Promoting the mental health and well-being of vulnerable youth through art: A descriptive qualitative study

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Art-based interventions are accessible, but not thoroughly validated. Aim: The purpose of this project was to offer an art-based intervention for a very specific population benefiting from an after-school program in rural Quebec. Methods: Youth in Quebec, Canada, took part in a 7-week art-based intervention. A descriptive design was implemented to examine the implications this intervention had on students, particularly their mental health and well-being. Results: The majority of students described enjoying the intervention, many stating it had a positive impact on their lives. Students reported feeling positively during art-making and expressed interest in taking part in follow-up research. Discussion: Positive experiences with the present intervention support existing literature regarding the effectiveness of art-based methods for youth populations. youth art-based interventions mental health well-being community-based participatory research Background Low-income youth populations are some of the most vulnerable groups to environmental stressors, including low social support and poor family environment (Segal et al., 2021 ). This vulnerability is further perpetuated by limited access to mental health care services, which is a concern notably amongst rural communities in Quebec, Canada (Coulaud et al., 2022 ). Art-based interventions are a potential solution to alleviate the long waitlists for psychotherapy that are endured particularly by rural communities. Art therapy has proven to be an easily accessible and effective method to alleviate symptoms of psychological disorders in adults, yet there is a lack of youth-focused art therapy research. Moreover, what little data exists on this topic is quantitative, which can limit participants’ voices. The current research provides a unique perspective into the perceived effects of an art-based intervention on the mental health of children in an impoverished community in Quebec, Canada. Access to Mental Health Services Globally, youth experiencing mental health concerns have consistently been underserved, with less than half of these youth receiving the mental health services they need (Augsberger et al., 2024 ; Iyer et al., 2019 ). Moreover, only 20% of the 1.2 million Canadian youth experiencing mental health issues are receiving appropriate care and treatment (Canadian Institutes of Health Research, 2023). One of the most notable difficulties regarding youth populations receiving mental health services is a lack of youth-friendly programming (Iyer et al., 2019 ). It thus seems imperative to invest in early interventions for young people that aim to prevent mental illness and promote mental health (Paltser et al. 2016 ; Iyer et al., 2019 ). In fact, 70% of mental health problems emerge in childhood and adolescence (Mental Health Commission of Canada, 2017). Inaccessibility to youth-appropriate mental health services is further impacted by living in a rural area (Chan et al., 2022 ). Individuals living in rural areas are more likely to report unmet mental health service needs by comparison to those in larger cities (Coulaud et al., 2022 ). In recent years there have been specific increases in budgetary envelopes to target this issue ( Ministère Des Finances Du Québec | Budget 2024–2025 English Version , 2024; Canadian Institutes of Health Research, 2023). Mental health prevention programs should be effective, well-adapted, and accessible to ensure implementation and effectiveness. Conventional approaches to therapy with children are vast and well-reviewed, yet lack availability (Boekhoven et al., 2012 ). For example, cognitive behavioural therapy has proven to be effective amongst a wide variety of youth populations (e.g., Perkins et al., 2022 ; Wuthrich et al., 2023 ), but it is not as easily accessible (Dubé et al., 2019 ). Conversely, unconventional approaches to treatment such as art-based interventions have been less studied, but have the potential for wider availability (Boekhoven et al., 2012 ). These interventions are an integrative mental health service that engages participants through art-making, creative process, applied psychological theory, and human experience ( American Art Therapy Association - About Art Therapy , 2023). Further, they have the capacity to support both personal and relational treatment goals, as well as community needs ( American Art Therapy Association - About Art Therapy , 2023). As mentioned, art-based interventions are more accessible than traditional therapeutic approaches (Dubé et al., 2019 ). For example, the wider availability of art-based interventions allows individuals to experience the positive effects of art making at home without the presence of the therapist (Martin & Colp, 2022 ). However, there are varying perspectives regarding the effectiveness of art-based approaches (e.g., Handayani et al., 2023 ; Park & Hong, 2010 ). Effectiveness of Art-Based Interventions Considering the adaptability of art-based interventions, it is arguable that its efficacy can be strengthened through integrating with conventional therapies, as more traditional methods have stronger empirical support (David et al., 2018 ; Cecil, 2019 ). Although art and conventional therapies such as CBT have rarely intersected (Boekhoven et al., 2012 ), research regarding the combination of these approaches for adults (Carter et al., 2023 ) and youth (Wymer et al., 2020 ; Losinski et al., 2016 ; Cecil, 2019 ) is emerging. Specifically, Cecil ( 2019 ) found that combining CBT and DBT, examples of conventional therapies, with art-based methods reduced anxiety disorder symptoms and improved quality of life amongst children with anxiety disorders. Within this work, it was described that combining CBT, DBT, and art-based interventions allowed participants to express their feelings through art, which in turn helped them identify and verbalize thoughts and feelings; something that youth tend to struggle with in traditional psychotherapy (Cecil, 2019 ). Although research regarding the effectiveness of art-based interventions alone amongst youth populations is emerging, it has shown to improve quality of mental health and symptoms of posttraumatic stress disorder amongst adolescents (Iyendo et al., 2023 ). Within this work, 470 students in Nigeria were divided into control, fine art therapy, and music therapy groups, and it was found that fine art therapy was more effective than music therapy at reducing PTSD symptoms (Iyendo et al., 2023 ). Thus, these positive findings support the effectiveness of art-based interventions, and this is also true when it is complemented by conventional approaches such as CBT and DBT (Cecil, 2019 ). By comparison to conventional therapies, there are various unique attributes to art-based interventions ( American Art Therapy Association - About Art Therapy , 2023). Namely, art-based interventions acknowledge our subjective experiences through a creative process ( American Art Therapy Association - About Art Therapy , 2023). Being creative can have a positive impact on mental health and well-being (Tan et al., 2021 ). For example, being creative enhances meaning-making (Zhao et al., 2022 ) and satisfaction in daily life amongst individuals experiencing severe mental illness (Hansen et al., 2023 ). Conversely, well-being has also been found to be conducive to creativity; highlighting the reciprocal relationship between the two constructs (Tan et al., 2021 ). Positive emotions, such as those experienced when being creative (Tan et al., 2021 ), expand individuals’ thoughts and actions; motivating them to think differently without fear. Positive emotions promote creativity, which in turn builds one’s psychological, physical, social, and intellectual resources (Fredrickson, 2004 ). Engaging in the creative process through art-based interventions have served to overcome youth populations’ resistance to therapy (Shuman et al., 2022 ) and relieve the delays associated with seeking conventional therapy (Boekhoven et al., 2012 ). Art-based interventions can be particularly beneficial for children who may not possess the vocabulary to thoroughly describe their emotions (Boaz & Bat-Or, 2022 ). Indeed, art therapies can facilitate unique, nonverbal communication for youth who experience trouble verbally communicating their thoughts and feelings (Boaz & Bat-Or, 2022 ). Although there is a lack of research comparing the effectiveness of art-based interventions to more conventional forms of therapy, art-based therapies have been reported to be the preferred mode of therapy by youth who have experienced mental health concerns (Versitano et al., 2023 ), making it a suitable and promising intervention for vulnerable populations. Art-Based Intervention Amongst Vulnerable Populations Art-based interventions are particularly beneficial for vulnerable populations, namely youth, immigrants, refugees, and individuals of colour (Collins et al., 2023 ; Feen-Calligan et al., 2023 ; Gerami, 2021 ; Hanania, 2018 ; Kim et al., 2022 ). Specifically, art-based interventions are beneficial for these populations as it circumvents language barriers and focuses on positivity and growth (Rowe et al., 2017 ). Moreover, art-based interventions allow individuals to explore memories and emotions, which provides a safe space to overcome the effects of trauma (Rowe et al., 2017 ). Among youth, immigrants, refugees, and individuals of colour, art-based interventions have proven to decrease symptoms of depression and stress (Feen-Calligan et al., 2023 ; Gerami, 2021 ; Kim et al., 2022 ), and enhance positive emotions such as hope and resilience (Collins et al., 2023 ; Feen-Calligan et al., 2023 ). Research regarding interdisciplinary group programming for adolescents in inpatient care found that participants preferred taking part in creative activities and art-based interventions to verbal psychotherapy, which they found to be too confronting (Versitano et al., 2023 ). Despite this preference for engaging in the arts, there is little to no research regarding which art-based methods are most effective amongst youth. To navigate this gap in the literature, participants can often inform the art-based interventions themselves (Feen-Calligan et al., 2023 ). Through collaborative research designs, investigators can cater the intervention so that it is culturally and age appropriate, and aligns with the context of participants (Feen-Calligan et al., 2023 ; Hanania, 2018 ). The vast mediums within art allow for psychologists to adapt their interventions according to the demographic they are working with, which is particularly important within art-based interventions (Hanania, 2018 ). With regards to working with youth populations specifically, art-based interventions allow psychologists to engage children while giving them a sense of control through the creative process (Ugurlu et al., 2016 ). According to Boaz and Bat-Or ( 2022 ), involving participants in the creation of research, known as taking a community-based approach, attempts to create a safe space for communal art-making while integrating participants’ needs and wishes. Art-making in a group setting can also bring a community closer through sharing similar experiences with one another during sessions (Hanania, 2018 ; Kira et al., 2012 ). A community-based approach was deemed particularly beneficial - and thus adopted - in the current project as we created art with underprivileged children in a rural community with a specific focus on promoting positive mental health. Study Aim This study’s overarching aim was to offer an art-based intervention for vulnerable youth attending an after-school program. Specifically, through a qualitative descriptive design, we aimed to document children’s perceived benefits of engaging in artistic creation on their overall mental health. The guiding research question was: how will vulnerable youth benefitting from an art-school program respond to an art-based intervention aimed at improving their mental health and well-being? Materials and Methods Design A descriptive qualitative design was used for this study. Data was obtained through semi-structured interviews with the students, as well as through group discussions and observational data of the workshops. Through qualitative research, one can further investigate how to optimally facilitate and test proposed interventions (Eldridge et al., 2016 ). The efficacy of interventions that are not yet empirically validated can be explored through qualitative feedback, as we collect data on what worked and didn’t work for participants. Given that the current intervention had not previously been assessed, our theoretical approach to this work was directed by both pragmatist epistemology and participatory action research. A pragmatic paradigm is associated with a plurality of methods, asserting that researchers should implement the philosophical and/or methodological approach that is most effective for the particular research problem or group being investigated (Kaushik & Walsh, 2019 ). Pragmatism emerged from a rejection of traditional ways of inquiring and gaining knowledge about our reality, which had believed that social inquiry could be conducted only through a single scientific method (Kaushik & Walsh, 2019 ). In a similar vein, pragmatist epistemology asserts that our knowledge and perception of the world are based on experience (Kaushik & Walsh, 2019 ). Pragmatist epistemology is similar to participatory action research as they maintain that without action, we do not know what is useful or desirable for participants (Hammond, 2013 ; Huffman, 2013 ). Participatory action research is conducted with the intention of transforming the lives of socially marginalized populations (Kaushik & Walsh, 2019 ). Through working alongside the coordinators of our partnering program throughout the research process, we were able to curate the intervention design so that it best served our population of interest. Specifically, certain themes were chosen with the intention of uplifting participants and helping them realize their full potential, and the intervention plan was approved by the program coordinators prior to the onset of data collection. Further, the weekly activities were altered on occasion if students were not initially receptive to them. Participants The current project was conducted in an English town in rural Quebec, which is ranked among the lowest communities on Quebec’s Socioeconomic Environment Index. Participants attended schools that were amongst the most disadvantaged in the province where the majority of families in this area have been considered below the low income threshold index ( Government and Municipalities of Québec - Indices of deprivation , 2023). Youth taking part in this study faced four prominent challenges: deprivation and vulnerability, language challenges, a lack of role models, and isolation and stigma. Many of the students who attended the after-school program - and took part in this study - experienced emotional, behavioural, and/or developmental challenges, making them more likely to have significant mental health care needs (Graaf & Snowden, 2019 ). Noteworthy, many of the study participants were not bilingual (and have English as their mother tongue). However, in the province of Quebec, where French is the official language, access to appropriate mental health interventions is particularly challenging for youth who belong to a linguistic and cultural minority (Dubé et al., 2019 ). Study participants included three groups of 5th and 6th grade elementary school students ( n = 27; aged 11 and 12 years old), divided between English speakers ( n = 9) and French speakers ( n = 18), all of whom attended an after-school program. Factors for vulnerability among these students included, but were not limited to: low socio-economic status, low level of education among parents, single-parent families, high incidence of mother abandonment, high level of learning and behaviour difficulties, and lack of access to essential services in English (speech therapy, social workers, etc.). Recruitment was non probabilistic, through our research partnership with the program. Specifically, the program coordinator presented the study to parents of children attending the program and obtained consent for their child to take part in the intervention and an individual interview at the end of the study. The present study obtained approval from the Bishop’s University Ethics Board on March 17th, 2023 (102681), which adheres to the 2018 Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2) and the Bishop’s University Research Ethics Policy. Intervention The art-based intervention used in this work was developed by a child psychologist (CMH) and a M.Sc. student in psychology (KS), in collaboration with a researcher who has extensive training in dance and movement therapy (AM). Weekly themes and activities were chosen based on previous work led by the research team which aimed to improve elementary school children’s mental health (e.g., Léger-Goodes et al., under review). The intervention was reviewed by the partnering program’s coordinators and was adjusted with their feedback in mind. The 7-week intervention included various themes (e.g., relationships, emotions, optimism) and mediums (e.g., drawing, dancing, sculpting). A variety of art mediums were chosen so that participating students could express themselves creatively through different means. See Table 1 for a complete overview of the intervention. Workshops were facilitated by a master’s student (KS) and undergraduate psychology students, all of whom were supervised by a child psychologist (CMH). Each twenty-five minute session focused around a single theme and proceeded as follows: instructions, artistic creation, group discussion and sharing of created art. The art-based activities were selected to encourage introspection and creative expression in students. Table 1 Breakdown of art-based activities Intervention week Art medium Theme 1 Drawing Emotions 2 Collaging Identity 3 Dance Coping 4 Sculpture Safe space 5 Writing and drawing Relationships 6 Meditation and drawing Hope and optimism 7 Drawing Summary of project Data Collection In accordance with pragmatic theory, data was obtained from various sources: researcher observations, group discussions following each workshop, and individual semi-structured interviews with students at the end of the intervention. Observations were collected throughout the intervention by the assisting undergraduate researchers. They focused on topics such as students’ reactions to the weekly activity, non-verbal messages from students, and the interactions that occurred between students during the activity. See Table 2 in Appendix A for the observation grid our team used. Following each activity, as a group, students were asked about what they had created, if they wished to share their creation, their reactions to the activity, and how the activity may have related to their everyday lives. Group conversations were conducted weekly with the intention of receiving participant feedback in a timely manner, rather than weeks later in the individual interviews. Group discussions were recorded and transcribed. After seven weeks of group activities, each student took part in a brief, semi-structured interview led by a member