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.     

Infusing Integrated Behavioral Health in an MSW Program: Curricula,Field, and Interprofessional Educational Activities

ABSTRACT

An essential aspect of integrated care is the coordination of medical and behavioral health needs concurrently. This has sparked renewed emphasis on interprofessional (IP) education and practice. The impetus for IP efforts was crystalized in large part because of health care reforms, and federal funding to expand the behavioral health work force. Using an ecological systems perspective, this article describes how one school is preparing a new generation of MSW students to work in integrated behavioral health care using a three-pronged approach involving curricula, field education, and IP activities. Social work education must ensure that new and experienced professionals can (a) understand the profession’s role in IP health care settings, and (b) navigate an evolving and complex health care environment.     

An Innovative Behavioral Health Workforce Initiative: Keeping Pace with an Emerging Model of Care

ABSTRACT

Recent policy shifts in health care have created opportunities for social workers to provide services in integrated primary care and behavioral health settings. However, traditionally prepared social workers may not have the skill set necessary to meet practice demands. This article describes a behavioral health workforce initiative that trains master’s of social work students for work in integrated primary care settings with children, adolescents, and transition-age youths. The training model includes field placements in integrated care settings, co-curricular seminars, and advanced clinical electives. This article identifies challenges of creating new field placements and developing new curricula to support students’ acquisition of knowledge and skills required in integrated care settings. Additionally, it presents data on changes in students’ knowledge and confidence.     

Navigating Intersectional Approaches,Methods, and Interdisciplinarity to Health Equity in LGBTQ+ Communities

Abstract

The broad spectrum of health services and wellness surrounding lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities operates within multiple layers of social inequities. Research using intersectionality features numerous research methods purposed specifically for clarity toward increasing health equity. Generated in the scope of various research methods (e.g., quantitative, qualitative, mixed-methods), utilizing intersectionality illustrates potential to explore complex phenomena and outcomes within LGBTQ+?communities. As intersectionality thrives on interdisciplinarity, this article focuses on three overarching purposes: (a) accentuate health equity and social justice across an interdisciplinary scope for LGBTQ+?communities, (b) highlight formative principles grounded in intersectionality, and (c) supplement recommendations for research targeting health equity.     

LGBTQ + community organizations under neoliberalism in Ontario,Canada: Contradictions and disconnects

Abstract

This study examines the impact of neoliberal policy—which introduces competition for funding and pressure to professionalize and bureaucratize—on the working conditions and precarity of a purposive sample of southern Ontario (Canada) organizations dealing with LGBTQ?+?health. Findings from semi-structured, in-depth interviews with 20 community-based organization stakeholders and government bureaucrats confirmed that neoliberal policy pressures these organizations to professionalize and bureaucratize, while restricting political advocacy. Queer Liberation Theory’s three central tenets of anti-assimilationism, solidarity across movements, and the political economy of queer health are used to understand the situation and possible futures for third-sector organizations within the LGBTQ?+?movement.     

Serving our (in)visible elders: The impact of a LGBTQ+ aging presentation on a rural college campus

ABSTRACT

As the number of individuals 65 and older continues to grow, so too does the richness and complexity of their identity. Specifically, the culture of aging within the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community has received little attention in the literature. In order to best serve this population, human service professionals must understand the reality of aging within diverse communities. This article explores the impact of an invited campus speaker focused on LGBTQ+ aging on a rural college campus. Results indicate a general increase in overall knowledge and appreciation for issues directly impacting the aging LGBTQ+ community. Recommendations for practice, grounded in a social justice framework, are shared.     

Time to ask and tell: Voices of older gay and bisexual male veterans regarding community services

ABSTRACT

This participatory action study involved lesbian, gay, bisexual, transgender, and queer (LGBTQ) veterans in determining community-based service needs for health and wellness, illuminating perspectives of older LGBTQ veterans regarding community services. This study explored veterans' perceptions of being LGBTQ later in life. The study included data from interviews with gay and bisexual male veterans ages 51 to 87. Participants valued engagement as part of community. Their recommendations for action included communal meals, transportation, housing, and the coming-out process. Community services facilitated community engagement to support health and wellness for LGBTQ older veterans. The authors used participatory action research (PAR), a method of systematic inquiry integrating the perspective of persons living the experience, to organize the study. Further PAR is recommended to implement community services to meeting health and wellness needs of participants.     

