Family Caregiver Communication in the ICU: Toward a Relational View of Health Literacy

We interviewed 18 family caregivers about their communication experiences in the ICUs at an urban hospital. Analysis of their narratives suggests health literacy is important in family caregiver/healthcare provider communication, especially as complicated illnesses move the caregiver deeper into decision making. Using the domains of Yuen et al.’s conceptual model of caregiver health literacy (2015), we identified three themes within the context of ICU communication: agency, coordinated communication, and caregiver’s evolving role. We saw family caregivers negotiating domains of health literacy as they built upon knowledge of the patient’s needs, their rights as family caregivers, and the hierarchy of the professional staff. We found that these narratives represent co-created, or relational communication, rather than individual health literacy skills. Conceptualized in the transaction of relationship, health literacy is enacted; it is socially constructed and is the scaffolding upon which family caregivers make decisions, care for their loved one, and care for themselves.     

Mental illness etiology beliefs among African American men with serious mental illness and their social support networks

Semi-structured qualitative interviews were conducted with 26 African American men with serious mental illness who were consumers of community mental health services and 26 members of their social support networks. All participants were asked what they believed had caused the consumers’ mental illness. Consumer participants most commonly identified chronic life stressors as a causal factor, while social supports most often identified intrinsic factors such as genetics or biology as causes of mental illness. Some support participants believed that unintentional drug use had precipitated the onset of mental illness or had no causal theories. The fact that some support participants could not identify a causal explanation may indicate failure on the part of mental health care systems to engage with consumers’ social support networks and provide education about mental illness and its causes. The implications of etiology beliefs on mental health service utilization are discussed.     

Inappropriate Comparisons: The LGB Population's Missing Reference Group

ABSTRACT

Given that many professional organizations emphasize the need for comparing assessment results to appropriate reference groups in their codes of ethics, we consider this practice through an ecological perspective as it applies to the lesbian, gay, and bisexual (LGB) population. The purpose of norming and types of assessment bias is discussed with respect to LGB population, which frequently lack specific norming data. The authors discuss whether the LGB population has characteristics similar to other commonly normed for groups and explore how group-shared constructs such as minority stress and internalized homophobia may introduce bias and affect the validity of assessments. A social anxiety assessment as well as a personality disorder inventory are examined for bias as case examples explaining how these assessments may exhibit bias when used with the LGB population. Increases in validity and effects on treatment planning are discussed as benefits of providing LGB-specific norms. Risks of providing these norms, such as minimizing subgroup differences and possibly increasing the risk of discrimination are also addressed before providing clinicians with recommendations as to how they may minimize the risk of bias in their assessment process.     

“Friendly” Initiatives: An Emerging Approach to Improve Communities for Vulnerable Populations

A growing number of cities and towns are implementing “friendly” initiatives to change the community’s social and physical infrastructure to address the needs of a particular vulnerable segment of their population. Three prominent examples are aging-friendly, child-friendly, and immigrant-friendly initiatives. Although the limited but growing literature describes these initiatives as promising strategies to improve the quality of life of the targeted population, to date there has been little written about the underlying goals, values, and assumptions of these efforts. Using the value-critical approach, this article aims to better understand these aspects of population-friendly initiatives by examining the scholarly and grey literature. Social workers engaged in community and policy practice can play a key role in these efforts and call attention to the ways they may alleviate or exacerbate inequities. Future research is needed to assess the effects of these initiatives on their targeted population as well as other community residents.     

Disclosure Stress,Social Support,and Depressive Symptoms Among Cisgender Bisexual Youth

Bisexual youth are at elevated risk for depression when compared with lesbians and gay men. Research on bisexual stigma suggests that these youth are uniquely vulnerable to stress related to sexual identity disclosure. Depression associated with this stress may be buffered by social support from parents and friends. We examined the differential influence of social support from parents and friends (Child and Adolescent Social Support Scale) on the relation between disclosure stress (LGBTQ Coming Out Stress Scale) and depressive symptoms (Beck Depression Inventory) and differences by gender in a sample of cisgender bisexual youth (N = 383) using structural equation modeling. Parental support buffered the association between stressful disclosure to family and depressive symptoms, especially for bisexual men; bisexual women seemed not to benefit from such support when disclosure stress was high. This nuanced examination elucidates the ways family members and clinicians can best support bisexual youth sexual identity disclosure.     

LGBT Family Lawyers and Same-Sex Marriage Recognition: How Legal Change Shapes Professional Identity and Practice

ABSTRACT

Lawyers who practice family law for LGBT clients are key players in the tenuous and evolving legal environment surrounding same-sex marriage recognition. Building on prior research on factors shaping the professional identities of lawyers generally, and activist lawyers specifically, I examine how practice within a rapidly changing, patchwork legal environment shapes professional identity for this group of lawyers. I draw on interviews with 21 LGBT family lawyers to analyze how the unique features of LGBT family law shape their professional identities and practice, as well as their predictions about the development of the practice in a post-Obergefell world. Findings reveal that the professional identities and practice of LGBT family lawyers are shaped by uncertainty, characteristics of activist lawyering, community membership, and community service. Individual motivations and institutional forces work to generate a professional identity that is resilient and dynamic, characterized by skepticism and distrust coupled with flexibility and creativity. These features are likely to play a role in the evolution of the LGBT family lawyer professional identity post-marriage equality.     

Validation of the Australian Midwifery Standards Assessment Tool (AMSAT): A tool to assess midwifery competence

Background

There is no current validated clinical assessment tool to measure the attainment of midwifery student competence in the midwifery practice setting. The lack of a valid assessment tool has led to a proliferation of tools and inconsistency in assessment of, and feedback on student learning.