. Freire (1970, 1993) advanced the concepts of critical consciousness and social action in relation to the collective power gained by oppressed Latin American communities. Y-PAR’s proponents seek to expand awareness that social challenges are situated beyond individuals and must involve processes and social institutions that act on youth (Cammarota & Fine, 2008).

PAR is explicitly connected to the rights-based orientation underpinning a health equity perspective and agenda (London, 2008). Engagement and knowledge creation with marginalized populations help to address health inequities in two ways: first, they increase evidence about the health and social conditions of populations, particularly those who have been excluded from research and policy; second, when evidence is applied, PAR increases equitable access to health services by creating appropriate programs and policies tailored for the needs of distinct groups (Israel et al., 2010, 2019; Wallerstein & Duran, 2010). A recent integrative review of 45 articles describing PAR with children and youth showed evidence of positive outcomes for children, organizations, and communities (Shamrova & Cummings, 2017).

Tensions are an inherent and potentially productive feature of Y-PAR (Kirshner, 2010) and often focus on the characteristics and practices of the adults involved. Adults involved must be self-reflexive and willing to relinquish their status as sole experts in the creation of knowledge (Berman & Jiwani, 2014; Canas et al., 2020; Kemmis et al., 2013; Rodríguez & Brown, 2009). A related and important concern, is that the action element in Y-PAR has often proven less effective than desired because medical institutions and other organizations find the philosophical shift difficult (Ahmed et al., 2004; Foster-Fishman et al., 2010). To make the tensions of Y-PAR productive, we have reflected on the negotiation needed between planning the activities of a Y-PAR project and controlling the process of research (Kirschner, 2010). Bradbury-Huang (2010; see also, Bradbury-Huang et al. 2019) articulated seven choice points for quality in an action research project, a selection of which will be discussed in detail as related to the work of MINDS: (1) Articulation of objectives; (2) Partnerships and participation; (3) Methods and process; (4) Actionability; (5) Reflexivity; and (6) Significance. Though MINDS activities have been varied, iterative, and often overlapping in their development, we draw on these points of action to structure our description. We call this way of planning and working, with a firm sense of irony, a ‘quality review’ for our Y-PAR process.

Implementing action research MINDS using the quality criteria

Articulation of objectives

MINDS was created with the express purpose of improving youth mental health in our community. The focus on youth was chosen by the Community Collective involved with MINDS at its outset. Further direction came from extensive consultation with young people, the adults supporting them in health and social services in the region, and other adult allies/family caregivers. SIL techniques of facilitation and group ‘sprints’ helped MINDS to articulate a “complex challenge statement” orienting Lab activities and its collective impact.

London-Middlesex is a community where youth experience optimal mental and emotional wellbeing because they a) are intrinsically valued, b) have hope for a better future and, with others in the community, are building it; c) develop and maintain positive relationships; d) are engaged in meaningful activities; and, e) can cope with challenges of life.

This challenge statement is designed to explicitly initiate a shift in community wide philosophical orientation. It focuses on three areas of youth wellbeing, with the objective of making positive change in youths’ sense of: (a) meaning and purpose; (b) quality relationships; and (c) resilience and self-efficacy. The challenge statement’s capaciousness provides opportunity for the inherent diversity referenced in the singular youth to be captured. Youth herein encompasses a significant developmental age range (16–25), all racial and ethnic backgrounds, the full span of socioeconomic scale, degree of educational attainment, all genders and sexual orientations, and all intersectionalities. MINDS employed additional techniques and constructs from the SIL model to refine objectives, such as in the facilitation of convenings, or large stakeholder gatherings where youth and adults defined their priorities, designed interventions, and envisioned paths forward. Research questions, methods and an REB submission developed gradually from these discussions.