Voices from the stories untold: Lesbian,gay, bisexual,trans, and queer college students' experiences with campus climate

ABSTRACT

Twelve self-identified college students within the lesbian, gay, bisexual, transgender, and queer (LGBTQ) spectrum were interviewed on campus climate perceptions and their experiences of discrimination and isolation at their university. Thematic analysis was conducted to identify themes from the data. This process resulted in the emergence of three themes, identified as discrimination, isolation, and avoidance. The most salient experiences of discrimination and isolation reported by participants came from within LGBTQ organizations or from lesbian or gay male individuals that participants sought out for social support. LGBTQ intra-community discrimination was considered to be particularly damaging to participants' sense of belonging and involvement within the LGBTQ community. Discrimination and isolation from straight-identified organizations or individuals was reported mostly in the context of fraternities/sororities and religious organizations. Furthermore, actions by members of these latter groups caused participants to avoid these groups out of expectations of negative interactions. These results inform empirical research to bring awareness to acts of discrimination that continue to take place within the university toward LGBTQ students. Specific implications for social work practice with LGBTQ college students and future research on diverse LGBTQ populations and resources are discussed.     

Teaching Note—Meeting the Demand for Behavioral Health Clinicians: Innovative Training Through the GLOBE Project

ABSTRACT

The national move toward integrated mental health and substance abuse service delivery has a significant impact on social work education and necessitates changes in how we train students. To address this need, the Global Leaders of Behavioral Health Education (GLOBE) training project was developed. GLOBE is a student training and stipend program that prepares students for clinical behavioral health practice in integrated care. This teaching note describes GLOBE, reports challenges encountered in its implementation, and provides strategies for overcoming them. The challenges include assigning students to grant-compliant field placements, engaging other health care professionals in the educational efforts, and implementing curriculum changes. Suggestions for social work program administrators interested in integrated care training are provided.     

Integrated care workforce development: university-community collaboration

ABSTRACT

Behavioral health workforce shortages to provide quality care services for children, adolescents, and transitional age youth are well established. This paper highlights the workforce shortage and the need to infuse interprofessional education to engage in integrated care for children, adolescents and transitional age youth with behavioral health needs. A specialized training curriculum to build behavioral health workforce in Nevada was conceptualized and delivered through 10 workshops under the auspices of the Health Resources & Services Administration (HRSA) funded Behavioral Health Workforce Education and Training (BHWET) grant funded in 2014. To train existing workforce and in alignment with the spirit of the grant to build behavioral health workforce and existing workforce, workshops were extended to social service providers in the community. In an effort to enhance university-community collaboration, workshop presenters were invited from various units in the University and from social service agencies in the community. Implications of such training are addressed from a policy, practice, research, and university-community collaboration perspective.     

Fighting for survival: The experiences of lesbian,gay, bisexual,transgender, and questioning students in religious colleges and universities

ABSTRACT

Little is known about the experiences of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students attending religious colleges and universities. This study used grounded theory to analyze the narratives (N = 271) of LGBTQ former and current students. The central theme described by LGBTQ students was a fight for survival with five subthemes: (a) institutionalized homo/transphobia (strict school policies, enforcement of heterosexuality and gender conformity through discipline, conversion therapy); (b) a culture of fear (fear of exposure, homophobic panic and code words, seeking cover); (c) marginalization and isolation; (d) struggle (suffering and suicide, reconciling faith and LGBTQ identity); and (e) coping and resilience (surviving through critical thinking and strategic activism). Implications for practice are provided.     

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.     

