Projects

On this page, you will find information about our active projects and some of our earlier projects. Please visit our Resources page for articles and other resources produced as a result of some of our earlier projects. To learn more about our research or if you have ideas for related future projects, please contact us: lgbtq_health@camh.net.

Active Projects

Guidelines for Community Based Research in Mental Health and Addictions

In fields such as Aboriginal health and HIV, the principles of community-based research (CBR) have successfully become ‘mainstream’, where even major research funders expect them to be integrated in research on these topics. In contrast, relatively little research in the area of mental health and addictions integrates the principles of CBR, and as such, communities of individuals with lived experience of mental health and/or addiction systems have less often had opportunities to experience the potential benefits associated with CBR, both in terms of capacity building and research resulting in social change. This project aims to produce a user-friendly document, which will encourage the use of CBR by individuals or organizations undertaking research in the area of mental health and/or addictions.

This is a project of the CAMH Community Advisory Committee for Research (CACR) members and partners on this project include The Empowerment Council and Working for Change.

To learn about people’s research experiences a thorough consultation with individuals with lived experience of mental health and/or addiction systems and have participated in research will be done. Focus groups will take place for people to discuss their past research experiences to better understand how they would like to be involved in research projects and will help to validate the content and usefulness of newly developed community-based research guidelines.

Project Team

• Principal Investigator: Dr. Lori Ross
• Co-Investigators: Jennifer Chambers (Empowerment Council), Dr. Joyce Brown (Working for Change)
• Project Coordinator: Victoria Jakobson

Pathways to Effective Depression Treatment

Pathways is one of several research projects led by the Re:searching for LGBTQ Health team designed to build our understanding of barriers to accessing culturally competent mental health care among gender and sexual minorities in Ontario.

Pathways is a community-based research project that will ask women and/or trans people of all sexual orientations about their experiences with depression and seeking mental health services (1). One of our goals is to understand the intersections of racial/ethnic identities and socioeconomic status with LGBTQ identities, particularly in relation to mental health service experiences.

This study is funded for two years by the Canadian Institutes for Health Research (CIHR). Partners in the study include Rainbow Health Ontario, Women’s Health in Women’s Hands Community Health Centre, York University, and the University of Toronto. An advisory committee representing people with lived experiences of mental health issues and/or use of mental health services and mental health service providers with expertise in working with LGBTQ people provides guidance to this study.

Pathways is a mixed-methods study. This means we collect both qualitative and quantitative data to answer our research questions. For this study, our first step is to conduct an online quantitative questionnaire asking people about their experiences of depression and poor mental health, whether they sought help, and how helpful they found any services they received. Our goal is to reach 900 people in Ontario with this survey. This will provide us with the opportunity to analyze intersections of gender identity, sexual orientation, race/ethnicity and socioeconomic status with experiences of mental health and seeking help.

Building upon the information and contacts from the online questionnaire, we will connect with approximately 40 respondents from different regions of Ontario and from a diverse background of identities and experiences to conduct face-to-face interviews. Among other things, we plan to ask participants, ‘what would you say if you had five minutes to spend with someone who could really make changes to the mental health system in Ontario?’

Pathways has an extensive knowledge translation plan to share what we learn with the broader LGBTQ communities, health and social service providers, policy and decision-makers, and researchers. We hope that lessons from our participants and research will be able to contribute to the mental health and addiction reform processes currently taking place in the province, so that all Ontarians have access to quality, culturally competent health care.

Project Team

• Co-Principal Investigators: Dr. Lori Ross and Dr. Leah Steele
• Co-Investigators: Dr. Andrea Daley, Loralee Gillis, Dr. Charmaine C. Williams and Deone Curling
• Project Coordinator: Heather McKee (Year 1), Datejie Green (Year 2)
• Community Coordinator: Scott Anderson
• Research Assistant: Sarah James-Abra

For more information, contact Heather McKee:

Funded by the Canadian Institutes of Health Research Operating Grant: Making progress in women’s mental health in the Province of Ontario

Creating Our Families: A pilot study of the experiences of lesbian, gay, bisexual and trans people accessing assisted human reproduction services in Ontario

