Incorporating sexual orientation into MFT training programs: infusion and inclusion

Many authors have questioned the preparedness of family therapists to deal with sexual minority clients. Even though the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) has called for the integration of sexual orientation into the curriculum of marriage and family therapy training programs, the subject continues to be marginalized. The purpose of this article is to encourage trainers to examine their programs' curricula for evidence of heterosexist bias and introduce ways that they might integrate issues related to same-sex affectional and sexual orientations into their programs via the classroom and the clinic.     

Human Sexuality Education in Marriage and Family Therapy Graduate Programs

Given the likelihood that marriage and family therapists will encounter clients with sexual concerns, it is important to know how graduate training programs are preparing future clinicians to work with this domain of life. Sixty‐nine marriage and family therapy (MFT) program directors completed an online survey to examine how sexual health education is integrated into graduate training programs. Findings indicate that while the majority of program directors value sexuality curriculum, and most programs require at least one course in this area, there are barriers to privileging sex topics in MFT graduate programs. Barriers include few MFT faculties with expertise in human sexuality and marginalized sexual health topics. Implications for training MFT graduate students and their work with future clients are discussed.     

Measuring Sexual Orientation: A Review and Critique of U.S. Data Collection Efforts and Implications for Health Policy

The U.S. Department of Health and Human Services’ (HHS) Healthy People 2020 goals sought to improve health outcomes among sexual minorities; HHS acknowledged that a dearth of sexual orientation items in federal and state health surveys obscured a broad understanding of sexual minority–related health disparities. The HHS 2011 data progression plan aimed to advance sexual orientation data collection efforts at the national level. Sexual orientation is a complex, multidimensional construct often composed of sexual identity, sexual attraction, and sexual behavior, thus posing challenges to its quantitative and practical measurement and analysis. In this review, we (a) present existing sexual orientation constructs; (b) evaluate current HHS sexual orientation data collection efforts; (c) review post-2011 data progression plan research on sexual minority health disparities, drawing on HHS survey data; (d) highlight the importance of and (e) identify obstacles to multidimensional sexual orientation measurement and analysis; and (f) discuss methods for multidimensional sexual orientation analysis and propose a matrix for addressing discordance/branchedness within these analyses. Multidimensional sexual orientation data collection and analysis would elucidate sexual minority–related health disparities, guide related health policies, and enhance population-based estimates of sexual minority individuals to steer health care practices.     

Drinking Motives,Alcohol Use,and Sexual Attraction in Youth

Sexual minority youth were found to be more likely to drink alcohol during weekdays compared to heterosexual youth. Drinking during weekdays was associated with consuming alcohol as a coping strategy. Sexual minority youth also more frequently consumed alcohol to eliminate personal worries (coping) and to not be excluded by their peers (conformity). Sexual orientation–related alcohol problems should be addressed at an early stage. Such efforts are likely to be effective if insecurities and stress related to sexual orientation are addressed as well.     

The nature of incoming graduate social work students' attitudes toward sexual minorities

Competent social work practice with sexual minorities requires educators to identify factors that can be addressed in the graduate social work curriculum to foster affirming attitudes among students. This study explored the attitudes incoming master of social work (MSW) students hold toward sexual minorities, utilizing a scale that addresses contemporary subtle biases toward lesbian, gay, and bisexual (LGB) people, rather than overt, fear- and morality-based objections measured in previous studies. We explored the role of race/ethnicity, age, sex, sexual orientation, religiosity, political ideology, perceived biological causation of sexual orientation, and LGB social contacts on students' attitudes toward sexual minorities. Multivariable linear regression results suggest that being African American/Black (versus White), older, and heterosexual (versus sexual minority), and greater religiosity (importance of religion and frequency of service attendance) and conservative political ideology, predicted less affirming attitudes, while greater endorsement for genetic causation of sexual orientation and exposure to LGB friends and immediate family members each predicted more affirming attitudes among our sample.     

