The burden of disease related to mental health disorders has increased in Canada, especially during periods of transition.[1] Most recently, the importance of mental health has come to the forefront as the psychiatric consequences of the COVID-19 pandemic are seen in Canada. Substance use rates have skyrocketed, and the number of deaths from the drug toxicity crisis in some provinces, such as British Columbia, outweigh the number of deaths from COVID-19.[2]

While standard treatments for substance use disorders in Canada (as illustrated by the Canadian Centre on Substance Use and Addiction and Health Canada’s Substance Use and Addictions Program) focus primarily on medical interventions such as opioid agonist therapies, deaths related to substance use have continued to increase.[3,4] Between January and December 2021, 7560 people died from opioid-related toxicity in Canada.[5]

Gaps in mental health care affect youth

Mental health concerns affect young people disproportionally. In BC, one in four young people live with a mental health or substance use disorder that impairs their functioning.[6] Furthermore, in 2021, 13% of young people aged 15 to 29 years were not in education, employment, or training.[7] Due to the lack of socioeconomic considerations regarding available treatment paradigms, our most vulnerable youth wrestle with continued unemployment, unchanged social circumstances, and homelessness.[8] Current gaps in care include the lack of consideration for supporting youth in domains such as poverty reduction, employment, education, and housing. A larger focus must be placed on “psychosocial, rehabilitation and aftercare services,” as described in Indicator 3.5.1 of the United Nations Sustainable Development Goals.[9]

A promising solution is vocational rehabilitation, where patients build tangible skills and focus on career training as a form of treatment.[10] Community employment opportunities and career support result in changes to a person’s socioeconomic status over time. The Foundry Work and Education Program creates outpatient employment support that re-engages young people who are experiencing mental health, substance use, and other complex challenges, with the goal of attaining a better quality of life in BC.

Foundry Work and Education Program

Foundry is a BC-wide network of integrated health and wellness services for youth aged 12 to 24 years and their families or caregivers. Foundry’s walk-in oriented model allows youth and caregivers to access support without a referral. Once a young person is connected to a centre, the Foundry team works with them and their caregiver to understand their needs and help them access the specific services they require. Core services include mental health care, substance use services, physical and sexual health care, youth and family peer supports, and social services. Some examples are individual, family, and group interventions; gender-affirming care; vocational and school supports; and leisure and social wellness programs. As of March 2023, there were 14 physical Foundry centres across BC [Figure], and free resources and appointments were available virtually through the Foundry BC mobile app. Foundry has more than 140 partners and is operated by Providence Health Care; its online platform is powered by BC Children’s Hospital. Between 2018 and 2021, 23 749 youth were served, and more than 110 145 services were provided.

The Foundry Work and Education Program began in 2015. As part of a $15 000 pilot project, a 16-week work and study program was conducted at Foundry’s first centre. Nine out of 10 youth graduated from the program, and they all found employment or study opportunities within 6 weeks of graduating.[11] The program used an individual placement and support model of employment, an evidence-based model shown to be effective across 28 randomized controlled trials.[12,13] In 2016, the program was expanded through a partnership with the YMCA of Greater Vancouver to deliver supported employment programming. The 43 youth who completed the program reported improvements in their mental health, quality of life, functional status, and safety. In addition, 74% of those youth were able to find meaningful employment within 11 weeks of graduating from the program.[11] With funding from the Canadian Institutes of Health Research, this model continued for 3 years, and a total of 168 young people were served. In subsequent years, funding from Service Canada and the BC Ministry of Social Development and Poverty Reduction allowed for the official establishment and expansion of the program across the centres and virtual care. Currently, the program is funded by Service Canada and the BC Ministry of Social Development and Poverty Reduction. The research arm of the program is funded partly by the Future Skills Centre through the Centre for Addiction and Mental Health.

Each centre has two providers who carry, on average, 20 youth per caseload at a time. With support from the Foundry Central Office, the specialists evaluate the program, ensure that fidelity to the individual placement and support model is achieved, and allow communities to come together to share innovation. Additionally, in partnership with the Centre for Addiction and Mental Health, Douglas Mental Health University Institute, and the University of British Columbia, a pan-Canadian study on the effect of this model within integrated services is being conducted.

Participation in the program

There are both internal and external pathways for participation in the Foundry Work and Education Program. Internally, Foundry staff who work in other services within the organization can refer youth to the program. Externally, eligible youth can access a virtual intake form on the Foundry website or access the service by walking in, emailing, or calling their local Foundry centre. For youth or caregivers who require more help to connect with the Foundry centre, health professionals are invited to call or visit the centre with the youth or caregiver to provide a more supported experience.

Any young person who enters a Foundry centre is provided with a “not in employment, education, or training” screening. Those who answer “no” to being in school or work, demonstrate interest in the program, and are not currently enrolled in a different employment program will receive direction from a Foundry Work and Education Program specialist regarding the next steps. The young person is then provided with information about the structure, supports, and mutual expectations of the program. The youth is asked about their specific goals and interests and is asked to provide personal information and the necessary documents for enrollment in the program. They are also invited to participate in a provincial and national study.

