You’re Deaf? Breaking through Myths for Effective Therapeutic Practice

ABSTRACT

Most mental health practitioners provide services to hearing clients and might be unprepared when a deaf individual requests services. The purpose of this article is to explore commonly held stereotypes and myths about deaf people and to provide guidance to clinicians who encounter deaf clients in their practices. Myths and stereotypes can affect the way clinicians perceive their clients’ needs. This can lead to miscommunication, misunderstanding, and misinformation, which can harm the therapeutic relationship, thus making effective therapy unattainable. Clinicians should reframe these beliefs and overcome barriers to make way for the therapeutic process to begin.     

Baseline Characteristics of Dependent Youth Who Have Been Commercially Sexually Exploited: Findings From a Specialized Treatment Program

ABSTRACT

Commercial sexual exploitation of children has emerged as a critical issue within child welfare, but little is currently known about this population or effective treatment approaches to address their unique needs. Children in foster care and runaways are reported to be vulnerable to exploitation because they frequently have unmet needs for family relationships, and they have had inadequate supervision and histories of trauma of which traffickers take advantage. The current article presents data on the demographic characteristics, trauma history, mental and behavioral health needs, physical health needs, and strengths collected on a sample of 87 commercially sexually exploited youth. These youth were served in a specialized treatment program in Miami-Dade County, Florida, for exploited youth involved with the child welfare system. Findings revealed that the youth in this study have high rates of previous sexual abuse (86% of the youth) and other traumatic experiences prior to their exploitation. Youth also exhibited considerable mental and behavioral health needs. Given that few programs emphasize the unique needs of children who have been sexually exploited, recommendations are offered for providing a continuum of specialized housing and treatment services to meet the needs of sexually exploited youth, based on the authors’ experiences working with this population.     

Responsive engagement in mental health services for foster youth transitioning to adulthood

ABSTRACT

As youth near the transition to adulthood and aging out of the foster care system, exposure to stress increases, especially for youth who have less-than-adequate support systems. Although mental health problems among foster youth often continue into adulthood, service use decreases dramatically within a year of turning age 18. Understanding how foster youth experience mental health services as they transition from care provides social workers and other mental health professionals important insight that can lead to specific, targetable strategies. This study sought to explore what situations were helpful in supporting mental health as foster youth transitioned to adulthood. Focus groups and interviews with former foster youth and professionals informed the development of a quantitative instrument, which was used to identify the most supportive and frequently encountered situations former foster youth experienced. Findings indicate the most helpful situations were those in which professionals and mentors were flexible and responsive to their individual needs and trusted their ability to make decisions. Supportive adults who honored their choices and collaborated in decision-making were also helpful. Engaging, empowering, and partnering with transition-age youth may increase the likelihood of positive mental health outcomes for this population, offering implications for family-centered, strengths-based practice.     

Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Planned Change in the Disability Community

Abstract

Planned change with people, who are physically or mentally disabled, as with other special populations, requires a range of skills and knowledge; several specific aspects of the change process are identified and discussed in this article: the characteristics of the change agent, the timing of the change event, and creating a vision for change. These aspects are illustrated through the writer's own experiences as a change agent working a long-range change event to improve access¹ to mental health services in the US with and for people who are deaf and hard of hearing.     

Caregiver perceptions of empowerment and self-efficacy following youths’ discharge from residential care

ABSTRACT

Residential care is one of the most restrictive out-of-home care settings; however, this is a temporary placement and youth eventually reintegrate into the home and community setting. Reintegration presents many challenges, and aftercare becomes critical for maintaining youth gains and promoting family stability. Aftercare programs and supports should align to individual family needs that entail understanding individual and familial characteristics. Previous studies have explored characteristics related to family functioning, mental health, behavior, and perceptions of need during reintegration; yet little is known regarding how affective characteristics (i.e., self-efficacy, empowerment) factor into reintegration, or the implications this may have for providers. The purpose of this study was to address this gap by exploring empowerment and self-efficacy in caregivers (N = 120) who had a child return home within 1 month of departing residential care. Overall, caregivers reported high levels of empowerment and self-efficacy during the initial transition period. Significant differences for empowerment and self-efficacy were present in characteristics such as race, income, number of children in the home, and free/reduced lunch status.     

Psychodynamics and empowerment in community mental health

Abstract

This paper examines the relationship between empowerment philosophy and psychodynamic principles and practices, as it applies to community mental health work. It suggests that as empowerment philosophy is more a system of values than a model of mental health and illness, it cannot in itself act as a framework for understanding and working with disturbed people. I suggest ways of disentangling the often fraught relationship between the two frameworks by identifying the contribution I see each as able to make to the task of providing services which sustain people in the community, and attempt to articulate the elements of a practice model consistent with both sets of principles.     

