Family and Friends as Respite Providers

Abstract

Consumer-directed service options in home- and community-based care are increasingly available to adults with chronic conditions and cognitive impairments and to their family caregivers. Few studies, however, examine the experience of family caregivers who, when given a choice of providers of respite assistance (i.e., relief from the stress of providing constant care), prefer to hire family or friends rather than service providers. This study describes the in-home respite experience of family caregivers served by California's Caregiver Resource Centers “direct-pay” program who hire family or friends (n = 39) or service providers (n = 77) to provide in-home respite assistance. Findings revealed similarities between the two groups with few exceptions: caregivers who hired family or friends reported poorer physical health, were slightly more satisfied with the respite assistance, and received more hours of respite at a lower unit cost. These findings lend support to consumer-directed respite service options where family caregivers are given flexible alternatives that may act to remove barriers to respite service availability and use.     

Provider and Care Workforce Influences on Quality of Home-Care Services in England

Abstract

A key trend in home care in recent years in England has been movement away from “in-house” service provision by local government authorities (e.g., counties) towards models of service commissioning from independent providers. A national survey in 2003 identified that there were lower levels of satisfaction and perceptions of quality of care among older users of independent providers compared with in-house providers. This paper reports the results of a study that related service users views of 121 providers with the characteristics of these providers. For the most part, characteristics associated with positive perceptions of quality were more prevalent among in-house providers. Multivariate analyses of independent providers suggested that aspects of the workforce itself, in terms of age and experience, provider perceptions of staff turnover, and allowance of travel time, were the most critical influences on service user experiences of service quality.     

Assessing Service Providers at LGBTQ-Affirming Community Agencies on Their Perceptions of Training Needs and Barriers to Service

Service providers (N = 109) at lesbian, gay, bisexual, transgender, and questioning (LGBTQ)-affirming social service agencies were surveyed on their perceived training needs, experiences, and barriers to service access experienced by their clients. Hierarchical regression analysis identified that training experiences significantly influenced self-perceived competence, controlling for agency-related factors including the extent of perceived barriers to service. Findings are discussed with implications for training, practice, and future research.     

Traversing the Margins: Intersectionalities in the Bullying of Lesbian,Gay, Bisexual and Transgender Youth

SUMMARY

This study explores the perspectives of service providers and youth advocates on bullying of lesbian, gay, bisexual and transgender (LGBT) youth and intersectionalities in LGBT peer victimization. In depth, semi-structured interviews were conducted with nine key informants (4 male, 4 female, 1 transgender male; 4 gay, 3 lesbian, 2 non-identified; 6 white, 1 South Asian, 2 Middle Eastern) recruited using purposive sampling from diverse education and social service settings. Narrative thematic analysis and a constant comparative method were used to identify themes. Five themes emerged from the data: (1) “transgressing gender norm boundaries”; (2) homophobic sexism vs. sexist homophobia; (3) “you choose sexuality or you choose race”; (4) newcomer youth and citizenship; and (5) “multiple wires together … create the cage.” Findings suggest the importance of an intersectional approach to conceptualizing and addressing LGBT bullying and to uncovering the differential experiences of bullying among LGBT youth. Bullying related to sexual orientation should not be assumed to be the only or primary form of violence shaping the lives of LGBT youth.     

Reproductive Knowledge and Preferences of Adolescents and Adults with Cystic Fibrosis: A Web-Based Assessment

ABSTRACT

The reproductive consequences of cystic fibrosis (CF) have increased in relevance as individuals with CF now live well into their reproductive years. This article describes the first Internet-based study of sexual and reproductive health (SRH) knowledge, experiences, and preferences of adolescents and adults with CF participating in an online discussion board. Although broad SRH knowledge was demonstrated, CF-specific SRH knowledge was incomplete. Respondents reported wanting providers to initiate reproductive health discussions and offer more CF-specific SRH information. Respondents also reported experiencing a variety of disease-specific reproductive health issues (e.g., shortness of breath with sexual activity, vaginal dryness due to viscous mucous, etc.). Future research should explore how to enhance access to disease-specific SRH information.     