Training Knowledge of Professionals on Specific Topics in Child Sexual Abuse

This exploratory study examined the training background and self-reported level of knowledge of a group of professionals on specific topics in child sexual abuse. The results show that while the vast majority of those working with adult victims, female victims, and incest victims have received training, many professionals working in the area of child sexual abuse treatment have not had training on topics directly related to their work. It was found that fewer than 40% of those working with female offenders, victims and offenders who are gay or lesbian, victims and offenders who have developmental disabilities, or in cases where cultural issues are relevant, have had training in working with these types of cases. Those professionals who had received training reported feeling more knowledgeable on these topics than did those without training. It is recommended that graduate degree programs and continuing education programs examine their offerings in the area of child sexual abuse.     

Heteronormativity Prevails: A Study of Sexuality in Norwegian Social Work Bachelor Programs

This article reviews how sexuality is addressed in the curricula of Norwegian social work bachelor’s programs. The purpose of the review was to examine whether heteronormativity was problematized in social work curricula. A keyword search revealed that sexuality was addressed in only 0.08% of curriculum materials in the 2013–2014 academic year (90 pages). Among the 6 articles identified that addressed sexuality, a thematic analysis showed that 5 problematized heteronormative assumptions, whereas 1 focused solely on problematic aspects of being gay and lesbian. The finding that heteronormativity was addressed in less than 0.08% of course content indicates that heteronormativity prevails. This study concludes that heteronormative discourses dominate the curricula of Norwegian social work bachelor’s programs. Suggestions for reorienting course content to address sexuality as a hierarchical construction producing otherness are presented.     

The impact of schools and school programs upon adolescent sexual behavior

Because most youth are enrolled in school for many years before they initiate sex and when they initiate sex, schools have the potential for reducing adolescent sexual risk-taking. This paper reviews studies which examine the impact upon sexual risk-taking of school involvement, school characteristics, specific programs in school that do not address sexual behavior, and specific programs that do address sexual risk-taking. Multiple studies support several conclusions. First, involvement in and attachment to school and plans to attend higher education are all related to less sexual risk-taking and lower pregnancy rates. Second, students in schools with manifestations of poverty and disorganization are more likely to become pregnant. Third, some school programs specifically designed to increase attachment to school or reduce school dropout effectively delayed sex or reduced pregnancy rate, even when they did not address sexuality. Fourth, sex and HIV education programs do not increase sexual behavior, and some programs decrease sexual activity and increase condom or contraceptive use. Fifth, school-based clinics and school condom-availability programs do not increase sexual activity, and either may or may not increase condom or contraceptive use. Other studies reveal that there is very broad support for comprehensive sex- and HIV-education programs, and accordingly, most youth receive some amount of sex or HIV education. However, important topics are not covered in many schools.     

Sexual Education,Gender Ideology,and Youth Sexual Empowerment

Sexual education plays an essential role in preventing unplanned pregnancy and the transmission of sexually transmitted infections (STIs). School-based sexual education programs, in particular, may be well positioned to address social factors that are empirically linked to negative sexual health outcomes, such as traditional social norms surrounding gender and sexuality. However, youth are seldom granted access to sexual education programs that explicitly address these issues. This study presents findings from a pretest–posttest survey of a sexual education program that did. It was designed for eighth graders (N=95) in the context of a school–community collaboration. The study assessed the links between several components of sexual empowerment, including gender ideology, sexual knowledge, and contraceptive beliefs. Findings link participation in the sexual education program to more progressive attitudes toward girls and women, less agreement with hegemonic masculinity ideology, and increases in sexual health and resource knowledge. Structural equation models suggest that traditional attitudes toward women were significantly related to hegemonic masculinity ideology among both boys and girls, which was in turn negatively related to safer contraceptive beliefs.     

Lesbian, gay, and bisexual clients' experiences in treatment for addiction

This study examined the extent to which lesbian, gay, and bisexual clients perceived their addiction counselors and treatment programs to be sensitive to issues related to sexual orientation. The experiences they considered most successful were reported as more affirmative than experiences they considered least successful; however, in neither situation were counselors or treatment programs consistently affirmative.     