The participatory approach fostered a sense of solidarity, collective responsibility, and better understanding of the complexity of the task at hand. Partners became aware that no single intervention would address the multiple gaps in youth mental health in the community, or the needs of a population that is inherently diverse. Organizational factors, issues of feasibility, and the immensity of challenges in the community quickly entered discussion. While objectives such as ‘quality relationships’ seemed clear enough, how such quality relationships could be achieved varied widely based on the conditions of youths’ lives. For example, for TAY engaged in structured learning, quality intergenerational relationships could be promoted through interactions with adults in their school environments. Young people experiencing housing instability, outside of education or employment settings, or with previous histories of trauma or other mental health challenges, had entirely different contexts for increasing quality relationships, requiring distinct approaches to pace, trust, and accountability in any interventions.

The articulation of objectives raised other interesting questions. Defining a community-wide vision of impact contravene some of the ideals of SI, namely the use of new, often-disruptive ideas in the service of avoiding what has been tried in the past (Fairweather, 1967; Mulgan, 2006). From a strictly SIL lens, the focus on sense of meaning and purpose, quality relationships, and self-efficacy may not have been a new idea. These areas of focus are supported by ample theoretical and empirical development (Bandura, 1982; Christmas & Khanlou, 2018; McKnight & Kashdan, 2009). Nonetheless, these areas for change are what members of our community identified as important. Choosing them was an example of remaining loyal to the Y-PAR values, even when in tension with the SIL approach. It provoked consideration of how to achieve objectives in ways that were new and disruptive, and that did not duplicate work or initiatives already tried. The SIL framework alerted us to forms of ‘incrementalism’ that undermine the long-standing SI goal of radical change (Phills et al., 2008). These concerns were trumped by the Y-PAR commitment young people determining their priorities for change, raising the question: If young people want to see change that is not considered by adult allies as radical or innovative, but it is what they want, whose agenda should be followed?

From the outset, the Director and Founder of MINDS was explicit that the voices of youth with lived experience, their needs, their desires, and their unique knowledge as experts in their own experience, would constitute the ideology upon which the activities of MINDS would be based. As one of the core values of MINDS, we aim to tackle the complex challenges of mental health and wellbeing in the places we live, learn, work, play and grow, with the eventual goal of changing the way youth seek support and receive care. SI, at its core, is intended to disrupt and create radical change within the system, moving away from conventional or traditional approaches to complex problems that are ineffective. In this way, taking a Y-PAR approach was closely aligned with SI, as historically solutions to mental ill-health have been contrived of by those in positions of leadership or power and not by those the solutions intend to serve. By embracing Y-PAR as a foundation, youth voice could not only directly contravene the direction and needs highlighted by adults in the room, but also redirect and redefine the goal. Thus, approaches that adult allies may not deem “innovative” or “radical” may indeed encapsulate exactly what youth with lived experience recognize as disruptive.

Partnership and participation

The relational component of research (Bradbury-Huang, 2010) occurs as a continuum from consultation with stakeholders, to working with stakeholders as full co-researchers. The central focus of MINDS for partnership development and participation is young people. To date, 20 people have participated as core staff, advisory, and/or research partners in the Lab (including 8 academic researchers from different faculties, 9 staff roles involving both youth and adults, and 5 rotating community-engagement student placements). All persons engaged as part of the core research team are listed as co-applicants of the project and received training/resources in ethical research with young people, Y-PAR, and SI. Four youth were hired as research assistants supported by adult MINDS staff. Participation with this core team has included biweekly meetings that support the youth researchers’ comfort with the methodologies employed, data-collection and analysis, operational processes, ongoing mentorship of peers and new youth researchers, and knowledge translation activities. One youth member outlines their experience:

I was drawn to MINDS because of their priority to tackle mental ill-health and addictions in youth. MINDS stood out from other organizations because they purposefully include youth in all areas [emphasis added…] showing respect of everyone’s opinions regardless of their role on the team. (Y1)

Given the resources required to train youth to contribute as equal partners, money for paid positions, and time for adequate training, opportunities for youth to be partners in the research process were more limited. Youth participation eventually evolved into youth partnership represented by strong youth involvement in the prototypes. All prototypes were born in the minds of youth, who further engaged in the design, development, and implementation of the prototypes – receiving appropriate mentorship and reimbursement for their time. Youth participation and partnership is not only dependent on the resources available at MINDS but also the youths’ time restrictions, and current state of well-being. Given that MINDS engages youth who have lived experience in the mental health care system, we must remain cognizant of the ongoing difficulties that some of the youth involved are living with. Being able to meaningfully participate with low time commitment, and/or without the expectations of engagement associated with a paid position, may be a more feasible option for youth who have other obligations, responsibilities, and mental health and well-being needs. Having both options allows the Lab to engage with more youth in a way that works for them. This can however, lead to tension and difficulty when it comes to progressing work in a way that in youth-driven at times the youth involved do not have the capacity to engage.

