Sexual orientation and cognition in aging populations: Results from the Canadian Longitudinal Study on Aging

The current study utilized the Canadian Longitudinal Study on Aging (CLSA) data to investigate the relationship between sexual orientation and cognitive health of the aging population. Cognitive flexibility and verbal fluency were examined as outcome variables in the study. A total of 45,993 respondents were included in the analyses. Each model had social support or social participation as a mediator. A series of mediation analysis, stratified by gender, revealed that aging gay men performed better in cognitive tasks related to cognitive flexibility when compared to their heterosexual counterparts. The results also indicated that social support is a protective factor for cognitive health in aging lesbian women. This study provides an opportunity to consider how clinical and social services can strategize to build inclusive environments for the aging sexual minority population.

Impact of Neighborhood Deprivation on Aging Sexual Minority People's Depression: Results from the CANUE and CLSA data

As the aging population grows across the world, exploring the impact of social environment on minority populations' aging and well-being would be an essential step towards building an inclusive society. Using the Canadian Longitudinal Study on Aging (CLSA) and Canadian Urban Environmental Health Research Consortium (CANUE) data, the study investigated the relationship between deprivation and depression level in aging sexual minority people to examine how neighborhood level social and material deprivation influence mental health. 48,792 survey respondents were included in our analyses and the average age was 62.9. The study had 47,792 heterosexual, 760 gay/lesbian, and 240 bisexual individuals (23,977 men and 24,815 women). Regression analyses were conducted while controlling for age in each model. Results revealed that neighborhood material deprivation has a significant impact on mental health outcomes of aging lesbian women and bisexual men. The study provides an opportunity for intervention considerations for materially deprived neighborhoods to serve the aging sexual minority people residing in such areas.

Emotions, Agency, and Materiality: Embodiment of Homophobic Discrimination Amongst Mexican LGBTQ+ Youth

Embodiment refers to understanding the body as the object and subject of culture, a process that allows an understanding of political, cultural, social, and emotional processes in the assemblage of a particular identity. We describe a qualitative-narrative study utilizing focus groups and interviews in three Mexican cities with 75 LGBTQ+ youth to understand the effects of discrimination and how this impacts subjectivity through embodied affection. Through axial and line-by-line analysis, we describe the process of embodiment through four dimensions: violence, emotions, agency, and materiality. Violence operates as the sediment for LGBTQ+ youth's subjective, social, and political life, and paves the way for particular emotions, such as guilt, shame, fear, sadness, and pain, that directly relates to material aspects such as gender expression and body presentation, beauty standards and a discourse around perversion and promiscuity. Finally, the combination of emotions and materiality prove relevant for certain expressions of agency and resilience.

Perceived Social Support and Mental Health Indicators of a Mexican LGBT Sample During the COVID-19 Pandemic

The COVID-19 pandemic created mental health challenges for LGBTQ + communities worldwide, however there is a paucity of research on Mexican populations. Existing data show that LGBTQ + people in Mexico experience acute forms of violence and discrimination that impact their mental health. This article explores the relationship between social support, discrimination, and mental health for LGBTQ + populations in Mexico (N = 1525) during the COVID-19 lockdown. Utilizing social media recruitment strategies, participants answered an online survey exploring five mental health indicators: depression, anxiety, stress, suicidal ideation, and suicide attempt during lockdown. Mediating, and multiple regression analyses revealed that neuroticism is the most important variable in predicting poor mental health, and that perceived social support plays a mediating role in the case of depression. Discomfort with one's own family holds positive correlations with mental health indicators, showing that the greater the discomfort, higher levels of depression, anxiety, stress, and suicidal ideation. Results also showed that discrimination, and drug use hold significant relationships to suicidal attempt. Practice recommendations for Mexican LGBTQ + communities are offered.

Assessing the Fidelity of an Affirmative Cognitive Behavioral Group Intervention

PURPOSE

Support implementation fidelity in intervention research with lesbian, gay, bisexual, transgender, queer, and sexual and gender diverse (LGBTQ+) populations, this study explores the systematic development of a fidelity process for AFFIRM, an evidence-based, affirmative cognitive behavioral therapy group intervention for LGBTQ+ youth and adults.

METHOD

As part of a clinical trial, the AFFIRM fidelity checklist was designed to assess clinician adherence. A total of 151 audio-recorded group sessions were coded by four trained raters.

RESULTS

Adherence was high with a mean fidelity score of 84.13 (SD = 12.50). Inter-rater reliability was 81%, suggesting substantial agreement. Qualitative thematic analysis of low-rated sessions identified deviations from the manual and difficulties in group facilitation, while high-rated sessions specified affirmative and effective clinical responses.

DISCUSSION

Findings were integrated into clinical training and coaching. The fidelity process provides insights into the challenges of implementing social work interventions effectively with LGBTQ+ populations in community settings.

Processes and Manifestations of Digital Resilience: Video and Textual Insights From Sexual and Gender Minority Youth

Minority stressors harm sexual and gender minority youth (SGMY). This may be mitigated by promotive and protective factors and processes that manifest resilient coping. SGMY increasingly interact with information communication technologies (ICTs) to meet psychological needs, yet research often problematizes youths’ ICT use, inhibiting understanding about ICTs’ potential resilience-enhancing utilities. This study analyzes text and video responses of 609 SGMY aged 14 to 29 residing in Canada or the United States to an open-ended survey question about the benefits of using ICTs. Constructivist grounded theory integrating multimodal coding was used to analyze the data, producing a framework of digital resilience—digital processes and actions that generate positive growth—with four themes: Regulating Emotions and Curating Microsystems; Learning and Integrating; Advocating and Leading; and Cultivating Relationships and Communities of Care. Implications for clinical practice, survey innovation, and application of findings in fostering affirming digital microsystems for SGMY are discussed.