Equity vs. Invisibility: Sexual Orientation Issues in Social Work Ethics and Curricula Standards

The responsibility of the social work profession to be inclusive and equitable in its service provision is reviewed via policies relating to professional training regarding sexual orientation issues. A comparative review of Canada, the United Kingdom (UK) and the United States of America (USA) and international standards regarding sexual orientation issues in social work codes of ethics and curricula standards was undertaken. A consistency exists in the USA between its ethics code and curriculum standards further backed by a mandated approach, but it is weak in the area of ethically principled practice skills. Both Canada and the UK are less consistent and comprehensive and lack a mandated approach. The results speak to where consistencies exist and where they need to be established in order to develop an infrastructure that properly trains social workers in cultural competency for these populations.     

Caring Adults: A Brief Report Assessing Adults’ Needs in Feeling More Comfortable Having Sexual Health Conversations with Youth in South Texas

Abstract

Objectives: As part of a larger Substance Abuse and Mental Health Services Administration-funded project in South Texas, this study sought to understand adults’ needs with regard to engaging in sexual health conversations with youth and young adults.

Methods: A total of 223 participants were surveyed to assess comfort engaging in sexual health conversations. Data were analyzed using thematic coding. Stigma surrounding sexual health conversations underlined all themes.

Results: Differences by gender and sexual orientation in the data were noted. Stigma around sexual health topics reduced participants’ comfort.

Conclusions: To this end, interventions must go beyond psychosocial and educational programs and address societal factors that contribute to the stigma.     

Sexual Health Education in OB-Gyn Residencies—The Program Directors’ Survey

Abstract

Objective: To evaluate U.S. obstetrics-gynecology (OB-Gyn) program Director appraisal of resident physician female sexual health training. Methods: An OB-Gyn resident sexual health curriculum survey was developed and sent to 237?U.S. OB-Gyn program directors. University/military programs were compared to community-based programs. Results: 115 OB-Gyn residency program directors responded (48.5% participation); 37.9% university/military and 43.2% community OB-Gyn Program Directors appraise the resident curriculum as “not well” preparing residents to manage sexual health therapies upon graduation. Topics not sufficiently covered include human sex trafficking, sexual health for women with disabilities, and cultural competency. Conclusions: This study identifies opportunities in OB-Gyn residency female sexual health education.     

Ethnic- and Gender-Sensitive Social Work Practice

Abstract

Attempts to incorporate into social work educational programs subject matter related to culture, ethnicity, and women have not produced sequential articulated content. This article presents a framework which provides systematic inclusion of topics pertaining to racial, cultural, ethnic, and women's issues and concerns through all social work curriculum and practice.     

Gender differences in the enactment of sociosexuality: An examination of implicit social motives,sexual fantasies,coercive sexual attitudes,and aggressive sexual behavior

An unrestricted sociosexual orientation (the endorsement of casual sex) has been found to correlate with undesirable behaviors and personality characteristics more so in men than in women. Using a community sample of men and women, we investigated the correlations between sociosexuality and behaviors, motives, attitudes, and fantasies related to sexual aggression. Participants (n = 168; ages 21–45) completed self‐report measures of sociosexual orientation, sexual conservatism, rape myth acceptance, adversarial sexual beliefs, attitudes toward women, sexual behaviors, and perpetration of sexual aggression. Participants also wrote five brief stories that were scored for power and affiliation‐intimacy motives and two sexual fantasies that were coded for the theme of dominance. For both men and women, an unrestricted sociosexual orientation was correlated with behavioral items indicating earlier life experiences with sex, a greater number of lifetime sex partners, and more frequent sexual activity. For men, an unrestricted sociosexual orientation was linked with higher levels of rape myth acceptance and adversarial sexual beliefs; more conservative attitudes toward women; higher levels of power motivation and lower levels of affiliation‐intimacy motivation; and past use of sexual aggression. For women, an unrestricted sociosexual orientation was associated with sexual fantasies of dominance and lower levels of sexual conservatism.     

