Facilitating Transition Among Transgender Clients: Components of Effective Clinical Practice

Although transgender clients seek services in a number of settings in which social workers practice, there is a dearth of scholarly literature available to guide effective clinical practice with this population. When transgender issues are included in the practice literature, the trend has been to consolidate the needs of transgender clients with those of the larger lesbian, gay, and bisexual community or to simply focus on increasing the comfort level of clinicians working with this population. This is concerning because transgender individuals represent a vulnerable subgroup of clients with unique and specific treatment needs related to the transition experience. Social workers play a critical role; they may serve transgender clients and their families in many ways: as advocate, educator, diagnostician, and individual, couples or family therapist. The purpose of this article is to identify several key components of trans-specific clinical practice and the role of social workers in supporting and facilitating client transition. Specifically, the authors will discuss: (a) relevant definitions and terminology, (b) emerging issues related to depathologizing the needs and experiences of transgender individuals, (c) the critical elements of trans-specific clinical assessment, and (d) clinical advocacy associated with the medical legal and social aspects of the transition process. Specific recommendations for trans-affirmative social work practice will be offered.     

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.     

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.     

Policy, Practice and People: Current Issues Affecting Clinical Practice

This commentary highlights current policy issues affecting lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in the US with implications for mental and behavioral health care and social work services. These issues include conversion or reparative therapies, especially for young people, and conscience clauses that may exempt some students and practitioners from serving LGBTQ people and their families. While not a “policy” per se, emerging knowledge about health disparities that affect LGBTQ people will also be summarized because of its relevance to practice; many of these concern mental health and behavioral health. Finally, some resources for making health care organizations more responsive to the needs of LGBT people are identified.     

Facilitating Mental Health Service Use for Caregivers: Referral Strategies among Child Welfare Caseworkers

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers' use of different referral strategies and the extent to which these strategies are associated with caregivers' receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers' direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed.     

Supporting families with a mentally ill parent: European perspectives on interagency cooperation

This paper reports on the findings of a cross-country comparison of cooperation between services for community mental health and child protection in 11 states. The authors consider the implications of the findings for English practice. When children have a parent with mental health problems, they have needs over and above those of other children. Often these needs are met by the family, but this is not always possible. There are increasing numbers of these children, and they feature disproportionately in the case loads of child welfare professionals, health visitors and social workers. The cross-country comparisons demonstrate the ways in which differences in structures, resources, expectations and attitudes affect professional responses and the experiences of families. The findings provide information on several levels. A comparison of commonalities and differences highlights the problems that are shared across countries, and alternative ways of responding to them at ground level are discussed. The factors that facilitate a good outcome are analysed in relation to English practice and service structures. The research findings are relevant for British social welfare strategies, and the paper highlights the implications of the findings for policy and practice. Copyright © 2001 John Wiley & Sons, Ltd.     

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.     

Children,adolescents and social work: A statement from the editor

Current social policy affects clinical social work with children, adolescents, and their families. As a result of inadequate funding, many resources that are needed for prevention and therapeutic work are not adequate for the needs of the client group. Gaps in resources affect the welfare of children and their families and often contribute to the causes of mental health problems. Other issues related to service systems and professional arrangements affect the identity and status of clinical social workers and interfere with optimal professional activities.     

A Bioethics Approach to Social Work Practice With Transgender Clients

Increased advocacy for the informed consent model of transgender health care specifies that patients should be in control of access to receiving medical interventions such as hormone therapy or surgery. However, in practice, mental health clinicians, including clinical social workers, are increasingly called upon by medical providers to serve as gatekeepers for these processes. It is frequently the role of social workers to assess transgender clients’ baseline mental health and their understanding of the consequences of treatment, and to forward recommendations to medical providers regarding the readiness of patients to transition. Therefore, social workers assisting transgender clients must be aware of the ethical standards that are particularly pertinent to their work with this marginalized and oppressed population. They must also be prepared to address unique ethical dilemmas that may be especially challenging to resolve. In this article we apply the most commonly utilized bioethical framework known as Principlism to describe the ethical standards and values that are particularly important to consider when working with transgender clients, namely autonomy; beneficence; nonmaleficence; and social justice. Because clinical social workers are frequently in the position of balancing client self-determination with their role as gatekeepers, a framework for resolving resulting ethical dilemmas is described (I CARE) and applied to three case examples.     

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.     

Inter‐professional working in child protection with families with long‐term and complex needs

Within the United Kingdom there is growing awareness of the need to identify and support the small number of children who are living in families experiencing multiple problems. Research indicates that adverse experiences in childhood can result in poor outcomes in adulthood in terms of lack of employment, poorer physical and mental health and increases in social problems experienced. It is acknowledged that most of these children are known to child welfare professionals and that some are referred to social services, subsequently entering the child protection system. This paper reports research conducted with 28 experienced child welfare professionals. It explores their views about families known to the child protection system with long‐term and complex needs in relation to the characteristics of children and their families; the process of intervention with families; and the effects of organisational arrangements on practice. The research indicates that these families are characterised by the range and depth of the problems experienced by the adults, such as domestic violence, mental health difficulties and substance misuse problems, and the need for professionals to have good inter‐personal skills and access to specialist therapeutic services if families are to be supported to address their problems. Copyright © 2008 John Wiley & Sons, Ltd.     