Experiences of COVID‐19 pandemic‐related stress among sexual and gender minority emerging adult migrants in the United States

There is a dearth of research that examines COVID-19-related stress among multiply marginalised individuals who are in the developmental phase of emerging adulthood. This qualitative study investigated how the intersection of emerging adulthood, sexual and gender minority (SGM) identity, and migrant status were reflected in the experiences of SGM individuals (n = 37; ages 20-25 years old) who migrated to various parts of the United States in the last 5 years. Data were collected online using semi-structured interviews. Thematic analysis revealed that participants' developmental processes (e.g., identity exploration, building financial independence) were shaped by pandemic-related stressors, especially unemployment and financial instability. Participants who were able to maintain employment did so but at the risk of their health and safety. Findings also showed that participants experienced feelings of anxiety and depression due to social isolation, but online communication played an important role in combatting loneliness. Findings highlight the potential for trauma-informed and intersectional approaches to practice with SGM emerging adult migrants and expanded health services and temporary entitlement programs to mitigate the pandemic's effects on this population's psychosocial and financial well-being.

Cultural consideration for cognitive-behavioural therapy for sexual minority young people in Chinese societies: Perspectives from practitioners and target users

Although cognitive-behavioural therapy has demonstrated effectiveness in improving mental health outcomes for sexual minority young people (SMYP), existing interventions are primarily designed and evaluated in Western contexts, and their acceptability and responsiveness to culturally relevant issues in the Chinese contexts is uncertain. This study aimed to address this gap by exploring how a manualised community-based cognitive-behavioural intervention (AFFIRM) could be culturally reconsidered for SMYP in Taiwan and Hong Kong and suggest recommendations for future adaptation. Following an empirical, community-based participatory approach, qualitative data were collected between August and September 2018 through five focus groups with 15 SMYP and 18 frontline practitioners in Taiwan and Hong Kong. Thematic analysis revealed that at the surface structural level, translation and examples, and promotion strategies can be fine-tuned to better fit the Chinese context. On the deep structural level, self-differentiation and a pragmatic plan to come out to parents were identified as two concerns of cultural importance for Chinese SMYP. This study exemplifies an empirical, collaborative approach to identifying areas of cultural adaptation for mental health intervention for SMYP in the Chinese cultural milieu. The rationale and strategy for adapting existing intervention protocols to accommodate divergent cultural values are described.

Demonstrating LGBTQ+ Affirmative Practice in Groups:: Developing Competence through Simulation-Based Learning

Lesbian, gay, bisexual, transgender, queer, and other sexual and/or gender minority (LGBTQ+) populations experience significant mental and behavioral health disparities. Social workers are uniquely positioned to address these vulnerabilities. However, clinical graduate education has not effectively promoted or taught competent practice with LGBTQ+ populations. This qualitative study details the foundational competencies required for affirmative practice in group therapy with LGBTQ+ populations and describes a simulation-based learning activity designed to develop these competencies in graduate students. The following themes were identified as critical to affirmative practice, as identified through student reflections on their simulation-based learning experiences: deeply engaging in a strengths-based stance, keeping the group in group therapy, avoiding the expert trap, and managing identity assumptions. Implications for clinical social work education and practice are discussed.

Riding the wave: pandemic social work in hospitals

The COVID-19 pandemic significantly impacted social work practice globally. Using a cross-sectional survey, we examined the experiences of hospital social workers (N = 230) in Ontario, Canada during the second wave of the pandemic. Nearly three quarters (73%) of respondents reported workload changes, and 82% had increased responsibilities due to patient care demands. Hospital social workers adapted and made an important contribution to health care during the pandemic by employing virtual resources, supporting interprofessional colleagues, focusing on advocacy, and providing mental health and trauma-focused care. They sought educational opportunities and contributed to the development of procedures. Recommendations to strengthen hospital pandemic social work practice are provided.

Cannabis use among youth in Canada: a scoping review protocol

INTRODUCTION

Canadian youth (aged 15-24) have the highest rates of cannabis use globally. There are increasing concerns about the adverse effects of cannabis use on youth physical and mental health. However, there are gaps in our understanding of risks and harms to youth. This scoping review will synthesise the literature related to youth cannabis use in Canada. We will examine the relationship between youth cannabis use and physical and mental health, and the relationship with use of other substances. We will also examine prevention strategies for youth cannabis use in Canada and how the literature addresses social determinants of health.

METHODS AND ANALYSIS

Using a scoping review framework developed by Arksey and O'Malley, we will conduct our search in five academic databases: MEDLINE, Embase, APA PsycInfo, CINAHL and Web of Science's Core Collection. We will include articles published between 2000 and 2021, and articles meeting the inclusion criteria will be charted to extract relevant themes and analysed using a qualitative thematic analysis approach.

ETHICS AND DISSEMINATION

This review will provide relevant information about youth cannabis use and generate recommendations and gaps in the literature. Updated research will inform policies, public education strategies and evidence-based programming. Results will be disseminated through an infographic, peer-reviewed publication and presentation at a mental health and addiction conference. Ethics approval is not required for this scoping review.

Suicidality Among Transgender Youth: Elucidating the Role of Interpersonal Risk Factors

Data indicate that 82% of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth. Using minority stress theory and the interpersonal theory of suicide, this study aims to better understand suicide risk among transgender youth. The present study examines the influence of intervenable risk factors: interpersonal and environmental microaggressions, internalized self-stigma, and adverse childhood experiences (ACEs), and protective factors: school belonging, family support, and peer support on both lifetime suicide attempts and past 6-month suicidality in a sample of transgender youth (n = 372). SPSS 22 was utilized to examine the impact of the independent variables on both suicidality and lifetime suicide attempt through two separate logistic regressions. Fifty six percent of youth reported a previous suicide attempt and 86% reported suicidality. Logistic regressions indicated that models for both lifetime suicide attempts and suicidality were significant. Interpersonal microaggressions, made a unique, statistically significant contribution to lifetime suicide attempts and emotional neglect by family approached significance. School belonging, emotional neglect by family, and internalized self-stigma made a unique, statistically significant contribution to past 6-month suicidality. Results have significant practice and policy implications. Findings offer guidance for practitioners working with parents and caregivers of trans youth, as well as, for the creation of practices which foster interpersonal belonging for transgender youth.

