A cocreation process of a cultural adaptation of an integrated youth services in Québec (Canada).

Background: Integrated Youth Services (IYS) has aimed to offer an alternative to traditional services for youth (Halsall et al., 209; Hetrick et al., 207). However, If IYS seem appropriate and effective in meeting the needs of young people, they do not always consider the cultural particularities of diverse youth (Bentayeb et al., 2022). Despite high attendance rates, several barriers persist in services reaching immigrant youth (Hilferty et al., 205), including language barriers for immigrant youth (Hilferty et al., 205; Patulny et al., 203) and the lack of community involvement in service development (Communio, 2009; Hilferty et al., 205). Field actors suggest several strategies to promote access and engagement in services (Bentayeb et al., 2022; Communio, 2009; Hilferty et al., 205), a need to culturally adapt services for diverse youth (Bentayeb et al., 2022), ethnic and racial communities (Moore, 208) and in particularly, for immigrant youth and their families/caregivers (Nadeau et al., 2020; Nadeau et al., 208; Nadeau et al., 207). Approach: Since 208-209, Aire ouverte, an IYS for youth aged 2 to 25, has been implemented across Quebec, Canada. In order to plan the Aire ouverte cultural adaptation at the early implementation stages, we adopted an interdisciplinary, intersectoral, and intersectional approach to ensure equitable access. Thus, our research, based on a co-creation approach (Baptista et al., 2020; Torfing et al., 209), seeks to co-create this cultural adaptation with the relevant actors, for racialized, immigrant, refugee, and cultural minority youth in four Quebec regions (Montreal, Capitale Nationale, Estrie, Outaouais). This cultural adaptation is framed on the Equity-Centered Community Design (ECCD) framework (Creative Reaction Lab, 208), which is a flexible system that addresses complex intersectional issues faced by diverse youth, their parents/caregivers/families, community leaders, and the practitioners. The ECCD approach allows us to adopt a democratic, non-linear, and emancipatory process divided into eight steps, emphasizing actorscontribution at every stage through creative and deliberative activities.Over a year and a half, we will conduct 4 co-creation circle meetings with practitioners, youth, parents/caregivers/families, and community leaders. These meetings will vary between subgroup discussions and larger group sessions, focusing on themes such as respect and mutual listening, diverse perspectives on lived and transmitted history, recognition and deconstruction of power dynamics, expression of needs, reflection on cultural adaptation, and anticipated impacts. The final two meetings will be deliberative workshops where stakeholders present their proposals for culturally adapting services to managers. Each region will have a territorial steering committee composed of clinicians, managers, parents, community leaders, and youth to oversee the process, support participant recruitment, and develop tools for service evaluation. Results: This inclusive co-creation process aims to balance and integrate the viewpoints, needs, and concerns of all actors, countering power imbalances. The cocreation process offers a collective learning space and empowers the cocreators. For integrated services, this research, hopefully, will enhance service access and retention for the target youth population, create a culturally safe care environment, and reduce health inequities. Implications: This proposition has many implications. The main ones are situated at a methodological level and a practical level. First, using the ECCD-based co-creation approach for service adaptation will serve as a model for other IYS implemented in different contexts in Canada and at an international level. Second, the outcomes of this cultural adaptation process will provide a roadmap for practitioners and managers to implement culturally adapted services and ensure a safe care environment for all youth. In our large research project, we plan to support Aire ouverte teams during cultural adaptation implementation and to evaluate the cocreation process and the implementation process.

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