Shattering the Myth of Invulnerability: Exploring the Prevention Needs of Sexual Minority Women Living with HIV/AIDS

Developing effective safer-sex programs for women living with HIV/AIDS (WLH/A) is a national HIV prevention priority. Existing programs focus predominantly on heterosexual women's experiences and ignore the needs of sexual minority women (SMW). Thus, we conducted semi-structured interviews with 16 sexual minority WLH/A to better understand their sexual risk behaviors and corresponding HIV prevention needs. Most of the interviewees were African American (75%) and poor (75%). We used strategies of Grounded Theory to code the interviews for key themes, which included the following: differences between relationships, risk, and protective behaviors in male and female relationships; links between substance abuse and unsafe sex; need for safer-sex or prevention programs to address SMW-specific skills and topics; and the importance of addressing women's resiliency and the social context of women's risk in prevention programs. Conclusions include concrete suggestions to make safer-sex programs more responsive to the needs of SMW.     

HOW HEALTH STATUS IMPACTS THE TYPES OF INFORMATION CONSUMERS SEEK ONLINE

A few studies examine what types of health information people seek online, yet we know little about how this varies by health status. To examine this question we used data collected from a random sample of 2,038 adults for the Pew Internet and American Life Project, which asked respondents in the United States whether they searched for 16 different types of information. These 16 topics were grouped into three broad areas, including medical conditions and treatments, health issues (e.g. diet and smoking cessation), and providers and payment (e.g. a particular hospital). To build on prior literature, two measures of health status were used: a self-report and the presence of a medical condition. The data suggest that health status impacts the types of health or medical information people seek on the Internet. Self-reported health status was not significantly related to any of the topics; however, respondents diagnosed with a disability or chronic disease were more likely to seek medical information on 13 of the 16 topics addressed. These include specific diseases or medical conditions, medical treatments or procedures, experimental treatments or medicines, alternative treatments or medicines, pharmaceutical or over-the-counter drugs, diet, immunizations, smoking cessation, depression, sexual health, environmental health hazards, a particular physician or hospital, and Medicaid/Medicare (governmental health programs in the United States for the poor and elderly). These results suggest that individuals in the United States who have a medical condition are more likely than healthy individuals to research most health topics online. The Internet can provide consumers with a wealth of information on issues of health and illness, yet healthcare providers need to educate consumers to be cautious given the range in quality.     

Etiology of Homosexuality and Attitudes Toward Same-Sex Parenting: A Randomized Study

Attribution theory suggests the hypothesis that heterosexuals' attitudes toward homosexual sexual orientation will be more negative when homosexuality is attributed to controllable causes. Our randomized study analyzed (a) whether beliefs about the genetic or environmental etiology of the homosexual sexual orientation can be immediately modified by reading a text and (b) the causal effect of attributions about the controllability (environmental etiology) or noncontrollability (genetic etiology) of homosexual sexual orientation on the rejection of same-sex parenting and their social rights. The sample was composed of 190 Spanish university students with a mean age of 22.07 years (SD = 8.46). The results show that beliefs about the etiology of the sexual orientation could be modified by means of a written text. Furthermore, participants who believed that sexual orientation had a genetic etiology showed greater support for social rights and less rejection of same-sex parenting. However, the effects were detected only when there was a traditional opposition to the family with same-sex parenting. When the opposition was normative, the effect was not statistically significant. Our results can be useful in planning variables for intervention programs designed to foster tolerance toward and normality of sexual diversity.     

Does Affirmative Training Matter? Assessing CFT Students’ Beliefs About Sexual Orientation and Their Level of Affirmative Training

This study examined couple and family therapy (CFT) students’ beliefs about sexual orientation, their self-reported competency working with lesbian, gay, and bisexual (LGB) clients, and the level of affirmative training students received in their CFT programs. One hundred and ninety students from accredited CFT programs completed the study. While participants reported feeling only somewhat competent to work with LGB clients and less than half reported receiving any training on affirmative therapy, the majority of the participants did appear to hold positive attitudes toward LGB clients. The results support the literature arguing for CFT programs to include specific training on affirmative therapy practices, as the level of affirmative training was directly related to participants’ self-reported clinical competency working with LGB clients.