of the research team. Similarly to the group discussions, these conversations were also recorded and transcribed. During the interview, students were asked questions regarding their perception of the intervention, their appreciation of specific activities, and the degree to which they felt the intervention had an impact on themselves or their lives. See Appendix B for the complete interview guide. All interviews were recorded and transcribed for analysis. As all activities and interviews with the French students were conducted in French, these data were translated to English prior to analysis. Analysis Collaborative thematic analysis was conducted between researchers (KS and JP) to analyze the individual interviews. Thematic analysis (Braun & Clarke, 2006 ) was used to allow for participants’ perceptions and experiences of our intervention to emerge, enabling our research team to grasp the impact the intervention had on participants. The transcriptions were analyzed using NVivo 14. Transcripts were read repeatedly by two researchers (KS and JP) prior to the initial open coding phase. Codes were determined inductively and defined early on in analysis. These codes were discussed with and reviewed by two other research team members (CMH and AM). The two researchers coded the data independently but frequently discussed observations, allowing them to collaboratively structure codes and deduce arisen themes. Themes were then defined. Following the thematic analysis of the individual interviews, group interviews were analyzed using both inductive and deductive content analysis. An inductive approach was used to interpret themes that emerged from observational data. Then, deductive analysis was conducted based on the codes and observations that emerged from the thematic analysis of the individual interviews. Compared to the first round of inductive thematic analysis, this second round of inductive thematic analysis allowed both code elements from the initial coding tree (deductive), and report coding frequency to provide an idea of the number of times certain elements were mentioned in the data. This type of qualitative analysis allowed researchers to analyze both the existence of themes within group conversations, and the frequency in which these themes occurred in the data. By using both inductive and deductive approaches, researchers could apply what emerged inductively from the observation data to the group conversation so that we could enrich our understanding of resulting concepts from both the individual and group discussions. Results Thematic analysis resulted in three overarching themes: general appreciation of the intervention, attitudes towards the activities, and feelings associated with art-making. Within these themes, the perceived impact of the intervention, students’ perceptions of their art, and challenges experienced throughout the intervention are also explored. General appreciation and acceptability of intervention This theme reflects how students felt about the intervention, and whether or not they wished to take part in a similar project in the future. Overall, the majority of students felt positively about the intervention, and indicated that they enjoyed taking part in the weekly activities. Students typically described having fun throughout the intervention. Observational data revealed that many participants enjoyed taking part in the intervention, as oftentimes students complained when our allotted activity time was over and they had to move onto doing homework. One student attributed their enjoyment of the intervention to not having to do as much homework: “I [liked] to do the activities because I don’t like doing homework” (participant 3). By contrast, some students were reluctant to participate in the intervention at times, explaining that they had a lot of homework to do. However, these students were enthusiastic about participating on weeks they did not have homework to complete. Additional feedback included two students expressing gratitude towards our research team for our time and effort in leading these sessions, one of whom stated they were happy that we came and were not “adults”. As such, throughout the intervention many students bonded with our research team, and the coordinators of the program expressed how much the students appreciated and looked up to us as mentors. Positive feedback from the students indicated the general appreciation they had for the intervention. Throughout individual interviews, a few students, most of whom were in the English group, appeared to either share mixed feelings or lack introspection about the intervention. Specifically, when asked about their overall perception of the intervention, these students described experiencing positive emotions as a result of participating in the intervention, but later stated that the intervention had no impact on themselves and their emotions. Some of the students who shared that they did not enjoy the intervention (“it was boring” [participant 23]), later mentioned that they would participate in the study again. Students’ perceived impact of the intervention Delving further into the perceived impact of the intervention, students generally indicated positive change in their life and skillset. For example, three students referred to becoming more confident and comfortable around others through taking part in the project. For example, one of these students told us “I feel more comfortable. [MB]: Do you feel more comfortable? Ok. With us or with your friends…? [Student]: Well like with the people here” (participant 1). In terms of students’ perceived impact of the intervention on their mental health and well-being, students referred to experiencing improvements eight times, while feeling no significant changes in well-being was coded ten times. Although many students did not elaborate on what specific changes they endured, those who did described feeling more calm or happy because they learned about themselves through taking part in the intervention: “I managed to discover a little bit of myself [with the drawings we did and the meditation]. [JP]: Because you realized these were things you loved doing? [Student]: yes” (participant 10). Generally speaking, those who tested their personal comfort level by fully committing to the intervention appeared to exhibit more positive implications from the intervention than those who did not put their full effort in or withdrew from certain activities. Students’ attitudes towards activities By contrast to the students’ feelings about the intervention overall, this theme pertains to attitudes surrounding specific activities and their perceptions of the art that was created. As per Table 1 , many artistic mediums were included in this intervention. Students had a variety of different favourite and least favourite activities, and often attributed their choice to the medium of the activity (e.g. dance), rather than the topic the activity explored (e.g. coping). Dance and lego were most frequently referred to as students’ favourite activities. By contrast, when asked about their least favourite activity, many other students said dance was their least preferred activity. In addition to dance as a common least favourite activity, students also referred to the writing activity, stating that they felt embarrassed writing a personal letter. The meditation was also frequently cited as students’ least favourite activity because other students were disruptive during the guiding of the meditation. Overall, however, a considerable number of students said that they liked all of the activities the same. Generally speaking, the students who were enthusiastic about participating in the activities chose to distance themselves from those who were being disruptive. However, students appeared far more willing to participate in an activity if they enjoyed its medium. For example, all students participated in the safe space activity where students built a lego art piece. Observational data revealed that students from the French group were generally more willing to participate in the art activities and share their thoughts during group discussions than those from the English group. Furthermore, content analysis of group discussions revealed that the French students appeared to grasp the intent of each activity with greater ease than the English students. For example, without announcing the theme prior to the meditation activity, many of the French students created within the theme and expressed emotions related to this undisclosed theme, while the English group required greater explanation and guidance from the researchers to grasp the theme. Additionally, although activities were guided, students had varying interpretations of directions and what to create. An example of the vast perceptions of the activity topics is the meditation, which followed with a drawing. In this activity, students listened to a script about a sailor lost at sea, who was later able to steer themselves to safety with the guidance of a lighthouse. Without sharing the theme of this activity (hope and optimism), students were tasked with drawing an image they visualized during the meditation. It was our intention to see if students focused more on positive emotions such as hope, or negative emotions such as fear. Despite our direction, some students focused on video game characters, places, or events that they associated with the feeling(s) they felt during the meditation. For example, one student described feeling fear from one of the scenes of the meditation, and chose to illustrate a school shooting; a situation in which she said she would feel fear. In the writing activity, students were tasked with writing a poem or letter to anyone or anything in their life, and then drawing a representation of that relationship. In this activity, another student drew their friend and fellow group member being shot and killed. They stated that it was a play on words, because that student was “dead funny” (participant 32). The varying interpretations and images that arose from the mediation activity demonstrates how, despite given direction in each activity, students felt they could create autonomously. Students’ perceptions of created art When describing how they felt about their art, some students felt most proud about the activities where they had the opportunity to outline their favourite things, activities, or places. By comparison, other students felt most proud about the piece of art they felt was most impressive or beautiful. Although most students had an activity they felt particularly proud of, many other students did not feel that any activities were exceptionally important to them. Interestingly, one student said that the activity they were most proud of, the writing activity about relationships, was also their least favourite activity to take part in: “although it was embarrassing, it also kind of felt good to express it” (participant 25). Within their letter, this participant expressed their appreciation for their favourite video game character, and shared the strong impact the character has had on their life. When asked if there was any piece of art they were particularly proud of, another student mentioned: “Well, the important things are the things we do. [MB]: Okay. [Student]: The memory. [MB]: Okay, yes. So do you like what you're doing right now? Ok. Is there a reason or just because it reminds you of positive moments or...? [Student]: It reminds me of positive moments, when I lost a baseball game, I look at my sheet and I say no problem…” (participant 3) Regardless of whether these students mentioned an activity they were particularly proud of, four students were critical of themselves and their artistic ability, referring to their creations as “ugly” or “bad”. In addition, analysis of discussion regarding students’ created art revealed that participants were particularly expressive when sharing their emotion wheels by comparison to other activities. Specifically, many students described the colours and images they associated with emotions such as fear, anger, and happiness. One student from the English group was particularly expressive about the art he created: I think the style you use when you’re drawing really makes the emotion pop out. It shows you which emotion you [inaudible] when you don’t even have to say it… For anger I did cross hatching, because it looks really rough, and so I thought that just represented anger. For fear, I did spikey lines. For sadness I did waves because waves represent water, and tears are salty like ocean water. And for happiness I just did a lot of bright colours. (participant 25) Feelings associated to art-making Conversations amongst the French groups led to discussions regarding art-making. When asked how they felt during and after art-making, the vast majority of students mentioned feeling positively. More specifically, of the eight students who were asked, seven felt positively both during and after art-making. Specific emotions discussed amongst those who felt positively during and/or after art-making include happiness and peacefulness. By contrast to those who felt positively during art-making, six students mentioned feeling embarrassed or bored at at least one point of art-making. Students who felt negatively typically attributed their feedback to feelings of embarrassment about the art they created, often stating that they felt they lacked artistic skill. Of those who expressed feeling bored, however, one student shared that they thought the intervention was pointless because they had done all of the art mediums included in the intervention before: “I’ve already done stuff like this, so it’s kind of getting annoying” (participant 37). When asked for their feedback about the intervention and what they would change, this student said: “Everything is just saying how kids feel and like trying to get them to be calmer. [MB]: To be calmer? [Student]: Yeah, basically just checking on how kids feel every five seconds and doing meditations and stuff like that. [MB]: [...] I wouldn’t say the aim was to make you feel calmer. I think the aim of this, at least for Kyra’s project, is to see if maybe doing certain activities like this have an improvement in life, your well-being, how you feel… [Student]: Mental health? (participant 37) Observational data also revealed that students occasionally felt hesitant to participate in activities, namely the dance and writing activities. Specifically, almost all of the English students withdrew from the dance activity, the reason for doing so was interpreted as the participants feeling uncomfortable dancing. Observational data supports the tone of embarrassment from English participants throughout art-making as many of our notes indicate students repeatedly needed support and encouragement from the staff and research team. By contrast, the French students were generally more willing to participate in the dance activity. For example, one of the French students mentioned that they learned “not to be shy when you have to do the dance” (participant 12). Additionally, many students were repeatedly hyperactive and did not take activities seriously, resulting in the groups frequently needing to be disciplined by our research team and program staff. Despite the frequently chaotic environment during art-making, two individuals who regularly shared their art with the group during weekly discussions described feeling heard and respected by their peers when sharing. In terms of the French participants, observational data revealed that 5th grade students were more open to creativity than the 6th grade students. Across both English and French groups, and regardless of whether the student was particularly enthusiastic to participate in the activities, students tended to disregard the weekly theme and instructions provided when art-making. Challenges impacting art-making Observation revealed that the primary challenges that inhibited participation in art-making included students’ energetic behaviour and lack of time. Specifically, students often arrived at the after-school program with copious energy and were often unwilling to listen to our research team or the program coordinators. Some children settled within the early minutes of an activity, however many others continued to be disruptive and were reluctant to participate, posing negative implications for those in the room who were focused on the given activity. Moreover, the time we were allotted to lead each art activity and follow-up discussion as a group proved to have limitations on students’ participation. Another challenge the students described was lacking inspiration on what to create: “I didn’t understand what to do [...] I had no inspiration in my head” (participant 7). In addition to these observed challenges, some students also felt that the intervention pushed them out of their comfort zone. Namely, a few students identified the feelings of embarrassment during art-making as being particularly challenging. By contrast to this feedback and the researchers’ observations, most students did not feel that there was anything challenging their ability to take part in the intervention. Discussion This study aimed to provide and evaluate an art-based intervention for a specific population of youth benefitting from an after-school program in rural Quebec. A descriptive qualitative design was used, and data consisted of group discussions, observational data, and individual semi-structured interviews with the students. These were analyzed using both inductive thematic analysis and content analysis. The primary themes that emerged from this work included general appreciation and acceptability of the intervention, students’ attitudes towards the activities, and feelings associated to art-making. General appreciation and acceptability of the intervention Students’ general enjoyment of the intervention indicated that, for the most part, they liked the activities and themes included in the project. These positive feelings towards the intervention lend support to the use of art-based interventions with youth (Kim et al., 2022 ; Boaz & Bat-Or, 2022 ; Malboeuf-Hurtubise et al., 2021 ) as an acceptable means for intervention. However, it should be noted that some students showed occasional reluctance to participate in the intervention. This may be attributable to academic pressures or feared judgment from peers, which we discuss further below. Based on results from this study, students reported being positively impacted by the art-based workshops. Namely, students expressed self-discovery and feeling more comfortable and confident around their peers and the program staff. These findings are consistent with that of previous work amongst youth in low income areas, which showed that an expressive art-based intervention improved participants’ confidence (Forrest-Bank et al., 2016 ). However, it should be noted that some indicated, on the contrary, that they disliked the activities. In digging further, many of those who expressed their dislike for the intervention gave various feedback. This feedback included students stating that they experienced positive emotions during art-making, but later mentioning that the intervention had no impact on their emotional well-being. Other students mentioned that they would like to participate in the study again, despite not enjoying the intervention. Varying mechanisms could be at play to explain this