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.     

Racial and Ethnic Differences in Family Caregiving in California

Abstract

Family caregivers are the main source of long-term care for older persons in the United States. At the same time, cultural values and beliefs shape decisions surrounding who provides care and whether families use formal support interventions to assist the caregiver. The current article examines how the family caregiving experience differs among racial and ethnic groups in terms of caregiver characteristics, service utilization, caregiver strain, and coping mechanisms. Telephone interviews were conducted in English and Spanish with a random sample of 1,643 respondents in California who provide care to someone age 50 or over. Bivariate analyses showed evidence of ethnic differences in the demographic characteristics of caregivers, intensity of care provided, caregiver health, level of financial strain, religious service attendance, formal service utilization and barriers to formal services. Odds ratios showed that White and African American caregivers were about two times as likely to use formal caregiver services as were Asian/Native Hawaiian/Pacific Islander and Latina American caregivers. Implied by these findings is the need for further understanding of caregiver service needs among diverse racial and ethnic groups.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Coming out in camouflage: A queer theory perspective on the strength,resilience, and resistance of lesbian,gay, bisexual,and transgender service members and veterans

ABSTRACT

Lesbian, gay, bisexual, and transgender (LGBT) service members have made profound contributions to the U.S. military despite serving under anti-LGBT military policies. Little is known about their everyday acts of strength and resistance, which is vital information for developing strengths-based services. This article utilizes a queer theory framework to (a) discuss LGBT military contributions and anti-LGBT military policies, (b) explore three LGBT-specific military minority stressors, and (c) identify four strategies of strength and resistance used to manage an anti-LGBT military environment. Clinical suggestions are proposed for integrating military and LGBT identities and designing interventions that blend military and LGBT cultures.     

Implementation fidelity and adolescent smoking: The X:IT study—A school randomized smoking prevention trial

BackgroundAssessing the actual implementation of multi-component interventions can provide important knowledge for future interventions. Intervention components may be implemented differently, knowledge about this can provide an understanding of which components are essential and therefore must be included. The aim of this study was to examine the implementation of one, two, or all three main intervention components at the individual level and to assess the association to current smoking among 13 year-olds in the X:IT study.MethodsData stems from a cluster-randomized controlled trial in 94 Danish elementary schools (51 intervention; 43 control schools). Implementation was measured by aspects of adherence, dose, quality of delivery, and participant responsiveness based on questionnaire data from 4161 pupils at baseline (mean-age: 12.5 years) and 3764 pupils at first follow-up eight months later. Coordinator responses from 49 intervention schools were also included. Associations between individual level implementation of the three main components and pupil smoking were examined through a 3-level logistic regression model.ResultsAlthough implementation fidelity for the three main intervention components was good, only one third (38.8%) of pupils in intervention schools were exposed to full implementation of the intervention. Among these pupils odds ratio for smoking was 0.25 (95% CI: 0.15 – 0.42).ConclusionsSchool-based programs can be very effective if carefully implemented. Future school-based smoking preventive initiatives should include multiple components, and seek to enhance implementation quality of all components.     

Queer Domicide

ABSTRACT

This article examines lesbian, gay, bisexual, and trans (LGBT) experiences of displacement, home loss, and rebuilding in the face of natural disasters. LGBT vulnerability and resilience are little studied in disaster research; this article begins to fill this gap, focusing on LGBT domicide—how LGBT homes are “unmade” in disasters. To do this, we critically read a range of non-government, scholarly, and media commentaries on LGBT experiences of natural disasters in various settings over 2004–12, including South Asia, the USA, Haiti, and Japan. Additionally, we utilize preliminary data from pilot work on LGBT experiences of 2011 disasters in Brisbane, Australia, and Christchurch, New Zealand. we find that disaster impacts are the first stage of ongoing problems for sexual and gender minorities. Disaster impacts destroy LGBT residences and neighborhoods, but response and recovery strategies favor assistance for heterosexual nuclear families and elide the concerns and needs of LGBT survivors. Disaster impact, response, and recovery “unmakes” LGBT home and belonging, or inhibits homemaking, at multiple scales, from the residence to the neighborhood. we focus on three scales or sites: first, destruction of individual residences, and problems with displacement and rebuilding; second, concerns about privacy and discrimination for individuals and families in temporary shelters; and third, loss and rebuilding of LGBT neighborhoods and community infrastructure (e.g. leisure venues and organizational facilities).     

Methodological Issues in Conducting Community-Based Health and Social Services Research Among Urban Black and African American LGBT Populations

Abstract

Health and social service utilization experiences of disenfranchised groups have recently gained renewed public attention. Reducing and eliminating racial disparities in health care has become a major national agenda. While a fairly substantial literature on Black and African American health outcomes and social service utilization does exist, and may help to influence interventions to reduce disparities, there is no comparable literature for Black and African American lesbian, gay, bisexual, and transgender (LGBT) persons. In this article the author examines factors affecting research with urban Black and African American LGBT populations. A brief case study is included that demonstrates the viability of the recommended research methods and discusses the possible negative consequences of deviating from these methodological suggestions.     