Welfare Reform on American Indian Reservations

Abstract

In this article we document trends in welfare caseloads and some initial experiences of service providers and welfare recipients on reservations within Arizona under Temporary Assistance for Needy Families (TANF). We document the issues and concerns of state and tribal service providers as they implement the legislation on reservations that are often geographically isolated and which lack infrastructure, jobs, childcare and transportation. We also record experiences of women with children on reservations with the 1996 federal welfare legislation. These families experience similar barriers when trying to move from welfare to work as do their counterparts across the country; however, these barriers are magnified on reservations. The welfare recipients' barriers include: a shortage of employment opportunities on reservations; a lack of transportation and childcare facilities; low levels of education and job experience; and, individual and family problems. Poor families in Indian communities face additional barriers to employment because of their geographic isolation, lack of access to basic necessities (like telephones), as well as stereotypes and discrimination by employers due to ethnicity or personal/family histories.     

The alcohol contexts of consent,wanted sex,sexual pleasure,and sexual assault: Results from a probability survey of undergraduate students

Objective: To examine, in a probability sample of undergraduate students, characteristics of students’ most recent sexual experiences (including alcohol use) as well as their experiences with nonconsensual sex. Participants: In January and February 2015, 22,046 students were invited to participate in an anonymous, cross-sectional, Internet-based survey; 7,032 surveys were completed (31.9%). Methods: Measures included background characteristics (age, gender, sexual orientation), most recent sexual event items (sexual pleasure, wantedness, alcohol use), and experiences with nonconsensual sex (since college and lifetime). Results: Respondents reporting sober consensual sex were more likely to report higher levels of sexual pleasure and wantedness. Nonconsensual oral, vaginal, or anal penetration occurring during college were reported by 15.8% of women and 7.7% of men. Students more often told friends, partners, or family members and rarely disclosed to university faculty or police. Conclusions: Implications for campus policy and health education are addressed.     

Barriers to healthcare for American Indians experiencing homelessness

Members of American Indian (AI) communities face many barriers to receiving both mental and physical healthcare. These barriers can have a negative effect on overall health. Barriers are compounded for AIs who are also experiencing homelessness, and AI make up a disproportionate percentage of the homeless population nationwide. In-depth semi-structured interviews were conducted with 12 service providers and 16 homeless participants in a mid-size Midwestern city to identify barriers to care for homeless participants. Key barriers identified in this study for homeless participants were: transportation, phone accessibility, discrimination, and cold and bureaucratic cultures of healthcare systems. Major barriers identified by service providers were: access to care, discrimination and mistrust, and restrictive policies. Given generally higher disease prevalence within the homeless population and health disparities within the AI community, steps should be taken to reduce barriers to healthcare.     

Lesbian,Gay, Bisexual,Transgender, Queer/Questioning (LGBTQ) Perceptions and Health Care Experiences

The goal of this study was to explore attitudes, health knowledge, and experiences with health care setting and providers among lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) individuals and to identify areas for improvement. Members of Equality Florida? residing in the five counties of the Tampa Bay region were recruited through e-mail invitation to complete a 60-item questionnaire assessing demographics, attitudes, and experiences with health care providers (HCPs). Additional open-ended questions focused on experiences with HCPs and suggestions for ways to improve HCPs' cultural competency. A total of 632 respondents completed the survey of which 41% were gay men and 29% were lesbian. The majority of participants were White, non-Hispanic (93%), married/partnered (78%), and had health insurance (88%). The majority (67%) reported they always or often disclosed their sexual orientation/identity to an HCP and few had negative reactions in the health care setting (<10%). Health care settings with equality signs and gender-neutral language were perceived as safer. Participants' responses suggested need for policy changes and improved cultural competence among HCPs. Results show high rates of sexual orientation disclosure, greater acceptance from providers of LGBTQ status, and the need for examination of hospital policies and improved cultural competency.     

Latinas and Sexual Assault

SUMMARY

This paper will discuss the problem of sexual assault among Latinas, an under-researched population whose social and cultural characteristics contextualize the trauma of sexual assault in ways that need to be considered by service providers striving to provide culturally syntonic interventions. The authors will present the sparse empirical data on sexual assault among Latinas, Including prevalence, assault characteristics, and post-assault sequelae. Given the bicultural reality of most Latinas in the U.S., a working model of sexual assault in Latinas is presented that frames the problem as occurring within both traditional Latino and modern American gender role systems. The result is a dual dilemma for Latina victims of sexual assault with both negative and positive implications that need to be better understood by victims and service providers.     

