Bioecological Implications of Narrative Exposure Therapy in Low‐Resource Settings: Individual,Family, Community,and Socio‐Political Contexts

Traumatic stress can have detrimental effects on individuals, families, and communities. Narrative exposure therapy (NET) is an evidence‐based intervention for decreasing individuals’ post‐traumatic stress disorder (PTSD) symptoms and has been tested in some of the most challenging contexts, such as in post‐conflict refugee camps. Although the focus of NET is on reducing individual PTSD symptoms, the impact of NET can be seen beyond the individual level. The purpose of this paper is to examine some of the ecological implications of using NET with trauma‐affected populations in low‐resource settings. We describe the implications of NET at the family, community, and sociopolitical levels using several case examples. Finally, we outline limitations and future directions for improving the delivery of NET in settings with limited resources.     

Implementing a college mental health program – an overview of the first twelve months

Objective: To evaluate the demographics and clinical utilization patterns among college students during the initial 12 months of a novel, multi-disciplinary, collaborative, college mental health program (CMHP). Participants: Undergraduate and graduate students receiving treatment at the CMHP from Jan-Dec 2015. Methods: De-identified data was obtained via electronic health records for all students receiving care through the CMHP. Results: 1.2 FTE clinical providers treated 278 undergraduate and graduate students during the year (65.1% < age 26, 53.6% female, 49.6% caucasian). There were 1822 CMHP outpatient visits, 318 other medical visits and 103 total emergency room (ER)/inpatient visits. Ten students were identified as high utilizers of ER/inpatient services, while charges to the CMHP totaled $470,157 and total charges to the Health System were $2,378,315. Conclusions: Students with complex psychiatric/medical co-morbidities received cost effective, convenient and integrative treatment. Over time, we hope to intervene earlier and decrease ER/inpatient visits.     

The importance of systems thinking,context, and inclusion when studying the feasibility of expanding the FoodShare (SNAP) outreach program to rural communities of Northern Wisconsin

Evaluators often neglect to question whether a program has been appropriately designed for a new context prior to a feasibility study’s commencement. In this paper, we document the results of a case study that closely examined context when determining the feasibility of implementing a FoodShare outreach program in rural northern Wisconsin. Using community-based participatory mixed methods, we examine how stakeholder engagement led to both study refinement and a more comprehensive understanding of community food security based on contextual factors and systems thinking. Lessons learned when conducting feasibility studies from this perspective are provided to improve evaluation practice.     

Albinism,spiritual and cultural practices,and implications for health,healthcare, and human rights: a scoping review

Persons with albinism – a disability found worldwide – are particularly at risk for human rights violations in Africa. The purpose of this scoping review was to establish the current state of knowledge on albinism, spiritual and cultural practices, and implications for health and health services. Electronic searches of nine databases were conducted. After screening, 40 articles were reviewed. Four themes emerged: health implications of albinism; health-related cultural and spiritual meanings attached to albinism; health-related experiences of persons with albinism; and human rights and albinism. The findings reveal that African ontologies, including witchcraft beliefs and practices, are implicated by their construction of the person with albinism as an ontologically different entity, although few studies explicated this relationship. How broader social structures influence persons with albinism disproportionately, resulting in health and social inequities, is another under-researched area. This scoping review lays the groundwork for intersectoral, interdisciplinary research.     

Sexual Health Services for Homeless Youth: A Qualitative Analysis of their Experiences

The sexual health problems experienced by homeless youth bring into question their use of available sexual health services. Using a qualitative typological analysis, this study aims to identify sexual health services utilization profiles for homeless youth, and to understand the role of the homeless experience on the utilization of sexual health services. Individual interviews were conducted with 33 homeless youth (17 men, 16 women) between 18 and 25?years of age. Typological analysis identified four profiles: (1) a targeted use of sexual health services to determine one’s serological status following a relational change during the homeless experience; (2) a limited use of sexual health services to manage sexual emergencies that arise during the homeless experience; (3) a regular use of sexual health services to avoid the risks associated with the homeless experience; (4) a frequent use of sexual health services to obtain support when engaging in prostitution during the homeless experience. This study shows that the precarious and unstable conditions within the homeless experience incite youth to utilize sexual health services in different ways. These findings point to the importance of rethinking sexual health services to better adapt them to the different utilization profiles of homeless youth.     