Many LGBTQ people choose to parent. However, many LGBTQ people must rely on outside assistance to create their families, including use of assisted human reproduction (AHR) services (2, 3). As a result, LGBTQ people make up a significant proportion of AHR service users in some parts of Canada (i.e., up to 30%, as reported by one Toronto clinic). Despite this high rate of service utilization, much of existing academic literature about LGBTQ people and AHR services is comprised of papers debating whether LGBTQ people should have access to AHR services. These debates stem from widespread societal misconceptions about the presumed inadequacy of LGBTQ people as parents. In contrast, the impact of these societal misconceptions on provision of AHR services to LGBT people has not been well studied. This is particularly important in light of recent policy developments: in 2008 an expert panel convened by the Ontario Ministry of Children and Youth Services examined the barriers to accessing fertility services in Ontario and specifically recommended the removal of social barriers to AHR for LGBTQ people. Further, the Assisted Human Reproduction Act (AHRA) includes a non-discrimination clause barring discrimination based on sexual orientation or marital status. In this context, it is critical to determine to what extent AHR services are meeting the family creation needs of Canadian LGBTQ people.

In the summer of 2010, we began recruiting LGBTQ people from all across Ontario in order to learn about their experiences with AHR services. Over 110 LGBTQ people responded to our call for participants. For a number of reasons, including the aim for our study to reflect the diversity of the LGBTQ population - in terms of sexual orientation, gender identity, geographical location, and race, to name a few of the many social determinants of health, as well as AHR service experience - we interviewed ~40 LGBTQ individuals (including couples, co-parents and donors) who have used AHR services since 2007, are in the process of using AHR services or who avoided using AHR services for a number of reasons (i.e., homophobic AHR service providers, cost of AHR services, rural location, etc.). We are currently wrapping up these semi-structured interviews and analyzing the data from these interviews.

From the AHR service experiences that LGBTQ people share with us, we aim to: a) Describe the experiences of LGBTQ people with AHR services in Ontario; b) Identify perceived barriers and supports to AHR service access for LGBTQ people; c) Determine similarities and differences in the experiences of lesbian, gay, bisexual and trans people with AHR services; and 4) Use the knowledge gained to inform AHR service delivery in Ontario, and develop future Canada-wide research on this topic. Particularly, we aim to provide recommendations to AHR service providers to better meet the needs of LGBTQ people.

Like all of our other studies, the Creating Our Families project is a community-based research project that includes an advisory committee of relevant stakeholders, including LGBTQ parenting experts and AHR service providers.

Project Team

• Principal Investigators: Dr. Lori Ross and Dr. Leah Steele
• Co-Investigator: Rachel Epstein
• Research Analyst/Interviewer: Datejie Green
• Co-Investigator/Interviewer: Stu Marvel
• Participant Recruitment & Screening Coordinator: Lesley Tarasoff
• Research Assistants: Mika Atherton, Emily Chen, Myera Wease, Nael Bhanji, and Alisa Das

For more information, contact Creating Families:

Funded by the Canadian Institutes of Health Research Catalyst Grant: Psychosocial Issues Associated with Assisted Human Reproduction

Using Theatre to Disseminate LGBT Peoples’ Experiences with Assisted Human Reproduction Services

Recently we received funding from CIHR to disseminate the results of the Creating Our Families project (see above) to our two key audiences: AHR service providers and LGBTQ prospective parents. We will use interactive or “forum” theatre, an art-based knowledge translation approach, to disseminate our research results. In forum theatre, audience members are shown a mini-play, which in this case would be about a client-service provider interaction, and the audience is given the opportunity to interact with the play, by having members step into the play to change, add or improve what is going on in the scene. Forum theatre sketches will be used with AHR service providers to engage them in discussions about how to provide culturally competent care for LGBTQ people. They will be used with LGBTQ people to build skills for self-advocacy in accessing AHR services. We believe this knowledge translation strategy will result in improved AHR service delivery and more equitable access to AHR services for LGBTQ people in Ontario.

For more information, contact:

Scott Anderson

Datejie Green

Funded by the Canadian Institutes of Health Research Meetings, Planning and Dissemination Grant: Dissemination Events

Risk and Resilience among Bisexual People in Ontario: A Community-Based Study of Bisexual Mental Health

Bisexual people are often left out of research. When they are included, they are often lumped in with heterosexuals, gays, or lesbians rather than being studied as a distinct group. This makes it next to impossible to get statistics about bisexual health, to compare bisexual health with the heath of non-bisexuals, or to identify health issues that are unique to bisexual people. As a result, bisexuals often receive little benefit from the research in which they have participated in.