Preparing social workers to address health inequities emerging during the COVID-19 pandemic by building capacity for health policy: a scoping review protocol

INTRODUCTION

The COVID-19 pandemic has brought tremendous changes in healthcare delivery and exacerbated a wide range of inequities. Social workers across a broad range of healthcare settings bring an expertise in social, behavioural and mental healthcare needed to help address these health inequities. In addition, social workers integrate policy-directed interventions and solutions in clinical practice, which is a needed perspective for recovery from the COVID-19 pandemic. It remains unclear, however, what the most pressing policy issues are that have emerged during the COVID-19 pandemic. In addition, many social workers in health settings tend to underuse policy in their direct practice. The objectives of this scoping review are to: (1) systematically scope the literature on social work, COVID-19 pandemic and policy; and (2) describe the competencies required by social workers and the social work profession to address the policy issues emerging during the COVID-19 pandemic.

METHODS AND ANALYSIS

The scoping review follows Arksey and O'Malley's five-stage framework. Identification of literature published between 1 December 2019 and the search date, 31 March 2021, will take place in two stages: (1) title and abstract review, and (2) full-text review. In partnership with a health science librarian, the research team listed keywords related to social work and policy to search databases including Medline, Embase, PsycINFO, CINAHL, Social Services Abstract and Social Work Abstracts. Two graduate-level research assistants will conduct screening and full-text review. Data will then be extracted, charted, analysed and summarised to report on our results and implications on practice, policy and future research.

ETHICS AND DISSEMINATION

Results will help develop a policy practice competence framework to inform how social workers can influence policy. We will share our findings through peer-reviewed publications and conference presentations. This study does not require Research Ethics Board approval as it uses publicly available sources of data.

The Self-Identification, LGBTQ+ Identity Development, and Attraction and Behavior of Asexual Youth: Potential Implications for Sexual Health and Internet-Based Service Provision

While often included in the spectrum of sexual minority identities, asexuality receives comparatively little attention. Awareness and understanding remains limited, and knowledge has been generated primarily from adult populations. This paper employs a sample of 711 self-identified asexual youth (aged 14-24, M = 17.43 years) who identified as members of the LGBTQ+ community to consider the implications of a number of different areas for service provision. Two-thirds (66.8%) of participants identified as gender minorities within the spectrum of transgender and non-binary identities. Findings include aspects of participants' LGBTQ+ developmental processes, including that only 14.3% had disclosed their LGBTQ+ status to everyone in their lives. However, just 2.4% had disclosed to no one. Their attraction and sexual activity were also explored, with 27.1% having never experienced any kind of romantic or sexual attraction and 20.6% having ever been sexually active. Findings regarding participants' accessing of LGBTQ+ health information and engagement in a range of offline and online LGBTQ+ community activities are also provided. Participants acquired more health information online than offline-including sexual health information. Recommendations for service provision, particularly implications for sexual health and Internet-based services, are discussed.

Towards an integrative self: a digital photo elicitation study of resilience among key marginalized populations of sexual and gender minority youth

Purpose: Sexual and gender minority youth (SGMY) experience unique challenges related to identity and disclosure, and cope in vibrant ways. Qualitative research has not yet fulsomely explored the risk, resilience, and identity intersections that impact vulnerable SGMY wellbeing. Methods: This digital photo-elicitation study (QueerView) recruited thirty SGMY (aged 14–29) from priority populations that had one or more of the following experiences:  trans and gender diverse, homelessness, child welfare, and immigration. From submission of fifteen photos representing resilience and a semi-structured interview via web conferencing, constructivist grounded theory was utilized for multimodal analysis of photos, interview video, and interview transcript. Triangulation, an audit trail, and member checking were employed to support trustworthiness. Results: A visual model emerged showing how participants work towards an integrative self, with themes of reflecting and knowing, discrimination and intersectional challenges, connecting, performing, curating, coping, (re)defining and (re)creating, growing and being. Sub-themes of the impact of family dynamic and values, mental health and trauma, and the cathartic benefit from advocacy and leadership offered insight. Participant images were captured in a digital gallery. Conclusions: QueerView animates the complex lives of multiply marginalized SGMY and their intersectional strengths and challenges while demonstrating the utility of a digital multimodal approach.

Comparison of independent and combined effects of the neurotensin receptor agonist, JMV-449, and incretin mimetics on pancreatic islet function, glucose homeostasis and appetite control

BACKGROUND

Neurotensin receptor activation augments the biosctivity of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). JMV-449, a C-terminal neurotensin-like fragment with a reduced peptide bond, represents a neurotensin receptor agonist.

METHODS

The present study assessed the actions of JMV-449 on pancreatic beta-cells alone, and in combination with GIP and GLP-1. Further studies examined the impact of JMV-449 and incretin mimetics on glucose homeostasis and appetite control in mice.

RESULTS

JMV-449 was resistant to plasma enzyme degradation and induced noticeable dose-dependent insulin-releasing actions in BRIN-BD11 beta-cells. In combination with either GIP or GLP-1, JMV-449 augmented (P < 0.05) the insulinotropic actions of both hormones, as well as enhancing (P < 0.001) insulin secretory activity of both incretin peptides. JMV-449 also increased beta-cell proliferation and induced significant benefits on beta-cell survival in response to cytokine-induced apoptosis. JMV-449 (25 nmol/kg) inhibited (P < 0.05-P < 0.001) food intake in overnight fasted lean mice, and enhanced (P < 0.01) the appetite supressing effects of an enzymatically stable GLP-1 mimetic. When injected co-jointly with glucose, JMV-449 evoked glucose lowering actions, but more interestingly significantly augmented (P < 0.05) the glucose lowering effects of established long-acting GIP and GLP-1 receptor mimetics. In terms of glucose-induced insulin secretion, only GIP receptor signalling was associated with increases in insulin concentrations, and this was not enhanced by JMV-449.

CONCLUSION

JMV-449 is a neurotensin receptor agonist that positively augments key aspects of the biological action profile of GIP and GLP-1.

GENERAL SIGNIFICANCE

These observations emphasise the, yet untapped, therapeutic potential of combined neurotensin and incretin receptor signalling for diabetes.

