Integrated Behavioral Health and Counseling Gender and Sexual Minority Populations

abstract

Counselors are increasingly expected to operate within an integrated behavioral health framework across systems of care. This critical literature review provides an overview of the integrated behavioral health paradigm, including the practice of interprofessional collaboration, with specific application to lesbian, gay, bisexual, transgender, queer (LGBTQ), and other gender and sexual minority issues. Implications for practice and research are discussed, along with a focus on concrete recommendations for application practicing interprofessionally with and on behalf of LGBTQ clients.     

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

Clinical Social Work Journal - Lesbian, gay, bisexual, transgender, queer, and other sexual and/or gender minority (LGBTQ+) populations experience significant mental and behavioral health...     

Acknowledging the Impact of Social Forces on Sexual Minority Clients: Introduction to the Special Issue on Clinical Practice with LGBTQ Populations

Over the last two to three decades, advances in clinical practice with lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals have been extensive. Many clinical social workers now incorporate LGBTQ-affirmative approaches into their practice, and a number of social workers have contributed to the literature on clinical practice with sexual minority clients. Despite these advances, we still require specialized knowledge to understand a number of LGBTQ-related mental health issues. The Clinical Social Work Journal’s first special issue on clinical practice with LGBTQ populations emphasizes psychotherapy techniques that acknowledge and also address social forces (e.g., transphobia, homophobia, and heterosexism) that affect the psychosocial functioning of LGBTQ clients. The special issue focuses on LGBTQ populations, such as transgender and bisexual individuals, sexual minority youth, and older adults, and psychotherapy modalities informed by a number of clinical and theoretical approaches. These in-depth articles offer guidance to clinical social workers who need to expand their knowledge of LGBTQ-related mental health issues and also provide those with existing knowledge an opportunity to refine their clinical skills and sharpen their thinking.     

The mental health of young people aging out of care and entering adulthood: Exploring the evidence from England and France

This paper explores the research evidence from England and France on the mental health of young people aging out of care and into adulthood. It represents the first comparative review based on the evidence from these two countries. Set in the legal, policy and service framework for both countries, it reviews evidence on the mental health of young people in the general population, young people living in care, young people aging out of care, and young adults. It shows: the high levels of psychological adversity of young people entering care; the high rates of mental health problems of young people in care compared with the general population of young people; the increased risk of mental and physical problems at the time of aging out of care, and the general improvement in longer-term outcomes for young adults, although some continue to have serious mental health problems. In conclusion, it suggests that interventions across the life course of young people are needed.     

Autism Spectrum Disorder: The Impact of Stressful and Traumatic Life Events and Implications for Clinical Practice

Research findings suggest that behavioral interventions are effective in improving educational outcomes and fostering skill development in people with autism spectrum disorder (ASD). However, high rates of comorbidity between ASD and other psychological disorders, including depression and anxiety, indicate that standard behavioral approaches are not adequately addressing issues related to mental health in this population. Research emerging since the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is advancing our understanding of the nature of childhood stress and trauma in people with ASD and its subsequent impact on mental health and wellbeing. Mounting evidence for stress and trauma as a risk factor for comorbidity and the worsening of core ASD symptoms may intimate a shift in the way clinical social workers and other clinical practitioners conceptualize and approach work with this population to include trauma-focused assessment strategies and clinical interventions. Future directions for research to better understand the nature of childhood stress and trauma and improve mental health in this population are also discussed.     

Needs and Perceptions of LGBTQ Caregivers: The Challenges of Services and Support

Increasing attention has been paid to the lack of services and support afforded older lesbian, gay, bisexual, transgender, and queer (LGBTQ) women in same-sex relationships, including caregivers. This study was designed to investigate the needs and perceptions of LGBTQ women from ages 35 to 91, including informal caregivers and older adults regarding services and support from health care providers. Questionnaires were completed by older LGBTQ women (N = 76), and follow-up interviews were conducted with 25% of caregiver respondents. The majority of subjects indicated a fear of future challenges and discrimination. Four main themes emerged when analyzing the open-ended responses: the need for health care workers who were both supportive and knowledgeable about LGBTQ issues; better and consistent recognition of same-sex partners and their rights to make decisions as primary caregivers; increased sensitivity training regarding the needs of LGBTQ patients and caregivers; and more open and accepting environments where LGBTQ patients and caregivers could feel comfortable discussing issues with the staff.     

Promoting the mental well-being of older people from black and minority ethnic communities in United Kingdom rural areas: Findings from an interview study

Drawing from 81 interviews with practitioners in social care and housing with care services in the United Kingdom, this paper explores practice issues in rural areas when supporting the mental health and well-being of older people from Black and minority ethnic groups. The paper begins with a review of the literature which provides evidence that BME older people are likely to be increasingly part of the populations of rural areas. Next it presents interview data revealing that while practitioners are aware of such demographic changes in general terms; some feel that they lack training and skills in adapting their professional practice to support all older people. Others express feelings of professional isolation in seeking to support older people from minority groups and are concerned that older people from minority groups may be at risk of isolation and loneliness. The paper concludes with a discussion of the study's implications for rural practice, policy and research.     

