The Impact of Cultural Safety on Treatment Outcomes and Access to Services in Youth Integrated Healthcare: A Scoping Review

Background: Mental health issues are amongst the leading health burdens for youth around the world. Historically marginalized or underserved youth populations, such as Indigenous and Aboriginal youth, disproportionately experience health disparities and are especially vulnerable to mental health concerns. Many of these youth face significant barriers to accessing treatment, such as stigma, cost, and lack of culturally safe providers and treatment pathways. Integrated care has emerged as a potential solution to overcoming such barriers. Some integrated youth healthcare networks have incorporated Cultural Safety principles and frameworks into their models of care in consideration of the Indigenous and Aboriginal youth they serve. However, there is little research on the impact of cultural safety and improved access to culturally sensitive healthcare services and health outcomes. This scoping review aims to map the current literature on cultural safety in integrated youth healthcare, as well as examine their effects on service access and treatment outcomes. Methods: Three electronic databases and gray literature resources were searched manually for articles published from 2000 onward, with preference for publications originating from the U.S., New Zealand, Canada, and Australia. Search terms included “integrated health care services,” “cultural safety,” and combinations of terms identifying various youth populations. After screening criteria were applied, 122 were included in the review. Results: Integrated care models and cultural safety frameworks share core principles, such as youth and family engagement in service design and implementation, community partnerships, easy and rapid access, and patient-centered, evidence-based care. Many models focus on early intervention, though nearly half of youth across centers present with moderate to severe conditions. Outcomes in various integrated healthcare centers demonstrate improvements in psychological distress, functional outcomes, and satisfaction among youth, though challenges remain in achieving consistent improvements across diverse populations. While a consistent collection of outcome measures are used by some international center sites, some centers recognize that developed outcome measures do not adequately address cultural aspects of wellbeing and outcome measures could benefit from the development of youth-centric global health outcome measures. Conclusion: Culturally safe integrated youth healthcare centers show promise in improving access to services and treatment outcomes for certain historically marginalized, underserved, and Indigenous or Aboriginal youth populations, but not without challenges. More research on effective short-term and long-term outcome measures, including measures to evaluate cultural safety, are needed.