What makes for effective, sustainable youth engagement in knowledge mobilization? A perspective for health services

Abstract Background Young people who seek mental health treatment often also seek the services of non‐profit organizations to support their well‐being. Wisdom2Action (W2A) is a Canadian knowledge mobilization network that focuses on improving the mental health and well‐being of children and youth in challenging contexts by increasing the use of evaluation, evidence and engagement in the youth‐serving sector. Since 2013, W2A has engaged youth advisors (YAs) to provide input to W2A's Board, lead their own projects and co‐design W2A activities. Objective In fall 2017, the YAs, as well as adult Board members and W2A staff, collaborated in a participatory evaluation to better understand the experiences and impacts of youth engagement. This article describes insights derived through this process. Design and participants Board, YAs and staff members participated in a reflective approach to informing, analysing and sharing the findings from this process. Individual interviews and review of documents, as well as iterative cycles of group analysis and synthesis, were conducted. Results Both YAC members and W2A benefit from YAs’ leadership and engagement. The YAs position themselves as members of the youth‐serving sector, not merely recipients of its services; as such, their professional development aligns with the mandates of W2A and merits further investment, despite challenges in impact measurement. Conclusion This article identifies challenges and facilitators of implementing an effective and sustainable youth advisory council model of engagement in the context of a pan‐Canadian network. The mutual gains and areas of growth for youth, adults and the organization described can inform health services, as well as funders and advocates for youth well‐being.


| INTRODUC TI ON
Current youth engagement (YE) in mental health treatment planning, 1 service development, 2 research 3,4 and knowledge mobilization (KMb) has contributed to a developing understanding of the benefits and challenges of involving young people in the design of services and to increased calls for evaluation of such processes. 5 In the youth-serving sector, youth advisory councils (YAC) are an increasingly common feature of large-scale research and KMb efforts, based on the principle that sustained youth perspectives are a necessary knowledge input into service and system improvement. 6,7 Wisdom2Action (W2A) is a Canada-wide KMb network (Network) that focuses on improving mental health services provided to youth by improving the uptake of evidence and evaluation in the youth-serving sector. W2A has also advocated for recognition of the role not-for-profit organizations (NPOs) can play in the well-being of young people. Young people who seek mental health treatment often also seek the services of NPOs to support their material, spiritual, mental and physical well-being. NPOs are particularly important for marginalized young people. Scholars note that young persons experiencing marginalization are more likely to use multiple services, need support for complex needs and have higher service-use patterns for basic needs, such as education, employment and housing. 8 Community-based NPOs that provide services and programmes for youth rarely access evidence-based practices (EBPs). 9 In the past, NPOs and their programmes or services have not been included as part of mental health treatment planning, yet their services can be essential for a young person's well-being.
W2A holds a history of investment in YE as part of its KMb activities to support NPOs. YE is a driving organizational value and a core component of Network processes and events. In this article, we reflect on the role of W2A's YAC, detailing its history, development and current significance upon the activities of the organization.
Youth advisors (YAs), staff and Board members of W2A, including the authors, collaboratively evaluated the effectiveness and impact of this type of YE in relation to the Network's mission to strengthen the youth-serving sector. Implications for KMb efforts in health services and research are included.

| Knowledge mobilization
Knowledge mobilization is defined as the reciprocal and complementary flow and uptake of research between researchers, knowledge brokers and knowledge users, with the purpose of informing public debate, policies and/or practice, and improving services. 10 KMb entails processes of knowledge generation, intra-and inter-organizational interactions, and knowledge sharing. In addition to advocating for diverse forms of evidence to inform service and policy decision making, KMb can be conceptualized as a suite of activities and services that support the multidirectional connection of researchers with decision-makers. 11 The relationship between the sharing and mobilization of knowledge and the engagement of various stakeholders (including youth) has been discussed within distinct but related paradigms that inform KMb. These paradigms include integrated knowledge translation, 12 co-production 13 and participatory research. 14 The latter, in particular, informs initiatives that recognize the importance of including diverse forms of expertise, and explicitly seeks out lived experience as key information to improve health services and outcomes. Despite all this early activity, W2A did not have an established youth council during its early stages, due in part to concerns about maintaining such a structure for KMb projects and the scarcity of precedents for such councils. After much discussion and deliberation with youth and adults, Network members were invited to nominate YAs, and the W2A YAC was born.  Table 1 provides an overview of activities involving the YAC.