A youth who was enrolled in the Foundry Work and Education Program described their situation prior to entering the program: “I was unaware of what to expect . . . although I did have a general plan, I was lost in my situation due to a lot of uncertainty and did not know what to do next.” Foundry offers a place for youth to come for help when faced with unideal or changing life circumstances and tenuous social supports.

The Foundry Work and Education Program offers career and education supports that are tailored to the youth’s unique needs and goals, which are identified through a rapport-building period and guided by the completion of a career and study profile. An individualized support plan is then generated, which includes career and education coaching sessions, skill-building workshops, and involvement of the integrated health team. Foundry Work and Education Program specialists adapt their approach to meet each youth’s needs, and they use a variety of communication methods, such as text and email, to share opportunities and resources with youth in the program. Coaching sessions include offering supports and tools for managing social, mental, or physical health concerns, and explaining job development services. Over the course of weekly sessions with the participant (the number of sessions is determined by the participant), topics such as motivation to work, barriers to education and training, work experience, strengths and talents, necessary accommodations, preferred employment, and other support needs are discussed.

A participant in the program stated: “Each session, I came in with an issue. [A Foundry Work and Education Program specialist] helped me organize my thoughts and worked together with me to prioritize tasks for goals that best aligned with my values and needs.”

Employment skills and wellness workshops include topics such as résumé building, job searching, coping strategies, interview skills, and preparing for workplace challenges. Foundry centres can also propose additional workshops depending on the needs of the youth in their local community. Program participants are encouraged to attend these workshops to complement their individual coaching sessions and promote peer learning.

The youth who provided the previous quote also stated: “Not only did [the Foundry Work and Education Program specialist] help with the emotional side, but [they also] provided assistance with my other needs, which had a strong effect on my emotions: job search, tailoring résumé, understanding of a specific job market, understanding and brainstorming possible options, weighing pros and cons for different situations, etc.”

Guided by the individual placement and support model, Foundry Work and Education Program specialists also engage in discussions with employers and hold meetings to review participants, share insights with interdisciplinary care team members, and discuss operational and administrative program needs. Help with educational opportunities such as additional certificate training and continuing formal education are also provided.

Foundry centres offer a range of health and social services to any young person aged 12 to 24 years, as well as supports and services for their parents, caregivers, and/or other family members. All centres deliver free, nonjudgmental, strength-based services in a youth-friendly space. Youth can drop in to talk to someone or to get support from a care provider, which can include peer support workers, counselors, physicians, nurse practitioners, and other allied health members. No referral is required. Physicians can connect youth directly to a centre. A complete list of operating centres, including their address and contact information, is provided on the Find a Foundry Centre web page (https://foundrybc.ca/get-support/find-a-centre) and in the Table.

For young people and caregivers who cannot conveniently access a centre or who would prefer a virtual service experience, Foundry Virtual BC is available (https://foundrybc.ca/virtual). Again, no referral is required. Young people and their caregivers can access the service directly to schedule a virtual counseling appointment, find peer support, access primary care, get support with employment, access virtual groups and workshops, or browse the library of tools and resources. To do so, the Foundry BC app can be downloaded or accessed through a browser.

More information about Foundry BC and access to online mental health and wellness resources is provided at https://foundrybc.ca.

Program outcomes

To date, 92 of the 273 youth who have participated in the Foundry Work and Education Program have secured and maintained competitive employment, and 7 have returned to school to complete their GED or pursue postsecondary education.

A youth shared their thoughts on their journey through the program: “I find that my situation overall has improved greatly. The main problem I came in with has been solved. I was able to get a job in the field that I wanted with [the Foundry Work and Education Program specialist]’s assistance. My mental state improved, and I have been given skills to maintain/improve further. I find that previous occurrences of uncontrollable high emotions are much more manageable and occur less often, if any at all. I am grateful that the 1:1 sessions with [the Foundry Work and Education Program specialist] and the CBT [cognitive-behavioral therapy] group heavily focused to provide their services in a supportive and nurturing environment. I took my understanding of CBT from the group sessions and advice from the 1:1 sessions to share with someone close to me. This also allowed me to review content I went over in Foundry.”

As the first organization to bring supported employment and education services to youth across BC in an integrated health setting, Foundry has achieved a significant milestone. This work has resulted in many vulnerable youth receiving support with their work, education, and training goals in a way that was previously unavailable. In combination with other Foundry services, this approach to integrated health and social services is changing the trajectory of their lives. Further, the Foundry Work and Education Program has been changing communities by developing partnerships, building community, and reducing systemic barriers and discrimination faced by young people. For these reasons, the Foundry Work and Education Program has become the cornerstone of Foundry’s social service stream and is critical to supporting youth employment, education, and training across BC.

Competing interests

None declared.

Acknowledgments

The Foundry Work and Education Program is funded by Service Canada and the BC Ministry of Social Development and Poverty Reduction.

This article has been peer reviewed.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Dr Tsang is a psychiatry resident physician at the University of British Columbia. Ms Alqutub is the provincial program manager for the Foundry Work and Education Program. Mr Wenger is a program implementation leader at the Foundry Central Office. Dr Mathias is a psychiatrist at Foundry BC. Dr Barbic is the head of research at Foundry BC.