基于协调发展度的重大工程团队免疫系统健康评价研究

为评价重大工程团队免疫系统的健康和协调发展状况,本文提出了一种基于协调发展度的评价模型。首先通过文献查询和深度访谈,构建能够体现重大工程团队免疫系统特征的健康评价指标体系;其次利用改进的DEMATEL确定指标权重,然后采用多层次模糊综合评价将相关指标定量化,最终得出重大工程团队免疫系统的健康指数和协调发展度;再次确立重大工程团队免疫系统健康等级和协调发展度划分标准,同时提出免疫系统健康的跟踪评价策略;最后,利用本文模型对某跨国输气管道工程团队的免疫系统进行实证研究。结果表明,协调发展度模型既能反映重大工程团队免疫系统的整体健康程度,又能衡量固有性免疫和适应性免疫的协调发展状况,同时对免疫系统健康的跟踪评价也取得了良好效果。     

The relationship between Black and gay community involvement and HIV-related risk behaviors among Black men who have sex with men

Black gay men must navigate identities and stigmas related to being gay and Black, and report higher HIV incidence relative to their White male counterparts although they report lower rates of drug use and risky sexual behaviors. This study examined whether closeness to the gay or Black community correlated with HIV-related risk and protective behaviors. Data were drawn from uConnect, a population-based cohort study of young Black men who have sex with men (YBMSM) on Chicago's South Side. The sample consists of 618 Black MSM ranging in age from 16 to 29. Cross-sectional measures for this study include Black and gay community closeness, drug use, sexual risk behaviors, HIV testing, and health promotion behaviors. Closeness with the gay community was associated with greater pre-exposure prophylaxis (PrEP) knowledge as well as participating in health promotion programs along with higher rates of transactional sex and having sex under the influence of substances, and increased odds of self-reported HIV seropositivity. Involvement in the Black community was associated with lower odds of reporting being HIV positive. Findings suggest that programs and initiatives are needed to help promote the positive aspects of the Black and gay communities, while minimizing the negative correlates of such involvements.     

Discrimination,mental health,and body image among transgender and gender-non-binary individuals: Constructing a multiple mediational path model

The purpose of the current study was to examine the relationships among discrimination, mental health, and body image in a national sample of transgender adults. Participants (N = 78) identified as transgender, genderqueer, or other gender-non-binary identities and were recruited via a national online survey. Harassment/rejection, work/school, and other discrimination explained 10.4% of the variance in body appreciation, while satisfaction with life, anxiety, self-esteem, and depression explained 60.7%. Within these models, harassment/rejection was inversely associated with body appreciation, while self-esteem and satisfaction with life were positively associated. A series of path models moving from a measurement model to a more parsimonious and excellent-fitting model found that the effect of harassment/rejection on body appreciation was fully mediated by self-esteem and satisfaction with life, resulting in a multiple mediation.     

The sacred and the profane in life science work: The case of assisted reproduction laboratories

Reproductive medicine and assisted reproduction therapies have been developed over the last decades resulting in over five million babies. The handling of human reproductive materials and patients is based on the ability to combine health care work and techno-scientific expertise in both the clinic and the laboratory setting. This study of Swedish assisted reproductive technology clinics demonstrates that the active day-to-day manipulation of human reproductive materials enact both the ‘profane’, through treating the embryos as raw materials in standardized procedures enabling economies of scale, and the ‘sacred’ through enacting a separation, the potential to human life, the patients ordeals, and seriousness. The enactment of the profane and the sacred is mostly balanced but at certain points in the work procedures, their intersecting becomes particularly salient. Such points provide opportunities for the study of the sense making of professionals in organizational grey zones, during techno-scientific activities.     

A Case Study Using Photovoice to Explore Racial and Social Identity Among Young Black Men: Implications for Social Work Research and Practice

This article describes an exploratory qualitative case study using a research method novel to social work known as Photovoice. This case study of the Photovoice process assesses its value as a community-based participatory research (CBPR) method with marginalized communities within social work research. Photovoice was used to engage young Black men as researchers into their own lived experience. Through a photographic and group participatory project, participants discussed how intersections of race, gender, and sexuality affect their lives and health. While this methodology has proliferated within public health literature, little research exists within social work. Photovoice represents a research well-aligned with core social work values of empowerment and social justice. This method offers our profession a participatory, action-oriented tool to inform practice and policy and does so in the voices of communities who often go unheard.