Those studies that do focus on bisexual people have found that bisexuals report poorer mental health and use mental health services more often than heterosexuals do. These studies also found that bisexuals report higher rates of anxiety, depression, poor self-rated mental health, suicidality and self-harm behaviour, than gay and lesbian people do. However, we have little understanding of why bisexuals experience these mental health disparities. Understanding the context of bisexual mental health, a pilot study conducted by our research team identified homophobia, biphobia, and monosexism as factors affecting the mental health of bisexuals in Ontario. Many reported a lack of in-group community support, and many felt marginalized in both the heterosexual community and the lesbian and gay community (4).

Our current project will survey 800 bisexual people from across Ontario to learn about their mental health and their experiences with mental health services. We aim to identify practices or strategies that improve mental health for bisexuals, and also identify barriers to mental health or mental health services. These findings will be used to improve the mental health services available to bisexual people.

For this study our definition of bisexual includes people attracted to more than one sex and/or gender. This may include those who self-identify as bisexual, queer, pansexual, omnisexual, two-spirited, fluid, or who choose another non-heterosexual identity label (5).

Our study will use respondent-driven sampling (RDS), a method by which people who complete the survey recruit new participants from their own social networks (6). RDS has been demonstrated to reduce sample bias. Without it, for example, one eager participant, say Project Coordinator Margaret Robinson, could recruit a large number of participants who are like herself and we might conclude that most bi people in Ontario are bisexual researchers in their 30s. Respondent-driven sampling allows us to calculate statistics to represent all bi people in Ontario by looking at how difficult each person who completed the survey was to recruit.

This project is guided by a community Advisory Committee made up of a diverse group of bisexuals from across the province. These committee members will help shape the language and content of the survey questions. Working with advisory committees helps keep our research relevant to the community that is being studied, and is one of the ways we put our values of partnership and accountability into practice.

Project Team

• Principal Investigator: Dr. Lori Ross
• Co-Investigators: Dr. Greta Bauer, Loralee Gillis and Ishwar Persad
• Project Coordinator: Dr. Margaret Robinson
• Consultant: Cheryl Dobinson

For more information, contact Margaret Robinson:

Funded by the Canadian Institutes of Health Research Operating Grant

Access to primary care for people with serious mental health and/or substance use issues: A qualitative study

People living with serious mental health and/or substance use issues face unique barriers accessing primary care (health care provided by a medical professional that is a patient’s first point of entry into the medical system) and often end up as unattached patients. Unattached patients are people who do not have regular access to a primary care provider (i.e., a doctor, nurse, or nurse-practitioner). We want to learn about what happens when people with serious mental health and/or substance use issues go to the doctor or try to go to the doctor and don’t get the care they need. We also want to learn about positive primary care experiences. We want to know what has helped people with mental health and/ or substance use issues access medical care.

In addition to some members of the Re:searching for LGBTQ Health team, partners on this project include The Empowerment Council, Parkdale Activity & Recreation Centre, Scadding Court Community Centre, Sherbourne Health Centre, Somerset West Community Health Centre, The Ontario College of Family Physicians, Susan Pigott and Barney Savage from CAMH and Dr. Simone Vigod from Women’s College Hospital. These partners contribute diverse and valuable insights which will help us to use our results to improve access to primary care for people with mental health and substance use issues.

Like all of our current projects, this is a community-based research (CBR) project. As such, we are concerned with asking questions that are important to people who are the focus of the research, in this case consumer/survivors, and including consumer/survivors in the design and development of the project.

We will use both interviews and a short questionnaire to learn about people’s primary care experiences. In the interview we will ask people who have experienced mental health and/or substance use issues to talk about their experiences seeking medical care. The questionnaire will ask questions regarding one’s identity or background such as their age, gender, and ethnic or cultural background. We will also interview service providers about what they think prevents people with mental health and/or substance use issues from accessing primary care and what supports them to access primary care.

We want to use the information gained from this project to provide ideas for programs and policies that will improve access to medical care for people with mental health and/or substance use issues.