Trauma-informed and affirmative mental health practices with LGBTQ+ clients

People with diverse sexual orientations, gender identities, and gender expression are at greater risk for trauma, discrimination, and victimization than heterosexual and cisgender populations. Trauma-informed care (TIC) provides a framework for providing lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ +) mental health services. Substance Abuse and Mental Health Services Administration (SAMHSA)'s principles of TIC guide practitioners to create safety, trust, transparency, collaboration, and empowerment in helping relationships, and to ensure that services have cultural and gender relevance. This article first explores the role of trauma in contributing to behavioral health concerns presented by LGBTQ + clients. The application of TIC to mental health counseling and social services for LGBTQ + clients will then be described, with specific suggestions for translating TIC principles into affirmative practice. Through the lens of trauma, clinicians can improve clinical case conceptualization and effective treatment strategies for LGBTQ + clients. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adapting Clinical Skills to Telehealth: Applications of Affirmative Cognitive-Behavioral Therapy with LGBTQ+ Youth

Online social work services (e.g., telemental health; telebehavioral health; virtual care; telehealth) present significant opportunities for clinical social workers to provide effective care to marginalized populations, such as LGBTQ+ youth. The COVID-19 pandemic has led to an increased focus on telehealth, and while there are excellent resources to guide ethics, standards, and legal decisions (NASW, n.d.), there is less guidance in the literature to specifically inform the adaptation of offline clinical skills to telehealth, particularly for LGBTQ+ youth. To address this gap, we present examples from our experience offering AFFIRM, an affirmative cognitive behavioral therapy (CBT) group intervention now being delivered through telehealth. Specifically, this paper will: (a) describe the key considerations for the delivery of CBT via telehealth to youth; (b) detail specific clinical skills and strategies to enable successful online implementation; (c) describe the adaptation approach through a case study of cognitive restructuring with a transgender youth; (d) and offer specific guidance to support clinicians to adapt their clinical skills to the virtual environment.

AFFIRM Online: Utilising an Affirmative Cognitive-Behavioural Digital Intervention to Improve Mental Health, Access, and Engagement among LGBTQA+ Youth and Young Adults

Digital mental health interventions may enable access to care for LGBTQA+ youth and young adults that face significant threats to their wellbeing. This study describes the preliminary efficacy of AFFIRM Online, an eight-session manualised affirmative cognitive behavioural group intervention delivered synchronously. Participants (Mage = 21.17; SD = 4.52) had a range of sexual (e.g., queer, lesbian, pansexual) and gender (e.g., non-binary, transgender, cisgender woman) identities. Compared to a waitlist control (n = 50), AFFIRM Online participants (n = 46) experienced significantly reduced depression (b = -5.30, p = 0.005, d = 0.60) and improved appraisal of stress as a challenge (b = 0.51, p = 0.005, d = 0.60) and having the resources to meet those challenges (b = 0.27, p = 0.059, d = 0.39) as well active coping (b = 0.36, p = 0.012, d = 0.54), emotional support (b = 0.38, p = 0.017, d = 0.51), instrumental support (b = 0.58, p < 0.001, d = 0.77), positive framing (b = 0.34, p = 0.046, d = 0.42), and planning (b = 0.41, p = 0.024, d = 0.49). Participants reported high acceptability. This study highlights the potential of digital interventions to impact LGBTQA+ youth mental health and explores the feasibility of digital mental health to support access and engagement of youth with a range of identities and needs (e.g., pandemic, lack of transportation, rural locations). Findings have implications for the design and delivery of digital interventions for marginalised youth and young adults.

Training Peers to Ease Hospital Discharge: A Community-Clinical Partnership in Complex HIV Care

BACKGROUND

Since many people now live with human immunodeficiency virus (HIV) as a complex, chronic health condition that may require frequent medical and psychosocial services, a potential new role for HIV-positive peers involves support during an inpatient admission that extends past discharge to improve the transition home from hospital. We sought to begin outlining scope of peer support in complex HIV care, by detailing a training curriculum alongside experiences and recommendations by Peer Volunteers.

METHODS

A community-clinical partnership designed a personalized peer intervention for people living with HIV who were acutely hospitalized and struggling with antiretroviral adherence and substance use. Five Peer Volunteers delivered the program, which involved being matched with a participant for a pre-discharge in-person meeting followed by frequent phone contact in the 7 weeks following discharge. A 4-day peer training focused on active listening, structuring a call, use of self, boundaries, and facilitating program closure. The curriculum was informed by theories of change, motivational interviewing, and simulation. Peer Volunteers participated in pre-match and post-match interviews with peer researchers (also living with HIV). Thematic analysis was employed by four independent coders to understand how prepared peers were and areas for program improvement.

CONCLUSIONS

Peers verified participant feelings and affirmed their experiences, followed-up on participant goals to track progress, disclosed their own relevant experiences to build rapport, and facilitated closure to enable program success. Peers struggled maintaining an emotional connection over the phone and were concerned when participants were nonresponsive. This article discusses how the training was piloted and adapted for practice.

QueerVIEW: Protocol for a Technology-Mediated Qualitative Photo Elicitation Study With Sexual and Gender Minority Youth in Ontario, Canada

Background

The experiences of resilience and intersectionality in the lives of contemporary sexual and gender minority youth (SGMY) are important to explore. SGMY face unique experiences of discrimination in both online and offline environments, yet simultaneously build community and seek support in innovative ways. SGMY who identify as transgender, trans, or gender nonconforming and have experiences with child welfare, homelessness, or immigration have been particularly understudied. A qualitative exploration that leverages technology may derive new understanding of the negotiations of risk, resilience, and identity intersections that impact the well-being of vulnerable SGMY.

Objective

The objectives of the QueerVIEW study were to (1) enhance understanding of SGMY identities, both online and offline, (2) identify experiences of intersectionality among culturally, regionally, and racially diverse SGMY in Ontario, Canada, (3) explore online and offline sources of resilience for SGMY, and (4) develop and apply a virtual photo elicitation methodological approach.

