Perceptions of transition-related health and mental health services among transgender adults

The opportunity to live authentically is critical for the well-being of transgender individuals. For many this requires accessing transition-related services. Current knowledge of transition-related care is limited. This study aims to elucidate experiences and needs of transgender individuals (N = 65) related to (a) therapeutic support, (b) medical care, and (c) aspects of living authentically in order to inform the development and delivery of trans-affirmative services. Findings reveal challenges accessing health care providers with trans-specific competency; gaps between critical aspects of transition-related care and receipt of services; and heterogeneity of experiences and needs. Recommendations for improving transgender-affirmative services are provided.     

“We're the Normal Ones Here”: Community Involvement,Peer Support,and Transgender Mental Health

This article uses ethnographic methods to explore how peer support and community involvement influence the mental health and well-being of transgender (or, trans) people in the southeastern United States. The study builds on existing research that suggests that trans community involvement and peer support among trans people enhance mental health experiences and moderate the effects of stigma and discrimination on health outcomes. Through qualitative analysis of 158 hours of participant observation and 33 in-depth interviews with members of a trans community organization in the U.S. Southeast, this paper identifies three key processes through which peer support and community involvement enhance the mental health and well-being of trans people: (1) the normalization of trans identities and experiences; (2) the creation of a social support network; and (3) the empowerment of trans people.     

Transgender Individuals' Perceptions of Maternal Support in Central Appalachia

The psychosocial experiences of transgender individuals are shaped by specific cultural beliefs and values that influence family and community interactions. Using a constant-comparative approach to thematic analysis, we analyzed in-depth interviews with 25 transgender-identified adults in Central Appalachia and discovered that their mothers play a crucial role in their social support experiences. Participants described supportive and unsupportive interactions with their mothers and how their mothers' attitudes and behaviors evolved in positive directions over time. They also perceived that their mothers played a key role in influencing how other family and community members behaved toward them. Participants gave meaning to their mothers' behaviors by placing them in the context of strong cultural values about distinct gender roles, family loyalty, religious conservatism, and pride of place. These findings serve as a reminder to family mental health practitioners and health service providers to directly assess family and community strengths and draw on these resources to facilitate the well-being of clients from stigmatized and under-resourced populations.     

Identifying and Navigating Social and Institutional Challenges of Transgender Children and Families

The purpose of this article is to highlight the voices and lived experiences of four families and their transgender children (male to female). The methodology consists of a qualitative case study approach and ethnographic research methods over the course of 1 year. With a focus on mezzo and macro-level issues, the results of this article illustrate some of the ways that these families navigate their child’s transition, the social challenges that they experience from a society that adheres to the gender binary, and institutional challenges that this community faces in the realms of education, religion, medicine, and mental health. A discussion follows of the ways in which social workers can promote the health, happiness and the well-being of gender-variant children and their families within the community. We conclude with advocating for re-conceptualizing rigid and binary definitions of gender and challenging institutions that perpetuate oppression against trans children and their families.     

Factors Affecting Subjective Weil-Being for Rural Elderly Individuals

Abstract

A cross-sectional survey design was used to examine the relationships between spirituality, religiousness, social support, and the subjective well-being in a sample of 215 elderly individuals in the rural counties of West Virginia and North Carolina. The Brief Multidimensional Measures of Religiousness/Spirituality (BMMRS) was used to measure various domains of religiousness/spirituality, including daily spiritual experiences, values/beliefs, forgiveness, private religious practice, religious/spiritual coping, and religious support. Multivariate analyses found social support was positively related to life satisfaction and spirituality/religiousness was inversely related to depression. These findings provide health/mental health care providers and social workers with information that can increase their awareness of and sensitivity to services or programs that are congruent with religious/spiritual values and beliefs in order to enhance quality of life among rural elderly individuals.     

Transition,Connection, Disconnection,and Social Media: Examining the Digital Lived Experiences of Transgender Individuals

In light of persistent discrimination, many individuals who are transgender lack a safe space to connect with others. Social media has become a platform for establishing social ties, receiving education, and sharing of resources that may not otherwise be available to individuals on the margins of society. Yet little is understood about the role of social media in the lives of individuals who are transgender. In this qualitative study, the researchers examined the experiences of adults who are transgender (N = 5) who use social media. The current study also explored possible benefits and hindrances of social media for individuals who are transgender. Two main themes emerged: social media as a resource and a path to self and authenticity. The researchers encourage counselors to become familiar with various social networking sites and their privacy settings, and propose using a theoretical framework to guide counseling work with individuals who are transgender to reflect on social media connections and disconnections.     