Experience of Racism as a Correlate of Developmental and Health Outcomes Among Urban Adolescent Mental Health Clients

Summary

Correlates of race/ethnicity and perceived racism among 760 urban, predominantly Hispanic/Latino and African-American, adolescent mental health clients were investigated using an exploratory, clinical data-mining approach. All racial/ethnic groups reported substantial rates of racism, ranging from 80.0% for Asian/Pacific Islanders to 32.4% for Hispanic/Latinos. Racism was associated with significantly elevated environmental risk (e.g., violence, sexual abuse or assault, exposure to drug use), behavioral risk (e.g., drug use) and worry (e.g., worry about hurting self or others, worry about doing dangerous things). Overall, racism was significantly associated with more negative health and well-being outcomes than ability to get a gun, sexual orientation, and being enrolled in school. The authors conclude that experience of racism should be routinely assessed at intake to mental health services along with traumatic experiences such as physical or sexual abuse.     

Parenting adolescents from ethno-cultural backgrounds: A scan of community-based programs in Canada for the promotion of adolescent mental health

ObjectivesTo i) describe current community-based programs across Canada to support parents for the promotion of adolescent mental health, with special attention to ethno-cultural populations; and ii) identify needs, gaps, and opportunities for the development of a framework to support parents for the promotion of adolescent mental health.MethodsWe conducted an internet-based cross Canada scan of community-based parenting programs that promote adolescent mental health in ethno-culturally diverse populations, followed by structured phone interviews with program staff. Findings were categorized according to audience (ethnicity/culture and age group), geographical distribution and coverage, and program type. Barriers to access and outreach mentioned by interviewees were documented.ResultsWe found a total of 47 programs that met our search criteria. The greatest numbers were found in the provinces of Ontario, British Columbia and Alberta, particularly in the Greater Toronto and Vancouver Areas. Most programs consisted of psycho-educational, information-based workshops, support groups, or used innovative approaches (e.g., arts, alternative medicine, mentorship, and skillsdevelopment courses). Five programs (11%) had parent and youth components. From the perspective of service providers, cultural distrust, stigma, financial constraints and language barriers pose challenges to outreach. Program evaluations are limited and often not publicly available.ConclusionThere are gaps in geographic coverage and types of programs available to parents for the promotion of adolescent mental health in ethno-cultural communities. Inconsistent and insufficient funding [and other forms of institutional support] detract from the capacity of community-based organizations to adequately support families and conduct, publicize, and evaluate their programs.     

Risk and new exclusions in community mental health practice

Abstract

Over the past two decades, mental health practice has become increasingly focused on assessing and managing the risks posed by service users. British researchers have made significant advances in studying the consequences of risk management for community-based health and welfare services, but in Australia this field remains largely undeveloped. Drawing on my experiences as a social worker in a Melbourne-based Crisis Assessment and Treatment Team from 1991 to 2008, the present paper offers a reflective analysis of the shift in practice orientation that has emerged through the growing prominence of risk as a foundation for intervention. Specifically, I argue that this shift has led to a narrowing of service provision and that “low-risk” clients are newly disadvantaged, often excluded from service.     

Asking About Sexual Orientation During Assessment for Drug and Alcohol Concerns: A Pilot Study

ABSTRACT

An assessment tool was designed to assist service providers in identifying lesbian, gay and bisexual (LGB) clients who present for assistance related to substance use concerns. Items were designed to facilitate self-disclosure of the individual's sexual orientation and identify concerns of LGB clients that will be relevant to treatment planning for substance use concerns. Therapists in general assessment and LGB-specialized services of a large treatment agency were trained to use the tool. This paper presents client and therapist comments made during the pilot study regarding the use and value of the assessment tool.     

Necessary Steps in Designing a Successful Contract

Abstract

Parents with a history of serious mental illness are vulnerable in many ways and are therefore likely to be accessing services from a range of government and community agencies. The use of multiple services, sometimes with conflicting practice frameworks, can result in sub-optimal management of these families. This study surveyed 77 service providers from a range of government and non-government agencies targeting their views regarding parents with a serious mental illness (specified in this study as schizophrenia, bipolar disorder and psychotic depression). They were asked what they perceived were difficulties for this population, interventions required to meet the needs of this group and finally, barriers to effective service delivery. We found that service providers reported that current services were inadequate for these parents. Parent-based interventions were seen as being more beneficial than those targeting children. Lack of liaison between agencies and lack of coordinated service provision were seen as the greatest barrier to effective service delivery. The results highlight the need for policy planners and service providers to develop strategies to ensure effective coordination between services that work with this population.     