MINDS’ engagement with the broader collective of organizational champions and community stakeholders has included three convenings (day-long sessions of group consultation) and individual meetings with specific organizations. MINDS has conducted interviews and focus groups with 12 youth and 27 adult allies — with the aim of understanding the roles and impacts of different sectors on the mental health and wellbeing of youth. Together, these discussions with individuals and with the MINDS collective have served to elicit the priorities and innovation ideas, or prototypes. For example, the YCP prototype was developed after a series of interviews with youth who had lived experienced and their caregivers. Consultations like these, led to better understanding of the contributors to youth mental health and ways in which the current mental health system can be transformed to better support youth.

Methods and process

Our institutional home base

The MINDS methods and process have been shaped by its positioning as a SIL tempered by research within an academic-hospital environment. The institutional homebase provides consistent and significant support in both operational and reputational terms. For example, the regular events hosted by MINDS to convene its collective of community organizations have featured hospital spaces and support, with opportunities for high-level decision-makers in community organizations to dialogue directly with each other and with the research/innovation leadership at the hospital. Resultantly, MINDS provides grounds for intersectoral collaboration that has generated new partnerships and new ways of understanding youth mental health.

However, the proscribed rituals and practices of a large institution can delay the speed or nature of innovation, particularly from a SI perspective. Being based in a hospital, the evaluative expectations of MINDS outcomes are tied to health-services and health outcomes; which has been difficult to reconcile with our diverse activities. To predetermine outcomes in Y-PAR is inconsistent with its ethos (Cahill, 2007; Foster-Fishman et al., 2010). Prototypes may align with the MINDS’ impact statement, but some may be more peripheral to the host organization’s interests. Reports to health-system funders may not have the flexibility required to do justice to participatory processes, or for prototype failures to be envisioned as positive adaptive experiences.

The quality of youth engagement

MINDS works with a diverse range of TAY from a multitude of backgrounds and experiences. All TAY with an interest in youth mental health and system transformation are encouraged to participate (regardless of their own personal lived experience – although majority do report having lived experience). To acknowledge the different needs of youth involved, MINDS provides great flexibility surrounding level of involvement ranging from volunteering to full-time employment. Youth participation is based on interests, availability, expertise, and experiences, as well as the needs of the Lab and available resources. This helps to ensure youth are meaningfully and authentically being involved in MINDS related work:

The lab has provided me with opportunities to take part in various research activities strengthening my skills and expanding my interest in mental health research. I have participated in the development and design of prototypes, collected data through focus groups, participated in grant and manuscript writing, and presented at research conferences. (Y2)

A second important insight relates to achieving authentic and immersive engagement with young researchers. The terminology “youth co-researchers” is inauthentic if youth simply play a consultative role in a Y-PAR project. A large part of MINDS’ day-to-day methods and processes focus on engagement with youth in the research team. The breadth and quality of engagement of youth co-researchers in the project cannot be overstated. Youth have been included from the outset in paid roles within the core team. They have gained experience working within a mental-health services environment and have participated in knowledge-sharing events alongside other professionals within the host network. One youth shares their experiences of engagement with MINDS:

My experience within youth mental health spaces had historically been driven by adults who believed they knew what was best, often with little thought to those they hoped to serve. MINDS understands that making change for youth requires working with youth, and that a lack of formal qualifications in youth doesn’t mean they are uncapable, rather that they may require additional support in the process. (Y3)

Youths work daily with adult mentors in the full gamut of activities undertaken by senior researchers including: reviewing literature; training in methodological and ethical approaches; recruiting, informing/consenting and interviewing study participants; transcribing, coding and analysing data; facilitating brainstorming and prototyping sessions; developing intervention charters and evaluation; and, contributing to publications and other knowledge translation efforts.

