Supporting Children and Families in Medical Settings: Insights from Child Life Specialists During the COVID-19 Pandemic.

Medical settings can be frightening and stressful places for pediatric patients and their families. During the COVID-19 pandemic fear and anxiety associated with receiving medical care increased as medical facilities dramatically altered the way they functioned in attempts to stop the spread of the virus. Certified Child Life Specialists (CCLSs) are medical professionals who provide psychosocial support for pediatric patients and their families by helping them understand and cope with medical procedures and the medical environment. In this role, CCLSs are likely to have important insights into the experiences and needs of pediatric patients and their families during COVID-19. Using a mixed-methods design, 101 CCLSs completed an online survey and 15 participated in follow-up interviews examining their experiences with and observations of children and families in medical environments during the pandemic. Participants emphasized a need to maintain a focus on child- and family-centered care for the well-being of patients and their families. While recognizing the need to socially distance to limit the spread of COVID, participants expressed concern about restrictive policies that did not balance the physical and mental health needs of patients and families. Participants also discussed the important role of child life services during the pandemic and the unique and multifaceted contributions CCLSs made to support patients, families, other medical professionals, and communities. Recommendations for supporting children and families in medical environments moving forward are discussed in light of lessons learned during the pandemic.

School Pushout: The Role of Supportive Strategies Versus Punitive Practices for LGBT Youth of Color.

Recently, schools have focused on supportive (e.g., behavioral supports) rather than punitive (e.g., suspension) strategies to reduce school pushout among marginalized youth. We examined the association between suspension and discipline practices for students with intersecting identities (e.g., LGBT youth of color). We used teacher and student data from 1,091 schools that participated in the California School Climate and California Healthy Kids Surveys. Relative to White LGBT youth, LGBT youth of color were at higher risk of being suspended, and youth were differentially affected by punitive policies depending on their race, sexual orientation, and/or gender identity. While supportive strategies were associated with lower risk of suspension, punitive practices were associated with higher risk of suspension, especially for LGBT youth of color.

Gay-Straight Alliances, Inclusive Policy, and School Climate: LGBTQ Youths' Experiences of Social Support and Bullying.

Gay-Straight Alliances (GSA) and school policies focused on support for lesbian, gay, bisexual, transgender, and queer/questioning youth may reduce bias-based bullying and enhance social supports in schools. Using multivariate regression, we tested the relationship between youth reports of the presence of GSAs and LGBTQ-focused policies, independently and mutually, with experiences bullying and perceived support (n = 1,061). Youth reported higher classmate support in the presence of GSAs and higher teacher support in the presence of LGBTQ-focused policies; the presence of both GSAs and LGBTQ-focused policies was associated with less bullying and higher perceived classmate and teacher support. The findings indicate that GSAs and LGBTQ-focused policies are distinctly and mutually important for fostering safer and more supportive school climates for youth.

Safe and supportive schools for LGBT youth: Addressing educational inequities through inclusive policies and practices.

Inclusive policies that attend to sexual orientation and gender identity (SOGI) are associated with more supportive school environments for lesbian, gay, bisexual, and transgender (LGBT) youth. We use the 2013-2015 California Healthy Kids Survey (n = 113,148) matched with principal reports of school policies from the 2014 California School Health Profiles to examine differential effects of SOGI-focused policies for LGB and transgender youth. SOGI-focused policies had a direct association with less truancy, and moderated the association between sexual orientation/gender identity and other school outcomes. SOGI-focused policies were associated with more positive experiences and perceptions of school climate for LGB youth and, to a lesser extent, transgender youth. Findings underscore the importance of inclusive policies, especially those that address the unique needs of transgender students.

Safe Schools? Transgender Youth's School Experiences and Perceptions of School Climate.

The magnitude of gender identity-related disparities in school-based outcomes is unknown because of a lack of representative studies that include measures of gender identity. By utilizing a representative sample generalizable to a broader population, this study elucidates the size of gender identity-related disparities, independent of sexual orientation, in school experiences associated with school connectedness and perceptions of school climate. Additionally, the inclusion of and comparison to results of a large non-representative sample allows for more direct comparisons to previous studies of the school experiences of transgender youth. The analyses in this study primarily draw on a sample of 31,896 youth representative of the middle and high school population in California who participated in the 2013-2015 California Student Survey (a subsample of the California Healthy Kids Survey, which includes the largest known sample of transgender youth). Over half the sample identified their sex as female (51.3%), and 398 identified as transgender (1.0%). The sample was racially and ethnically diverse: 30.7% identified as multiracial, 33.0% as White, 11.1% as Asian, 7.4% as Black, and 52.9% as Hispanic. Findings from multilevel analyses show that relative to non-transgender youth, transgender youth were more likely to be truant from school, to experience victimization and bias-based bullying, and to report more negative perceptions of school climate, though did not differ in self-reported grades. The findings have implications for improving school policies and practices to create safer and more supportive school climates for all youth.