somewhat contradictory feedback. Perhaps students lacked introspection, as previous research shows that metacognition to deeply reflect on one’s own thoughts and feelings is still in development in early adolescence (Mertens et al., 2022 ). It is also possible that students may have simply experienced short term benefits from the intervention, rather than long term impacts they could reflect on during the interviews which took place after the intervention ended. Another plausible explanation pertains to the difficulty associated with completing certain activities, such as creative writing and dancing. It is possible that these activities were least preferred by students because they were too challenging. However, it should be noted that some students later expressed desire to participate in them again because they were proud of overcoming personal limits. This explanation is corroborated by existing research by Léger-Goodes et al. (under review) on the use of an art-based intervention with elementary school students. Within this work, it was found that although students felt challenged by a dance activity, they felt proud of themselves for overcoming their feelings of embarrassment (Léger-Goodes et al., under review). It is also possible that mental health-related stigma prevented students from sharing that the intervention helped (and hence potentially admitting needing help). Indeed, the research process may have been too threatening for students as we regularly spoke of emotions and mental health. Previous research supports how some youth can be particularly reluctant to discuss sensitive topics such as mental health in interview settings (Wasserman et al., 2018 ). Indeed, interview questions were phrased in a direct manner, so those surrounding students’ mental health may have been too confronting and thus impacted students’ responses. For example, students were asked “if you think back to before we started the art activities and now, what differences do you see in how you feel and the emotions you experience?” However, these are only tentative explanations, given it was difficult to discern why students provided this feedback as they were particularly reluctant to expand on the responses given during the individual interviews. Nonetheless, this reluctance also points to a difficulty for students to be vulnerable and share how they feel. Although differing feedback prevents us from drawing concrete conclusions about the benefits of our intervention for this population, our overall observations indicated a positive effect. Specifically, when considering the socio-economic context of our participants and the adversity that many of them faced in their daily lives, many students took a liking to our research team and many positive interactions occurred between the research team and participants, suggesting that high quality relationships were developed throughout the course of the research. Previous work regarding school-based mentorship programs imply the wide range of effects quality mentorship has on youth (Bayer et al., 2015 ; Chan et al., 2013 ; Deutsch et al., 2013 ; Dutton et al., 2023 ). Indeed, youth mentorship programs resulting in sustained quality relationships are associated with improved mentee outcomes, such as academic outcomes (Bayer et a., 2015), connectedness resulting in increased prosocial behaviour (Deutsch et al., 2013 ), and improved relationship quality with parents and teachers (Chan et al., 2013 ). It is our understanding that similar mechanisms were at play in this project. A core component of successful mentorship relationships and qualitative research overall is establishing trust (Pryce, 2012 ; Pitts & Miller-Day, 2007 ). As such, it is possible that this bond may have strengthened the perceived effects the intervention had on students’ well-being. Indeed, research examining the research-participant relationships indicated that a strong partnership between researcher and participant can positively impact research outcomes (Rongits, 2022 ), especially when conducting community-based participatory research (Holden et al., 2014 ). Notably, positive mentorship developed in the present intervention in just seven weeks, with student interactions of one hour per week. By contrast, existing research such as that of Kuperminc et al. ( 2020 ), which found that group mentorship improved high school students’ school support, school belonging, prosociality, and peer relationships, was conducted over a full academic year. Findings from the present work suggest that mentorships can develop and have a positive impact on youth in just a short period of time. A strong therapeutic alliance may have been particularly important for the participants based on the numerous challenges they faced on a daily basis. Despite the therapeutic alliance being set, it may not have been strong enough for students to talk at length on an individual basis. Although having access to youth-appropriate mental health services such as art-based interventions was deemed beneficial by the students, simply being present and attentive of children who lack role models, face isolation and stigma has also had a positive impact on vulnerable youth (Kuperminc et al., 2020 ). Furthermore, art-based interventions could also play an active role in facilitating quality mentorship relationships, as they allow for youth to make sense of their thoughts and feelings (Cecil, 2019 ). Comprehension of their emotions would allow them to share their feelings, which is particularly important in establishing a quality mentorship. Indeed, greater mentee openness has been correlated with higher mentor relationship quality across nine youth programs in New Zealand (Dutton et al., 2023 ). When considering the context of the participants in the present work and the bonds that were created, it appears likely that the support and mentorship from our research had a positive influence on students. Students’ perceived impact of the intervention Several students exhibited positive changes in their mental health, overall life, and skillset. Of those who elaborated on the specific changes experienced, becoming more confident, comfortable, calm, and happy were mentioned most frequently. These findings mirror results of previous art-based work amongst youth (Collins et al., 2023 ; Versitano et al., 2023 ), although the interventions used in these studies lasted for an hour; much longer than the twenty-five minute sessions implemented in this project. For example, Collins et al. ( 2023 ) conducted weekly art therapy sessions for twelve weeks amongst youth in a secure care facility. Participating youth experienced enhanced hope and resilience by 29% and 16% respectively, and it was found that the intervention improved youths’ goals, levels of self-determination, and future orientations (Collins et al., 2023 ). Furthermore, Versitano et al.’s ( 2023 ) work, which assessed the effectiveness of an art-based intervention and other group therapies amongst adolescents in inpatient mental health care, was conducted over a four month period. Those in the art-based intervention group reported that their sessions were both enjoyable and helpful, and it was found that the use of creative elements promoted consistent group engagement (Versitano et al., 2023 ). In addition to referencing feeling more confident, comfortable, happy, and calm, experiencing self-discovery was discussed by participants who enjoyed the intervention simply due to liking art-making. These positive perceived impacts of the intervention indicate that the intervention was relevant to the context and needs of our participants, which was a core component of our community-based approach. Previous work suggests that art-based interventions can be conducive to self-discovery in youth (Huang et al., 2021 ). Specifically, adolescents who took part in two hour group art sessions for a period of eight weeks expressed starting to get to know themselves better, becoming able to explore their inner selves while noticing their emotions, developing a more positive self-concept, and having a clearer vision of their goals (Huang et al., 2021 ). Self-discovery and increased confidence may be particularly important for this population in helping them develop a clear and optimistic vision of the future. Students’ attitudes towards activities Students’ favourite and least favourite activities to take part in were often attributed to the medium of the art activity, rather than its theme. However, upon observation of the students, it was often difficult to determine whether students’ perceptions of the activities was attributable to either theme or medium. For example, the writing activity was based around relationships, and students were asked to write a letter about a loved one. Many of the students stated that the task was challenging because they felt their writing skills were poor, or because they thought the task was too personal. In this case, we cannot be sure if this activity was many students’ least favourite because of the medium or the theme. However, this activity may have been inappropriate for the students because of both reasons. Overall, both medium and theme may be important for engagement. Including a variety of art mediums is important so that students can feel challenged by the activity and remain engaged throughout the intervention. In accordance with a community-based approach, using themes and mediums that are relevant to the participants’ lives is important (Hanania, 2018 ). Moreover, when asked about activities that appeared to be particularly challenging, such as the dance activity on coping, students’ enjoyment varied. Many participants enjoyed the activity, while others felt quite embarrassed or were entirely unwilling to participate. In terms of the importance of providing challenging interventions, the dance activity may have been too challenging for some students. Within this activity, students were asked to think of a time where they coped with something challenging, represent overcoming the challenge through three movements, and then share those movements with a partner. As these students experienced emotional and behavioural challenges, and were thus prone to high emotional reactivity and negative affect, it is likely that students exhibited emotional avoidance (Kennedy & Ehrenreich-May, 2017). Indeed, enduring high, seemingly uncontrollable negative emotion often leads to ineffective attempts at emotional regulation that provide a short-term solution to coping, but ultimately result in long-term maintenance or exacerbation of negative symptoms (Kennedy & Ehrenreich-May, 2017). Thus, it is possible that if students were asked about more positive emotions or experiences, they would have been more willing to participate. If students were granted more time to become comfortable with movement or were educated on how it has been used for emotional expression and coping with trauma, and hence felt more connected to movement, they may have been more willing to participate. Indeed, an eight month dance intervention amongst adolescent girls found that dance in a non-judgmental environment resulted in participants feeling empowered, and gave rise to emotional expression, self acceptance, and trust in oneself (Duberg et al., 2016 ). Considering these findings, participation may have been better if students felt more comfortable and accepted by one another. Indeed, results tend to indicate that students were more willing to participate and enjoyed the activities where they were not asked to do anything they perceived as too personal or embarrassing. For example, students were open to discussing certain colours and images they chose in a drawing, but were reluctant to share the letter they wrote. Students’ perceptions of created art Student creativity was promoted as they were allowed autonomy and choice within creation. However, a couple of students illustrated alarming images at various points of the intervention (e.g., school shooting illustration). These comments suggest that these students face considerable emotional disturbances. Indeed, at-risk youth who experience emotional and behavioural challenges have a history of problems in the school and community (Cox et al., 2022 ). Existing research maintains that risk is further compounded by living in a rural area as they are affected by factors such as poverty, stigma of seeking services, and lack of availability to services, all of which can contribute to mental health concerns (Heflinger & Hoffmann, 2009) and influence further behavioural and emotional difficulties (Cox et al., 2022 ). In terms of how students felt about the work they created, many felt most proud about the activities where they were able to include their favourite things, activities, or places. In other words, the students enjoyed creating the things they liked. There was a lack of enjoyment, however, when students engaged in more challenging activities. Yet, they described feeling less shy, more comfortable, and proud of themselves for taking part in the more difficult activities. By contrast, one participant, who did not feel particularly proud of any piece they made, described feeling most proud of the person they were, rather than the art they created. Although this feedback suggests the student did not value creating art, it demonstrates how lessons behind certain activities were beneficial to them. Specifically, the student referenced feeling proud of the lessons they learned in the activity (or activities) that involved memories - which would be the dance and meditation. The themes behind these activities were coping and optimism, respectively, and the students feedback suggested that they were able to apply these themes to their life experiences. Other students felt particularly proud about the art that they felt was more aesthetically pleasing. Attributing pride about one’s creations to perceived artistic skill goes against a fundamental component of art-based methods: the importance of focusing on our subjective experiences in the creative process, rather than the finished piece of art (Fraser, 2008 ; Lyshak-Stelzer et al., 2007 ; Moon, 1999 ). Although criticizing one’s art goes against the aim of art-based interventions, it demonstrates the extent to which students focus on performance. The emphasis on performance was mirrored by other students, one of whom mentioned that they would not want to continue doing art at school because they were being graded on the finished product. As such, future work should aim to help children detach from performance. A solution for doing so is engaging in philosophical discussions about art and beauty. For example, discussing questions such as “what makes art beautiful? Can art be perceived differently by different people? How so? Does art need to be beautiful to be considered art?” could mitigate the focus on performance. Feelings associated to art-making Art-making elicited positive feelings for students during and after weekly sessions. The emotions of happiness and peacefulness that were discussed by students echo results from previous art-based work amongst inpatient care patients, where it was found that art-making had a calming effect (Noble & Hackett, 2023). In terms of the negative feedback, students who felt bored during art-making and expanded on their reasoning attributed their feelings to having done similar art mediums previously and feeling as though the aim of the activities were redundant. As mentioned, when asked about what they thought the purpose of the intervention was, one of these students stated that every activity aimed to calm the students down, so they grew bored and eventually stopped paying attention during sessions. Although the aim of the study was presented at the beginning of the intervention, and almost every weekly theme was presented to the students prior to the activity, it appears as though reminding students every week about the purpose of the intervention to avoid wrongly assuming the aim may have positively influenced art-making. Specifically, students who understood the weekly theme, the overall purpose of the study, and found both of these useful to them, may have put in greater effort and been more enthusiastic to participate. However, further research regarding how participants’ perception of an intervention impacts their effort and engagement in a given project is needed. Similarly, participants’ engagement in the activities appeared to have an impact on the emotions they felt about art-making. Specifically, the more engaged students were, the more positively they felt about art-making. This finding aligns with previous work on client engagement and therapeutic outcomes. For example, through their review of 97 studies, Holdsworth et al. ( 2014 ) aimed to determine how client engagement with psychotherapeutic interventions had been defined and assessed, the client and therapist characteristics associated with positive engagement, and the treatment factors involved. Although understanding and assessment of client engagement varied across the reviewed works, it was found that clients’ capacity to address their problems was positively associated with engagement (Holdsworth et al., 2014 ). Indeed, as it appeared that participants lacked the willingness or ability to self-reflect and address their emotions, capacity to introspect may explain poor engagement in the present intervention. Students who were particularly unengaged during the activities were also hesitant to share their work during the weekly discussion. Considering that students who attend this after-school program come from unstable homes and face a variety of challenges, it is likely that those who were hesitant to share lacked confidence; an important aspect of self-esteem, which can be inhibited by low socioeconomic status (Yuan et al., 2022 ), family functioning, and parenting (Shaheen et al., 2023 ). Indeed, family functioning has been shown to have an indirect effect on adolescents’ behaviour problems via self-esteem (Shaheen et al., 2023 ). To encourage participation during the weekly discussion periods, members of the research team in charge of leading the activities would share their own creation with the group. By contrast, those who felt positively during art-making were much more likely to share their art during discussion periods. This suggests that, within the context of group art-based interventions, comfort level and enjoyment of art influence feelings associated with art-making. Indeed, research amongst 5th graders regarding openness to creativity, which is implied through enjoyment of the arts, supports this notion (Theurer et al., 2021 ). Furthermore, participants’ age appeared to have impacted art-making as the French 5th grade students appeared to be more open to creativity during art sessions than French 6th grade students. Specifically, as youth approach adolescence they become increasingly aware of what their peers think of them (Irani et al., 2024 ). This increased sensitivity can act as motivation for youth to maintain positive relationships by acting in accordance with group norms and expectations (Irani et al., 2024 ). Thus, older students may have been less willing to participate in art-making because they feared being judged by their peers. At various points of the intervention, students ignored the weekly theme and instructions provided, neglecting to give their full effort into the activity. Students may have