While the host organization provided significant resources, its institutional procedures have slowed our progress, including the time required for hiring and human resources orientations. Changes in staffing have also compromised the capacity to have a collective working memory. It was difficult to ensure that all youth trained in the complex Y-PAR and SI approaches, and familiar with the hospital health and safety human resources process, could stay with the project continuously; particularly as engagement for some youth were tied to academic cycles (e.g., co-op students, university course placements), or the youth transitioned into a new stage in their lives (e.g., full-time employment outside of MINDS). It takes a significant amount of time to create a shared understanding of the values and methods enacting Y-PAR, if trusted relationships are lost due attrition, there is either a loss of relational strengths and organizational direction, or research must slow down to train staff and volunteers in the value system. MINDS addresses these concerns by implementing iterative sessions of team capacity- and trust-building, as well as explicit adult and youth mentorship strategies and ongoing team reflection. In order for MINDS to maintain focus on its impact statement, shared value vocabulary and ways of operating such sessions were necessary as new members joined the Lab team or new community partners joined us in creating interventions. Additionally, keeping with Y-PAR principles, when new youth researchers are hired, existing youth researchers provide mentorship and training to the newly hired youth. We called this “moving at the speed of trust”, in recognition of the fact that we were perhaps moving more slowly than ideal in SI (which progresses more quickly), but were doing so in service of meaningful youth and community input. This process has been discussed by some commentators in Y-PAR as part of the commitment to genuine participation (Berman & Jiwani, 2014; Elliott et al., 2017; Fox & Fine, 2013), and as an enactment of the value of knowledge democratization and solidarity (Caraballo et al., 2017). Youth report feeing connected and valued in the lab:

I started at MINDS with a passion for mental health but no experience in conducting research. Receiving adult lab members’ mentorship helped me to gain the skills necessary to be a research assistant in the lab. Besides the more practical skills that I’ve gained through mentorship; I also formed strong and supportive relationships, which have made me more confident in myself overall. The earlier and continuing mentorship I received now serves as a model for me as I take over the mentor role when interacting with new youth members. (Y4)

Youth co-researchers continue to take the lead on several prototypes in terms of testing and delivery. In addition, youth co-researchers also take the lead in preparing grant applications, ethics applications, participant recruitment, data collection, data analysis, and preparing abstracts and manuscripts for publication. More specifically, for this manuscript, R. Pervez and A. Cook contributed significantly to the writing of the initial draft and multiple rounds of edits. This continual engagement and shift into higher order leadership roles demonstrates the authenticity and the impact of meaningful engagement. When working with adults, tensions in power dynamics may occur, the adults in the group may not have experience working on youth-led projects and youth may not feel comfortable voicing their opinion to adults. To prevent group tensions from occurring, MINDS works with youth to ensure that they are feeling supported and safe while continuing their work (see the Reflexivity).

The project has had to go at the pace of the youth, for example putting an element of the work on pause as a youth co-researcher focuses on another aspect of their lives (such as exams, moving, career) or transitioning an element of the work to another team member if people leave or join the project. The short-term nature of high school-level placements means that the lab has had to repeatedly train new young people on the terms and processes of SI, knowing that they will move on to other experiences outside the lab. This, again, is where SI and the prototyping process provide flexibility, as having multiple initiatives undertaken simultaneously allows for shifting priorities without stalling the whole.

Actionability

Bradbury-Huang (2010) refers to action research that demonstrates knowledge creation that “transcends rationalist empiricism to acknowledge whole persons as relational beings” (p. 17). In both areas – in the convening of multiple organizational/service-provider perspectives in the community, and in the development of interventions and research knowledge based on strong youth leadership – MINDS has generated new ways of connecting ideas and understanding that promotes youth mental health in the community. As evidenced in the continuing participation of youth and organizations in MINDS activities, youth and adult stakeholders are developing a strong sense of evolution in their practices, their understanding of their practices, and the transformation of the situations in which they practice. We see this shift as a significant community change enacted by MINDS. However, it may not be enough to satisfy MINDS objectives of making change in the world, or its funders’ reasonable need to evaluate the nature and extent of that impact.