Transmen's Health Care Experiences: Ethical Social Work Practice Beyond the Binary

Informed by institutional ethnography approaches, this study includes interviews with 3 young transmen (21–29) about their experiences regarding Canadian health care and the work they perform to access care. Semistructured interviews were used to gather data that were then analyzed to identify key aspects of participants’ experiences and perceptions. Findings describe the extra work transmen perform to compensate for a lack of provider competence in transgender health care. Influences of the dominant gender binary ideology as it shapes the health care experiences of transmen are discussed. This article calls for social workers to challenge the gender binary and use practice frameworks informed by transgender theory.     

Navigating Intersecting Identities,Self-Representation,and Relationships: A Qualitative Study with Trans Sex Workers Living and Working in Los Angeles,CA

This qualitative research study highlights the lived experiences and voices of diverse trans sex workers who are living and working in Los Angeles, California. Informed by transgender theory, feminist intersectionality theory, and standpoint feminist theoretical approaches to research, this study uses life history case studies, qualitative interactive interviews, and a life timeline approach with six trans sex workers living and working in various aspects of the sex trade in Los Angeles. This article focuses on the unique experiences of trans sex workers and examines how the intersectional identities of trans sex workers and the institutional forces they come into contact with shape the strengths, challenges, and empowering aspects related to their work in the sex trade, and their individual approaches to navigating personal and professional relationships/roles, maintaining quality of life, and resisting stereotypes and stigma.     

Older Adults’ Experiences of Sexual Difficulties: Qualitative Findings From the English Longitudinal Study on Ageing (ELSA)

There is a growing body of evidence demonstrating that sexual activity is important to the quality of life of older adults, and that it can be influenced by physical, psychological, and social factors. However, older adults’ experiences of sexual difficulties remain relatively unexplored. This article draws on qualitative data collected as part of the English Longitudinal Study of Ageing (ELSA). Participants answered a Sexual Relationships and Activities Questionnaire (SRA-Q), which included an open comment box for further details, 1,084 (1/7) of which were completed. These data were analyzed using Template Analysis, and findings on the experiences of sexual difficulties are presented in this article. Sexual difficulties were contextualized within the couple relationship and could be detrimental to the relationship, particularly if the partner would not seek professional help. Participants reported that sexual difficulties could also have a negative impact on psychological well-being, described mainly as frustration, depression, and sadness. For some participants the supportive nature of their relationship buffered these impacts. Few had sought professional help; those who had reported helpful and unhelpful experiences. These findings add to the limited evidence base and have implications for health care in the context of global aging and a growing recognition of older adults’ sexual rights.     

Applying health determinants and dimensions in social work practice

Dimensions and determinants related to physical health, mental health and well-being can be used as tools in social work practice. These frameworks are useful for assessment, planning and intervention activities in complex client situations, alerting social workers to consider diverse features and processes that influence well-being in people's lives. They can be applied in social work with individuals, families, groups, and communities. In our view health and well-being need to be viewed holistically, broadly and in each unique situation, changing over time over the life course. Literature based on key word searches of concepts we use in our teaching and research and that has informed our conceptualisation of dimensions and determinants in physical health, mental health and well-being, is reviewed. A case illustration is presented to illustrate how the dimensions and determinants are used to inform practice and compare and apply alternative frameworks. Finally, the implications of these and other frameworks for social work, not only in health care settings, but also in other fields of social work practice, are discussed.     

Military spouses speak up: A qualitative study of military and Veteran spouses’ perspectives

ABSTRACT

The purpose of this qualitative study was to examine military family life through the lens of military and Veteran spouses. Twenty-two female, active-duty military and Veteran spouses provided extensive written responses to essay questions as part of an online survey that were analyzed with qualitative data analysis methods. Findings revealed seven main themes: how military life has influenced health care access, spouses’ identities as caregivers, marital relationships, health outcomes, social support, spouses’ educational and career opportunities, as well as their personal growth. In summary, their experiences indicate that military service affects all aspects of their lives. Spouses gave numerous suggestions as to how service providers can address their unique experiences to improve the supports they offer military families, including ensuring the spouse is involved in health care, and providing support programs that focus on the entire family.     

