North B.E.A.T. (Barriers to Early Assessment and Treatment)

Dr. Chiachen Cheng

In brief

Aboriginal youth—including First Nations, Inuit, Métis, and non-status youth of Aboriginal heritage—comprise a particularly vulnerable population, especially in rural and remote communities.

North BEAT (Barriers to Early Assessment and Treatment) is a promising research project that’s trying to understand how to meet the mental health needs of northern youth who experience psychosis. Led by Dr. Chiachen Cheng, a researcher with St. Joseph’s Care Group in Thunder Bay, the project is looking at the perceived needs of Aboriginal and non-Aboriginal youth.

This issue of Research As It Happens explores the North BEAT project. Research As It Happens highlights evidence as it is being generated.

Read it below or download the PDF.


“North BEAT” (Barriers to Early Assessment and Treatment) is a promising research project that is being funded by the Sick Kids Foundation and Canadian Institutes of Health Research. This three-year project aims to understand how to meet the mental health needs of northern youth (≤ 18 years old) who experience psychosis.

What is the research about?

The research question of this study is: What are the perceived service needs of Aboriginal and nonAboriginal youth in Northern Ontario who experience first episode psychosis? The Rationale: Early Psychosis Intervention (EPI) has been shown to improve long-term outcomes for people who experience psychosis, and research in early intervention has made significant contributions to care.

However, in Northern Ontario, because of an expansive geography that includes many First Nations communities, services struggle to better understand unique presentations, experiences and care pathways.

Aboriginal youth—including First Nations, Inuit, Métis, and non-status youth of Aboriginal heritage—comprise a particularly vulnerable population, especially in rural and remote communities. Disparities in access to healthcare, have long been recognized. Within the five-year history of the EPI service in NW Ontario, over 30% of the clients have consistently self-identified as Aboriginal. This is an over-representation of the region’s 20% Aboriginal youth population.

In the NE EPI service, Aboriginal youth are under-represented at 15%.There is very little research evidence to answer “why”. These discrepancies need to be better understood. As such, the North BEAT project seeks to explore the service needs of people with severe mental illness (such as psychosis) and its intersection with three marginalized populations: rural and remote residents, Aboriginal people, and youth.

The Methods

Mixed-methods are being used to conduct this exploratory and descriptive study. Specifically, the study will recruit 120 youth, both Aboriginal and non-Aboriginal, from Northern Ontario to participate in self-reports about their general functional and mental health status. A smaller group of 24 youth will be interviewed to provide an in-depth narrative account of their experiences with mental health care service and the barriers and facilitators they face when seeking help. Similar discussions will take place with 24 caregivers of youth in service.

Who is conducting the research?

The project is being led by Dr. Chiachen Cheng who is a Child & Adolescent Psychiatrist and Researcher with St. Joseph’s Care Group in Thunder Bay. Co-investigators on the project are from the Centre for Rural and Northern Health Research (Lakehead University), and the Centre for Addiction and Mental Health. Collaborators in the research include Regional Early Intervention Psychosis Program (North Bay Regional Health Centre), Canadian Mental Health Association (Thunder Bay), and St. Joseph’s Care Group.

The project is also guided by an advisory committee which includes youth, Aboriginal, and mental health service representatives from Northern Ontario. Other project partners include Payukotayno James & Hudson Bay Family Services, Muskoka-Parry Sound Community Mental Health Service, Sault Area Hospital, and Health Sciences North (Sudbury). We also hope to engage the Weeneebayko Health Authority, and Nadmadwin Mental Health Clinic. 

What are the expected outcomes of the research?

This is a first step to learning about what is working to improve the lives of young people who experience psychosis in Northern Ontario. The project has four main intended outcomes:

  1. An understanding of the perceived mental health service needs of youth with psychosis.
  2. Evidentiary material that can describe the functional and mental health of affected adolescents receiving mental health care.
  3. To specifically examine Aboriginal youth as a significant and vulnerable population in Northern Ontario, and to engage Aboriginal youth in a discussion about their needs for mental health care.
  4. A better understanding of whether communities or cultures play a role in the intersection between psychosis, First Nations and rural or remote geography. 

What are the limitations of the research?

Study participants are youth who are receiving service for a severe mental illness and cannot speak to the barriers to service and service needs of those who do not make it to service. Further, the extent to which the study findings would generalize to other regions of Canada is not known.

Are there any future areas to expand or build on this research?

Knowledge exchange workshops will be held with project participants, First Nations communities, leaders, and youth mental health services. The goals of these activities are to engage First Nations communities, leaders and youth mental health services, to provide relevant information for evidence-informed service planning, and to contribute research knowledge. For more information on this project please contact Dr. Chiachen (Chi) Cheng at chengch [at] tbh [dot] net or check-out the project website: departments/research/projects/NorthBEAT.aspx

Author: Kim Karioja