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Family support plays an important role in promoting resilience and health among transgender and/or nonbinary youth (TNBY), but family members often experience barriers to supporting their TNBY, including minority-adjacent stress stemming from exposure to structural stigma and antitransgender legislation. TNBY and their families need effective family-level interventions developed using community-based participatory research (CBPR), which integrates community members (e.g., TNBY, family members, service providers for families with TNBY) into the intervention development process to ensure the resulting intervention is relevant and useful. Informed by findings from the Trans Teen and Family Narratives Project, we used CBPR to develop the Trans Teen and Family Narratives Conversation Toolkit, a family-level intervention designed to educate families about TNBY and facilitate conversations about gender. The toolkit was developed across 1.5 years (June 2019 to January 2021) using four integrated phases: (1) content development: digital storytelling workshop with TNBY; (2) content review: digital storyteller interviews and user focus groups; (3) content development: study team content synthesis and website development; and (4) content review: website review by TNBY, family members, and mental health providers, and intervention refinement. This article outlines the intervention development process, describes strategies employed to navigate challenges encountered along the way, and shares key learnings to inform future CBPR intervention development efforts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
RESUMEN
The incorporation of sex and gender variables in medical education can be made more intuitive and accurate with thoughtful intervention. The authors propose a flowchart to make medical education tools more precise and applicable to patients who would benefit from a nuanced approach to sex and gender. The Body Guidelines can empower educators to consider sex and gender in terms of the etiology and epidemiology of any given pathologic process or disease.
RESUMEN
The current study used family and ecological systems approaches to understand transgender and/or nonbinary (TNB) youths' experiences of their gender identity within family and community contexts. A sample of 33 TNB youth, ages 13-17 years (M = 15.18, SD = 1.24), were recruited from community-based venues in the New England region of the United States to participate in the Trans Teen and Family Narratives Project, a longitudinal community-based mixed methods study. TNB youth in the sample identified as trans girls (n = 12), trans boys (n = 17), and nonbinary (n = 3 assigned female at birth; n = 1 assigned male at birth). Race/ethnicity of the sample was 73% White and 15% mixed race/ethnicity. All participants completed a one-time, in-person semi-structured qualitative interview at baseline about their family and community-based experiences related to their TNB identity. Interviews were audio-recorded and professionally transcribed. Interview transcripts were coded and analyzed using immersion/crystallization and thematic analysis approaches. Eight themes were developed, which correspond to different levels of the ecological systems model: individual-level (identity processes, emotions/coping), family-level (general family experiences, family support), community-level (general community experiences; community support; lesbian, gay, bisexual, transgender, queer (LGBTQ) community), and societal/institutional-level (external forces). Findings emphasize the importance of using family and ecological systems approaches to understanding the family- and community-based experiences of TNB youth and have implications for improving clinical practice with TNB youth and families.
RESUMEN
BACKGROUND: Early identification and intervention is a gold standard for psychotic disorders, for which delays in care can have serious consequences. Screening for psychosis in primary care may circumvent barriers related to stigma and facilitate shorter pathways to care. Yet, there is debate regarding the benefit-risk balance for psychosis screening in general adolescent populations. METHODS: Primary care patients of an adolescent/young adult medical clinic in the US ages 14-21 self-administered surveys assessing age, sex, receipt of psychotherapy, and occurrence, frequency (1-5), and distress (0-3) for 23 psychosis risk (PR) symptoms, including 6 general/nonspecific items and 17 psychosis-specific items. Participants also completed the 9-item Patient Health Questionnaire (PHQ-9); scores of ≥10 suggested clinically significant depressive symptoms. Analyses characterized PR symptoms and examined associations of PR symptom distress with current therapy and depressive symptom severity. RESULTS: Of 212 patients who completed the survey, 75% endorsed ≥1 PR symptom and 27% rated ≥3 on distress for psychosis-specific items. Those with high PHQ-9 scores reported higher PR distress overall (t = -6.1, df = 52.3, p < 0.001) but not on psychosis-specific items such as hallucinations and suspiciousness. One in 9 participants reported heightened PR distress without being in therapy or having high depressive symptoms. CONCLUSIONS: Most adolescents in this primary care sample endorsed symptoms associated with PR. Distress related to these symptoms was less common but occurred even in the absence of depressive symptoms. PR screening only in youth with high depressive symptom screens or in mental health care may miss youth needing further assessment for psychosis.