Health Care innovation and children in poverty: lived experiences of caregivers of children with disabilities in a medicaid-serving ACO

This paper reports the results of a qualitative study of caregivers of children with disabilities enrolled in a Medicaid-serving accountable care organization (ACO). The state of Ohio mandated ACO enrollment for Medicaid-eligible children with disabilities in 34 of 88 counties effective July 2013. Research participants were queried in focus groups and individual interviews about their children’s care experiences and care coordination after enrollment. Most told researchers that they themselves are their children’s care coordinators, and many indicated that resource scarcity is a more pressing problem than fragmented care. Data analysis identified a theme of scarcity and four categories of insufficiency that made caregiver efforts on behalf of their children more difficult: a lack of health services under managed care, resource constraints on other agencies and programs for which families were eligible, a lack of financial support, and a lack of family support. A conceptual framework places ACO care coordination among more upstream factors and identifies ways in which ACOs serving Medicaid populations may wish to address the social determinants of the well-being of children with disabilities. Implications for future research are discussed.     

Elucidating transgender students’ experiences of microaggressions in social work programs: next steps for creating inclusive educational contexts

Social work education globally expresses an unwavering commitment to promoting social justice and the amelioration of oppression. Nevertheless, mounting research suggests that social work programs (SWPs) may inadvertently perpetuate microaggressions toward individuals who are transgender and gender non-conforming (TGNC). This qualitative study elucidates experiences of TGNC social work students in North America. Grounded theory analysis revealed six key themes related to students’ experiences of microaggressions within their SWPs: (1) structural oppression, (2) cisgender bias, (3) faculty knowledge gaps, (4) visible discomfort, (5) pervasive nature of transphobia, and (6) social exclusion. Despite the existence of educational and professional policies aimed at fostering transgender inclusive social work education and practice, results from this study underscore the need to take a closer look at the ways in which knowledge gaps, implicit cisgender biases, and existing practices and policies within SWPs inadvertently privilege the experiences of cisgender students and marginalize TGNC students. Key findings from the current study can be used to inform the implementation of transgender affirmative changes, contributing to efforts to eradicate transphobic bias within SWPs.     

Cross-cultural Child Development for Social Workers: An Introduction

Abstract

The transgender community represents a highly marginalised portion of the Australian population, frequently experiencing discrimination, social isolation, and harm. This review explores literature informing Australian social work with transgender people. It highlights the importance of generating a transgender-positive discourse within Australian social work to effectively engage with and advocate for individuals with nontraditional gender identities. Key themes emerged from reviewing the literature related to the medical model, the mental health of transgender people, interdisciplinary and alternative transgender literature, minority status of transgender people, existing social work approaches to transgenderism, and Indigenous transgender literature. The views of transgender Australians are largely absent from the literature. However, the Australian transgender community's emerging voice and political activism highlights the potential for collaboration to play a significant role in the process of building a working knowledge base for social work. Based on the identified gaps in literature, in this paper we call for continued progress in developing a theoretical and practical knowledge base that incorporates the lived experiences of transgender Australians. We argue for the development of an approach to practice that is responsive to gender diversity. Highlighted in the review are the conditions that promote greater engagement with the transgender community.     

Lessons from Post-War Experience: An Alternative Care Interventions for War-affected Children in Pakistan

This qualitative research analyses the literature and lived experiences of war-affected institutionalized children of Pakistan. It is well documented that war-affected children face a unique set of adverse childhood events that have lasting effects on their social, emotional, physical, and cognitive well-being and development. War-affected children of Pakistan exposed to childhood trauma require enhanced interventions during and after conflict to mitigate the compounded and lasting detriments to their well-being and development. Social-Ecological interventions for this war-affected population needs trained social workers, psychologists, and child-rights activists to approach all angles of their humanitarian needs in collaboration with NGOs, governmental agencies, and other stakeholders. The findings strengthen the argument for supporting familial attachment through community-based integrated interventions both during and after armed conflict for the orphaned children of Pakistan in alternative care. The goal of this article is to inform policy implementation and provide recommendations for additional support to this population.     