approached art-making in this manner because they felt that the activities were not catered to their needs or what they felt was important. Indeed, the intervention may have met the needs of some students, but not all. The intervention was co-created alongside the program coordinators, in that they elaborated on the unique lives and perceived needs of the students. Despite this, neglecting student voices in the creation of the intervention appears to have impacted participation. Regardless of the increase in youth-led movements, which demonstrate their capacity for orchestrating change, existing community-based research does not typically consider youth as full community partners (Bettencourt, 2018 ; Merves et al., 2015 ). Youth are typically excluded from the research process because our prevailing views, policies, and practices regarding youth are deficit-focused (Teixeira et al., 2021 ). A barrier to youth participation in research is adultism, which is “a lack of pro-child social norms that includes negative attitudes about youth, laws that delegitimize youth, and youth internalizing these negative beliefs” (Teixeira et al., 2021 , p. 143). Indeed, what is considered healthy youth development has been defined by adult “experts” rather than by, or in collaboration with, youth themselves (Langhout & Thomas, 2010 ; Teixeira et al., 2021 ). Adultism can be combatted by identifying youth in research in a manner that gives them agency and respects their ability to contribute (Teixeira et al., 2021 ), rather than limiting them to their age or lack of experience (Bettencourt, 2018 ). Existing youth community-based participatory research which provides youth with a leading role in the research process has found that partnering with youth can enhance the success and sustainability of adolescent health interventions (Merves et al., 2015 ). Challenges impacting art-making As mentioned, the primary factors which impeded art-making included lack of time and poor student behaviour. Indeed, in this study, time was a major constraint. As the weeks went on, observational data showed that some students would rush through activities because they feared they would lack sufficient time to complete their creation. This led them to put lesser effort into the activities. Additionally, these students would typically begin their homework after the artistic activities and some felt particularly anxious about having enough time to complete their homework. Indeed, anxiety surrounding students’ homework appears to have negatively impacted participation in the intervention. Noteworthy, this did not necessarily translate into them disliking the intervention. Considering that those who attend this after-school program are those who face the most difficulty, be it in their family lives and/or academically, it was interesting to see that many students wanted to hurry through the activities so that they could do homework; an activity in which most young students dislike and avoid. Although this could be interpreted as rushing through the art activities, we argue that this behaviour was in fact rushing to homework. The reason for this stance being that students are guaranteed help with their homework at this after-school program, and they may not receive the same support at home. Another possible explanation is that students may have wanted to complete their homework so that they no longer had to stress about doing it. Holland et al. ( 2021 ), who investigated the non-academic impact of homework for youth in grades 3–6, found that increasing academic demands is correlated with various challenges for youth, such as worsened well-being, sleep, emotional health, and parent/child relationships. Although art-based interventions with youth have often been administered in academic settings (e.g., Forrest-Bank et al., 2016 ; Sutherland et al., 2010 ; Malboeuf-Hurtubise et al., 2021 ), perhaps a different setting where students are removed from academic pressures would improve student engagement. By contrast to those who rushed, students who took their time and enjoyed the workshops felt as though they did not have enough time to complete each session. Our research team often had to hurry through describing each activity and its theme so that students could have enough time for art-making. However, this cohort of students were further impeded by those who did not wish to take part in the activity, or who chose to rush through it, as they were particularly disruptive during sessions. Overall, approximately ten minutes of every twenty-five minute session was dedicated towards settling the group down so that we could conduct the activity. Generally, art-based interventions with youth are no shorter than forty-five minutes (e.g., Kim et al., 2022 ; Boaz & Bat-Or, 2022 ; Malboeuf-Hurtubise et al., 2021 ), further solidifying the challenge posed by limited time in this project. Nonetheless, the majority of participants, even with limited weekly time devoted to artistic creation, reported a positive impact on their well-being and mental health. Student behaviour was arguably the most challenging aspect of this project, namely with regards to hyperactivity and impulsivity. Considering the context of our population, it is very possible that some had psychological disorders or were malnourished, although we did not compile this data in the current study. Indeed, students were provided with a healthy snack upon arrival to the after-school program to aid in mitigating potential malnourishment. Moreover, it is important to emphasize that these sessions took place directly after a full day of school, where students had been required to give their complete attention for hours on end. Naturally, it can be challenging to gain the attention of a large group of students, but this task can be exacerbated when they have just spent a full day at school. Furthermore, some students expressed having difficulty determining what to create because they either lacked inspiration or felt embarrassed about participating in the activity. We attribute lacking inspiration partially to time restraints, as students were not given much time to consider what they wanted to create. However, embarrassment about art-making can likely be explained by the group dynamic between the students. Specifically, students tended to make fun of one another and joke around, making those who took the intervention seriously uncomfortable to describe their art with full transparency. This idea was supported through feedback received in individual interviews, where many students were much more vulnerable than they were with the group. Indeed, childhood bullying and victimization have negative implications on the mental health and well-being of youth (Hong et al., 2018 ). Research has also shown that programs should aim to both reduce bullying and improve connectedness to one’s school, as focusing on only risk or protective factors of youth well-being - and not both - may be ineffective (Dow-Fleisner et al., 2023 ). Moreover, Yan et al. ( 2019 ), who conducted art therapy with children in rural China, found that art therapy effectively reduced childrens’ vulnerability to bullying. Indeed, art-based interventions have been found to increase empathy and emotional awareness in middle and high school students (Morizio et al., 2021 ). As such, future art-based interventions should aim to create a positive, supportive environment amongst students by including themes such as mutual respect, anti-bullying, and empathy. Future directions Considering the feedback students provided and the challenges that emerged during this work, future research should further investigate the importance of the therapeutic alliance in youth community- and art-based participatory research, particularly how the age of the facilitator can enhance rapport. Moreover, future works should aim to investigate the effectiveness of varying artistic mediums versus varying the theme of the creation, as our participants’ perceptions of the activities were typically determined by the activity’s medium, rather than theme. Interestingly, many students’ least favourite activity was also the one they were most proud of. Further research is needed to understand how art-based interventions, although sometimes unenjoyable, can have positive implications through pushing personal limits. Despite the time constraints we faced, future art-based research amongst youth populations should aim to ensure students’ understanding of the activities and allow for suitable time, at least forty-five minutes, for art-making. Future interventions should also address both risk and protective factors of youth well-being, as previous research demonstrates that the atmosphere during art-making can have an impact on the intervention outcomes. Declarations Funding details: This research was supported by the Social Sciences and Humanities Research Council’s Canada Graduate Scholarship - Master’s Program (CGS M). This funding source had no involvement in the conduct of this research. Statements and Declarations: We have no known conflicting interests to disclose. Author Contribution K.S. wrote the manuscript text. C.M., A.M., and T.LG. edited and reviewed the manuscript. J.P. and M.B., significantly contributed to data collection and analysis. Acknowledgments: We would like to thank the students and staff of the partnering program for their trust, time, and participation in this work. Note : This submission is intended for the BMC Psychology special issue: Cross-national research and practice evidence for mental health interventions in diverse educational contexts. Data availability: The data that support the findings of this study are available on request from the corresponding author, KS. The data are not publicly available due to their containing information that could compromise the privacy of research participants. References American Art Therapy Association - about art therapy . (2023, January 18). 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J Child Sex Abuse. 2022;31(1):127–46. https://doi.org/10.1080/10538712.2020.1801931 . Sutherland JH, Waldman G, Collins C. Art Therapy Connection: Encouraging troubled youth to stay in school and succeed. Art Therapy. 2010;27(2):69–74. https://doi.org/10.1080/07421656.2010.10129720 . Tan C, Chuah C, Lee S. Being creative makes you happier: The Positive Effect of Creativity on Subjective Well-Being. Int J Environ Res Public Health/International J Environ Res Public Health. 2021;18(14):7244. https://doi.org/10.3390/ijerph18147244 . Teixeira S, Augsberger A, Richards-Schuster K, Martínez LS. Participatory Research Approaches with Youth: Ethics, Engagement, and Meaningful Action. Am J Community Psychol. 2021;68(1–2):142–53. https://doi.org/10.1002/ajcp.12501 . Theurer C, Rogh W, Berner N. Interdependencies between openness and creativity of fifth graders. Psychol Aesthet Creativity Arts. 2021;15(3):391–400. https://doi.org/10.1037/aca0000299 . Ugurlu N, Akca L, Acarturk C. An art therapy intervention for symptoms of post-traumatic stress, depression and anxiety among Syrian refugee children. Vulnerable Child Youth Stud. 2016;11(2):89–102. https://doi.org/10.1080/17450128.2016.1181288 . Versitano S, Butler G, Perkes I. Art and other group therapies with adolescents in inpatient mental health care. Int J Art Therapy. 2023;1–8. https://doi.org/10.1080/17454832.2023.2217891 . Wasserman C, Poštuvan V, Herta D, Iosue M, Värnik P, Carli V. Interactions between youth and mental health professionals: The Youth Aware of Mental health (YAM) program experience. PLoS ONE. 2018;13(2):e0191843. https://doi.org/10.1371/journal.pone.0191843 . Wuthrich VM, Zagic D, Dickson SJ, McLellan LF, Chen JT, Jones MP, Rapee RM. Effectiveness of psychotherapy for internalising symptoms in children and adolescents when delivered in routine settings: A systematic review and meta-analysis. PubMed. 2023. https://doi.org/10.1007/s10567-023-00433-8 . Wymer B, Ohrt JH, Morey DaJ, Swisher S. Integrating expressive Arts techniques into Trauma-Focused treatment with children. J Mental Health Couns. 2020;42(2):124–39. https://doi.org/10.17744/mehc.42.2.03 . Yan H, Chen J, Huang J. (2019). School Bullying among Left-Behind Children: The Efficacy of art therapy on reducing Bullying Victimization. Frontiers in Psychiatry , 10 . https://doi.org/10.3389/fpsyt.2019.00040 . Yuan Y, Sun X, Chen Q, Liu Z, Xue G. Family socioeconomic status and youth leadership potential: Serial mediating effects of parental rearing behaviors and youth self-esteem. Curr Psychol. 2022;41(4):2034–44. https://doi.org/10.1007/s12144-020-00728-x . Zhao R, Tang Z, Fang L, Xing Q, Shen W. (2022). An updated evaluation of the dichotomous link between creativity and mental health. Frontiers in Psychiatry , 12 . https://doi.org/10.3389/fpsyt.2021.781961 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4546165","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":313451571,"identity":"2a3d03bd-6028-4f37-b0fe-1fef174151a7","order_by":0,"name":"Kyra Simons","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIie3RMYvCMBTA8ZRCXJ5kTaj4GQJCRRD8Ksni5H5bKYiZCq7KfQmnwzGS4RbBtXIO3tKpg90cOpiiiwihbg75L2/6kbwEIZ/vA6MoSJsJpJNiJJBuT3os063JvTHPBbazBWFLs9hU2wTYuozP5/rUHxIdXK4OElGpjuu9ARLNhlyqYjBaiZBlDtKngfrrKg3sexZTmRq5yRFG4CJk15AE+HEfU1FbctA4qF0XQ7IhIfAcLMGWaIFD1yls1eyiDLBs+mV3MXYXOY96DkIPv0VeqWRCOubn/1ob+2JmV5UO8hp/fO5bxOfz+XzP3QC4IVJZEfKaxwAAAABJRU5ErkJggg==","orcid":"","institution":"Bishop's University","correspondingAuthor":true,"prefix":"","firstName":"Kyra","middleName":"","lastName":"Simons","suffix":""},{"id":313451572,"identity":"29183a70-a1ac-4394-b684-a39f1fd11cb7","order_by":1,"name":"Adrianna Mendrek","email":"","orcid":"","institution":"Bishop's University","correspondingAuthor":false,"prefix":"","firstName":"Adrianna","middleName":"","lastName":"Mendrek","suffix":""},{"id":313451573,"identity":"884e5b88-495e-4735-8154-8a198dbd7b0b","order_by":2,"name":"Jasmine Piché","email":"","orcid":"","institution":"Bishop's University","correspondingAuthor":false,"prefix":"","firstName":"Jasmine","middleName":"","lastName":"Piché","suffix":""},{"id":313451574,"identity":"175beb8f-6940-4fca-8153-e3688a454a6b","order_by":3,"name":"Megan Bernier","email":"","orcid":"","institution":"Bishop's University","correspondingAuthor":false,"prefix":"","firstName":"Megan","middleName":"","lastName":"Bernier","suffix":""},{"id":313451575,"identity":"4128fd2b-93f5-4289-883e-84d68a26af1f","order_by":4,"name":"Terra Léger-Goodes","email":"","orcid":"","institution":"University of Quebec in Montreal","correspondingAuthor":false,"prefix":"","firstName":"Terra","middleName":"","lastName":"Léger-Goodes","suffix":""},{"id":313451576,"identity":"369438a0-4519-458c-8b3c-2d52e379d935","order_by":5,"name":"Catherine Malboeuf-Hurtubise","email":"","orcid":"","institution":"Bishop's University","correspondingAuthor":false,"prefix":"","firstName":"Catherine","middleName":"","lastName":"Malboeuf-Hurtubise","suffix":""}],"badges":[],"createdAt":"2024-06-07 12:40:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4546165/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4546165/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40359-025-02476-8","type":"published","date":"2025-03-03T15:58:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":78191451,"identity":"8d227209-c8a5-47e8-bc24-fd81f86475f7","added_by":"auto","created_at":"2025-03-10 20:01:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":969059,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4546165/v1/0da07bb8-2974-4944-bf29-76bdbbac856d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Promoting the mental health and well-being of vulnerable youth through art: A descriptive qualitative study","fulltext":[{"header":"Background","content":"\u003cp\u003eLow-income youth populations are some of the most vulnerable groups to environmental stressors, including low social support and poor family environment (Segal et al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This vulnerability is further perpetuated by limited access to mental health care services, which is a concern notably amongst rural communities in Quebec, Canada (Coulaud et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Art-based interventions are a potential solution to alleviate the long waitlists for psychotherapy that are endured particularly by rural communities. Art therapy has proven to be an easily accessible and effective method to alleviate symptoms of psychological disorders in adults, yet there is a lack of youth-focused art therapy research. Moreover, what little data exists on this topic is quantitative, which can limit participants\u0026rsquo; voices. The current research provides a unique perspective into the perceived effects of an art-based intervention on the mental health of children in an impoverished community in Quebec, Canada.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eAccess to Mental Health Services\u003c/h2\u003e \u003cp\u003eGlobally, youth experiencing mental health concerns have consistently been underserved, with less than half of these youth receiving the mental health services they need (Augsberger et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Iyer et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Moreover, only 20% of the 1.2\u0026nbsp;million Canadian youth experiencing mental health issues are receiving appropriate care and treatment (Canadian Institutes of Health Research, 2023).\u003c/p\u003e \u003cp\u003eOne of the most notable difficulties regarding youth populations receiving mental health services is a lack of youth-friendly programming (Iyer et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). It thus seems imperative to invest in early interventions for young people that aim to prevent mental illness and promote mental health (Paltser et al. \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Iyer et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In fact, 70% of mental health problems emerge in childhood and adolescence (Mental Health Commission of Canada, 2017).\u003c/p\u003e \u003cp\u003eInaccessibility to youth-appropriate mental health services is further impacted by living in a rural area (Chan et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Individuals living in rural areas are more likely to report unmet mental health service needs by comparison to those in larger cities (Coulaud et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In recent years there have been specific increases in budgetary envelopes to target this issue (\u003cem\u003eMinist\u0026egrave;re Des Finances Du Qu\u0026eacute;bec | Budget 2024\u0026ndash;2025 English Version\u003c/em\u003e, 2024; Canadian Institutes of Health Research, 2023).