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Kia H, Kenney KA, Abramovich A, Ferlatte O, MacKinnon KR, Knight R. "Nowhere else to be found": Drawing on peer support experiences among transgender and gender-diverse people to substantiate community-driven gender-affirming care. Soc Sci Med 2023; 339:116406. [PMID: 37979491 DOI: 10.1016/j.socscimed.2023.116406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
Increasingly, applied social scientists and clinicians recognize the value of engaging transgender and gender-diverse (TGD) people, particularly TGD individuals with lived experience as care recipients (peers), to inform the provision of gender-affirming care. Despite this trend, few researchers have systematically examined how this group can contribute to and enhance the development and delivery of interventions intended to affirm gender diversity. In this article, we address limitations in the literature by drawing on a secondary analysis of qualitative data - originally collected to examine the peer support experiences of TGD individuals - to explore the potential that TGD peers hold for elevating gender-affirming care. The study was informed methodologically by an abductive approach to grounded theory, and conceptually by critical resilience and intersectional scholarship. Data collection involved virtual, semi-structured interviews with 35 TGD individuals in two Canadian cities who indicated having experiences of seeking, receiving, and/or providing peer support. Data analysis comprised an iterative, abductive process of cross-referencing participant accounts with relevant scholarship to arrive at an account of how TGD peers may contribute to the growth of gender-affirming care. Our findings suggest, broadly, that TGD peers may enhance gender-affirming care by: (1) validating a growing diversity of embodiments and experiences in healthcare decision-making, (2) nurturing and diversifying relevant networks of safety, community support, and advocacy outside formal systems of care, and (3) strengthening possibilities for resisting and transforming existing healthcare systems. After outlining these findings, we briefly consider the implications of our analysis and leverage our inferences to substantiate the notion of community-driven gender-affirming care, meaning care that is intentional in its incorporation of relevant community stakeholders to shape governance and service provision. We conclude with reflections on the promise of community-driven care at a time of heightened volatility across systems serving TGD populations.
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Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, Canada.
| | - K A Kenney
- School of Social Work, The University of British Columbia, Canada
| | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | | | | | - Rod Knight
- École de Santé Publique, Université de Montréal, Canada
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Reynish TD, Hoang H, Bridgman H, Easpaig BNG. Kink-Oriented People and Exogenous Oppressions: Understanding Mental Health and Related Service Use in a Rural Context. JOURNAL OF HOMOSEXUALITY 2023; 70:1479-1502. [PMID: 35113001 DOI: 10.1080/00918369.2022.2036531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Rural, kink-oriented people experience much exogenous oppression and yet related research is scarce. This study examined the risk and protective factors of kink-oriented rural Tasmanian Australians with preexisting mental health conditions and help-seeking barriers and facilitators. Participants completed either an online survey (n = 42), an interview (n = 10), or both. Thematic analysis and descriptive statistics were used to analyze the qualitative and quantitative data, respectively. Participants aged 18 to 61 were gender and sexually diverse and better educated but had more lifetime suicide attempts than the general public. Despite the increasing normalization of kink, 90.5% of participants have never seen a kink-aware mental health professional (MHP) and nearly 83.0% did not disclose to an MHP for fear of stigma or discrimination. Self-awareness, resilience, social support and kink improved participants' mental health. Tailored support from trained MHP is vital to improve the mental health of kink-oriented people in rural areas.
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Affiliation(s)
- Tamara D Reynish
- Centre for Rural Health, College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Ha Hoang
- Centre for Rural Health, College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Heather Bridgman
- Centre for Rural Health, College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Bróna Nic Giolla Easpaig
- Centre for Healthcare Resilience & Implement Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Matthews EB, Rahman R, Schiefelbein F, Galis D, Clark C, Patel R. Identifying key roles and responsibilities of peer workers in behavioral health services: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 114:107858. [PMID: 37348313 DOI: 10.1016/j.pec.2023.107858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/18/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE The roles and responsibilities of peer workers (PWs) are not well articulated. This scoping review aims to systematically identify and describe the roles of PWs in outpatient, community based mental health and substance use services, and compare their roles and responsibilities across these service settings METHODS: The scoping review was a priori developed and implemented according to the Joanna Briggs Institute methodology, which includes stating the review objectives, conducting a three-step search method, and charting the results. RESULTS Forty-four peer reviewed manuscripts were included in the review. PWs were used more often in mental health (n = 27) than substance use (n = 10) programs. Peers adopted a wide range of skills. Across program contexts, peers were frequently used as a source of informal support or mentorship and care coordination. Mental health programs often used peers to deliver manualized interventions, while substance use programs more frequently leveraged PWs to facilitate service linkage and engagement. CONCLUSION Roles of peers differed between substance use and mental health programs, reflecting significant diversity in how peers are being integrated into the behavioral health workforce. PRACTICE IMPLICATIONS Peer certification programs must balance consistency with the wide range of skills required of this workforce.