Intersections of Identities

ABSTRACT

This paper addresses several key issues related to counseling lesbian, gay, bisexual, and transgender (LGBT) Asian-Americans. An understanding of the intersections of these identities is important, yet can be complex because of the diversity within Asian-American cultural groups (i.e., ethnicity, generation, skin color, religion, levels of minority stress, and acculturation) and within LGBT communities. These factors may influence counselors' selection of developmentally appropriate and culturally sensitive counseling approaches for LGBT Asian-American clients. We propose a framework for understanding the intersection of racial/ethnic and sexual identity development, the Racial Ethnic and Sexual Orientation Identification Chart (RSIC), which is designed to assist therapists in determining relevant counseling issues and strategies. A case study is included along with a discussion of multidimensional assessment and clinical implications.     

Most Successful Intervention Strategies for Abused Older Adults

ABSTRACT

In this Project CARE study, intervention plans for 83 cases, with a total of 473 strategies, are analyzed in a qualitative content analysis method. The 473 strategies are designed and implemented by an abuse-trained, multidisciplinary, health and social service agency, home care team. Each strategy is rated by the team for its acceptance/refusal by clients and levels of success. The most accepted and successful strategies for abused older adults are concrete: nursing and other medical care and homemaking assistance, followed by empowerment strategies, such as support groups for abused older adults, information about rights and resources and volunteer buddy/advocates. Less successful strategies for abused persons are referrals to general community activities and programs. For caregiver abusers, the most successful and accepted interventions involve individual supportive counselling to reduce anxiety, stress and depression and education and training. Abuser-oriented strategies are most accepted and successful in the study. Thus, it would seem pertinent for intervenors to focus services and strategies on abusers and not only on abused older adults, in particular offering them supportive individual counselling to reduce anxiety, stress, and depression. For abused care receivers, home-based services can offer the necessary support to move out of their abuse situation with the help of volunteers and support group activities.     

Relative Efficacy of a Pregnancy,Sexually Transmitted Infection,or Human Immunodeficiency Virus Prevention–Focused Intervention on Changing Sexual Risk Behavior Among Young Adults

Abstract

Objectives: Despite findings suggesting that young adults are more concerned about experiencing an unplanned pregnancy or contracting a sexually transmitted infection (STI) than becoming human immunodeficiency virus (HIV) infected, no empirical work has investigated whether the specific focus of an intervention may be more or less efficacious at changing sexual behavior. Participants: Participants were 198 college students randomized to 1 of 4 conditions: pregnancy intervention, STI intervention, HIV intervention, or a control condition during 2008–2009. Methods: The authors compared the efficacy of 3 theory-based, sexual risk–reduction interventions that were exactly the same except for an exclusive focus on preventing pregnancy, STI, or HIV. Condom use and risky sexual behavior were assessed at baseline and 4-week and 8-week follow-up. Results: Participants exposed to the pregnancy or STI interventions reported greater condom use and less risky sexual behavior than those exposed to the HIV intervention. Conclusions: The focus of sexual risk–reduction interventions may lead to differential behavior change among young adults.     

Afrocentric Intervention Paradigm: An Overview of Successful Application by a Grassroots Organization

A grassroots social service organization's successful use of Afrocentric ideas, theories, and frameworks in its programs and services illustrates that many African Americans respond more readily to human and social services interventions that value and understand their historical experiences and include their cultural influences as “protective factors” in social service interventions. This article describes how the Community Empowerment Association's programs and services are designed to be culturally proficient by holding African customs, ethos, history, mores, society, and traditions in high esteem.     

Personalized boosters for a computerized intervention targeting college drinking: The influence of protective behavioral strategies

ABSTRACT

Objective: Computerized interventions are cost-effective and can quickly deliver individual feedback to many students. However, in-person interventions are more efficacious. The current study sought to improve the efficacy of a popular online intervention via e-mailed boosters with personalized feedback. Participants: Participants were 213 student drinkers at a southeastern public university, ages 18–24. Methods: Students were randomized into (1) intervention only, or (2) intervention plus booster. Alcohol consumption and related problems were assessed at baseline, 2 weeks post, and 4 weeks post. Results: Boosters yielded reductions in drinking, but not alcohol-related problems. Boosters were associated with significant reductions for drinking frequency, heavy drinking days, peak drinks, and associated blood alcohol concentration (BAC). Protective behavioral strategies (PBS) moderated this effect, with significant reductions for students low in PBS, but not students already highly engaged in PBS use. Conclusions: Easy dissemination and low cost make e-mailed boosters a very efficient way to promote student health.     