\u003c/p\u003e \u003cp\u003eMental health prevention programs should be effective, well-adapted, and accessible to ensure implementation and effectiveness. Conventional approaches to therapy with children are vast and well-reviewed, yet lack availability (Boekhoven et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). For example, cognitive behavioural therapy has proven to be effective amongst a wide variety of youth populations (e.g., Perkins et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Wuthrich et al., \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), but it is not as easily accessible (Dub\u0026eacute; et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Conversely, unconventional approaches to treatment such as art-based interventions have been less studied, but have the potential for wider availability (Boekhoven et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). These interventions are an integrative mental health service that engages participants through art-making, creative process, applied psychological theory, and human experience (\u003cem\u003eAmerican Art Therapy Association - About Art Therapy\u003c/em\u003e, 2023). Further, they have the capacity to support both personal and relational treatment goals, as well as community needs (\u003cem\u003eAmerican Art Therapy Association - About Art Therapy\u003c/em\u003e, 2023). As mentioned, art-based interventions are more accessible than traditional therapeutic approaches (Dub\u0026eacute; et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). For example, the wider availability of art-based interventions allows individuals to experience the positive effects of art making at home without the presence of the therapist (Martin \u0026amp; Colp, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, there are varying perspectives regarding the effectiveness of art-based approaches (e.g., Handayani et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Park \u0026amp; Hong, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEffectiveness of Art-Based Interventions\u003c/h2\u003e \u003cp\u003eConsidering the adaptability of art-based interventions, it is arguable that its efficacy can be strengthened through integrating with conventional therapies, as more traditional methods have stronger empirical support (David et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Cecil, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Although art and conventional therapies such as CBT have rarely intersected (Boekhoven et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), research regarding the combination of these approaches for adults (Carter et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and youth (Wymer et al., \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Losinski et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Cecil, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) is emerging. Specifically, Cecil (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) found that combining CBT and DBT, examples of conventional therapies, with art-based methods reduced anxiety disorder symptoms and improved quality of life amongst children with anxiety disorders. Within this work, it was described that combining CBT, DBT, and art-based interventions allowed participants to express their feelings through art, which in turn helped them identify and verbalize thoughts and feelings; something that youth tend to struggle with in traditional psychotherapy (Cecil, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough research regarding the effectiveness of art-based interventions alone amongst youth populations is emerging, it has shown to improve quality of mental health and symptoms of posttraumatic stress disorder amongst adolescents (Iyendo et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Within this work, 470 students in Nigeria were divided into control, fine art therapy, and music therapy groups, and it was found that fine art therapy was more effective than music therapy at reducing PTSD symptoms (Iyendo et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Thus, these positive findings support the effectiveness of art-based interventions, and this is also true when it is complemented by conventional approaches such as CBT and DBT (Cecil, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBy comparison to conventional therapies, there are various unique attributes to art-based interventions (\u003cem\u003eAmerican Art Therapy Association - About Art Therapy\u003c/em\u003e, 2023). Namely, art-based interventions acknowledge our subjective experiences through a creative process (\u003cem\u003eAmerican Art Therapy Association - About Art Therapy\u003c/em\u003e, 2023). Being creative can have a positive impact on mental health and well-being (Tan et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). For example, being creative enhances meaning-making (Zhao et al., \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and satisfaction in daily life amongst individuals experiencing severe mental illness (Hansen et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Conversely, well-being has also been found to be conducive to creativity; highlighting the reciprocal relationship between the two constructs (Tan et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Positive emotions, such as those experienced when being creative (Tan et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), expand individuals\u0026rsquo; thoughts and actions; motivating them to think differently without fear. Positive emotions promote creativity, which in turn builds one\u0026rsquo;s psychological, physical, social, and intellectual resources (Fredrickson, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEngaging in the creative process through art-based interventions have served to overcome youth populations\u0026rsquo; resistance to therapy (Shuman et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and relieve the delays associated with seeking conventional therapy (Boekhoven et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Art-based interventions can be particularly beneficial for children who may not possess the vocabulary to thoroughly describe their emotions (Boaz \u0026amp; Bat-Or, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Indeed, art therapies can facilitate unique, nonverbal communication for youth who experience trouble verbally communicating their thoughts and feelings (Boaz \u0026amp; Bat-Or, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Although there is a lack of research comparing the effectiveness of art-based interventions to more conventional forms of therapy, art-based therapies have been reported to be the preferred mode of therapy by youth who have experienced mental health concerns (Versitano et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), making it a suitable and promising intervention for vulnerable populations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eArt-Based Intervention Amongst Vulnerable Populations\u003c/h2\u003e \u003cp\u003eArt-based interventions are particularly beneficial for vulnerable populations, namely youth, immigrants, refugees, and individuals of colour (Collins et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Feen-Calligan et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Gerami, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Hanania, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Kim et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Specifically, art-based interventions are beneficial for these populations as it circumvents language barriers and focuses on positivity and growth (Rowe et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Moreover, art-based interventions allow individuals to explore memories and emotions, which provides a safe space to overcome the effects of trauma (Rowe et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Among youth, immigrants, refugees, and individuals of colour, art-based interventions have proven to decrease symptoms of depression and stress (Feen-Calligan et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Gerami, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Kim et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and enhance positive emotions such as hope and resilience (Collins et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Feen-Calligan et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Research regarding interdisciplinary group programming for adolescents in inpatient care found that participants preferred taking part in creative activities and art-based interventions to verbal psychotherapy, which they found to be too confronting (Versitano et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Despite this preference for engaging in the arts, there is little to no research regarding which art-based methods are most effective amongst youth.\u003c/p\u003e \u003cp\u003eTo navigate this gap in the literature, participants can often inform the art-based interventions themselves (Feen-Calligan et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Through collaborative research designs, investigators can cater the intervention so that it is culturally and age appropriate, and aligns with the context of participants (Feen-Calligan et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Hanania, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The vast mediums within art allow for psychologists to adapt their interventions according to the demographic they are working with, which is particularly important within art-based interventions (Hanania, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). With regards to working with youth populations specifically, art-based interventions allow psychologists to engage children while giving them a sense of control through the creative process (Ugurlu et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to Boaz and Bat-Or (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), involving participants in the creation of research, known as taking a community-based approach, attempts to create a safe space for communal art-making while integrating participants\u0026rsquo; needs and wishes. Art-making in a group setting can also bring a community closer through sharing similar experiences with one another during sessions (Hanania, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Kira et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). A community-based approach was deemed particularly beneficial - and thus adopted - in the current project as we created art with underprivileged children in a rural community with a specific focus on promoting positive mental health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy Aim\u003c/h2\u003e \u003cp\u003eThis study\u0026rsquo;s overarching aim was to offer an art-based intervention for vulnerable youth attending an after-school program. Specifically, through a qualitative descriptive design, we aimed to document children\u0026rsquo;s perceived benefits of engaging in artistic creation on their overall mental health. The guiding research question was: how will vulnerable youth benefitting from an art-school program respond to an art-based intervention aimed at improving their mental health and well-being?\u003c/p\u003e \u003c/div\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eDesign\u003c/h2\u003e\n \u003cp\u003eA descriptive qualitative design was used for this study. Data was obtained through semi-structured interviews with the students, as well as through group discussions and observational data of the workshops. Through qualitative research, one can further investigate how to optimally facilitate and test proposed interventions (Eldridge et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). The efficacy of interventions that are not yet empirically validated can be explored through qualitative feedback, as we collect data on what worked and didn\u0026rsquo;t work for participants.\u003c/p\u003e\n \u003cp\u003eGiven that the current intervention had not previously been assessed, our theoretical approach to this work was directed by both pragmatist epistemology and participatory action research. A pragmatic paradigm is associated with a plurality of methods, asserting that researchers should implement the philosophical and/or methodological approach that is most effective for the particular research problem or group being investigated (Kaushik \u0026amp; Walsh, \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). Pragmatism emerged from a rejection of traditional ways of inquiring and gaining knowledge about our reality, which had believed that social inquiry could be conducted only through a single scientific method (Kaushik \u0026amp; Walsh, \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). In a similar vein, pragmatist epistemology asserts that our knowledge and perception of the world are based on experience (Kaushik \u0026amp; Walsh, \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). Pragmatist epistemology is similar to participatory action research as they maintain that without action, we do not know what is useful or desirable for participants (Hammond, \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e; Huffman, \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e). Participatory action research is conducted with the intention of transforming the lives of socially marginalized populations (Kaushik \u0026amp; Walsh, \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). Through working alongside the coordinators of our partnering program throughout the research process, we were able to curate the intervention design so that it best served our population of interest. Specifically, certain themes were chosen with the intention of uplifting participants and helping them realize their full potential, and the intervention plan was approved by the program coordinators prior to the onset of data collection. Further, the weekly activities were altered on occasion if students were not initially receptive to them.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipants\u003c/h2\u003e\n \u003cp\u003eThe current project was conducted in an English town in rural Quebec, which is ranked among the lowest communities on Quebec\u0026rsquo;s Socioeconomic Environment Index. Participants attended schools that were amongst the most disadvantaged in the province where the majority of families in this area have been considered below the low income threshold index (\u003cem\u003eGovernment and Municipalities of Qu\u0026eacute;bec - Indices of deprivation\u003c/em\u003e, 2023).\u003c/p\u003e\n \u003cp\u003eYouth taking part in this study faced four prominent challenges: deprivation and vulnerability, language challenges, a lack of role models, and isolation and stigma. Many of the students who attended the after-school program - and took part in this study - experienced emotional, behavioural, and/or developmental challenges, making them more likely to have significant mental health care needs (Graaf \u0026amp; Snowden, \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). Noteworthy, many of the study participants were not bilingual (and have English as their mother tongue). However, in the province of Quebec, where French is the official language, access to appropriate mental health interventions is particularly challenging for youth who belong to a linguistic and cultural minority (Dub\u0026eacute; et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eStudy participants included three groups of 5th and 6th grade elementary school students (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;27; aged 11 and 12 years old), divided between English speakers (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9) and French speakers (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18), all of whom attended an after-school program. Factors for vulnerability among these students included, but were not limited to: low socio-economic status, low level of education among parents, single-parent families, high incidence of mother abandonment, high level of learning and behaviour difficulties, and lack of access to essential services in English (speech therapy, social workers, etc.). Recruitment was non probabilistic, through our research partnership with the program. Specifically, the program coordinator presented the study to parents of children attending the program and obtained consent for their child to take part in the intervention and an individual interview at the end of the study. The present study obtained approval from the Bishop\u0026rsquo;s University Ethics Board on March 17th, 2023 (102681), which adheres to the 2018 Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2) and the Bishop\u0026rsquo;s University Research Ethics Policy.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eIntervention\u003c/h2\u003e\n \u003cp\u003eThe art-based intervention used in this work was developed by a child psychologist (CMH) and a M.Sc. student in psychology (KS), in collaboration with a researcher who has extensive training in dance and movement therapy (AM). Weekly themes and activities were chosen based on previous work led by the research team which aimed to improve elementary school children\u0026rsquo;s mental health (e.g., L\u0026eacute;ger-Goodes et al., under review). The intervention was reviewed by the partnering program\u0026rsquo;s coordinators and was adjusted with their feedback in mind. The 7-week intervention included various themes (e.g., relationships, emotions, optimism) and mediums (e.g., drawing, dancing, sculpting). A variety of art mediums were chosen so that participating students could express themselves creatively through different means. See Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e for a complete overview of the intervention. Workshops were facilitated by a master\u0026rsquo;s student (KS) and undergraduate psychology students, all of whom were supervised by a child psychologist (CMH). Each twenty-five minute session focused around a single theme and proceeded as follows: instructions, artistic creation, group discussion and sharing of created art. The art-based activities were selected to encourage introspection and creative expression in students.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBreakdown of art-based activities\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention week\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eArt medium\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDrawing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmotions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollaging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIdentity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoping\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSculpture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSafe space\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWriting and drawing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelationships\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMeditation and drawing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHope and optimism\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDrawing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSummary of project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eData Collection\u003c/h2\u003e\n \u003cp\u003eIn accordance with pragmatic theory, data was obtained from various sources: researcher observations, group discussions following each workshop, and individual semi-structured interviews with students at the end of the intervention.\u003c/p\u003e\n \u003cp\u003eObservations were collected throughout the intervention by the assisting undergraduate researchers. They focused on topics such as students\u0026rsquo; reactions to the weekly activity, non-verbal messages from students, and the interactions that occurred between students during the activity. See Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e in \u003cspan class=\"InternalRef\"\u003eAppendix A\u003c/span\u003e for the observation grid our team used.