Social workers’ perspectives on the recovery-oriented mental health practice in Tshwane,South Africa

The challenge facing the mental health field today is the lack of knowledge related to interventions and services that will help people recover from severe mental health problems. In addition, the reluctance of social workers to embrace the recovery-oriented mental health practice is attributed to their lack of knowledge. Hence, they regard recovery in mental health as misleading and unrealistic.The article provides the findings on the social workers’ lack of knowledge and understanding of the recovery-oriented mental health practice. The social workers are based in non-governmental organizations in Tshwane, South Africa. Semi-structured interviews were conducted to gather data from social workers. Findings confirmed the lack of knowledge regarding the recovery-oriented approach, which has not yet been implemented in South Africa. Mental health services continue to be informed by the traditional medical model.     

Social Workers’ Observations of the Needs of the Total Military Community

Researchers surveyed licensed social workers from 5 Mid-Atlantic states to explore their perspectives on the current state of mental health and service delivery for military service workers, families, and contractors. Social workers identified needs in the following areas: mental health, physical health and wellness, social and environmental, interpersonal and family, and military-specific needs. The majority of needs were most critical during the postdeployment stage. Education related to the observed needs was reported; social workers were most interested in learning about military culture and how to coordinate resources within the community to support the total military community. Suggestions for social work education and future research are discussed.     

Appropriate Therapeutic Care for Families with Pre-Pubescent Transgender/Gender-Dissonant Children

In recent years, a new phenomenon has been observed in U.S. culture, that of pre-pubescent children transitioning socially from one gender role to another, with the support of their families. As this phenomenon becomes more widespread, families, schools and other institutions will turn to mental health care professionals for guidance in navigating new territory. Such children have often been assessed for gender identity disorder; the traditional treatment plan for those so diagnosed included attempts to steer their gender behavior in more “gender-appropriate” directions. Allowing such children to self-actualize, viewing their behavior as indicative of innate identity, is a relatively new approach. This paper will focus on the social worker’s or therapist’s role in helping pre-pubescent children and their families, should the families decide identity actualization is the path they would prefer.     

The Lived Experiences of Transgender Persons: A Meta-Synthesis

This article synthesises findings from qualitative studies which have explored the lived experiences of transgender persons, using Noblit and Hare's (1998) meta-ethnography method. Thirty-one qualitative studies related to the lived experiences of transgender individuals, published between 1998 and 2013, met the inclusion criteria. A literature search was conducted between November 2012 and September 2013 using computerized searches from nine databases as well as online manual searches of key journals. Results from these individual studies revealed five major themes: (a) crossing gender and physical problems in life, (b) experiencing psychological distress, (c) encountering discrimination and social exclusion, (d) having relationships does matter, and (e) dealing with difficulties in life. Yet, despite these negative experiences, transgender people have tried to find ways to help them deal with their difficulties. We conclude that there is a need for health care providers, social workers, and health promoters to support transgender individuals, for their health and well-being. This meta-synthesis provides a clear account of what transgender individuals experience in their lives, to support the development of sympathetic health and social care services to assist them with their difficulties, and enhance their health and well-being.     

Ethical Issues in Child Custody and Dependency Cases

Abstract

The emotional and psychological risks to children of high conflict divorce have led to the increased involvement of mental health professionals in child custody cases. Numerous service models (Greenberg & Gould, 2001; Johnston, 2000; Johnston & Roseby, 1997) have been developed to assist divorcing families in minimizing family conflict and supporting children'S needs. This underscores the need for judges and attorneys to understand the ethical and professional standards that underlie competent mental health practice in forensic cases. The practices of mental health professionals providing court-related services may have a substantial impact on the validity of their professional opinions, the effectiveness of services provided to children and families, and children'S development and adjustment. The authors suggest core ethical and clinical issues to be considered by all psychologists who work in the context of custody disputes. It is hoped that these professional practice suggestions will also be useful to attorneys and judicial officers in assessing the quality of mental health professionals' opinions.     

Being a service user and a social work academic: balancing expert identities

Abstract

I am a service user and academic working in a university social work department. My hybrid identity allows me to draw on different types of knowledge in all aspects of my work, including: academic, practice and experiential wisdom. Service user involvement is mandated across social work education but the scope and breadth of different kinds of participation is developed in diverse ways across university contexts. This article affirms the value of service user involvement in health and social care education, exploring its positive impact on students. When lecturers share personal experience of using services alongside practice and academic wisdom in the course of teaching, sometimes the value of experiential knowledge is doubted and its influence dismissed. I examine the importance of experiential wisdom in social work education, specifically when it is embedded in an academic role in a university social work department, and consider how it can be respected and valued. The parallel experiences of involving peer support workers in mental health services, who use their knowledge of recovery to mentor other service users, are then briefly examined, together with reflection of the concerns across mental health with professionals sharing their experiential wisdom with the people that they support.     

Mental health support needs of people with a learning difficulty: a medical or a social model?

People with learning difficulties, like all disabled people, face social oppression. Much recent policy and practice are underpinned by at least some understanding of this oppression, and the social model of disability has been influential in discussions of services and supports for people with learning difficulties. However, in the area of mental health, the picture is somewhat different. This paper argues that the medical model has predominated in discussions of mental health support for people with learning difficulties, and that a social model approach could have much to offer. The paper draws on an ongoing action research study in which service providers, families and young people with learning difficulties are working together to articulate what is needed, in order to find routes to improve the support offered to young people with learning difficulties and mental health support needs.     

The Lull of Tradition: A Grounded Theory Study of Television Violence, Children and Social Work

This article results from a study of television violence and social work practice with children. Twenty-one social workers who work primarily with children in schools, in community mental health agencies and in private practice were interviewed. A qualitative analysis using grounded theory indicates that social workers do little to elicit television content or information about children's television viewing. They do not believe that television experiences are central to their work. Although social workers express concern about the influence of television violence on children, their traditional beliefs in cause and effect, values neutrality, and gender lead many to minimize its importance.