An Exploratory Study of Group Therapy for Sexually Abused Adolescents and Nonoffending Guardians

ABSTRACT

Adolescent survivors of sexual abuse frequently report severe trauma, depression, anxiety, and low self-esteem. While cognitive-behavioral group interventions show promise, interpreting efficacy is problematic due to commonly high attrition. This article reports promising exploratory study findings relating to a 12-week multimodal abuse-specific group intervention with a nonoffending parent/caregiver component. Participants (aged 11–16 years) consisted of six adolescents with severe abuse histories, and their caregivers. Participants completed pre-, post-, and 1-month follow-up measures. The results were consistent with the possibility that the program produced clinically meaningful reductions in abuse-related psychological sequelae, the program had excellent face validity with participants, and there were no dropouts.     

Gay Bars and Serendipity

Abstract

HIV/AIDS continues to be a serious public health issue. As HIV changes from an acute disease to a more chronic illness, it places increased responsibility on family caregivers to provide on-going assistance. Based on a conceptual model of caregiving resilience, this study found high variation in caregiving outcomes with many caregivers demonstrating high levels of well-being despite adverse life circumstances. Factors that contributed significantly to caregiver well-being included income, caregiver health, discrimination, multiple loss, dispositional optimism and self-empowerment. These findings suggest that HIV/AIDS and caregiving entail more than stress and distress and that future research needs to consider caregiving within the context of a historically disadvantaged community, resilience of informal caregivers, and risk and protective factors at the personal, cultural and community levels. Such information is necessary to design community-based interventions to support informal caregivers and persons living with HIV/AIDS.     

Examining the Gray Zones in Guardianship and Involuntary Protective Services Laws

ABSTRACT

Multidisciplinary focus groups were convened in three geographically diverse areas of Ohio to compare the application of guardianship and adult protective services interventions in the lives of vulnerable adults. The results suggest that there is general agreement in understanding the concepts of “incapacity” and “incompetence.” Professional differences in value orientation were found that may affect how these concepts are applied in given cases. Regional differences in modes of assessment, resource availability, and intervention style were found. A decision-making grid is presented to assist in the examination when one or both forms of involuntary intervention are appropriate.     

It Kind of Made Me Feel Important

Abstract

The enactment of the Personal Responsibility Work Opportunity and Reconciliation Act (PRWORA) in 1996 led to sweeping changes in U.S. welfare policy and practice. Given the time limits placed on adult recipients of cash assistance, and the multiple barriers to employment that many of these recipients face, alternative intervention strategies need to be developed. Welfare-to-work interventions provided by faith-based groups are one such intervention strategy. This paper discusses the rationale for faith-based services and introduces research conducted on one particular faith-based model of intervention for the target population. Findings presented center on participants' perceptions of the faith-based services they received, particularly on aspects of the program that were helpful and meaningful to them.     

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.     

INTERNET RESOURCES

Abstract

The Internet has been an important way for lesbian, gay, bisexual, and transgender (LGBT) people to connect with one another since it was discovered by the community in the late 1980s (Weinrich, 1998). It offers anonymity and easy access, helping those isolated by geography, disability, ignorance, or fear to connect with other individuals and become part of a larger community (Alexander, 1997; Haag & Chang, 1998). With so many LGBT people communicating with each other and gathering information online, it is essential that social service professionals understand how this is done, the climate in which it occurs, and what kind of information people are retrieving. Knowledge of the increasingly sophisticated resources available to professionals online can also help those who work in policy development and social research. This article discusses searching for information on the Internet and reviews several directories, including some specifically oriented for LGBT users.     

An Overview and Critique of the Experience Corps for Independent Living Initiative

Abstract

This article presents findings of the evaluation of the Experience Corps for Independent Living (ECIL) initiative. The ECIL initiative was a two-year demonstration program designed to test innovative ways to use the experience, time, and resources of volunteers over 55 to expand significantly the size and scope of volunteer efforts on behalf of independent living services for frail older people and their caregivers in specific communities. Six demonstration projects were selected to participate in this initiative. The intensive volunteers, the critical component of the program, were more highly skilled than typical volunteers from existing senior volunteer programs. ECIL volunteers collaborated with agency partners to develop new programs, supervise direct service activities, and enhance the performance of the agencies being served. Although the projects addressed many of the goals of the initiative, they did not fully accomplish all of their objectives. The ECIL initiative was particularly successful in providing independent living services to frail elders and their families in the communities served. It was less successful in developing and maintaining the team and corps concept, in attracting and retaining the anticipated numbers of volunteers during the study period, and in becoming self-sufficient by the end of Year Three.