‘I shouldn’t be living there because I am a sponger’: negotiating everyday geographies by people with learning disabilities

Learning disability policy has for some time been framed by the goal of inclusion which purports to enable people with learning disabilities to lead a ‘life like any other’ person. This article examines the extent to which this is the case in England, by tracing the lived experiences of people with learning disabilities within their communities. The article draws on two interlinked qualitative studies involving interviews that examined their local place-based experiences of inclusion and exclusion. The findings reveal ‘moments of inclusion’ and opportunities for social encounter from peer support, but these were situated amidst wider experiences of exclusion and harassment.     

How is participation related to well-being of homeless people? An explorative qualitative study in a Dutch homeless shelter facility

The majority of homeless people is socially excluded which negatively affects their well-being. Therefore, participation-based programs are needed. The current research is conducted within a Dutch homeless shelter facility that offers educational, recreational, and labor activities to clients in an environment which is designed to feel safe (an enabling niche). The main aim of these activities is to facilitate social participation. We conducted two qualitative studies consisting of 16 semi-structured interviews, to explore clients’ experiences with participation in activities in relation to their well-being. The findings showed that clients experienced that participation had led to an improvement of physical, social, and mental well-being. In general, clients reported that due to participation in activities they have strengthened their social support network, improved their (mental and physical) health, self-esteem and personal growth. We concluded that in order to facilitate long-term positive outcomes of participation in practice, it is necessary to focus on group cohesion, and on the social worker’s behavior and attitude.     

Communication in Online Forums About the Experience and Management of Relational Uncertainty in Military Life

Relational uncertainty is an undeniable aspect of military life, but the literature lacks knowledge about the lived experiences of military couples. We examined how individuals communicate in online forums about relational uncertainty in military life using a grounded theory approach to analyze 1,794 pages of threads. Results demonstrated that posters detected deception and/or recognized change, which led to volatile emotions, and ultimately prompted them to seek help for managing relational uncertainty. Posters dealt with their questions by engaging in self-care, justifying the partner’s behavior, postponing action, and doing relationship work. In reply, responders provided emotional support by offering comfort and reframing change. They provided informational support by recommending that posters acknowledge deception, take care of themselves, consider the partner’s perspective, defer major changes, and work on the relationship. These findings advance theorizing about relational uncertainty and social support; they also suggest guidelines for helping military couples manage relational uncertainty.     

Marital Status and Perceived Discrimination Among Transgender People

Despite calls for increased attention to the experiences of transgender people, scientific understanding of the stigma and discrimination this population experiences is limited. The authors integrate minority stress and marital advantage perspectives to assess marital status differences in transgender‐related perceived discrimination among transgender people in multiple life domains: the workplace, family, health care, and public accommodations. They analyze one of the first and most comprehensive large‐scale samples of transgender people in the United States (N = 4,286), the National Transgender Discrimination Survey. They find that married transgender respondents tend to report lower levels of perceived discrimination than their cohabiting and previously married transgender counterparts. Married transgender respondents do not, however, report lower levels of perceived discrimination than their never married counterparts, once all covariates are accounted for. These marital status differences appear primarily among transwomen but not transmen. Economic resources account for some, but not all, of these differences.     

Racial and Ethnic Differences in Experiences of Discrimination in Accessing Social Services Among Transgender/Gender-Nonconforming People

Members of the transgender/gender-nonconforming (GNC) community experience higher rates of discrimination based on their gender compared to their cisgender counterparts. Similarly, people of color experience higher rates of discrimination than White people. This study examines the difference in experiences of discrimination among transgender/GNC individuals in accessing social services providers by race/ethnicity (White and people of color). The data collected in a national cross-sectional survey (N = 6,451) and analyzed via chi-square test of independence and binary logistic regression demonstrate the disproportionate prevalence of discrimination based on race/ethnicity within the transgender/GNC population when accessing social services such as drug treatment centers, mental health clinics, domestic violence shelters, and rape crisis centers. Social workers are the most common provider of social services to the community, and have an ethical commitment to provision of services without discrimination. High rates of discrimination in accessing social services among transgender/GNC people, with even higher rates of discrimination for transgender/GNC people of color, highlight the need for improvement in social work education and practice.