The Lab is challenged in the pace of its prototype implementation and evaluation. Seen through SI, prototypes should be fast, liable to error but quick to implement (Antadze & Westley, 2012; Westley et al., 2015). However, such speed merits caution in the context of MINDS. First, when working with populations of youth who have experienced vulnerability (e.g., mental illness, housing instability), the ethics of do-no-harm must take precedence over speed. Working with youth requires sufficient trust and such relationships take time to build and cannot be compromised if an idea fails or must be replaced. Secondly, work must be done together, a shared understanding which is consistent with the critical and emancipatory goals of Y-PAR. This is fostered in concrete steps, such as facilitating the information and consent process with youth and/or their adult allies. It is a subtle and time-consuming effort that builds on interpersonal relationships between MINDS’ staff and community members and provides insight into the larger structural and social dimensions of the context.

An important tension in MINDS approach to Y-PAR and SI has been the definition of meaningful action within the principles/vision of impact and the priorities of its funders. If young people take leadership roles in meetings within an institution that had not previously invited youth to its meetings, is that a meaningful action, or is it the task of painstakingly carving out and maintaining space for youth in non-traditional space (one of the key processes of MINDS)? Is the design of interventions by youth an action, even if such interventions are too difficult to implement in the community? By tenets of action research, this focus on the context of practice, rather than outcomes, has inherent value (Bradbury-Huang, 2010). Additionally, these processes hold intrinsic merit in that they fight adultism (Bettencourt, 2020), ventriloquism (Sexton & Sen, 2018) and tokenism (Kesby, 2007), and serve to democratize knowledge production (Kesby, 2005).

Through the process of using Y-PAR and SI to engage with youth and adults in the community, transformation is seen in their attitudes and ability to work effectively and respectfully together. In the Safe Storytelling Toolkit working group, we have perhaps most clearly addressed the transformative aspect that Y-PAR has had on all our prototypes. The Storytelling Toolkit could have easily been a checklist of requirements for storytellers, focused on organizational needs (telling a dramatic story to encourage community giving). Instead, a Y-PAR informed process allowed us to create a toolkit that focused on the needs and safety of the storyteller rather than the benefits to the organization. The visual format, writing style, and inquisitive tone all support this underlying message. This is a transformative outcome that encourages youth to appreciate their own value and contributions and choose to represent themselves in a way that will not lead to regret and disappointment down the line. In turn supporting them to become stronger advocates who do not feel that their stories have been monopolized and tokenized by the organizations designed to support them. It addresses the implied power imbalance between professionals and youth and makes an effort to shift it neutrally.

This type of community work also strengthens the relationship between youth and professionals in ways that are directly observable by adult allies. When they are listened to, and their voice respected, youth are more engaged and willing to share their experiences and opinions. Additionally, during the development of the prototypes, there has been an evident change in adult attitudes towards working with youth. Adults give equal value to youths’ opinions and experiences and respect their role as leaders in the prototypes. This allows for a long (and potentially) deeper connection between youth and the professionals they work with. Through the development of prototypes, MINDS has seen youth become advocates, able to voice their views more easily, and collaborate with mental health professionals on transforming the mental health system.