Methods

This is the first study to pilot a completely virtual approach to a photo elicitation investigation with youth, including data collection, recruitment, interviewing, and analysis. Recruited through social media, SGMY completed a brief screening survey, submitted 10 to 15 digital photos, and then participated in an individual semistructured interview that focused on their photos and related life experiences. Online data collection methods were employed through encrypted online file transfer and secure online interviews. Data is being analyzed using a constructivist grounded theory approach, with six coders participating in structured online meetings that triangulated photo, video, and textual data.

Results

Data collection with 30 participants has been completed and analyses are underway. SGMY expressed appreciation for the photo elicitation and online design of the study and many reported experiencing an emotional catharsis from participating in this process. It is anticipated that results will form a model of how participants work toward integrating their online and offline experiences and identities into developing a sense of themselves as resilient.

Conclusions

This protocol presents an innovative, technology-enabled qualitative study that completely digitized a popular arts-based methodology—photo elicitation—that has potential utility for contemporary research with marginalized populations. The research design and triangulated analyses can generate more nuanced conceptualizations of SGMY identities and resilience than more traditional approaches. Considerations for conducting online research may be useful for other qualitative research.

International Registered Report Identifier (IRRID)

DERR1-10.2196/20547

Describing a Clinical Group Coding Method for Identifying Competencies in an Allied Health Single Session

Introduction

Competencies that integrate research findings and practice expertise are necessary to maintain comprehensive evidence-based practice for allied health professions, such as social work. The context of modern multidisciplinary healthcare, especially in acute or emergency settings, means that an individual clinician may only have a single session with a patient. Maximizing the benefit of single sessions requires advanced competence that extends beyond diagnostics and biomedical treatments to the impact of social systems on health outcomes; multi-level advocacy for reduction of existing health disparities and equity in access to health and mental health services; and “working knowledge” of non-pharmacological treatments.

Methods

This study employed a practice-based research methodology whereby health social workers group coded 32 simulation videos, drawn from an advanced social work practice course, to develop a practice-based competency framework that incorporates these advanced skills. Constructivist grounded theory was employed through a cyclical coding process of viewing video data, identifying and discussing skills and competencies, and summarizing/synthesizing the discussions for critical reflection.

Results

The resulting Clinician Group Coding Method utilized systematic and collaborative group coding of practice simulation videos by three clinicians and two researchers to identify relevant competencies for a single session. Emphasis was placed on the progressive phases of single-session patient interactions (eg, joining, working, ending), a practice format that frequently occurs in social work and other allied health professions. These phases include themes of preparing, agenda setting and refining, addressing context, providing education, planning the next steps, and encouraging success.

Discussion

The group coding process allowed for immediate discussions and clarifications, supporting the clinicians to synthesize their experiences toward shared understandings of “best practices” in single-session healthcare contexts. This approach facilitated the understanding of critical actions that allied health clinicians could undertake to improve single-session interactions. This practice-based competency framework may have significant utility for multidisciplinary healthcare education and practice.

Frequencies and patterns of adverse childhood events in LGBTQ+ youth

BACKGROUND

Trauma, specifically adverse childhood experiences (ACEs), predicts significant health and mental health disparities, yet there is a paucity of research with LGBTQ + youth.

OBJECTIVE

This study explored ACE prevalence in a large sample of LGBTQ+ youth; examined ACE patterns within and across subgroups; and compared results with the general population.

PARTICIPANTS AND SETTING

Participant (n = 3,508) ages ranged between 14-18 (x̄ = 16.02) and represented a range of sexual orientations: pansexual (33.9 %), bisexual (26.6 %), and queer (16.2 %), and gender identities: female (39.9 %), non-conforming (38 %), male (14.9 %), and transgender (16.6 %).

METHODS

An online cross-sectional survey was conducted with LGBTQ+ youth ages 14-18 that self-identified as LGBTQ+ and resided in the US or Canada. Descriptive statistics generated the prevalence of ACEs, and ANOVAs and post-hoc tests were run for comparisons.

RESULTS

Participants reported multiple ACEs (M = 3.14, SD = 2.44) with emotional neglect (58 %), emotional abuse (56 %), and living with a family member with mental illness (51 %) as the most prevalent. Notably, 43 % of participants experienced 4+ ACEs, considered to be a high level of trauma exposure. Compared to national samples, LGBTQ + youth demonstrated unique patterns of ACEs and were higher in 9 of 10 categories. Significantly high (all p < .001) ACEs were found in pansexual (t = 7.67), transgender and gender non-conforming (t = 5.19), American-Indian (t = 6.42), Latinx (t = 2.83) and rural youth (F = 12.12) while those with highly educated parents (F = 83.30, p < .001), lived with a parent (t = 6.02), and in Canada (t = 6.14) reported fewer ACEs.

CONCLUSION

LGBTQ+ youth experience significant childhood trauma with potential impact on their mental health. This study identifies implications for trauma-informed practice and research.

How Intersectional Are Mental Health Interventions for Sexual Minority People? A Systematic Review

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.

It's my safe space: The life-saving role of the internet in the lives of transgender and gender diverse youth

Background: Public awareness of Transgender and Gender Diverse (TGD) identities has grown significantly; however, acceptance and support remain elusive for many TGD youth. Resultant experiences of marginalization and stigmatization contribute to elevated rates of psychological distress and suicidality among TGD youth. Emergent evidence suggests that the internet may offer TGD youth safety, support, and community previously unavailable. Aim: The primary aim of this qualitative inquiry is to engage in an in-depth exploration of the online experiences and processes which help protect against psychological distress and promote well-being among TGD youth. Methods: Data were culled from a mixed-methods, online study of sexual and gender minority youth from across the United States and Canada which followed Institutional Review Board approved protocols. Participants for this study represent a sample (n = 260) of TGD participants aged 14-22 (x̄ = 17.30). Data were analyzed using Charmaz' grounded theory strategies. Results: Data revealed that the internet offers TGD youth affirming spaces that, for the most part, do not exist in their offline lives. Online, TGD youth were able to engage meaningfully with others as their authentic selves, often for the first time. These experiences fostered well-being, healing, and growth through five processes: 1. Finding an escape from stigma and violence, 2. Experiencing belonging, 3. Building confidence, 4. Feeling hope, and 5. Giving back. Discussion: The unique and innovative ways in which participants use online spaces to foster resilience offer important insights to inform affirmative practices with TGD young people.