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Affiliation(s)
- Elizabeth B Matthews
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA.
| | - Rahbel Rahman
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Faith Schiefelbein
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Danielle Galis
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Carson Clark
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Rupal Patel
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
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Reynish T, Hoang H, Bridgman H, Nic Giolla Easpaig B. Barriers and enablers to mental health help seeking of sexual, gender, and erotic minorities: A systematic literature review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2036666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tamara Reynish
- Centre for Rural Health, College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Ha Hoang
- Centre for Rural Health, College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Heather Bridgman
- Centre for Rural Health, College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Bróna Nic Giolla Easpaig
- Centre for Healthcare Resilience & Implement Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Foss L, Brown SA, Sutherland S, Miller CJ, Philliber S. A randomized controlled trial of the impact of the Teen Council peer education program on youth development. HEALTH EDUCATION RESEARCH 2022; 37:36-47. [PMID: 35134906 DOI: 10.1093/her/cyac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 01/07/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
This paper presents results of an impact evaluation of Teen Council, a program that trains youth as peer educators. Teen Council is designed to help peer educators make healthy sexual and reproductive decisions, increase their confidence and abilities to educate their peers and inspire them to advocate for just sexual policies. The program's impact on these educators was evaluated using a randomized controlled trial. Over 5 years, interested high school students in seven states were randomly assigned to a study condition. An intent-to-treat framework using ordinary least square (OLS) regression was employed to measure program effects. Relative to control, Teen Council youth showed enhanced comfort with their own sexuality, greater comfort with and more frequent communication with parents about sexuality and more positive sexual health behaviors, including accessing reproductive health care and adopting more effective means of contraception. Teen Council youth also reported greater confidence in talking with peers about sexuality and more confidence in their civic engagement skills.
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Affiliation(s)
- L Foss
- Philliber Research & Evaluation, 16 Main Street, Accord, NY 12404, USA
| | - S A Brown
- Philliber Research & Evaluation, 16 Main Street, Accord, NY 12404, USA
| | - S Sutherland
- Planned Parenthood of the Great Northwest and the Hawaiian Islands, 2001 E. Madison, Seattle, WA 98122, USA
| | - C J Miller
- Planned Parenthood of the Great Northwest and the Hawaiian Islands, 2001 E. Madison, Seattle, WA 98122, USA
| | - S Philliber
- Philliber Research & Evaluation, 16 Main Street, Accord, NY 12404, USA
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Ellis AE, Martino S, Simiola V, Mackintosh MA, Bellamy C, Cook JM. Study design and interventions for a peer-delivered motivational interviewing group treatment for sexual and gender minority male sexual trauma survivors. Contemp Clin Trials 2021; 111:106597. [PMID: 34653650 DOI: 10.1016/j.cct.2021.106597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Sexual abuse of boys and men is a public health problem that has received relatively little attention from clinical scholars and researchers. Given unique pathways for development of and recovery from trauma-related emotional distress, sexual abuse survivors who identify as men may require distinct psychosocial interventions to engage in formal mental health care and assist in symptom reduction. This paper describes the rationale for and methodology of a randomized controlled trial comparing the effectiveness of Motivational Interviewing (MI) versus MI with affirmative care (MI-AC) for sexual and gender minority men who have been sexually traumatized. This study is designed to randomly assign 356 participants to either condition of six online group sessions delivered by two trained peers with lived experience of sexual trauma. Assessments will be conducted at baseline, post-treatment, 60- and 120-day follow-up. The primary hypotheses are that participants assigned to MI-AC, compared to those in MI only, will report reduced symptoms of depression and increased levels of engagement in formal mental health treatment. Additional hypotheses relate to secondary outcome variables, including post-traumatic stress disorder, suicidality, and substance use.