\u003c/p\u003e\n \u003cp\u003eFollowing each activity, as a group, students were asked about what they had created, if they wished to share their creation, their reactions to the activity, and how the activity may have related to their everyday lives. Group conversations were conducted weekly with the intention of receiving participant feedback in a timely manner, rather than weeks later in the individual interviews. Group discussions were recorded and transcribed.\u003c/p\u003e\n \u003cp\u003eAfter seven weeks of group activities, each student took part in a brief, semi-structured interview led by a member of the research team. Similarly to the group discussions, these conversations were also recorded and transcribed. During the interview, students were asked questions regarding their perception of the intervention, their appreciation of specific activities, and the degree to which they felt the intervention had an impact on themselves or their lives. See Appendix B for the complete interview guide. All interviews were recorded and transcribed for analysis. As all activities and interviews with the French students were conducted in French, these data were translated to English prior to analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eAnalysis\u003c/h2\u003e\n \u003cp\u003eCollaborative thematic analysis was conducted between researchers (KS and JP) to analyze the individual interviews. Thematic analysis (Braun \u0026amp; Clarke, \u003cspan class=\"CitationRef\"\u003e2006\u003c/span\u003e) was used to allow for participants\u0026rsquo; perceptions and experiences of our intervention to emerge, enabling our research team to grasp the impact the intervention had on participants. The transcriptions were analyzed using NVivo 14. Transcripts were read repeatedly by two researchers (KS and JP) prior to the initial open coding phase. Codes were determined inductively and defined early on in analysis. These codes were discussed with and reviewed by two other research team members (CMH and AM). The two researchers coded the data independently but frequently discussed observations, allowing them to collaboratively structure codes and deduce arisen themes. Themes were then defined.\u003c/p\u003e\n \u003cp\u003eFollowing the thematic analysis of the individual interviews, group interviews were analyzed using both inductive and deductive content analysis. An inductive approach was used to interpret themes that emerged from observational data. Then, deductive analysis was conducted based on the codes and observations that emerged from the thematic analysis of the individual interviews. Compared to the first round of inductive thematic analysis, this second round of inductive thematic analysis allowed both code elements from the initial coding tree (deductive), and report coding frequency to provide an idea of the number of times certain elements were mentioned in the data. This type of qualitative analysis allowed researchers to analyze both the existence of themes within group conversations, and the frequency in which these themes occurred in the data. By using both inductive and deductive approaches, researchers could apply what emerged inductively from the observation data to the group conversation so that we could enrich our understanding of resulting concepts from both the individual and group discussions.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThematic analysis resulted in three overarching themes: general appreciation of the intervention, attitudes towards the activities, and feelings associated with art-making. Within these themes, the perceived impact of the intervention, students\u0026rsquo; perceptions of their art, and challenges experienced throughout the intervention are also explored.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eGeneral appreciation and acceptability of intervention\u003c/h2\u003e \u003cp\u003eThis theme reflects how students felt about the intervention, and whether or not they wished to take part in a similar project in the future. Overall, the majority of students felt positively about the intervention, and indicated that they enjoyed taking part in the weekly activities. Students typically described having fun throughout the intervention. Observational data revealed that many participants enjoyed taking part in the intervention, as oftentimes students complained when our allotted activity time was over and they had to move onto doing homework. One student attributed their enjoyment of the intervention to not having to do as much homework: \u0026ldquo;I [liked] to do the activities because I don\u0026rsquo;t like doing homework\u0026rdquo; (participant 3). By contrast, some students were reluctant to participate in the intervention at times, explaining that they had a lot of homework to do. However, these students were enthusiastic about participating on weeks they did not have homework to complete. Additional feedback included two students expressing gratitude towards our research team for our time and effort in leading these sessions, one of whom stated they were happy that we came and were not \u0026ldquo;adults\u0026rdquo;. As such, throughout the intervention many students bonded with our research team, and the coordinators of the program expressed how much the students appreciated and looked up to us as mentors. Positive feedback from the students indicated the general appreciation they had for the intervention.\u003c/p\u003e \u003cp\u003eThroughout individual interviews, a few students, most of whom were in the English group, appeared to either share mixed feelings or lack introspection about the intervention. Specifically, when asked about their overall perception of the intervention, these students described experiencing positive emotions as a result of participating in the intervention, but later stated that the intervention had no impact on themselves and their emotions. Some of the students who shared that they did not enjoy the intervention (\u0026ldquo;it was boring\u0026rdquo; [participant 23]), later mentioned that they would participate in the study again.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStudents\u0026rsquo; perceived impact of the intervention\u003c/h2\u003e \u003cp\u003eDelving further into the perceived impact of the intervention, students generally indicated positive change in their life and skillset. For example, three students referred to becoming more confident and comfortable around others through taking part in the project. For example, one of these students told us \u0026ldquo;I feel more comfortable. [MB]: Do you feel more comfortable? Ok. With us or with your friends\u0026hellip;? [Student]: Well like with the people here\u0026rdquo; (participant 1). In terms of students\u0026rsquo; perceived impact of the intervention on their mental health and well-being, students referred to experiencing improvements eight times, while feeling no significant changes in well-being was coded ten times. Although many students did not elaborate on what specific changes they endured, those who did described feeling more calm or happy because they learned about themselves through taking part in the intervention: \u0026ldquo;I managed to discover a little bit of myself [with the drawings we did and the meditation]. [JP]: Because you realized these were things you loved doing? [Student]: yes\u0026rdquo; (participant 10). Generally speaking, those who tested their personal comfort level by fully committing to the intervention appeared to exhibit more positive implications from the intervention than those who did not put their full effort in or withdrew from certain activities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStudents\u0026rsquo; attitudes towards activities\u003c/h2\u003e \u003cp\u003eBy contrast to the students\u0026rsquo; feelings about the intervention overall, this theme pertains to attitudes surrounding specific activities and their perceptions of the art that was created. As per Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, many artistic mediums were included in this intervention. Students had a variety of different favourite and least favourite activities, and often attributed their choice to the medium of the activity (e.g. dance), rather than the topic the activity explored (e.g. coping). Dance and lego were most frequently referred to as students\u0026rsquo; favourite activities. By contrast, when asked about their least favourite activity, many other students said dance was their least preferred activity. In addition to dance as a common least favourite activity, students also referred to the writing activity, stating that they felt embarrassed writing a personal letter. The meditation was also frequently cited as students\u0026rsquo; least favourite activity because other students were disruptive during the guiding of the meditation. Overall, however, a considerable number of students said that they liked all of the activities the same.\u003c/p\u003e \u003cp\u003e Generally speaking, the students who were enthusiastic about participating in the activities chose to distance themselves from those who were being disruptive. However, students appeared far more willing to participate in an activity if they enjoyed its medium. For example, all students participated in the safe space activity where students built a lego art piece. Observational data revealed that students from the French group were generally more willing to participate in the art activities and share their thoughts during group discussions than those from the English group. Furthermore, content analysis of group discussions revealed that the French students appeared to grasp the intent of each activity with greater ease than the English students. For example, without announcing the theme prior to the meditation activity, many of the French students created within the theme and expressed emotions related to this undisclosed theme, while the English group required greater explanation and guidance from the researchers to grasp the theme.\u003c/p\u003e \u003cp\u003eAdditionally, although activities were guided, students had varying interpretations of directions and what to create. An example of the vast perceptions of the activity topics is the meditation, which followed with a drawing. In this activity, students listened to a script about a sailor lost at sea, who was later able to steer themselves to safety with the guidance of a lighthouse. Without sharing the theme of this activity (hope and optimism), students were tasked with drawing an image they visualized during the meditation. It was our intention to see if students focused more on positive emotions such as hope, or negative emotions such as fear. Despite our direction, some students focused on video game characters, places, or events that they associated with the feeling(s) they felt during the meditation. For example, one student described feeling fear from one of the scenes of the meditation, and chose to illustrate a school shooting; a situation in which she said she would feel fear. In the writing activity, students were tasked with writing a poem or letter to anyone or anything in their life, and then drawing a representation of that relationship. In this activity, another student drew their friend and fellow group member being shot and killed. They stated that it was a play on words, because that student was \u0026ldquo;dead funny\u0026rdquo; (participant 32). The varying interpretations and images that arose from the mediation activity demonstrates how, despite given direction in each activity, students felt they could create autonomously.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStudents\u0026rsquo; perceptions of created art\u003c/h2\u003e \u003cp\u003eWhen describing how they felt about their art, some students felt most proud about the activities where they had the opportunity to outline their favourite things, activities, or places. By comparison, other students felt most proud about the piece of art they felt was most impressive or beautiful. Although most students had an activity they felt particularly proud of, many other students did not feel that any activities were exceptionally important to them. Interestingly, one student said that the activity they were most proud of, the writing activity about relationships, was also their least favourite activity to take part in: \u0026ldquo;although it was embarrassing, it also kind of felt good to express it\u0026rdquo; (participant 25). Within their letter, this participant expressed their appreciation for their favourite video game character, and shared the strong impact the character has had on their life. When asked if there was any piece of art they were particularly proud of, another student mentioned:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;Well, the important things are the things we do. [MB]: Okay. [Student]: The memory. [MB]: Okay, yes. So do you like what you're doing right now? Ok. Is there a reason or just because it reminds you of positive moments or...? [Student]: It reminds me of positive moments, when I lost a baseball game, I look at my sheet and I say no problem\u0026hellip;\u0026rdquo; (participant 3)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eRegardless of whether these students mentioned an activity they were particularly proud of, four students were critical of themselves and their artistic ability, referring to their creations as \u0026ldquo;ugly\u0026rdquo; or \u0026ldquo;bad\u0026rdquo;.\u003c/p\u003e \u003cp\u003eIn addition, analysis of discussion regarding students\u0026rsquo; created art revealed that participants were particularly expressive when sharing their emotion wheels by comparison to other activities. Specifically, many students described the colours and images they associated with emotions such as fear, anger, and happiness. One student from the English group was particularly expressive about the art he created:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI think the style you use when you\u0026rsquo;re drawing really makes the emotion pop out. It shows you which emotion you [inaudible] when you don\u0026rsquo;t even have to say it\u0026hellip; For anger I did cross hatching, because it looks really rough, and so I thought that just represented anger. For fear, I did spikey lines. For sadness I did waves because waves represent water, and tears are salty like ocean water. And for happiness I just did a lot of bright colours. (participant 25)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFeelings associated to art-making\u003c/h2\u003e \u003cp\u003eConversations amongst the French groups led to discussions regarding art-making. When asked how they felt during and after art-making, the vast majority of students mentioned feeling positively. More specifically, of the eight students who were asked, seven felt positively both during and after art-making. Specific emotions discussed amongst those who felt positively during and/or after art-making include happiness and peacefulness. By contrast to those who felt positively during art-making, six students mentioned feeling embarrassed or bored at at least one point of art-making. Students who felt negatively typically attributed their feedback to feelings of embarrassment about the art they created, often stating that they felt they lacked artistic skill. Of those who expressed feeling bored, however, one student shared that they thought the intervention was pointless because they had done all of the art mediums included in the intervention before: \u0026ldquo;I\u0026rsquo;ve already done stuff like this, so it\u0026rsquo;s kind of getting annoying\u0026rdquo; (participant 37). When asked for their feedback about the intervention and what they would change, this student said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;Everything is just saying how kids feel and like trying to get them to be calmer. [MB]: To be calmer? [Student]: Yeah, basically just checking on how kids feel every five seconds and doing meditations and stuff like that. [MB]: [...] I wouldn\u0026rsquo;t say the aim was to make you feel calmer. I think the aim of this, at least for Kyra\u0026rsquo;s project, is to see if maybe doing certain activities like this have an improvement in life, your well-being, how you feel\u0026hellip; [Student]: Mental health? (participant 37)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eObservational data also revealed that students occasionally felt hesitant to participate in activities, namely the dance and writing activities. Specifically, almost all of the English students withdrew from the dance activity, the reason for doing so was interpreted as the participants feeling uncomfortable dancing. Observational data supports the tone of embarrassment from English participants throughout art-making as many of our notes indicate students repeatedly needed support and encouragement from the staff and research team. By contrast, the French students were generally more willing to participate in the dance activity. For example, one of the French students mentioned that they learned \u0026ldquo;not to be shy when you have to do the dance\u0026rdquo; (participant 12). Additionally, many students were repeatedly hyperactive and did not take activities seriously, resulting in the groups frequently needing to be disciplined by our research team and program staff. Despite the frequently chaotic environment during art-making, two individuals who regularly shared their art with the group during weekly discussions described feeling heard and respected by their peers when sharing.\u003c/p\u003e \u003cp\u003eIn terms of the French participants, observational data revealed that 5th grade students were more open to creativity than the 6th grade students.\u003c/p\u003e \u003cp\u003eAcross both English and French groups, and regardless of whether the student was particularly enthusiastic to participate in the activities, students tended to disregard the weekly theme and instructions provided when art-making.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eChallenges impacting art-making\u003c/h2\u003e \u003cp\u003eObservation revealed that the primary challenges that inhibited participation in art-making included students\u0026rsquo; energetic behaviour and lack of time. Specifically, students often arrived at the after-school program with copious energy and were often unwilling to listen to our research team or the program coordinators. Some children settled within the early minutes of an activity, however many others continued to be disruptive and were reluctant to participate, posing negative implications for those in the room who were focused on the given activity. Moreover, the time we were allotted to lead each art activity and follow-up discussion as a group proved to have limitations on students\u0026rsquo; participation. Another challenge the students described was lacking inspiration on what to create: \u0026ldquo;I didn\u0026rsquo;t understand what to do [...] I had no inspiration in my head\u0026rdquo; (participant 7). In addition to these observed challenges, some students also felt that the intervention pushed them out of their comfort zone. Namely, a few students identified the feelings of embarrassment during art-making as being particularly challenging. By contrast to this feedback and the researchers\u0026rsquo; observations, most students did not feel that there was anything challenging their ability to take part in the intervention.