Reflexivity

At the core of the tensions described above is the negotiation between Y-PAR’s emancipatory origins – including its commitment to the organic development and wide appreciation of emergent forms of knowing by young people – and its institutional accountabilities. This tension is lived daily by research teams who must anticipate and detail research protocols and ethics review board applications, hire and train staff, and schedule times of high activity – all before it is decided what such activities might be, given that Y-PAR should be determined by the young people for whom the research is oriented to serve. To negotiate these tensions, and use them productively, the MINDS team has employed ongoing reflection as a fundamental part of its operations. Core team members are continually being called to reflection through surveys and personal reflexive writing activities, and community collaborators and stakeholders have opportunities to reflect on the Lab’s progress in community convenings. Annual community convenings have included space where stakeholders, including youth, adult allies, service providers, and policy makers can both publicly and privately reflect upon the processes and products coming out of MINDS. For example, stakeholders have had an opportunity to reflect on how the complex challenge to be addressed by MINDS has been defined, as well as contributing to the development and actioning of prototypes to address the challenge. Spaces are made for feedback in large and small groups or confidential written feedback. This community reflection allows for honest accounting of the work of MINDS in the context of the broader community.

Youth and adult community members actively involved in ongoing MINDS prototypes are also given opportunities to reflect on their participation in the Lab’s work. Community volunteers are asked to fill out anonymous feedback forms, used to ensure that volunteers feel comfortable giving honest feedback to members of the MINDS team and the larger working group. When concerns have been raised, they are dealt with immediately – keeping youth at the core of solution. Even with an explicit shared understanding of Y-PAR among the collective, tensions in this area were still paramount. Ironically, we experienced this tension most strongly in the Repairing Damaged Relationships prototype. After several months of working on this prototype, youth participants reported that they felt their voice had been silenced by the numerous adult “allies” in the group. Work was immediately halted, and a series of youth-only meetings were held receive feedback that resulted in substantive change to the prototype while also consulting with the youth to ensure that meetings were run in accordance with Y-PAR. The entire process took several months and resulted in multiple adult members choosing to leave the project. The willingness and ability to respond reflexively reflected both MINDS commitment to Y-PAR and SI. Such reflection on the systems within which we operate is a hallmark of social innovation (Westley et al., 2015)

Significance

Insights derived from this research have relevance outside the immediate context of this project in at least two ways. First, our initial complex challenge statement, the vision for this Lab, is a lofty ideal of community-wide culture and values change – none of which can happen rapidly or nimbly. Articulating this collective challenge proved effective in galvanizing a significant and diverse community, holding space for the voice of the values of stakeholders who may not have had the opportunity to formulate them explicitly. However, broader emancipatory goals need to be supported by tracking pragmatic, developmental achievements that are communicated continuously. Because MINDS has had the mandate and resources to focus on such communication, we have been able to share lessons from associated activities and gradual progress; this has served to maintain the Collective’s commitment to the broad shared vision. While this complex challenge statement and vision remains visible to the community, it also in part orients the host institution’s approach to a strength based, socio-ecological understanding of youth wellbeing and participation. This may well be the philosophical shift in a large organization that is aspired to by Ahmed et al. (2004). MINDS was tasked with convincing organizational leadership that a SI approach to mental health was a viable option. The local zeitgeist established by the Collective to expand the scope and understanding of mental health care for youth, was instrumental in creating a responsivity within leadership to expands its established focus and definition of research.

The second area where MINDS has significance concerns its processes. MINDS is uniquely and advantageously supported to effect SI while using the ethical and values infrastructure of participatory research, and thereby presents a case of Y-PAR that enjoys multiple resources. Nonetheless, the pragmatic considerations that link participatory research to everyday practice (such as the relationship-building and training of community partners and co-researchers, and the accountability to funders and other stakeholders) still present significant challenges to authentic participation and tangible action. As we embark on MINDS prototypes that adapt to and respond to young people’s changing needs in our community, we look forward to seeing the extent to which our activities really do have an impact.

Conclusion

In this article, we described the methodological and organizational approach employed by the MINDS Social Innovation Lab, outlining how its participatory principles are operationalized in diverse individual, group and community-wide research activities focused on youth mental health. Framed by Bradbury-Huang’s (2010) seven points of quality in action research, we detailed the collaborative processes by which young people and their adult allies together generated knowledge and objectives, developed intervention activities in the community, and reflected upon their impact.

An important and unique focus of our discussion describing SI approaches as contributing to what Y-PAR can do in this context. Positioning MINDS as a SIL in a hospital/research institution has facilitated our activities, generating interest from other organizations in the community, and advancing the development and piloting of community interventions. The conditions and activities of SI have given MINDS a framework while protecting the necessary space for emergence of youth leadership at all stages of the research and innovation processes.

