Danya Fast

Background: The toxic drug crisis in British Columbia, Canada has accelerated efforts to expand residential substance use treatment beds for young people between the ages of 14 and 19 in Greater Vancouver. While various barriers to accessing residential substance use treatment among young people who use drugs have been well documented in the literature, little research has examined how young people, and in particular adolescents, navigate and experience these treatment programs.Methods: This qualitative study draws on a critical phenomenological approach to describe and contextualize experiences and understandings of residential substance use treatment among 35 young people ages 14 to 19 in Vancouver. I thematically analyze data from in-depth, semi-structured interviews conducted with participants attending, just about to attend, or having previously attended “Cypress Place”, a local residential treatment center, between October 2019 and May 2021. Results: Findings underscore that young people are actively engaged in making, unmaking, and remaking their senses of self and social worlds prior to and throughout residential treatment. Many participants envisioned and experienced residential treatment as a time and space in which to actualize future selves. However, once they were in residential treatment, most young people encountered challenges in navigating past and ongoing traumas and complex social dynamics, which at times undermined their evolving self- and world-making projects.Conclusions: This study demonstrates how adolescents actively engage in re-making themselves and their social worlds in and across settings, allowing for a re-imagining of youth treatment and recovery programming and services that better align with the needs, priorities, and desires of young people themselves.

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Background: Physical distancing measures implemented to address the spread of COVID-19 between 2020 and 2021 introduced challenges for accessing mental healthcare and social support for queer youth. COVID-19 disrupted the provision of mental healthcare, social support, and in-person approaches to qualitative research. Thus, there is a critical need to understand how queer youth’s experiences of mental health have been impacted by COVID-19 and the associated with pivoting from in-person to virtual data collection methods to study these impacts. Therefore, the objectives of this thesis are to: 1) Document my experiences pivoting from an in-person to virtual data collection methods, and 2) Identify how evolving experiences with the COVID-19 pandemic impact the mental health experiences of queer youth. Methods: Using a social constructivist framework, I thematically analyze digital diary entries and data from semi-structured interviews collected between November 2020 and June 2021 in Vancouver, Canada, from a sample (n=15) of queer youth recruited using purposeful and snowball sampling. Findings: The findings of this thesis describe how digital diary methods and remote semi-structured interviews provided opportunities for exploring unanticipated areas of inquiry and opportunities for participants previously experiencing barriers to in-person research. However, this approach also featured several limitations, including instances where poor internet connectivity resulted in Zoom calls being cut off multiple times and difficulty in maintaining private space during remote interviews where guardians interrupted interviews. Physical distancing measures had unintended negative effects on the mental health experiences of queer youth by interrupting processes of identity-development, isolating queer youth and leading them to rely on limited in-person social supports and introducing barriers to virtual mental health support for queer disabled youth. Conclusion: These findings show how combining remote interviewing and digital diary methods provide equity-enhancing opportunities for disabled and immunocompromised queer youth, how queer social capital plays an important role in queer youth’s ability to transition their mental healthcare and social lives online, and the necessity of accessibility being built-in at each point of virtual clinical care. Finally, they highlight how moralizing discourses around COVID-19 guideline compliance entrench existing mental health inequities by isolating them and subjecting them to discrimination.

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Background: Qualitative research demonstrates that, among youth who use substances in the context of entrenched poverty and homelessness, pregnancy is often viewed as an event that could change the trajectories of their lives. However, young people’s desires and decision-making regarding how to make changes do not always align with the perspectives of various professionals and systems regarding how best to intervene. Methods: This study draws on 14 months of longitudinal qualitative interviews and ethnographic fieldwork with 16 youth (under 29 years of age) to explore how pregnancy and early parenting shaped their trajectories. Eight of the 16 participants self-identified as Indigenous. Findings: The young people who participated in this study described pregnancy as a life event that could stabilize tumultuous romantic relationships and deepen a sense of romantic love in the midst of the everyday emergencies of substance use, homelessness, and poverty. As “moral assemblages,” romantic relationships shaped decision-making surrounding pregnancy and parenting on the streets, including the decision of whether or not to enter treatment. Consistent with previous research, pregnancy was envisioned by youth as a turning point that might allow them to realize different kinds of futures. However, intervention by child protection, healthcare, and criminal justice systems were often at odds with what youth envisioned for themselves, their families, and the future. In particular, interventions that separated young couples were often perceived by youth as destabilizing the very relationships that they felt would allow them to successfully navigate a pregnancy and create a family. Conclusions: This study highlights how a disjuncture between youth’s decision-making surrounding pregnancy and parenting and the systems that are intended to help them can further entrench young parents in cycles of loss, defeat, and harm that can be powerfully racialized. Two young people were not in romantic relationships during their pregnancies and were better able to navigate child protection and healthcare system demands and draw on other kinds of social support to ultimately maintain custody of their children. However, these fragile success stories further underscore the need for structural interventions that provide access to housing and income among vulnerable young parents.

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