Social services for sexual minority youth: Preferences for what,where, and how services are delivered

As part of an internet-based study to investigate experiences of sexual minority youth in the U.S., 544 youth, ages 14–19, were surveyed about their need for services, where they preferred to receive these services, and their preferred method of service delivery. The survey was anonymous and youth were recruited from LGBTQ-specific listservs and venues as well as through social networking sites as a way of reaching youth often not represented in LGBTQ surveys. Youth highly endorsed many types of services, settings, and modes of delivery. Some subgroup differences emerged. Transgender youth and those uncertain about their gender identity expressed stronger interest than others in services to address stress, family issues, and self-defense, and in receiving support and guidance from LGBTQ adults. Few differences in service preferences along demographic lines such as race/ethnicity emerged; however, African American youth were more likely than others to prefer services offered in a place of worship. Contrary to predictions, geographic and community variables were not related to service type, delivery format, or location preferences.     

Older lesbians' experiences with home care: Varying levels of disclosure and discrimination

ABSTRACT

There is considerable evidence that lesbian, gay, bisexual and transgender (LGBT) older adults have experienced barriers to health care access and have profound fears about how they will be treated in the long-term care system, but the specific experiences of older lesbians have received less attention. Most older adults needing long-term services and supports (LTSS) prefer to remain at home, and this is true for lesbians as well. This article reports on a national, qualitative study of the experiences of 20 older lesbians (age 65 and older) with home care workers. The experiences of six informal partner caregivers with home care services are also included. Emergent themes regarding level of disclosure, experiences with homophobia, evaluation of care received, and thoughts about ideal LTSS are described. Most study participants did not disclose their sexual orientation to their home care workers. A significant minority experienced homophobia, but nearly all ultimately found workers who provided good care with which they were comfortable. Their visions of ideal LTSS included greater affordability and particular qualities that were important for home care workers to possess, such as competence, caring and acceptance. Practice and policy implications are outlined including careful recruitment, training and supervision of home care workers to foster lesbian-sensitive care, but also improved wages and work conditions in order to maintain a quality home care workforce.     

Sexual Strategies Across Sexual Orientations

Abstract

The psychological intersection of biological sex, personality, and sexual orientation represents a unique prospect for investigating the evolution of human mating strategies. Evolved sex differences in human psychology may encounter different mating environments within homosexual and heterosexual contexts. The personality traits of homosexuals, if different from heterosexuals, may influence human mating dynamics in revealing ways. In the current study, 5,310 men (5,083 heterosexuals, 131 homosexuals, and 96 bisexuals) and 7,589 women (7,240 heterosexuals, 143 homosexuals, and 206 bisexuals) across four major world regions completed personality and sexuality self-report surveys. Consistent with previous research, sociosexual behavior (e.g., number of one-night stands) and personality traits (e.g., masculinity and openness to experience) varied across sexual orientation. In addition, personality traits were predictably related to sociosexual behavior. However, variability in personality traits did not account for the observed differences in sociosexual behavior across sexual orientation.     

Risk Factors of Gay,Lesbian, and Bisexual Adolescents

Abstract

Many researchers of gay, lesbian, and bisexual adolescents describe them as an “invisible” minority. These youth are also one of the most “at risk” youth populations, as they often experience a range of problems related to society's stigmatization of same-sex orientation. Although sexual orientation is not necessarily related to heightened difficulties, lack of social support, infrequent positive interactions, and chronic stress may lead to increased problem behaviors for these youth. To further understand the risk and protective factors experienced by sexual minority adolescents, this article explores a number of these factors and reviews the current empirical research on specific topics, including: family, peer and school, substance use, suicide, and HIV/AIDS issues. Finally, practice implications are discussed to guide clinicians in working more effectively with this youth population.     

Caregiving and Care Receiving Among Older Lesbian,Gay, and Bisexual Adults

Abstract

A survey research design was used to examine caregiving, care receiving, and the willingness to provide caregiving among lesbian, gay, and bisexual (LGB) older adults recruited from community groups. More than one-third reported receiving care from people other than healthcare providers in the last five years; more than two thirds provided care to other LGB adults. Those who had given care were more likely than non-caregivers to give care in the future. The gender and sexual orientation of recipients of future help affected participants' willingness to provide care, as did their education level and style of coping. Participants willing to provide care to older LGB adults perceived such experiences to be less burdensome and more personally rewarding than those who were un-willing to provide care.