Protocol for a pilot randomised controlled trial evaluating feasibility and acceptability of cognitive remediation group therapy compared with mutual aid group therapy for people ageing with HIV-associated neurocognitive disorder (HAND) in Toronto, Canada

INTRODUCTION

HIV-associated neurocognitive disorder (HAND) may affect 30%-50% of people ageing with HIV. HAND may increase stress and anxiety, and impede coping. Psychosocial group therapy may ameliorate HAND's symptoms, yet the ideal intervention is unclear. This protocol outlines a pilot randomised controlled trial (RCT)-designed using community-based participatory research-to pilot cognitive remediation group therapy (CRGT) against an active comparator.

METHODS AND ANALYSIS

This is a pilot, parallel design, two-arm RCT that will recruit participants diagnosed with the mild neurocognitive disorder form of HAND from a neurobehavioural research unit at a tertiary care hospital in Toronto, Canada. Eligibility criteria include age ≥40 years, known HIV status for 5+ years, English fluency, able to consent and able to attend 8 weeks of group therapy. Eligible participants will be randomised to one of two treatment arms, each consisting of eight-session group interventions delivered once weekly at 3 hours per session. Arm 1 (novel) is CRGT, combining mindfulness-based stress reduction with brain training activities. Arm 2 (active control) is mutual aid group therapy. The primary outcomes are feasibility, measured by proportions of recruitment and completion, and acceptability, determined by a satisfaction questionnaire. The secondary outcome is intervention fidelity, where content analysis will be used to assess facilitator session reports. A between-group analysis will be conducted on exploratory outcomes of stress, anxiety, coping and use of intervention activities that will be collected at three time points.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Research Ethics Boards of St. Michael's Hospital and the University of Toronto. Findings will be disseminated through peer-reviewed publications, conference presentations and community reporting. This study could provide insight into design (eg, recruitment, measures) and intervention considerations (eg, structure, content) for a larger trial to lessen the burden of cognitive decline among people ageing with HIV.

TRIAL REGISTRATION NUMBER

NCT03483740; Pre-results.

Effects of an enzymatically stable C-terminal hexapseudopeptide fragment peptide of xenin-25, ψ-xenin-6, on pancreatic islet function and metabolism

Xenin-25 undergoes rapid enzyme metabolism following secretion. Early studies demonstrated bioactivity of a C-terminal hexapeptide fragment of xenin-25, namely xenin-6, which were enhanced through introduction of a reduced N-terminal peptide bond, to yield Ψ-xenin-6. The present study was undertaken to define the biological actions and potential antidiabetic properties of Ψ-xenin-6. In vitro enzymatic stability, insulin and glucagon secretory activity, as well as effects on beta-cell survival were determined. Studies in mice were used to assess the impact of Ψ-xenin-6 on glucose homeostasis and satiety. Ψ-xenin-6 was resistant to murine plasma degradation. In BRIN-BD11 cells and isolated murine islets, Ψ-xenin-6 significantly stimulated insulin secretion, and prominently enhanced the insulinotropic actions of GIP. Xenin-6 and Ψ-xenin-6 had no impact on glucagon secretion, although xenin-6 partially reversed the glucagonotropic action of GIP. Further in vitro investigations revealed that, similar to GLP-1, Ψ-xenin-6 significantly augmented proliferation of human and rodent clonal beta-cells, whilst also fully protecting against cytokine-induced beta-cell cytotoxicity, with greater potency than xenin-25 and xenin-6. When administered to mice in combination with glucose, Ψ-xenin-6 significantly reduced glucose levels and enhanced glucose-induced insulin release, with a duration of biological action beyond 8 h. Ψ-xenin-6 also significantly enhanced the glucose-lowering action of GIP in vivo. In overnight fasted mice, Ψ-xenin-6 exhibited satiety actions at both 25 and 250 nmol/kg. These data demonstrates that Ψ-xenin-6 is a metabolically stable C-terminal fragment analogue of xenin-25, with a metabolic action profile that merits further study as a potential antidiabetic compound.

Characterisation of Glucose-Dependent Insulinotropic Polypeptide Receptor Antagonists in Rodent Pancreatic Beta Cells and Mice

Hypersecretion and alterations in the biological activity of the incretin hormone, glucose-dependent insulinotropic polypeptide (GIP), have been postulated as contributing factors in the development of obesity-related diabetes. However, recent studies also point to weight-reducing effects of GIP receptor activation. Therefore, generating precise experimental tools, such as specific and effective GIP receptor (GIPR) antagonists, is of key significance to better understand GIP physiology. Thus, the primary aim of the current study was to uncover improved GIPR antagonists for use in rodent studies, using human and mouse GIP sequences with N- and C-terminal deletions. Initial in vitro studies revealed that the GIPR agonists, human (h) GIP(1-42), hGIP(1-30) and mouse (m) GIP(1-30), stimulated (P < 0.01 to P < 0.001) insulin secretion from rat BRIN-BD11 cells. Analysis of insulin secretory effects of the N- and C-terminally cleaved GIP peptides, including hGIP(3-30), mGIP(3-30), h(Pro³)GIP(3-30), hGIP(5-30), hGIP(3-42) and hGIP(5-42), revealed that these peptides did not modulate insulin secretion. More pertinently, only hGIP(3-30), mGIP(3-30) and h(Pro³)GIP(3-30) were able to significantly (P < 0.01 to P < 0.001) inhibit hGIP(1-42)-stimulated insulin secretion. The human-derived GIPR agonist sequences, hGIP(1-42) and hGIP(1-30), reduced (P < 0.05) glucose levels in mice following conjoint injection with glucose, but mGIP(1-30) was ineffective. None of the N- and C-terminally cleaved GIP peptides affected glucose homeostasis when injected alone with glucose. However, hGIP(5-30) and mGIP(3-30) significantly (P < 0.05 to P < 0.01) impaired the glucose-lowering action of hGIP(1-42). Further evaluation of these most effective sequences demonstrated that mGIP(3-30), but not hGIP(5-30), effectively prevented GIP-induced elevations of plasma insulin concentrations. These data highlight, for the first time, that mGIP(3-30) represents an effective molecule to inhibit GIPR activity in mice.

An Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth (Project Youth AFFIRM): Protocol for an Implementation Study

BACKGROUND

Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential.

OBJECTIVE

The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY.

METHODS

SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol.

RESULTS

Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed.

CONCLUSIONS

AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/13462.

The ART of conversation: feasibility and acceptability of a pilot peer intervention to help transition complex HIV-positive people from hospital to community

OBJECTIVES

To pilot a peer-based intervention for people living with HIV who used substances, had challenges with antiretroviral adherence and would be discharged from hospital to community.

STUDY DESIGN

A community-based, quasi-experimental pilot intervention study designed to assess feasibility, acceptability and connection to a community-based HIV organisation.

SETTING

This study was conducted in Toronto, Canada, at Casey House (CH; hospital for people living with HIV) in collaboration with the AIDS Committee of Toronto (ACT; community-based HIV organisation).

PARTICIPANTS

People living with HIV who were CH inpatient between 1 April 2017 and 31 March 2018, struggled with antiretroviral adherence, actively used substances and would be discharged to community were eligible. Forty people met criteria, 19 were approached by an inpatient nurse and 17 consented. Average age was 48.8 years (SD=11.4), 58.8% were male and participants averaged 7.8 physical and mental health comorbidities (SD=3.1).

INTERVENTION

Titled 'The ART of Conversation', the three-pronged personalised intervention was developed through input from CH clients and ACT volunteers, all living with HIV. Intervention components were (a) predischarge goal-setting (adherence, substance use and self-identified goal) with the study nurse; (b) predischarge meeting with an HIV+ peer volunteer (PV) and (c) nine postdischarge phone calls between PV and participant, once per day for 3 days, then once per week for 6 weeks.

PRIMARY OUTCOMES

Feasibility was measured through proportion of eligible participants recruited and PV availability. Acceptability was assessed through participant interviews at three times (preintervention, post-intervention and 6 weeks follow-up) and through PV call logs. Client records determined connection to ACT within the study timeframe.

RESULTS

Twelve participants completed the intervention and nine connected with ACT. Predischarge goal-setting and PV meeting were both feasible and acceptable. Postdischarge phone calls were a challenge as half of completers missed at least one call.

CONCLUSIONS

Although predischarge goal-setting and PV meeting were feasible, methods to maintain connection following discharge require further investigation.

Solvent-Dependent Light-Induced Structures in Gem-Dichlorocyclopropanated Polybutadiene Solutions

The formation of permanent structures upon mild red laser illumination in transparent polydiene solutions is examined in the case of gem-dichlorocyclopropanated polybutadiene (gDCC-PB) polymers bearing 15% functional units of the dichlorocyclopropane groups. The response was found to be distinct from the precursor PB. Whereas fiber-like patterns were clearly observed in both precursor and gDCC-PB solutions in cyclohexane, these were absent in the case of gDCC-PB/chloroform but were present in the precursor PB/chloroform solutions. The involved mechanical stresses were not sufficient for the gDCC activation to be detected by NMR spectroscopy. Remarkably, addition of even 10 wt % gDCC-PB into the latter solution sufficed to suppress the light-induced patterning. The importance of the chemical environment on the response to light irradiation was further checked and confirmed by use of other PB copolymers. Different diameter patterns and kinetics were observed. The strong solvent and comonomer mediated effect was reflected neither in solvency nor in optical polarizability differences of the polymers solvent couples.

Influence of Information and Communication Technologies on the Resilience and Coping of Sexual and Gender Minority Youth in the United States and Canada (Project #Queery): Mixed Methods Survey

Background

Sexual and gender minority youth are a population in peril, exemplified by their disproportionate risk of negative experiences and outcomes. Sexual and gender minority youth may be particularly active users of information and communication technologies (ICTs), and it is important to identify the potential contributions of ICTs to their resilience and well-being.

Objective

Our aim was to (1) investigate the use of ICTs by sexual and gender minority youth, (2) identify the ways that ICTs influence the resilience and coping of sexual and gender minority youth, focusing on promotion of well-being through self-guided support-seeking (particularly using mobile devices), (3) develop a contextually relevant theoretical conceptualization of resilience incorporating minority stress and ecological approaches, (4) generate best practices and materials that are accessible to multiple interested groups, and (5) identify whether video narratives are a viable alternative to collect qualitative responses in Web-based surveys for youth.

Methods

Mixed methods, cross-sectional data (N=6309) were collected via a Web-based survey from across the United States and Canada from March-July 2016. The sample was generated using a multipronged, targeted recruitment approach using Web-based strategies and consists of self-identified English-speaking sexual and gender minority youth aged 14-29 with technological literacy sufficient to complete the Web-based survey. The survey was divided into eight sections: (1) essential demographics, (2) ICT usage, (3) health and mental health, (4) coping and resilience, (5) sexual and gender minority youth identities and engagement, (6) fandom communities, (7) nonessential demographics, and (8) a video submission (optional, n=108). The option of a 3-5 minute video submission represents a new research innovation in Web-based survey research.

Results

Data collection is complete (N=6309), and analyses are ongoing. Proposed analyses include (1) structural equation modeling of quantitative data, (2) grounded theory analysis of qualitative data, and (3) an integrative, mixed methods analysis using a data transformation design. Theoretical and methodological triangulation of analyses integrates an interwoven pattern of results into a comprehensive picture of a phenomenon. Results will be reported in 2017 and 2018.

Conclusions

This research study will provide critical insights into the emerging use of ICTs by sexual and gender minority youth and identify intervention strategies to improve their well-being and reduce risks encountered by this vulnerable population. Implications for practice, research, and knowledge translation are provided.

Complex families, the social determinants of health and psychosocial interventions: Deconstruction of a day in the life of hospital social workers

The roles of hospital social workers are delineated in the literature; however, their daily interventions have only been described anecdotally. This study analyzes the daily work of social workers in a pediatric hospital through a survey completed which examined factors related to interventions utilized and time spent per case over a 1-day period. Length and types of interventions were associated with the social determinants of health, time since diagnosis, biopsychosocial issues, and perception of complexity. The study offers a snapshot of the personalized expertise, provided by social workers that addresses complex contextual and biopsychosocial concerns of patient and families.