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to provide and evaluate an art-based intervention for a specific population of youth benefitting from an after-school program in rural Quebec. A descriptive qualitative design was used, and data consisted of group discussions, observational data, and individual semi-structured interviews with the students. These were analyzed using both inductive thematic analysis and content analysis. The primary themes that emerged from this work included general appreciation and acceptability of the intervention, students\u0026rsquo; attitudes towards the activities, and feelings associated to art-making.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eGeneral appreciation and acceptability of the intervention\u003c/h2\u003e \u003cp\u003eStudents\u0026rsquo; general enjoyment of the intervention indicated that, for the most part, they liked the activities and themes included in the project. These positive feelings towards the intervention lend support to the use of art-based interventions with youth (Kim et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Boaz \u0026amp; Bat-Or, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Malboeuf-Hurtubise et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) as an acceptable means for intervention. However, it should be noted that some students showed occasional reluctance to participate in the intervention. This may be attributable to academic pressures or feared judgment from peers, which we discuss further below.\u003c/p\u003e \u003cp\u003eBased on results from this study, students reported being positively impacted by the art-based workshops. Namely, students expressed self-discovery and feeling more comfortable and confident around their peers and the program staff. These findings are consistent with that of previous work amongst youth in low income areas, which showed that an expressive art-based intervention improved participants\u0026rsquo; confidence (Forrest-Bank et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). However, it should be noted that some indicated, on the contrary, that they disliked the activities. In digging further, many of those who expressed their dislike for the intervention gave various feedback. This feedback included students stating that they experienced positive emotions during art-making, but later mentioning that the intervention had no impact on their emotional well-being. Other students mentioned that they would like to participate in the study again, despite not enjoying the intervention. Varying mechanisms could be at play to explain this somewhat contradictory feedback. Perhaps students lacked introspection, as previous research shows that metacognition to deeply reflect on one\u0026rsquo;s own thoughts and feelings is still in development in early adolescence (Mertens et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). It is also possible that students may have simply experienced short term benefits from the intervention, rather than long term impacts they could reflect on during the interviews which took place after the intervention ended.\u003c/p\u003e \u003cp\u003eAnother plausible explanation pertains to the difficulty associated with completing certain activities, such as creative writing and dancing. It is possible that these activities were least preferred by students because they were too challenging. However, it should be noted that some students later expressed desire to participate in them again because they were proud of overcoming personal limits.\u003c/p\u003e \u003cp\u003eThis explanation is corroborated by existing research by L\u0026eacute;ger-Goodes et al. (under review) on the use of an art-based intervention with elementary school students. Within this work, it was found that although students felt challenged by a dance activity, they felt proud of themselves for overcoming their feelings of embarrassment (L\u0026eacute;ger-Goodes et al., under review). It is also possible that mental health-related stigma prevented students from sharing that the intervention helped (and hence potentially admitting needing help). Indeed, the research process may have been too threatening for students as we regularly spoke of emotions and mental health. Previous research supports how some youth can be particularly reluctant to discuss sensitive topics such as mental health in interview settings (Wasserman et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Indeed, interview questions were phrased in a direct manner, so those surrounding students\u0026rsquo; mental health may have been too confronting and thus impacted students\u0026rsquo; responses. For example, students were asked \u0026ldquo;if you think back to before we started the art activities and now, what differences do you see in how you feel and the emotions you experience?\u0026rdquo; However, these are only tentative explanations, given it was difficult to discern why students provided this feedback as they were particularly reluctant to expand on the responses given during the individual interviews. Nonetheless, this reluctance also points to a difficulty for students to be vulnerable and share how they feel.\u003c/p\u003e \u003cp\u003eAlthough differing feedback prevents us from drawing concrete conclusions about the benefits of our intervention for this population, our overall observations indicated a positive effect. Specifically, when considering the socio-economic context of our participants and the adversity that many of them faced in their daily lives, many students took a liking to our research team and many positive interactions occurred between the research team and participants, suggesting that high quality relationships were developed throughout the course of the research. Previous work regarding school-based mentorship programs imply the wide range of effects quality mentorship has on youth (Bayer et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Chan et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Deutsch et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Dutton et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Indeed, youth mentorship programs resulting in sustained quality relationships are associated with improved mentee outcomes, such as academic outcomes (Bayer et a., 2015), connectedness resulting in increased prosocial behaviour (Deutsch et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), and improved relationship quality with parents and teachers (Chan et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). It is our understanding that similar mechanisms were at play in this project.\u003c/p\u003e \u003cp\u003eA core component of successful mentorship relationships and qualitative research overall is establishing trust (Pryce, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Pitts \u0026amp; Miller-Day, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). As such, it is possible that this bond may have strengthened the perceived effects the intervention had on students\u0026rsquo; well-being. Indeed, research examining the research-participant relationships indicated that a strong partnership between researcher and participant can positively impact research outcomes (Rongits, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), especially when conducting community-based participatory research (Holden et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Notably, positive mentorship developed in the present intervention in just seven weeks, with student interactions of one hour per week. By contrast, existing research such as that of Kuperminc et al. (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), which found that group mentorship improved high school students\u0026rsquo; school support, school belonging, prosociality, and peer relationships, was conducted over a full academic year. Findings from the present work suggest that mentorships can develop and have a positive impact on youth in just a short period of time. A strong therapeutic alliance may have been particularly important for the participants based on the numerous challenges they faced on a daily basis. Despite the therapeutic alliance being set, it may not have been strong enough for students to talk at length on an individual basis. Although having access to youth-appropriate mental health services such as art-based interventions was deemed beneficial by the students, simply being present and attentive of children who lack role models, face isolation and stigma has also had a positive impact on vulnerable youth (Kuperminc et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, art-based interventions could also play an active role in facilitating quality mentorship relationships, as they allow for youth to make sense of their thoughts and feelings (Cecil, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Comprehension of their emotions would allow them to share their feelings, which is particularly important in establishing a quality mentorship. Indeed, greater mentee openness has been correlated with higher mentor relationship quality across nine youth programs in New Zealand (Dutton et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). When considering the context of the participants in the present work and the bonds that were created, it appears likely that the support and mentorship from our research had a positive influence on students.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStudents\u0026rsquo; perceived impact of the intervention\u003c/h2\u003e \u003cp\u003eSeveral students exhibited positive changes in their mental health, overall life, and skillset. Of those who elaborated on the specific changes experienced, becoming more confident, comfortable, calm, and happy were mentioned most frequently. These findings mirror results of previous art-based work amongst youth (Collins et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Versitano et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), although the interventions used in these studies lasted for an hour; much longer than the twenty-five minute sessions implemented in this project. For example, Collins et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) conducted weekly art therapy sessions for twelve weeks amongst youth in a secure care facility. Participating youth experienced enhanced hope and resilience by 29% and 16% respectively, and it was found that the intervention improved youths\u0026rsquo; goals, levels of self-determination, and future orientations (Collins et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Furthermore, Versitano et al.\u0026rsquo;s (\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) work, which assessed the effectiveness of an art-based intervention and other group therapies amongst adolescents in inpatient mental health care, was conducted over a four month period. Those in the art-based intervention group reported that their sessions were both enjoyable and helpful, and it was found that the use of creative elements promoted consistent group engagement (Versitano et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e In addition to referencing feeling more confident, comfortable, happy, and calm, experiencing self-discovery was discussed by participants who enjoyed the intervention simply due to liking art-making. These positive perceived impacts of the intervention indicate that the intervention was relevant to the context and needs of our participants, which was a core component of our community-based approach. Previous work suggests that art-based interventions can be conducive to self-discovery in youth (Huang et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Specifically, adolescents who took part in two hour group art sessions for a period of eight weeks expressed starting to get to know themselves better, becoming able to explore their inner selves while noticing their emotions, developing a more positive self-concept, and having a clearer vision of their goals (Huang et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Self-discovery and increased confidence may be particularly important for this population in helping them develop a clear and optimistic vision of the future.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStudents\u0026rsquo; attitudes towards activities\u003c/h2\u003e \u003cp\u003eStudents\u0026rsquo; favourite and least favourite activities to take part in were often attributed to the medium of the art activity, rather than its theme. However, upon observation of the students, it was often difficult to determine whether students\u0026rsquo; perceptions of the activities was attributable to either theme or medium. For example, the writing activity was based around relationships, and students were asked to write a letter about a loved one. Many of the students stated that the task was challenging because they felt their writing skills were poor, or because they thought the task was too personal. In this case, we cannot be sure if this activity was many students\u0026rsquo; least favourite because of the medium or the theme. However, this activity may have been inappropriate for the students because of both reasons. Overall, both medium and theme may be important for engagement. Including a variety of art mediums is important so that students can feel challenged by the activity and remain engaged throughout the intervention. In accordance with a community-based approach, using themes and mediums that are relevant to the participants\u0026rsquo; lives is important (Hanania, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMoreover, when asked about activities that appeared to be particularly challenging, such as the dance activity on coping, students\u0026rsquo; enjoyment varied. Many participants enjoyed the activity, while others felt quite embarrassed or were entirely unwilling to participate. In terms of the importance of providing challenging interventions, the dance activity may have been too challenging for some students. Within this activity, students were asked to think of a time where they coped with something challenging, represent overcoming the challenge through three movements, and then share those movements with a partner. As these students experienced emotional and behavioural challenges, and were thus prone to high emotional reactivity and negative affect, it is likely that students exhibited emotional avoidance (Kennedy \u0026amp; Ehrenreich-May, 2017). Indeed, enduring high, seemingly uncontrollable negative emotion often leads to ineffective attempts at emotional regulation that provide a short-term solution to coping, but ultimately result in long-term maintenance or exacerbation of negative symptoms (Kennedy \u0026amp; Ehrenreich-May, 2017). Thus, it is possible that if students were asked about more positive emotions or experiences, they would have been more willing to participate. If students were granted more time to become comfortable with movement or were educated on how it has been used for emotional expression and coping with trauma, and hence felt more connected to movement, they may have been more willing to participate. Indeed, an eight month dance intervention amongst adolescent girls found that dance in a non-judgmental environment resulted in participants feeling empowered, and gave rise to emotional expression, self acceptance, and trust in oneself (Duberg et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Considering these findings, participation may have been better if students felt more comfortable and accepted by one another. Indeed, results tend to indicate that students were more willing to participate and enjoyed the activities where they were not asked to do anything they perceived as too personal or embarrassing. For example, students were open to discussing certain colours and images they chose in a drawing, but were reluctant to share the letter they wrote.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eStudents\u0026rsquo; perceptions of created art\u003c/h2\u003e \u003cp\u003eStudent creativity was promoted as they were allowed autonomy and choice within creation. However, a couple of students illustrated alarming images at various points of the intervention (e.g., school shooting illustration). These comments suggest that these students face considerable emotional disturbances. Indeed, at-risk youth who experience emotional and behavioural challenges have a history of problems in the school and community (Cox et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Existing research maintains that risk is further compounded by living in a rural area as they are affected by factors such as poverty, stigma of seeking services, and lack of availability to services, all of which can contribute to mental health concerns (Heflinger \u0026amp; Hoffmann, 2009) and influence further behavioural and emotional difficulties (Cox et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn terms of how students felt about the work they created, many felt most proud about the activities where they were able to include their favourite things, activities, or places. In other words, the students enjoyed creating the things they liked. There was a lack of enjoyment, however, when students engaged in more challenging activities. Yet, they described feeling less shy, more comfortable, and proud of themselves for taking part in the more difficult activities. By contrast, one participant, who did not feel particularly proud of any piece they made, described feeling most proud of the person they were, rather than the art they created. Although this feedback suggests the student did not value creating art, it demonstrates how lessons behind certain activities were beneficial to them. Specifically, the student referenced feeling proud of the lessons they learned in the activity (or activities) that involved memories - which would be the dance and meditation. The themes behind these activities were coping and optimism, respectively, and the students feedback suggested that they were able to apply these themes to their life experiences.\u003c/p\u003e \u003cp\u003eOther students felt particularly proud about the art that they felt was more aesthetically pleasing. Attributing pride about one\u0026rsquo;s creations to perceived artistic skill goes against a fundamental component of art-based methods: the importance of focusing on our subjective experiences in the creative process, rather than the finished piece of art (Fraser, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Lyshak-Stelzer et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Moon, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). Although criticizing one\u0026rsquo;s art goes against the aim of art-based interventions, it demonstrates the extent to which students focus on performance. The emphasis on performance was mirrored by other students, one of whom mentioned that they would not want to continue doing art at school because they were being graded on the finished product. As such, future work should aim to help children detach from performance. A solution for doing so is engaging in philosophical discussions about art and beauty. For example, discussing questions such as \u0026ldquo;what makes art beautiful? Can art be perceived differently by different people? How so? Does art need to be beautiful to be considered art?\u0026rdquo; could mitigate the focus on performance.