Simple measures of case mix in mental health services.

The concept of Case Mix in community mental health service program evaluation can be useful in mental health program evaluation if the definition of case mix is expanded beyond Diagnostic Related Groups (DRG), where DRG is solely based upon diagnosis and length of hospitalization stay. A case mix definition based upon two principal characteristics is offered. One characteristic is clinical status defined in terms of diagnostic signs and symptoms, level of functioning, and age. The other characteristic is typical treatment strategy for a given period of time (e.g., 13 weeks). Two cases mixes typical of services designed for the chronically mentally ill are discussed.     

Influences of patient, service program, and clinician characteristics on judgments of functioning and treatment recommendations

The study examines the interactions among (a) type of service program (inpatient, partial hospital, and outpatient) (b) patient characteristics (social support, cooperativeness with treatment, and whether the symptoms of aggression are directed externally toward others or internally toward self), and (c) the type of level of functioning scale used (grossly versus behaviorally anchored scales) on two sets of dependent measures: (1) clinicians' judgments of patient level of functioning and (2) the clinicians' recommendations for initial treatment modality (inpatient, partial hospitalization, or outpatient individual or group therapy). Seventy-eight clinicians made judgments on 16 analogue cases systematically varied on the three patient variables. Forty-six clinicians worked in programs regularly using a behaviorally anchored functioning scale; of these, 27 made their level of functioning ratings with the nine point scale used by their programs, 19 used a grossly anchored scale (from “extreme dysfunction” to “no dysfunction”). The remaining 32 clinicians, from programs using structured scales, used the grossly anchored scale. Clinicians who used the behaviorally anchored scale gave higher level of functioning ratings overall and were less influenced by differences in the patient variables manipulated in the case vignettes. Male and female clinicians showed different effects of the patient social support variable. Treatment recommendations were influenced by the patient variables and by the type of service setting in which the clinician was working.     

‘All in all it is just a judgement call’: issues surrounding sexual consent in young people’s heterosexual encounters

In the UK, there has been growing concern about young people’s understanding of sexual consent, with the views of young people themselves often lost in academic and educational policy debates. However, the focus on high rates of sexual violence has meant a lack of attention on the everyday negotiation of consensual heterosexual activity, leading to assumptions being made regarding young people’s lack of understanding of sexual consent. This paper emerges from a wider study of over 500 young people which sought to uncover their understanding of the issues. Drawing on data from workshops and the open text responses to an on-line survey the findings presented in this paper show that the majority of heterosexual young people understood the complexity of sexual consent as an embodied process, which can be difficult to define, talk about or practice uniformly. This complex understanding, in which sexual consent is a continuum rather than a dichotomy, has implications for sexual education initiatives. We argue that it is only by providing a closer understanding of how – within consensual sexual activities – young people understand and enact sexual consent through a range of embodied communication strategies that education surrounding sexual assault will become meaningful.     

College students' attitudes about lesbians: what difference does 16 years make?

The article reviews empirical studies on trends in attitudes toward lesbians and gay men and compares data from a 1985 survey of 297 students living in a college residence hall with data collected in 2001 when 152 students living in the same residence hall responded to a similar questionnaire. College students in 2001 expressed more accepting attitudes toward lesbians, reported more contact with lesbians, and assessed their parents' attitudes as more positive when compared with the 1985 sample. Consistent trends in the importance of these variables to the development of attitudes toward lesbians were shown, with gender role attitudes, parental attitudes, and exposure to education and media about gays and lesbians remaining the most important predictors. This suggests that strategies that discourage gender role stereotypes and provide educational and media experiences could increase acceptance of sexual minorities. Although gender was significant in 1985, there were no effects of gender in the 2001 sample. Continued study of trends in attitudes toward all sexual minorities and attention to the relative importance of gender and gender roles are recommended.     

Health and Cultural Determinants of Voluntary HIV Testing and Counseling Among Middle-Aged and Older Latina Women

The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people with HIV/AIDS is over age 50. This study describes the correlates of HIV Voluntary Counseling and Testing (VCT) using structural equation modeling techniques for a sample of 135 middle-aged and middle-aged and older Latinas in South Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to be the strongest predictor of VCT (odds ratio [OR] = 6. 38), followed by having a clinic as a regular source of healthcare (OR = 3.88). Social work implications are provided.     

Including Curriculum Content on Lesbian and Gay Issues

Abstract

This paper presents a rationale for requiring content on lesbian and gay issues in the social work curriculum. Recent research suggests that a considerable percentage of social workers possess homophobic attitudes. Some support exists for making education a tool to reduce negative attitudes toward the gay population. However, students are unlikely to receive adequate information about this population before they enter the social work curriculum. The goals of including content on lesbian and gay issues are to decrease homophobic attitudes and to prepare students to provide effective social work practice with lesbian and gay clients. Methods and resources for incorporating content on lesbian and gay issues in human behavior, direct practice, policy, community organization and research courses of the social work curriculum are presented.     

Conducting Research with Lesbian,Gay, and Bisexual Populations: Navigating Research Ethics Board Reviews

The acceleration of research with lesbian, gay, and bisexual (LGB) populations amid existing sexual prejudice and advancing human rights leads to sometime conflicting stances between researchers and ethics boards over acceptable methodological practices. Ethics boards, charged with ensuring the safety of research participants, may engage in ostensibly protective stances regarding potential risks and informed consent that are unwittingly founded upon negative stereotypes of LGB populations. We examine four case studies that demonstrate divergent stances between researchers and ethics boards, researchers’ responses to ethics reviews and their resolution. Based on these cases, we describe themes and strategies for researchers working with LGB populations in responsibly navigating ethics board concerns.     

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.     

Anal Cancer Screening: Barriers and Facilitators Among Ethnically Diverse Gay,Bisexual, Transgender,and Other Men Who Have Sex With Men

ABSTRACT

Knowledge and beliefs about anal cancer screening among gay and other men who have sex with men remains unclear, despite data that suggests significant risk for intra-anal HPV-related cancers. Nevertheless, community-based screening activities may be most effective when stakeholder perspectives are addressed. We conducted four focus groups among 16 male and 3 female health care advocates experienced in working with diverse gay and other men who have sex with men in Los Angeles. Barriers to anal cancer screening included lack of awareness, stigma, psychological and physical discomfort, the anus as hidden/private, primary concern with HIV, and men's lack of healthcare seeking. Facilitators were community screening sites, novel strategies such as home testing, health care system changes and targeted educational campaigns, which may increase anal cancer awareness and screening among ethnically diverse men who have sex with men.