The Mental Health System and Sense of Self Among Adults with Serious Mental Illness

Abstract

Development of a sense of self is a lifelong process. One's sense of continuity in the context of the demands of multiple role identities contributes to both psychological well-being and opportunities for acceptance into valued social roles. The onset of a mental illness can rupture an emerging sense of self and require intense and painful restructuring of one's beliefs and expectations. This study was a secondary analysis of qualitative data from interviews with twenty people who self-identified as having serious mental illness to explore how well the mental health system addresses the ingredients that promote, create, or restore a valued and adaptive sense of self.     

The Role of Non-Governmental Organizations for the Welfare of the Elderly

Summary

Since there has been a gradual increase in the population aged 60 and older, a developing country like India is unable to cope with the needs and problems of its aged populations. While the government continues its efforts to introduce programs for the elderly, the nongovernmental organizations (NGOs) have played a key role in bringing to the forefront the socioeconomic and health problems of older people in the society at large. This paper looks at the role of the NGOs through their various welfare activities and beneficial programs in carving out a place for the elderly in India. The work of HelpAge India is highlighted to examine how voluntary organizations have worked in the field of aging in India and made an impact on the lives of the senior citizens, especially those below the poverty line who are economically and socially deprived.     

Reflections of the Annual Meeting

Abstract

In preparation for planning counseling and mental health services at Columbia University, the authors conducted a mental health needs assessment survey that sampled representative numbers of students. Respondents were most concerned about academic and school-related issues, followed by concerns in the area of love relationships. Multiple regression analysis revealed certain subgroups that were more likely to have these concerns and certain health and mental health problems that were significantly associated with these concerns. The study identified serious psychological problems, including suicidal/homicidal thoughts and sexual abuse, and surveyed respondents' treatment preferences. Finally, the authors discuss how the study findings contributed to sharpening and expanding focus on different aspects of program development in the collaboration between mental health and health education.     

Information Systems and Mental Health Services

Summary

This paper examines issues related to applying information technology in behalf of mental health service delivery systems. Each of these issues has an impact on how well information technology has been able to serve the mental health system. These are not primarily information technology issues. They are concerns that have to do with the structure of the mental health system; the way management might use an information system; and the role of money and power in the mental health system. How these issues are resolved will have a major impact on how well the promise inherent in information technology is realized in the coming decade.     

Inclusion and exclusion in the digital economy: disability and mental health as a live streamer on Twitch.tv

ABSTRACT

In this paper I explore economic and inclusion opportunities for people with disabilities and mental health issues afforded by ‘live streaming’ ? the live broadcast of one’s activities over the internet to a globally dispersed audience. In both 2016 and 2017, the leading live streaming platform Twitch.tv broadcast over 500,000 years of video, which were produced by over two million regular broadcasters (‘streamers’), and consumed by an audience of several hundred million viewers. Streamers can profit, up to and including a full-time living ‘wage’ for those at the highest levels. Numerous successful streamers with chronic health issues have discussed the personal and professional benefits streaming brings them. Utilising data from a research project with 100 interviews, alongside approximately 500 hours of ethnographic observation, this paper examines the experiences of live streaming for broadcasters with disabilities, mental health issues, or physical health issues. Firstly, I explore the positive elements of streaming for these broadcasters, focusing on the many conditions represented in this demographic, and the benefits streaming gives for inclusion and community. Secondly, I consider the negative experiences of these streamers, focused on entanglements of health and technology that make their streaming lives potentially more challenging than their colleagues. Thirdly, I focus on the economic opportunities, and the potential for entrepreneurial activity, the platform affords. I conclude the analysis by exploring how these aspects make live streaming a potentially exemplary emancipatory and entrepreneurial space for these individuals, but not one without challenges.     

Sexuality and mental handicap

Abstract

In the twenty years since the appearance of Janet Martinson's important and immensely readable book, many wide-ranging changes have taken place in the field of mental handicap. These changes have had important consequences for the way in which we now discuss sexuality in relation to people who have a mental handicap or learning difficulties.     

The university as developmental space – a case for thinking differently?