Examining the Development of Positive Space in Health and Social Service Organizations: A Canadian Exploratory Study

All health care sectors are currently examining factors that influence delivery of high-quality services for diverse groups with an understanding that minority populations experience barriers to service access that contribute to well-documented ill health and health inequities. With a goal of understanding dynamics that can improve access to care in the home care sector, this qualitative exploratory study examined processes to create inclusive, positive space for diverse lesbians, gay men, bisexuals, transgender, and queer (LGBTQ) people in community-based health and social service agencies. A purposeful sample of eight key informants from agencies in Toronto, Ontario, Canada, which offer programs and services to LGBTQ communities, completed in-depth interviews. Conventional content analysis and a critical lens were used. Themes offered insight into the histories, challenges, and turning points which shaped the development of LGBTQ-positive spaces in these organizations. Community engagement and leadership emerged as relevant, as did strategies to embed LGBTQ voices and visibility within everyday organizational functioning. Given the gap in literature addressing LGBTQ access to home care and the unique dynamics that shape care in the home, implications address the application of these study findings for creating positive space in the home care sector.     

Mental health assessment of infants in foster care

Infants placed in foster care are at high risk for emotional and behavioral problems. Assessment of their mental health must account for their often-adverse life experiences prior to placement and the involvement of multiple systems that shape their lives in lieu of parents' authority. This article presents practice guidelines for infant mental health evaluations with consideration of legal requirements and the unique issues conferred by foster care.     

Access to Mental Health Services: The Struggle of Poverty Affected Urban Children of Color

It is estimated that, in the United States, one in ten children and adolescents suffer from illness severe enough to cause some level of psychosocial dysfunction. Urban children, and in particular low-income children of color, are at greater risk of developing mental health problems, and are less likely to receive effective child mental health services. Prompt and effective access to mental health services by urban children of color is a critical direct practice and social policy concern. This article provides an overview of significant barriers to mental health care experienced by poverty affected urban children of color and their families. It also addresses a broad range of practice and policy issues that need to be raised in order to ensure competent delivery of mental health services for children living in urban environments. The role of social work in assisting poor urban children of color to access and benefit from mental health services is stressed. Manny John González, D.S.W., is an Assistant Professor of Social Work at Fordham University Graduate School of Social Service.     

Using social support for LGBTQ clients with mental illness to be out of the closet,in treatment,and in the community

ABSTRACT

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are often faced with societal challenges that can lead to mental health or substance abuse issues. They may be misunderstood or mistreated when seeking services because of a lack of training in offering culturally sensitive treatment by service providers. A program, the Rainbow Heights Club, was developed to support LGBTQ individuals with a mental health diagnosis. All of the members are in treatment for their mental health and/or substance abuse problems, but prior to the development of the program did not have a place to feel accepted, supported, or have a sense of community. Members were surveyed determine if Rainbow Heights was helpful in maintaining themselves in the community. Results indicated that 75% of members are more consistent in following prescribed treatments, keeping them free from inpatient hospitalization, and 79% reported being clean and sober since coming to the Club.     

Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

Activating adult allies from a rural community on lesbian,gay, bisexual,transgender, and queer student issues in school using photovoice

Purpose: Many students who are lesbian, gay, bisexual, transgender, or queer (LGBTQ) face hostile school environments that can negatively impact their mental health and education. This study involved a photovoice project where high school students from a gay-straight alliance in the rural southeastern United States took photographs that depicted the issues LGBTQ students were facing and then exhibited their photographs and stories to individuals from the school system and local community to promote awareness, dialogue, and action. Methods: Twenty adults who attended the photovoice exhibit responded to an online survey about their experiences with the intervention. Results: Eighty-five percent of adults reported that the intervention made them think about issues they had not previously considered, including the struggles LGBTQ youths face, gender issues, and living in a rural community. Common emotions experienced at the intervention included feeling excited, concern for the youths, and proud of the youths. Furthermore, 81% of the adults indicated that they would take action or behave differently as a result of the intervention, including supporting and affirming LGBTQ students, using gender-neutral and -inclusive language, and confronting bias in themselves and others. Conclusions: Photovoice is a promising strategy for LGBTQ students to activate adult allies in their community.     

Substance Use and Mental Health Severity Among LGBTQ Individuals Attending Minnesota Model-Based Residential Treatment

This administrative data analysis examined substance use and mental health severity among a sample of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals receiving residential treatment for an alcohol or drug use disorder. LGBTQ were statistically compared to heterosexual patients on a number of variables, including frequency and amount of pretreatment alcohol use, frequency of pretreatment illicit drug use, co-occurring Axis I mental health diagnoses, and past history of physical or sexual abuse. LGBTQ patients exhibited significantly greater severity on nearly all variables, suggesting a strong relationship between clinical severity and being a sexual minority. This study also found a relationship between patient gender and the pattern of differences between LGBTQ and heterosexual patients. These results replicate and extend those of studies examining LGBTQ in the general population and suggest opportunities for development of alcohol/drug treatment approaches that address the unique needs of LGBTQ.     