Project Team

• Principal Investigator: Dr. Lori Ross
• Co-Investigators: Dr. Simone Vigod (Women’s College Hospital), Barney Savage (CAMH), Jennifer Chambers (Empowerment Council), Jan Kasperski (Ontario College of Family Physicians)
• Project Coordinator: Scott Anderson
• Research Assistants: Myera Waese and Dean Spence

For more information, contact Scott Anderson:

Funded by the Centre for Addiction & Mental Health Development and Dissemination Fund

Transforming Family: Trans Voices on Parenting

The relationship between researchers, clinicians and trans communities has long been acknowledged as troubled, with a review of the literature revealing particular nuances for trans people who are parents. Steeped in a yet unchallenged psychopathology approach to gender diversity, accepted practice in early gender identity clinics was to advise those who presented for sex-reassignment surgery to sever all contact with their established lives, including relationships with their own children. Though no longer practiced, the implied assumption of harm has left a legacy in research and social policy surrounding trans parents, evident in: deficit models in research with the children of trans parents, questioning if these children can be as healthy as others; discrimination against trans parents in family planning policy and practice, including adoption and assisted human reproduction policy; and bias against trans parents in child custody decision-making. Though these phenomena can be understood as manifestations of transphobia, they are underscored by the unquestioned assumption of the normalcy and legitimacy of people who are not trans: cisnormativity. Unsurprisingly, the possibility of unique strengths among trans parents, because of, rather than in spite of their trans identity, has gone unexplored in research. To respond to these concerns, the Transforming Family study was born.

The Transforming Family study is a community-based research project concerned with the impact of discrimination on trans parents and the strengths trans people bring to parenting. The goal of this study is to create visibility around trans parents’ struggles by sharing this information with service providers and the broader community and to better position trans parents to respond to the policies impacting their families.

In the winter of 2010-2011, focus groups were held with trans parents (step-parents, adoptive parents, birth parents, non-birth parents, etc.) in the Toronto area. Data analysis is now in progress.

Lead by trans dad of two Jake Pyne, the Transforming Family project is supported by a team of researchers and community members from the LGBTQ Parenting Network and the Re:searching for LGBTQ Health Team.

This project is funded through the Community One Foundation and the Centre for the Study of Gender, Social Inequities and Mental Health.

For more information about this study, contact Principal Investigator Jake Pyne:

• Transgender Parents: Struggles, Strategies and Stories of Transformation
• Transforming family: Trans voices on parenting

Some Earlier Projects

Lesbian, gay, bisexual, transgender, transsexual, and two-spirit adoption in Ontario: Policy, practice and personal narratives

An overarching goal of our work in the area of LGBTQ parenting is to improve the quality and accessibility of health and social services for all LGBTQ parents and prospective parents. One of our earlier studies addressed this goal by focusing on LGBTQ adoption: Lesbian, gay, bisexual, transgender, transsexual, and two-spirit adoption in Ontario: Policy, practice and personal narratives. We collected survey data from 44 adoption agencies in Ontario (97 were asked to participate). We found that only 13 agencies had a policy regarding adoption by LGBTQ, most of which were public, secular agencies in larger urban settings; only 16 actively recruited LGBTQ adoptive parents, i.e., table at community organizations or events (i.e., Pride); and only 3 of 44 agencies/individuals who participated indicated that they had received education about specific needs and concerns of sexual and gender minority prospective parents. We also interviewed LGBTQ adoptive parents to learn about their stories of adoption, beginning with their decisions to pursue adoption and closing with their experiences since the adopted child(ren) joined their family. Please visit our Resources page for some of the resources we produced as a result of this project.

Project Team

• Principal Investigator: Dr. Lori Ross
• Collaborators: Dr. Leah Steele, Rachel Epstein and Dr. Carol Strike
• Research Coordinator: Scott Anderson

Funded by the Social Sciences & Humanities Council of Canada

Mothering on the Margins

Funded by CIHR, The Mothering on the Margins (MOMs) project was a research study carried out by researchers at the CAMH and the LGBTQ Parenting Network. The goals of this research were (a) to learn about the factors that contribute to emotional well being in lesbian, gay, bisexual, transgender, transsexual, and Two-Spirit (LGBT) mothers and mothers-to-be, and (b) to learn what services LGBT mothers and mothers-to-be find helpful, and what services they wish existed, to address their emotional needs.