Abstract

In recent years, there has been a sizeable increase in young people approaching University Counselling and Well-being Services for support in managing mental health difficulties with one research project suggesting an increase of demand upwards of 33%. Support is necessarily often targeted at those who present most ‘at risk’, but this ignores the potential positive impact that universities can have on promoting mental health for future generations, not least given that nearly half of all young people in the UK participate in Higher Education. Drawing on a case study of one UK undergraduate student, this paper will explore themes common to university students such as difficulties in transitioning from home, defensive-bonding in relationships and low self-esteem. The paper argues the need for universities and colleges to provide ongoing support for students who are ‘just about managing’ in order to enable them to flourish, both emotionally and academically.     

Needs assessment of youths in residential child care in Portugal / Evaluación de necesidades de jóvenes en acogimiento residencial en Portugal / Evaluación de necesidades de jóvenes en acogimiento residencial en Portugal

Residential child care in Portugal is the most common protection measure in cases of family separation, since family foster care is still very rare. However, little is known about the needs of these children and young people. The purpose of this study is to describe the profile of adolescents close to legal adulthood who are in residential care, comparing it with a Spanish sample. The sample is composed of 345 young people aged 16 to 17 on whom information has been collected regarding their history of protection, family background, schooling, mental health and offending behaviour. A Spanish sample was selected as a comparison group (N = 384). The results reveal the complexity and special seriousness of the profile of young people in residential care in Portugal compared to a Spanish sample, highlighting a high presence of mental health problems and especially suicidal behaviours. Given these results, efforts should be focused on developing specialized residential care programmes adapted to the specific needs of these young people.     

Schizophrenia,Community Integration,and Recovery

Abstract

Rooted in deinstitutionalization policy, the community inclusion required by the Olmstead case, and the grass roots recovery movement, community integration for those who have diagnoses of serious mental illnesses has become an increasingly important policy goal. The purpose of this project was to examine empirical evidence describing experiences with social or community integration for people with psychiatric disabilities, with a particular interest in the schizophrenias. Studies chosen for review all involved direct survey or interview data from people with psychiatric disabilities and examined subjective experiences with social relationships or linked social participation with clinical, functional, or quality of life outcomes. Experiences involving the dynamics of social stigma, the achievement of personal agency, and innovative pathways to satisfying social inclusion are core themes found that are highly relevant for practitioners. Social work, with its ecological perspective, is well suited to address the complexities of conflicting interests and objectives that have arisen in mental health care in the pursuit of community integration. Suggestions for fruitful responses are presented.     

A case for psychodynamic social work

Abstract

Psychodynamic casework is not as popular in social work theory and practice as it once was. It is considered by some to be impractical, unscientific, and not suitable for those customarily receiving a social work service. Task-centred casework, behavioural approaches, the newer psychotherapies, and family therapy have all taken over as major paradigms of social work method. This is especially so, I think, for the social worker working in a psychiatric setting, where many clients stay only for a short time and where emphasis is placed on assessment and short-term intervention.

In this paper I shall argue that a psychodynamic approach in social work is still relevant; that it is important for its humanizing qualities, for understanding and working with people with severe problems and for, perhaps, helping us to locate the position of social work vis-a-vis other mental health professions. I shall do this by focusing on a particular case I had as a social work student on placement in a psychiatric day hospital.     

Effects of Testosterone Treatment and Chest Reconstruction Surgery on Mental Health and Sexuality in Female-To-Male Transgender People

ABSTRACT. Objectives: This study examined the effects of testosterone treatment with or without chest reconstruction surgery (CRS) on mental health in female-to-male transgender people (FTMs). Methods: More than 200 FTMs completed a written survey including quantitative scales to measure symptoms of anxiety and depression, feelings of anger, and body dissatisfaction, as well as qualitative questions assessing shifts in sexuality after the initiation of testosterone. Fifty-seven percent of participants were taking testosterone and 40% had undergone CRS. Results: Cross-sectional analysis using a between-subjects multivariate analysis of variance showed that participants who were receiving testosterone endorsed fewer symptoms of anxiety and depression as well as less anger than the untreated group. Participants who had CRS in addition to testosterone reported less body dissatisfaction than both the testosterone-only or the untreated groups. Furthermore, participants who were injecting testosterone on a weekly basis showed significantly less anger compared with those injecting every other week. In qualitative reports, more than 50% of participants described increased sexual attraction to nontransgender men after taking testosterone. Conclusions: Results indicate that testosterone treatment in FTMs is associated with a positive effect on mental health on measures of depression, anxiety, and anger, while CRS appears to be more important for the alleviation of body dissatisfaction. The findings have particular relevance for counselors and health care providers serving FTM and gender-variant people considering medical gender transition.