The unique framework of MINDS as a SIL has the potential to influence Y-PAR on a global scale. There are numerous examples of Y-PAR being used to engage youth in the implementation and evaluation of youth-based health programs (e.g., Abraczinskas & Zarrett, 2020; Goto et al., 2012; Mathikithela & Wood, 2021; Ritterbusch et al., 2020). These examples demonstrate the power of youth to influence structural changes that meet the needs and interests of the youth they serve; increasing buy-in and engagement with the interventions themselves. MINDS similarly focuses on youth as catalysts of change, with the SI lens of failure as progress and re-focus leading to future. We adapt and change agilely in a way that allows us to iterate and re-address quickly. Incorporating an SI approach to Y-PAR based projects, would open the space for youth to explore and investigate authentically while reflecting on all outcomes as opportunities for growth.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by St. Joseph’s Health Care London Foundation and Ontario Trillium Foundation under grant Seed Fund 2018.

Author biographies

Eugenia Canas was a post-doctoral fellow in Health Information Science, Faculty of Information & Media Studies and the Faculty of Health Sciences at Western University. She was a founding member of the Centre for Research on Health Equity and Social Inclusion (CRHESI) and served as the centre’s first coordinator. Her research interests were deeply rooted in youth participatory action research and mental health systems transformation. She was the founding Director of Research of MINDS of London-Middlesex. Eugenia sadly passed away in June 2021.

Richard Booth is an Associate Professor and the Arthur Labatt Family Chair in Nursing at Western University. His research interests seek to explore the relationships between human and technological interactions within health(care) and educational contexts and cross domains of nursing education, health informatics, social robotics, socio-technical perspectives, mental health, and social media.

Romaisa Pervez is a Quantitative Research Analyst at Mission Analytics Group, Inc., and previously a transitional age youth research assistant at MINDS of London-Middlesex, St. Joseph’s Health Care London. She obtained her MS in Epidemiology and Biostatistics from Western University.

Alec Cook is a transitional age youth research assistant at MINDS of London-Middlesex, St. Joseph’s Health Care London. He is a current undergraduate student in Psychology at Western. His research interests include youth-centred practice, social innovation, and mental health system transformation.

Melissa Taylor-Gates is the Innovation and Evaluation Manager at MINDS of London-Middlesex, St. Joseph’s Health Care London. She holds a Masters of Library and Information Science from Western University. Her work centralizes around power inequality and authentic communication.

Abe Oudshoorn is an Associate Professor and Associate Director (Graduate Programs) at the Arthur Labatt School of Nursing, Western University, and the Arthur Labatt Family Chair in Nursing Leadership in Health Equity. He holds cross appointments with Lawson Health Research Institute and the Department of Psychiatry, Western University, as well as serving as a member of the Centre for Research on Health Equity and Social Inclusion (CRHESI). His research interests include homelessness prevention, intersectional understandings of homelessness, homelessness globally, program evaluation, health promotion, refugee housing outcomes, critical ethnography, and participatory action research, among others.

Ross Norman is Emeritus Professor in the Departments of Psychiatry and Epidemiology and Biostatistics at Western University, London, Canada.

Renee Hunt is the Associate Director of Research and Operations for MINDS of London-Middlesex. She has a PhD in Social Psychology from Wilfrid Laurier University. Her research interests include positive psychological practices, mental health and addiction system transformation, and prejudice and discrimination.

Arlene G. MacDougall is the Principal Investigator and Director of MINDS of London-Middlesex Lawson Health Research Institute - St. Joseph’s Health Care London. She is the Director of Research for the Department of Psychiatry, and an Associate Professor (Clinician Researcher) of Psychiatry and Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University. She is a psychiatrist and Director of Research and Innovation for Mental Health Care at St. Joseph’s Health Care London. Her research interests include mental health system innovation, youth mental health, mindfulness, early psychosis, and collaborative care.

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