A total of 64 women participated in the study; including women who were trying to conceive, pregnant women, and biological and non-biological mothers of children under one year of age. Participants completed self-administered surveys assessing health and mental health issues, family and parenting issues, as well as social issues such as discrimination. Interviews were held with 20 of the participants to further investigate mental health issues and support and service utilization and needs.

From the MOMs study, we learned that:

• Perinatal depression is not less common and may be more common among lesbian and bisexual women relative to heterosexual women.
• Experiences of discrimination affect mental health, and women who experience multiple discrimination is particularly important.
• Lesbian and bisexual women face significant barriers in accessing fertility services and pre- and postnatal care.

For articles and other resources produced as a result of the MOMs study, please visit our Resources page.

Project Team

• Principal Investigator: Dr. Lori Ross
• Co-Investigators: Dr. Leah Steele, Rachel Epstein, Dr. Carol Strike, Dr. Brenda Toner and Dr. Meir Steiner
• Research Assistant: Cheryl Dobinson

Funded by the Canadian Institutes of Health Research Institute of Gender and Health

Understanding the context of bisexual mental health

This is a qualitative study of 55 bisexual people’s experiences with mental health services and care in Ontario that serves as the pilot study to our current study on bisexual mental health (see above). Please visit our Bisexual Community page for more information about this study.

• Principal Investigators: Dr. Lori Ross and Anna Travers
• Co-Investigator: Cheryl Dobinson

Funded by the Centre for Addiction & Mental Health Community Research Capacity Enhancement Program

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Notes:

1. For purposes of inclusion in the Pathways study we are including women and trans people who identify as any sexual orientation. This can include individuals who self identify as lesbians (cissexual and trans women), bisexual women (cissexual and trans women), queer women (cissexual and trans women), heterosexual trans women, heterosexual cissexual women, heterosexual trans men, gay, bisexual or queer trans men, genderqueer people, people with trans experience, people with any other trans or genderqueer identities. Cissexual = non-trans people

2. Assisted human reproduction (AHR) is also known as assisted reproductive technology (ART). AHR services or ARTs include intra-uterine insemination (IUI), in vitro fertilization (IVF), and surrogacy, to name a few.

3. For more information about LGBTQ people’s experiences with AHR services, see:

Ross, L.E., Steele, L.S., & Epstein, R. (2006a). Service use and gaps in services for lesbian and bisexual women during donor insemination, pregnancy, and the postpartum period. Journal of Obstetrics & Gynaecology Canada, 505-511.
Permission to post this article on this website has been provided courtesy of the Society of Obstetricians and Gynaecologists of Canada

Ross, L.E., Steele, L.S., & Epstein, R. (2006b). Lesbian and bisexual women’s recommendations for improving the provision of assisted reproductive technology services. Fertility & Sterility, 86(3), 735-738.

Epstein, R. (2008). The Assisted Human Reproduction Act and LGBTQ Communities: A paper submitted by the AHRA / LGBTQ Working Group. Toronto: Sherbourne Health Centre.

Epstein, R. (2008). LGBTQ Communities and AHR Services: Beginning a conversation. Infertility Awareness Association of Canada.

4. To learn more about bisexual mental health and bisexual peoples’ experiences with mental health services, you can read these articles based on the data from our pilot study Understanding the context of bisexual mental health.

Ross, L.E., Dobinson, C., & Eady, A. (2010). Perceived determinants of mental health for bisexual people: A qualitative examination. American Journal of Public Health, 100(3), 496-502, doi: 10.2105/AJPH.2008.156307.

Eady, A., Dobinson C., & Ross, L.E. (2010). Bisexual peoples’ experiences with mental health services: A qualitative investigation. Community Mental Health Journal, doi: 10.1007/s10597-010-9329-x.

Canadian Mental Health Association, Ontario. (2010). “Study explores bisexual people’s experiences with mental health services in Ontario”.

Boon, M. (2008). Study explores link between bisexuality & poor mental health: Bisexuals face prejudice from straight and queer communities, lack bi-specific services: report. Xtra!.

5. This includes trans people who identify as bisexual or any of the above terms.

6. A detailed description of Respondent-Driven Sampling can be found here. Also see Heckathorn, D.D. (1997). Respondent-Driven Sampling: A New Approach to the Study of Hidden Populations. Social Problems, 44(2), 174-199. Alternatively, check out the Trans PULSE project as an example of a community-based research project that uses RDS.