Transgender Youth Substance Use Disparities: Results From a Population-Based Sample.

PURPOSE: The purpose of this study was to examine rates of substance use between transgender and nontransgender youth using a representative population-based sample and to examine mediating risk factors. METHODS: A statewide cross-sectional sample of California middle and high schools collected between 2013 and 2015. This representative sample of students in California included 335 transgender and 31,737 nontransgender youth. Using multivariate linear and logistic regression, we assessed differences between transgender and nontransgender youth in substance use behaviors related to alcohol, cigarette, marijuana, other illicit drugs, polysubstance use, and heavy episodic drinking. Substance use was assessed with lifetime use, age of onset, and past 30-day use for alcohol, cigarettes, and marijuana. Past 30-day use was also assessed for other illicit drugs and polysubstance use. Models were adjusted for demographics and risk factors including victimization, depressive symptoms, and perceived risk of substance use. RESULTS: The prevalence of substance use was 2.5-4 times higher for transgender youth compared with their nontransgender peers (depending on the substance). Transgender youth were also at greater risk for early age of onset and recent substance use than nontransgender youth. In addition, psychosocial risk factors related to victimization, depressive symptoms, and perceived risk of substance use partially mediated the relationship between gender identity and substance use. CONCLUSIONS: Using data from the first representative study of youth to include a measure of gender identity, we show that transgender youth are at heightened risk for substance use compared with nontransgender peers. Future research is needed to identify the structural and psychosocial mechanisms that drive these disparities.

Prevalence and Correlates of Suicidal Ideation Among Transgender Youth in California: Findings From a Representative, Population-Based Sample of High School Students.

OBJECTIVE: No representative population-based studies of youth in the United States exist on gender identity-related disparities in suicidal ideation or on factors that underlie this disparity. To address this, this study examined gender identity-related disparities in the prevalence of suicidal ideation; evaluated whether established psychosocial factors explained these disparities; and identified correlates of suicidal ideation among all youth and stratified by gender identity. METHOD: Data were derived from the 2013 to 2015 California Healthy Kids Survey (CHKS; N = 621,189) and a weighted subsample representative of the Californian student population (Biennial Statewide California Student Survey [CSS], N = 28,856). RESULTS: Prevalence of past 12-month self-reported suicidal ideation was nearly twice as high for transgender compared with non-transgender youth (33.73% versus 18.85%; χ2 = 35.48, p < .001). In fully adjusted models within the representative sample, transgender youth had 2.99 higher odds (95% CI 2.25-3.98) of reporting past-year suicidal ideation compared with non-transgender youth. Among transgender youth, only depressive symptoms (adjusted odds ratio 5.44, 95% CI 1.81-16.38) and victimization (adjusted odds ratio 2.66, 95% CI 1.26-5.65) remained significantly associated with higher odds of suicidal ideation in fully adjusted models. In multiple mediation analyses, depression attenuated the association between gender identity and suicidal ideation by 17.95% and victimization by 14.71%. CONCLUSION: This study uses the first representative population-based sample of youth in the United States that includes a measurement of gender identity to report on gender identity-related disparities in suicidal ideation and to identify potential mechanisms underlying this disparity in a representative sample.

Are school policies focused on sexual orientation and gender identity associated with less bullying? Teachers' perspectives.

Bullying is common in U.S. schools and is linked to emotional, behavioral, and academic risk for school-aged students. School policies and practices focused on sexual orientation and gender identity (SOGI) have been designed to reduce bullying and show promising results. Most studies have drawn from students' reports: We examined teachers' reports of bullying problems in their schools along with their assessments of school safety, combined with principals' reports of SOGI-focused policies and practices. Merging two independent sources of data from over 3000 teachers (California School Climate Survey) and nearly 100 school principals (School Health Profiles) at the school level, we used multi-level models to understand bullying problems in schools. Our results show that SOGI-focused policies reported by principals do not have a strong independent association with teachers' reports of bullying problems in their schools. However, in schools with more SOGI-focused policies, the association between teachers' assessments of school safety and bullying problems is stronger. Recent developments in education law and policy in the United States and their relevance for student well-being are discussed.

Fathers' accounts of struggle and growth in early adulthood: an exploratory study of disadvantaged men.

This chapter explores how fatherhood prompts struggle and growth in the psychological, social, and economic changes associated with the transition to adulthood. Little is known about these connections, especially for disadvantaged Latino and White fathers who live in small and mid-sized American communities. We draw on eight in-depth focus groups with 48 fathers (27 Latino and 21 White) who have children in low-income schools in a small and mid-sized American community. These men face significant challenges in establishing themselves at work-a central task of both adulthood and fatherhood-and in balancing these demands alongside the strong expectation that they also be involved fathers. Involved fathering is key to understanding dynamics related to identity and meaning and to relationships with spouses and friends, which are also intertwined with the process of becoming adult. The discussion considers how fatherhood can promote and constrain adult development for disadvantaged men.