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eFeelings associated to art-making\u003c/h2\u003e \u003cp\u003eArt-making elicited positive feelings for students during and after weekly sessions. The emotions of happiness and peacefulness that were discussed by students echo results from previous art-based work amongst inpatient care patients, where it was found that art-making had a calming effect (Noble \u0026amp; Hackett, 2023). In terms of the negative feedback, students who felt bored during art-making and expanded on their reasoning attributed their feelings to having done similar art mediums previously and feeling as though the aim of the activities were redundant. As mentioned, when asked about what they thought the purpose of the intervention was, one of these students stated that every activity aimed to calm the students down, so they grew bored and eventually stopped paying attention during sessions. Although the aim of the study was presented at the beginning of the intervention, and almost every weekly theme was presented to the students prior to the activity, it appears as though reminding students every week about the purpose of the intervention to avoid wrongly assuming the aim may have positively influenced art-making. Specifically, students who understood the weekly theme, the overall purpose of the study, and found both of these useful to them, may have put in greater effort and been more enthusiastic to participate. However, further research regarding how participants\u0026rsquo; perception of an intervention impacts their effort and engagement in a given project is needed.\u003c/p\u003e \u003cp\u003e Similarly, participants\u0026rsquo; engagement in the activities appeared to have an impact on the emotions they felt about art-making. Specifically, the more engaged students were, the more positively they felt about art-making. This finding aligns with previous work on client engagement and therapeutic outcomes. For example, through their review of 97 studies, Holdsworth et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) aimed to determine how client engagement with psychotherapeutic interventions had been defined and assessed, the client and therapist characteristics associated with positive engagement, and the treatment factors involved. Although understanding and assessment of client engagement varied across the reviewed works, it was found that clients\u0026rsquo; capacity to address their problems was positively associated with engagement (Holdsworth et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Indeed, as it appeared that participants lacked the willingness or ability to self-reflect and address their emotions, capacity to introspect may explain poor engagement in the present intervention.\u003c/p\u003e \u003cp\u003eStudents who were particularly unengaged during the activities were also hesitant to share their work during the weekly discussion. Considering that students who attend this after-school program come from unstable homes and face a variety of challenges, it is likely that those who were hesitant to share lacked confidence; an important aspect of self-esteem, which can be inhibited by low socioeconomic status (Yuan et al., \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), family functioning, and parenting (Shaheen et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Indeed, family functioning has been shown to have an indirect effect on adolescents\u0026rsquo; behaviour problems via self-esteem (Shaheen et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). To encourage participation during the weekly discussion periods, members of the research team in charge of leading the activities would share their own creation with the group. By contrast, those who felt positively during art-making were much more likely to share their art during discussion periods. This suggests that, within the context of group art-based interventions, comfort level and enjoyment of art influence feelings associated with art-making. Indeed, research amongst 5th graders regarding openness to creativity, which is implied through enjoyment of the arts, supports this notion (Theurer et al., \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Furthermore, participants\u0026rsquo; age appeared to have impacted art-making as the French 5th grade students appeared to be more open to creativity during art sessions than French 6th grade students. Specifically, as youth approach adolescence they become increasingly aware of what their peers think of them (Irani et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This increased sensitivity can act as motivation for youth to maintain positive relationships by acting in accordance with group norms and expectations (Irani et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Thus, older students may have been less willing to participate in art-making because they feared being judged by their peers.\u003c/p\u003e \u003cp\u003eAt various points of the intervention, students ignored the weekly theme and instructions provided, neglecting to give their full effort into the activity. Students may have approached art-making in this manner because they felt that the activities were not catered to their needs or what they felt was important. Indeed, the intervention may have met the needs of some students, but not all. The intervention was co-created alongside the program coordinators, in that they elaborated on the unique lives and perceived needs of the students. Despite this, neglecting student voices in the creation of the intervention appears to have impacted participation. Regardless of the increase in youth-led movements, which demonstrate their capacity for orchestrating change, existing community-based research does not typically consider youth as full community partners (Bettencourt, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Merves et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Youth are typically excluded from the research process because our prevailing views, policies, and practices regarding youth are deficit-focused (Teixeira et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A barrier to youth participation in research is adultism, which is \u0026ldquo;a lack of pro-child social norms that includes negative attitudes about youth, laws that delegitimize youth, and youth internalizing these negative beliefs\u0026rdquo; (Teixeira et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, p. 143). Indeed, what is considered healthy youth development has been defined by adult \u0026ldquo;experts\u0026rdquo; rather than by, or in collaboration with, youth themselves (Langhout \u0026amp; Thomas, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Teixeira et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Adultism can be combatted by identifying youth in research in a manner that gives them agency and respects their ability to contribute (Teixeira et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), rather than limiting them to their age or lack of experience (Bettencourt, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Existing youth community-based participatory research which provides youth with a leading role in the research process has found that partnering with youth can enhance the success and sustainability of adolescent health interventions (Merves et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eChallenges impacting art-making\u003c/h2\u003e \u003cp\u003eAs mentioned, the primary factors which impeded art-making included lack of time and poor student behaviour. Indeed, in this study, time was a major constraint. As the weeks went on, observational data showed that some students would rush through activities because they feared they would lack sufficient time to complete their creation. This led them to put lesser effort into the activities. Additionally, these students would typically begin their homework after the artistic activities and some felt particularly anxious about having enough time to complete their homework. Indeed, anxiety surrounding students\u0026rsquo; homework appears to have negatively impacted participation in the intervention. Noteworthy, this did not necessarily translate into them disliking the intervention. Considering that those who attend this after-school program are those who face the most difficulty, be it in their family lives and/or academically, it was interesting to see that many students wanted to hurry through the activities so that they could do homework; an activity in which most young students dislike and avoid. Although this could be interpreted as rushing through the art activities, we argue that this behaviour was in fact rushing \u003cem\u003eto\u003c/em\u003e homework. The reason for this stance being that students are guaranteed help with their homework at this after-school program, and they may not receive the same support at home. Another possible explanation is that students may have wanted to complete their homework so that they no longer had to stress about doing it. Holland et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), who investigated the non-academic impact of homework for youth in grades 3\u0026ndash;6, found that increasing academic demands is correlated with various challenges for youth, such as worsened well-being, sleep, emotional health, and parent/child relationships. Although art-based interventions with youth have often been administered in academic settings (e.g., Forrest-Bank et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Sutherland et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Malboeuf-Hurtubise et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), perhaps a different setting where students are removed from academic pressures would improve student engagement.\u003c/p\u003e \u003cp\u003eBy contrast to those who rushed, students who took their time and enjoyed the workshops felt as though they did not have enough time to complete each session. Our research team often had to hurry through describing each activity and its theme so that students could have enough time for art-making. However, this cohort of students were further impeded by those who did not wish to take part in the activity, or who chose to rush through it, as they were particularly disruptive during sessions. Overall, approximately ten minutes of every twenty-five minute session was dedicated towards settling the group down so that we could conduct the activity. Generally, art-based interventions with youth are no shorter than forty-five minutes (e.g., Kim et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Boaz \u0026amp; Bat-Or, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Malboeuf-Hurtubise et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), further solidifying the challenge posed by limited time in this project. Nonetheless, the majority of participants, even with limited weekly time devoted to artistic creation, reported a positive impact on their well-being and mental health.\u003c/p\u003e \u003cp\u003eStudent behaviour was arguably the most challenging aspect of this project, namely with regards to hyperactivity and impulsivity. Considering the context of our population, it is very possible that some had psychological disorders or were malnourished, although we did not compile this data in the current study. Indeed, students were provided with a healthy snack upon arrival to the after-school program to aid in mitigating potential malnourishment. Moreover, it is important to emphasize that these sessions took place directly after a full day of school, where students had been required to give their complete attention for hours on end. Naturally, it can be challenging to gain the attention of a large group of students, but this task can be exacerbated when they have just spent a full day at school.\u003c/p\u003e \u003cp\u003eFurthermore, some students expressed having difficulty determining what to create because they either lacked inspiration or felt embarrassed about participating in the activity. We attribute lacking inspiration partially to time restraints, as students were not given much time to consider what they wanted to create. However, embarrassment about art-making can likely be explained by the group dynamic between the students. Specifically, students tended to make fun of one another and joke around, making those who took the intervention seriously uncomfortable to describe their art with full transparency. This idea was supported through feedback received in individual interviews, where many students were much more vulnerable than they were with the group. Indeed, childhood bullying and victimization have negative implications on the mental health and well-being of youth (Hong et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Research has also shown that programs should aim to both reduce bullying and improve connectedness to one\u0026rsquo;s school, as focusing on only risk or protective factors of youth well-being - and not both - may be ineffective (Dow-Fleisner et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Moreover, Yan et al. (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), who conducted art therapy with children in rural China, found that art therapy effectively reduced childrens\u0026rsquo; vulnerability to bullying. Indeed, art-based interventions have been found to increase empathy and emotional awareness in middle and high school students (Morizio et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). As such, future art-based interventions should aim to create a positive, supportive environment amongst students by including themes such as mutual respect, anti-bullying, and empathy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eFuture directions\u003c/h2\u003e \u003cp\u003eConsidering the feedback students provided and the challenges that emerged during this work, future research should further investigate the importance of the therapeutic alliance in youth community- and art-based participatory research, particularly how the age of the facilitator can enhance rapport. Moreover, future works should aim to investigate the effectiveness of varying artistic mediums versus varying the theme of the creation, as our participants\u0026rsquo; perceptions of the activities were typically determined by the activity\u0026rsquo;s medium, rather than theme. Interestingly, many students\u0026rsquo; least favourite activity was also the one they were most proud of. Further research is needed to understand how art-based interventions, although sometimes unenjoyable, can have positive implications through pushing personal limits. Despite the time constraints we faced, future art-based research amongst youth populations should aim to ensure students\u0026rsquo; understanding of the activities and allow for suitable time, at least forty-five minutes, for art-making. Future interventions should also address both risk and protective factors of youth well-being, as previous research demonstrates that the atmosphere during art-making can have an impact on the intervention outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding details:\u003c/strong\u003e This research was supported by the Social Sciences and Humanities Research Council\u0026rsquo;s Canada Graduate Scholarship - Master\u0026rsquo;s Program (CGS M). This funding source had no involvement in the conduct of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatements and Declarations:\u0026nbsp;\u003c/strong\u003eWe have no known conflicting interests to disclose.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eK.S. wrote the manuscript text. C.M., A.M., and T.LG. edited and reviewed the manuscript. J.P. and M.B., significantly contributed to data collection and analysis.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments:\u003c/h2\u003e\n\u003cp\u003eWe would like to thank the students and staff of the partnering program for their trust, time, and participation in this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: This submission is intended for the BMC Psychology special issue: Cross-national research and practice evidence for mental health interventions in diverse educational contexts.\u003c/p\u003e\n\u003ch2\u003eData availability:\u003c/h2\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author, KS. 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An updated evaluation of the dichotomous link between creativity and mental health. \u003cem\u003eFrontiers in Psychiatry\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyt.2021.781961\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2021.781961\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"youth, art-based interventions, mental health, well-being, community-based participatory research","lastPublishedDoi":"10.21203/rs.3.rs-4546165/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4546165/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eChildren in rural communities represent some of the most vulnerable populations in Canada, posing implications for their mental health and well-being, particularly regarding their access to mental health services. Art-based interventions are accessible, but not thoroughly validated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003eThe purpose of this project was to offer an art-based intervention for a very specific population benefiting from an after-school program in rural Quebec.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Youth in Quebec, Canada, took part in a 7-week art-based intervention. A descriptive design was implemented to examine the implications this intervention had on students, particularly their mental health and well-being.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe majority of students described enjoying the intervention, many stating it had a positive impact on their lives. Students reported feeling positively during art-making and expressed interest in taking part in follow-up research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e Positive experiences with the present intervention support existing literature regarding the effectiveness of art-based methods for youth populations.\u003c/p\u003e","manuscriptTitle":"Promoting the mental health and well-being of vulnerable youth through art: A descriptive qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-27 03:48:31","doi":"10.21203/rs.3.rs-4546165/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-12T07:15:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-12T05:30:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-12T00:45:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2024-06-07T12:39:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"84c7f3f8-15e6-4a5e-9146-88b3addfddbc","owner":[],"postedDate":"June 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-10T20:01:11+00:00","versionOfRecord":{"articleIdentity":"rs-4546165","link":"https://doi.org/10.1186/s40359-025-02476-8","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2025-03-03 15:58:23","publishedOnDateReadable":"March 3rd, 2025"},"versionCreatedAt":"2024-06-27 03:48:31","video":"","vorDoi":"10.1186/s40359-025-02476-8","vorDoiUrl":"https://doi.org/10.1186/s40359-025-02476-8","workflowStages":[]},"version":"v1","identity":"rs-4546165","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4546165","identity":"rs-4546165","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}