Intersectionality and Engagement among the LGBTQ+ Community

ABSTRACT

As the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community makes progress toward attaining equal rights, a growing body of scholarly attention is focusing on this increasingly visible minority group. Yet studies of attitudes among LGBTQ+ Americans themselves remain limited because of small sample sizes and scarce data. As a result, scholarly work on LGBTQ+ issues is almost entirely devoted to measuring straight America’s opinions. In this study we administer both a survey and an experiment to a sample of LGBTQ+ Americans. Our findings are twofold. First, we demonstrate that intersectionality has important effects on attitudes within the LGBTQ+ community. Specifically, LGBTQ+ respondents who are at the intersection of multiple minority groups display lower levels of political engagement. Second, we test the mobilizing influence of out-group versus in-group cues on LGBTQ+ Americans. In line with previous work, we find that government action to support a threatening out-group engages LGBTQ+ Americans to support in-group candidates, whereas government action to support their own in-group has a significantly smaller effect. These findings help us to understand an increasingly politically active subset of the electorate and, more broadly, shed light on the influence of intersectionality on political attitudes.     

Enhancing Competence in Health Social Work Education Through Simulation-Based Learning: Strategies From a Case Study of a Family Session

ABSTRACT

Simulation-based learning (SBL) is a powerful tool for social work education, preparing students to practice in integrated health care settings. In an educational environment addressing patient health using an integrated care model, there is growing emphasis on students developing clinical competencies prior to entering clinical placements or clinical practice settings. This article highlights the importance of SBL in the development of the clinical competencies of graduate social work students enrolled in a Social Work Practice in Health course. The development and implementation of an educational initiative using a family-based simulation scenario to enhance classroom learning for health social work practice is described, and recommendations for future educational initiatives using SBL are provided.     

Proposing an Initiative Research Methodology for LGBTQ+ Youth: Photo-Elicitation and Thematic Analysis

ABSTRACT

A framework for approaching lesbian, gay, bisexual, transgender, queer+ (LGBTQ+) youth is presented that honors their voice. This methodology utilizes participant-driven photo elicitation as a qualitative data collection method, and then integrates thematic analysis. A brief review of current literature is provided to outline gaps, which establish the need to expand effective research methods with LGBTQ+ youth. Photo elicitation is explained with discussion specific to use with LGBTQ+ youth. Thematic analysis is identified and explained as an analytic approach. Challenges of implementing this methodology are discussed with attention to ethical concerns.     

Intersecting Sexual,Gender, and Professional Identities Among Social Work Students: The Importance of Identity Integration

ABSTRACT

Discrimination toward lesbian, gay, bisexual, transgender, and queer (LGBTQ) social work students can negatively affect academic performance and personal and professional identity development. Intersectionality is a conceptual approach that states that social identities interact to form different meanings and experiences from those that could be explained by a single identity. This study explored how the educational experiences of LGBTQ social work students in the United States and Canada influenced their professional and personal identities. Using an intersectional analysis, three major themes emerged: the need for social work programs to better promote LGBTQ identity and emerging social work professional identity integration, a lack of LGBTQ content in the curriculum, and unsupportive LGBTQ school climates. Implications for social work education are considered.     

How discrimination in adoptive,foster, and medical systems harms LGBTQ+ families: Research on the experiences of prospective parents

Abstract

LGBTQ+?people face multiple challenges to parenthood because of barriers such as discriminatory legislation and policies influencing foster parenting, adoption, and reproductive health services. This study documents these obstacles and examines their impact through a grounded theory analysis of interviews of LGBTQ+?prospective parents. Stressors included social isolation, unnecessary medicalization, prohibitive financial costs related to accessing social and medical services (sometimes across state lines), and being denied services, parental leave, and insurance coverage. Findings indicate that heteronormative attitudes and discrimination can lead to debilitating and enduring harm upon the economic, emotional, and relational well-being of growing LGBTQ+?families.     

Victimization and Microaggressions Targeting LGBTQ College Students: Gender Identity As a Moderator of Psychological Distress

ABSTRACT

Lesbian, gay, bisexual, transgender, and queer and questioning (LGBTQ) discrimination continues to be common on college campuses. While a number of studies have examined blatant victimization among students, little attention has been given to LGBTQ microaggressions. In this study, we examine both blatant victimization and microaggressions and their association with psychological distress among LGBTQ college students (N = 497) and look at whether gender identity moderates these relationships. Both forms of discrimination are associated with lower self-esteem and greater stress and anxiety. Victimization is more negatively associated with self-esteem among trans* students. Our findings emphasize the importance of addressing both blatant and subtle forms of discrimination targeting LGBTQ college students.     

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.