The intersecting cognitive and aging needs of HIV-positive older adults: Implications for social work practice

Cognitive impairment is a significant health concern for people aging with HIV/AIDS. Using a community-based participatory research (CBPR) framework, we surveyed (n = 108) and interviewed (n = 20) people living with HIV who were over age 50 about their cognitive concerns and recommendations for social work intervention development. Quantitative findings indicate that our sample was greatly engaged in their HIV care, yet participants had many cognitive concerns. Qualitative findings highlighted fear, shame, and uncertainty concerning HIV and aging alongside a need for increased social work support. This paper provides practical engagement strategies for social workers to support clients concerning HIV, aging, and cognition.

Affirmative Cognitive Behavior Therapy with Transgender and Gender Nonconforming Adults

Although there is growing awareness in contemporary society regarding transgender and gender nonconforming (TGNC) identities, transgender people continue to be highly marginalized and subject to transphobic discrimination and victimization. As a result, authentically expressing and navigating a TGNC identity can be difficult. Psychiatrists and other mental health professionals can play a key role in supporting TGNC client health and well-being through the use of trans-affirmative approaches. Trans-affirmative practice recognizes all experiences of gender as equally healthy and valuable This article focuses on transgender affirmative cognitive behavior therapy.

Minority Stress and HERoic Coping Among Ethnoracial Sexual Minority Girls: Intersections of Resilience

This study used a focus group methodology to explore the experiences of stress and coping among 40 Hispanic, Caribbean Black, Haitian, and African American cisgender sexual minority girls living in the southeastern United States. An analysis of the data using grounded theory strategies revealed that participants were part of a cultural context in which few boundaries existed between family, religion, and culture, and that they tended to believe that they were betraying family and culture because of their sexual minority identities. Participants described (a) real or perceived transgressions of gender expectations and roles, (b) violating religious doctrine, and (c) emotional exclusion and taunting by family members. In the same context, the theme of HERoic Coping described participants’ resilience that manifested as (a) serving as the family educator, (b) being “out” in the open with family, and (c) creating safety. This study found that the negotiation of complex family, religious, and community environments is critical to understanding resilience in ethnoracial sexual minority girls.

Cultivating Professional Allies for Sexual Minority Youth: A Community-Based Educational Intervention

Sexual minority youth (SMY) face multiple risks in their daily lives that may influence their need for supportive care. Health and social service providers have unique opportunities to provide culturally competent services to these youth. This article describes a community-based educational intervention created to increase providers' knowledge, skills, and intention to support SMY. Based on the Information-Motivation-Behavioral Skills model, this pilot study found that for a diverse sample of multidisciplinary professionals (n = 2,850), the odds of behavioral intention (BI) to support SMY were significantly higher when trainings were relevant to the professionals' experience (OR = 1.3), were sensitive (OR = 1.3), developed skills (OR = 1.1), and incorporated policy (OR = 1.2). Implications for the delivery of community-based trainings are provided.

Empirically Supported Interventions for Sexual and Gender Minority Youth

When empirically supported treatments (ESTs) are effectively adapted for use with minority populations, they may be more efficacious. As such, there is a need to adapt existing ESTs for use with diverse sexual and gender minority youth (SGMY). The unique bias-based challenges faced by SGMY require the integration of affirmative practices into ESTs to effectively address the specific needs of this underserved group of youth. The primary purpose of the authors in this article is to present a clearly articulated stakeholder driven model for developing an affirmative adapted version of cognitive behavioral therapy (CBT) for use with diverse SGMY. The authors' approach to adaptation follows the "adapt and evaluate" framework for enhancing cultural congruence of interventions for minority groups. A community based participatory research approach, consistent with a stakeholder driven process, is utilized to develop the intervention from the ground up through the voices of the target community. Researchers conducted 3 focus groups with culturally diverse SGMY to explore salient aspects of youths' cultural and SGM identities in order to inform the intervention and ensure its applicability to a wide range of SGMY. Focus group data is analyzed and integrated into an existing group-based CBT intervention. The following themes emerge as critical to affirmative work with diverse SGMY: (1) the interplay between cultural norms, gender norms, sexual orientation, and gender identity; (2) the complex role of religious community within the lives of SGMY; and (3) consideration of extended family and cultural community as youth navigate their SGM identities.

Thinking big, supporting families and enabling coping: the value of social work in patient and family centered health care

Patient and family-centered care has become a focus in health services. Social work has a rich history of providing responsive patient care. This study identified the contribution and value of social work to PFCC from the key stakeholder perspectives of health social workers (n = 65). Utilizing interpretive description, four themes emerged: (1) Thinking big and holistically, (2) Intervening with families, (3) Enabling patient and family coping, and (4) Maximizing hospital and community resources. Barriers included a lack of power, professional isolation and role creep. Implications for research and practice are provided.

Can information and communication technologies support patient engagement? A review of opportunities and challenges in health social work

Despite becoming a prerequisite for participation in an information-based society, the use of information communication technologies (ICT) within social work and health care remains in its infancy. Currently, there is a push to adopt newer technologies to enhance practice. This article aims to highlight some of the innovative ways in which ICT have been adopted and adapted to augment social work practice. The need for social workers to become proficient in the use of newer technologies, opportunities for implementing ICT within a health care setting, and potential challenges at the professional, ethical, and systemic level are explored. Using the available literature as a guide, recommendations and strategies to strengthen implementation of ICTs into health social work are provided.

Exclusionary health policy: responding to the risk of poor health among sexual minority youth in Canada

Measuring indicators of health status and demographics are essential in the population health approach. In Canada, sexual minority youth face increased risk for poor health outcomes in behavioral and mental health indicators, yet the health policy response has been severely lacking. The current population health approach exacerbates the social exclusion of a vulnerable, at-risk population. The authors examine health status through the social determinants of health to highlight the need for including sexual identity, attraction, and behavior in youth population health surveys. Additional interventions that address the social determinants of health are needed.