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Affiliation(s)
- Amy E Ellis
- Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Steve Martino
- Yale School of Medicine, New Haven, CT, United States of America; VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Vanessa Simiola
- Kaiser Permanente, Center for Health Care Research, Honolulu, HI, United States of America
| | | | - Chyrell Bellamy
- Yale School of Medicine, New Haven, CT, United States of America
| | - Joan M Cook
- Yale School of Medicine, New Haven, CT, United States of America
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Bettergarcia J, Wedell E, Shrewsbury AM, Thomson BR. “There’s a stopgap in the conversation”: LGBTQ + mental health care and community connection in a semi-rural county. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2021. [DOI: 10.1080/19359705.2021.1900973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jay Bettergarcia
- Department of Psychology and Child Development, California Polytechnic State University, San Luis Obispo, California, USA
| | - Emma Wedell
- Department of Psychology, College of William and Mary, Williamsburg, Virginia, USA
| | | | - Bonnie Rose Thomson
- Department of Psychology and Child Development, California Polytechnic State University, San Luis Obispo, California, USA
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Huang YT, Ma YT, Craig SL, Wong DFK, Forth MW. How Intersectional Are Mental Health Interventions for Sexual Minority People? A Systematic Review. LGBT Health 2020; 7:220-236. [PMID: 32412864 DOI: 10.1089/lgbt.2019.0328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: Complex and widespread stigma exposes sexual minority people to disproportionate risks for adverse mental health. Intersectionality theory calls for consideration of the unique experiences of living with multiple forms of inequality. Yet, concerns remain regarding the extent to which intersectionality theory has been integrated into mental health interventions for sexual minority populations. This systematic review aims to assess the degree to which available mental health interventions account for intersecting forms of marginalization and to identify methods that facilitate the application of intersectionality. Methods: A search for peer-reviewed English language journal articles was conducted using PsycINFO and PubMed to locate reports of mental health interventions for sexual minority groups. A coding framework was designed to evaluate how interventions incorporated intersectionality theory. Results: Of 1877 potentially eligible articles, forty-three were included in the analysis. They were each classified as low, medium, or high with regard to intersectionality. Thirteen (30.2%) were rated as low on intersectionality for only recruiting a homogeneous group of participants in the interventions; 23 (53.4%) were classified as medium for including additional identities in recruitment without responding to possible intersectional disadvantages; 7 (16.3%) were rated as high with adequate consideration of the complex effects of intersecting positions. In addition, the review identified community-based participatory research as a common and instrumental method to ensure intersectionality. Conclusions: This review highlights the limitations of interventions for sexual minority people in addressing intersectionality. Guidelines are needed for clinical practice and evaluation to adequately incorporate intersectionality theory.
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Affiliation(s)
- Yu-Te Huang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yuk Tung Ma
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Daniel Fu Keung Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Marty W Forth
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
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Willging C, Gunderson L, Shattuck D, Sturm R, Lawyer A, Crandall C. Structural competency in emergency medicine services for transgender and gender non-conforming patients. Soc Sci Med 2018; 222:67-75. [PMID: 30605801 DOI: 10.1016/j.socscimed.2018.12.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/20/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022]
Abstract
In this formative qualitative research, we draw upon the concepts of structural vulnerability and structural competency to examine how transgender and gender non-conforming (TGGNC) patients and healthcare personnel experience service delivery in Emergency Departments (EDs), and how this experience can be improved upon. Between October 2016 and June 2017, we undertook 31 semi-structured interviews with TGGNC patients (n = 11) and physicians (n = 6), nurses (n = 7), and non-clinical staff (n = 7) in four community-based EDs in New Mexico. Our iterative coding and analysis process resulted in eight sets of findings: (1) reasons why TGGNC patients seek care from EDs; (2) perceptions about and experiences of TGGNC patients; (3) relevance of gender identity and sex at birth; (4) bureaucracy and communication; (5) spatial considerations; (6) preparing providers and staff to care for TGGNC patients; (7) the lack of resources for structural prescriptions; and (8) respect, humanity, and sameness. Findings suggest that structural issues adversely impact the health and wellbeing of TGGNC patients and service-delivery practices in the ED. We describe study implications for training ED personnel and modifying this practice setting to prevent delayed care and ensure appropriate services for TGGNC patients in need of structurally competent emergency medicine.
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Affiliation(s)
- Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Lara Gunderson
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Daniel Shattuck
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Robert Sturm
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; New Mexico Community AIDS Partnership, 903 West Alameda #764, Santa Fe, NM, 87501, USA.
| | - Adrien Lawyer
- Transgender Resource Center of New Mexico, 149 Jackson Street, NE, Albuquerque, NM, 87108, USA.
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico, MSC11-6025, 700 Camino de Salud, Albuquerque, NM, 87131, USA.
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