Systematic challenges in providing culturally responsive mental health and addictions services have produced widespread inequities for racialized service providers, clients, and communities. There is a pressing need for coordinated system-level change. In this article, we present findings from a cross-sectional mixed methods study examining current organizational practices in advancing racial equity in the child and youth mental health and addictions sector in Ontario. To understand current efforts and identify a path forward, we surveyed executive leaders from 102 agencies and conducted case studies with 10 agencies on their practices along five domains: organizational leadership, intersectoral partnerships, workforce diversity and development, client and community engagement, and continuous improvements. Leaders shared a strong desire to advance racial equity and had begun this work to varying degrees. Fifty-one percent of agencies had made a public commitment to racial equity; however, few had developed written plans to support these efforts. Over 60% of agencies had developed relationships with cross-sectoral and community partners to facilitate this work. Seventy-five percent of agencies had offered racial equity training to staff, and some had implemented targeted recruitment efforts for racialized staff. Over 69% of agencies provided translation services and referrals to other agencies, whereas only 39% provided clients the option to request service providers who reflected their cultural identity. Less than 29% of agencies collected and used race-based data routinely to inform their work. Our findings, in particular the domains examined and barriers and facilitators, can inform parallel efforts in related sectors across Canada and internationally.

Background: While there are mental health treatment programs for children and young people in secure settings (i.e., secure treatment programs) in many countries, there is a lack of transparency and consistency across these that causes confusion for stakeholders and challenges for the design and delivery of high-quality, evidence-based programs. This systematic review addresses two questions: What do mental health treatment programs for children and young people in secure community settings look like across jurisdictions? What is the evidence underlying the various components of these programs? Methods: Twelve databases were searched in November 2021: CINAHL, EMBASE, MEDLINE, PsycINFO, PubMed, Scopus, Science Direct, Academic Search Complete, Psychology and Behavioral Sciences collection, Google Scholar, OpenDOAR, and GreyLit.org. To be included, publications had to be empirical literature or a report on mental health treatment within a secure setting for people under the age of 25; contain pre-identified keywords; be based on a research or evaluation study conducted since 2000; and be assessed as low risk of bias using an adaptation of the Critical Appraisal Skills Programme qualitative research checklist. The systematic review included 63 publications. Data were collected and analyzed in NVivo qualitative software using a coding framework. Results: There are secure treatment programs in Australia, Belgium, Canada, New Zealand, the Netherlands, England and Wales, Scotland, and the United States of America. Although there are inconsistencies across programs in terms of the systems in which they are embedded, client profiles, treatments provided, and lengths of stays, most share commonalities in their governance, definitions, designs, and intended outcomes Conclusions: The commonalities across secure treatment programs appear to stem from them being designed around a need for treatment that includes a mental disorder, symptom severity and salience involving significant risk of harm to self and/or others, and a proportionality of the risks and benefits of treatment. Most share a common logic; however, the evidence shows that this logic tends not to lead to sustained outcomes. Policymakers, service providers, and researchers could use the offered recommendations to ensure the provision of high-quality secure treatment programming to children and young people with serious and complex mental health needs.