State homophobia? India’s shifting UN positions on LGBTQ issues

Why has India adopted contradictory policies with regard to LGBTQ rights at the UN? From 2004 to 2010, India consistently supported draft language for a UN resolution to allow a Special Rapporteur to investigate extra-judicial executions that would include the term ‘sexual orientation’. More recently, however, India has opposed or abstained from UN votes on LGBTQ rights. While India's conservative posture on LGBTQ issues was catalyzed by the Supreme Court's re-criminalization of homosexual activities in 2013 and the rise of the Hindu nationalist BJP, we argue that the state's posture is not a reflection of deep ideological commitments or a new strategic realignment. Instead, India's policy reflects a generally uncoordinated foreign policy apparatus that has been unprepared to respond to the rapid ascendancy of LGBTQ issues on the human rights agenda. It is not currently possible to predict India's future posture due to its lack of a clear policy commitments.     

Issues of shared parenting of LGBTQ children and youth in foster care: preparing foster parents for new roles

Foster parents have increasingly assumed new and challenging roles during the past decade. Meeting the developmental, attachment, and grieving needs of children and youth in out of home care is challenging by itself, but can become even more difficult with the issues that arise when the child is lesbian, gay, bisexual, transgender, or questioning (LGBTQ). Preservice and in-service foster parent training programs can strengthen shared parenting skills by focusing on the universal critical issues of safety, well being, and permanence for children and youth in foster care. This article will focus on these skill areas: (1) sharing parenting to promote healthy growth and development of LGBTQ youth in foster care, (2) threats to safety of LGBTQ youth in foster care, and (3) general challenges and strategies for preparing foster parents of LGBTQ youth to build support systems.     

Availability of Mental Health Services for Individuals Who Are Deaf or Deaf-Blind

A survey of state mental health agencies found that a majority have no specific policy or procedure regarding how to provide mental health services to persons who are deaf or who are deaf-blind. Agency representatives report that staff lack knowledge of how to provide mental health services to persons who are deaf-blind and the agencies lack qualified interpreters. They recommend training for social workers and counselors to address best practices in working with people who are deaf-blind concerning communication methods and strategies, physical interaction, cultural issues, everyday life, sensory deprivation, ethics, use of an interpreter, and other general issues.     

Anticipatory Economic Stressors: Perceived and Potential Sources of Economic Disadvantage for LGBTQ Adults

This article examines anticipatory economic stress—or the stress of future economic crises or events that may negatively impact material well-being—for LGBTQ adults. Using qualitative interview data from 76 LGBTQ adults, three main sources of anticipatory economic stress emerged: the family, the workplace, and health care. Following an intersectionality framework, these anticipatory economic stressors are experienced differently across gender and racial lines, heightening anticipatory economic stress for LGBTQ people of color and transgender respondents. This article has significant implications for understanding the role of future economic stress in the present and provides important insight into what specific forms of anticipatory economic stress that shape the lives of LGBTQ individuals.     

We Need More Resources: Stories of QTPOC* Survival in the South

While men’s sexual violence against women is unarguably a social and public health issue, both nationally representative data and smaller studies tell us that rates for lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) individuals are equally or significantly higher. Despite this, there remains little structural support for LGBTQ?+?survivors. This article highlights the voices of 38 queer and trans people of color (QTPOC)-identified U.S. Southerners who have experienced sexual violence and came together across three focus groups to detail their interactions with advocates and other professionals and explore posttraumatic needs. Nearly all survivors reported that the level of awareness regarding sexual violence in their communities was limited, with most reporting that they did not successfully access mainstream services, due to concerns about homophobia, transphobia, and racism. To address sexual violence in LGBTQ?+?communities, survivors pointed to the importance of friendship and community networks “outside the system,” knowledge sharing about LGBTQ+-specific violence tactics (e.g., threats of outing a partner), and holding batterers accountable for their behavior within LGBTQ?+?circles. Findings highlight the need to move beyond “culturally competent” health care by proactively engaging LGBTQ?+?communities in education, networking, resource sharing, and anti-violence outreach.     

Health Care “As Usual”: The Insertion of Positive Psychology in Canadian Mental Health Discourse

The recent shift to a “positive psychological” approach that emphasizes a “health model,” rather than a “disease model,” in mental health discourses is intended both to reduce the stigma around mental health issues and to enable people to play a role in monitoring their own mental health. As a component of a larger study on access to and utilization of mental health services by immigrant women, and a partial reflection of the current ideological context of mental health policy and practice in Canada, this shift was examined by analyzing the Canadian Mental Health Association's mental health discourse as posted in Web-based text using features of critical discourse analysis. Although considered an improvement over previous approaches by some, the current mental health discourse continues to reflect ideologies that assume a universal psychology of individual mental health. Framing this research with aspects of sociocultural and postcolonial theories, this article seeks to identify the possibilities of this new discourse and expose its limitations in relation to immigrants to Canada.