| E VALUATI ON ME THODS
In the fall of 2017, W2A conducted a participatory evaluation involving members of the YAC, W2A's core team and W2A's Board. The goal of this process was to articulate the story of W2A's YE and to collectively envision next steps. An independent evaluator (Canas) was hired to facilitate the process. In keeping with the tenets of participatory evaluation, 36  A second round of interviews was then conducted with the YAs, in order to discuss and deepen data collected so far. As a last participatory step, a draft version of this report was distributed among all persons who participated in interviews, and their perspectives were used to further refine the final report. This article is a result of collaborative synthesis of the report, and further reflection, on the part of the authors. Pseudonyms have been used in this publication to preserve anonymity. The data that support the findings of this article are available from the corresponding author upon reasonable request.

| RE SULTS
In the following paragraphs, the themes derived from this evaluation are described in relation to the particular areas of focus and concern expressed by the YAs.

| Engagement inputs, facilitators and challenges
Inputs of YE identified consistently as part of the processes at

| Flexibility
Youth and adults spoke of the need to factor in the changing circum-

| Mentorship
Participants recognized that YAs benefit from supportive mentor- Steven, a Board member, said: "If mentorship is something that we seek to do intentionally, we will need to include that in the terms of reference with current members, and make it a part of the commitment. Different skill-sets may also be needed."

| Retention
Adult participants noted that keeping youth engaged is subject to the same challenges as retaining volunteers in board and volunteer management. Joan described the tasks involved were "sustaining people's interest, adapting to everyone's schedules, and securing regular meeting attendance and prompt email communications." Participants agreed that facilitators of effective board and volunteer management would also benefit YE. These included supported and increased communication across YAs and from the organization to the YAC, as well as policies that support the YAC in its current activities. Laura described the need for better documentation and tracking of processes for the YAC: "I wonder if some of the stuff needs to be written in a policy. If there's a conference you want to go to, this is the way you can pitch to go to a conference. Some people will put their name forward, but others may not know that it's an option (to propose a conference)."

| Professional development
An important challenge to sustainable engagement centred on the professional development of youth and their growing need for market-level remuneration. All participants expressed the recognition that volunteer and semi-volunteer activities are not sustainable for young people, a message that the Network has mobilized among NPOs as a best practice. Emma YA said: "We are mentoring all these organizations and we're already telling them that they shouldn't ask for youth involvement for free. We're telling them that they should be paying people, but sometimes paying them a living wage for where they live is still sometimes coming up short." In this YAC, tensions existed between young people's need for growth (economic

| Organizational sustainability
Because all of the challenges and facilitators described require organizational resources, the commitment to deliver on the values of YE represents an investment and challenge of sustainability for W2A. YAs felt that the mentorship and capacity building of YAs is a means of strengthening the youth-serving sector itself. As such, the investments of YE are wholly in line with the organizational mission and vision. This stance was supported by the adult participants.
Mark, a Board member, stated: "Particular engagement tactics may be different for youth, and may require more investment in capacity building … But it is up to the organization to articulate the rationale and resource-allocation approach to address this particular way of delivering on its values."

| Participatory evaluation as a tool for organizational self-reflection
This evaluation process, in its question generation, analysis and iterative consultation, adhered to the participatory tenets of foregrounding the voices of persons previously excluded as knowers or experts. 3,19 The history of involvement between W2A and its YAs-as well as the optimism and openness to change relayed through the interviews with both youth and adults-is congru-

| The need to better understand impacts
This process underscored the need for ongoing evaluation efforts at the broader W2A level, to better understand how the Network is supporting NPOs through all of its activities, including the inclusion of YA perspectives. YAs feel heard by staff within the organization and feel that their input into W2A events is heard and implemented; however, they are uncertain whether their impact extends to the strategic vision of the organization or the broader Network members and sector. This concern aligns with known challenges in measuring the impact of both engagement 14 and KMb activities. 11,12

| Directions for growth
The rates. An important mechanism to advance this practice will be to articulate, to funders and other partners, the value of training and of equity-oriented remuneration of YAs as they transition into professional roles.

| CON CLUS ION
In this article, we have shown that, to date, YAs to the W2A Network These findings and recommendations hold the potential to support engagement in health service and other organizations that serve youth. Findings may also be of relevance to funders, in order to better understand the impact and rationale for youth engagement in many types of projects, including KMb.

ACK N OWLED G EM ENTS
The authors acknowledge the members of the Wisdom2Action (W2A) Youth Advisory Council (YAC) and Governance Board for their contributions to this article.

CO N FLI C T O F I NTE R E S T
The authors declare no conflict of interest.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this article are available from the corresponding author upon reasonable request.