The deployment of discretionary power in the prevention and enactment of structural violence against young people experiencing homelessness.

BACKGROUND: Young people experiencing homelessness (YEH) interact with, and are reliant on, multiple social systems in their daily efforts to meet their basic needs. Criminalization of homelessness contributes to victimization, and social service providers can act as gatekeepers for access to services, yet little is known about how criminalization and social service policies impact access to food, housing, and other basic needs resources. OBJECTIVE: This study aimed to explore how YEH access safety and basic needs resources and how they interface with social systems and systems agents while attempting to meet their basic needs. PARTICIPANTS AND SETTING: Forty-five YEH participated in youth-led interviews across San Francisco. METHODS: We conducted a qualitative Youth Participatory Action Research study utilizing Participatory Photo Mapping to interview YEH on their experiences of violence, safety, and accessing basic needs. A grounded theory analysis identified patterns of youth victimization and barriers to meeting their basic needs. RESULTS: Analysis revealed the role of decision-making power of authority figures (e.g., social service providers, law enforcement officers, other gatekeepers) in enacting or preventing structural violence against YEH. When authority figures utilized their discretionary power to allow access to services, YEH were able to meet their basic needs. Discretionary power enacted to limit movement, prevent access, or cause physical harm limited the ability of YEH to meet their basic needs. CONCLUSIONS: The discretionary power of authority figures can contribute to structural violence when their discretion is used to interpret laws and policies in ways that prevent access to limited basic needs resources for YEH.

Reconsidering the role of place in health and welfare services: lessons from the COVID-19 pandemic in the United States and Canada.

Places-the meaningful locations of daily life-have been central to the wellbeing of humans since they first formed social groups, providing a stable base for individuals, families, and communities. In the United States and Canada, as elsewhere, place also plays a foundational role in the provision of critical social and health services and resources. Yet the globally destabilizing events of the COVID-19 pandemic have dramatically challenged the concept, experience, and meaning of place. Place-centered public health measures such as lockdowns and stay-at-home orders have disrupted and transformed homes, neighborhoods, workplaces, and schools. These measures stressed families and communities, particularly among marginalized groups, and made the delivery of vital resources and services more difficult. At the same time, the pandemic has stimulated a range of creative and resilient responses. Building from an overview of these effects and drawing conceptually on theories of people-place relationships, this paper argues for critical attention to reconsidering and re-envisioning prevailing assumptions about place-centric policies, services, and practices. Such reappraisal is vital to ensuring that, going forward, scholars, policymakers, and practitioners can effectively design and deliver services capable of maintaining social connections, safety, and wellbeing in contexts of uncertainty, inequality, and flux.

"It's Being Compassionate, Not Making Assumptions": Transmasculine and Nonbinary Young Adults' Experiences of "Women's" Health Care Settings.

BACKGROUND: Transgender and nonbinary (TNB) individuals assigned female sex at birth experience discrimination, misgendering, problems with insurance, and denial of services when accessing health care. This study aimed to understand the experiences of TNB young adults in accessing "women's" health care-a form of care that is structurally gendered that few studies have investigated. METHODS: In 2015, we conducted in-depth interviews with 20 TNB young (ages 18-29) adults assigned female sex at birth. We thematically analyzed the data. RESULTS: Participants described feelings of comfort and trust-and lack thereof-at every step of the health care-seeking process, including scheduling, checking in, waiting, and interactions with clinicians and other staff. Gendered language served as a constant stressor; participants-especially nonbinary participants-noted few opportunities to provide their correct pronouns and names. Participants relayed negative experiences associated with waiting rooms in "women's" health care spaces, where TNB patients are forced to disclose their identity simply through their presence or owing to actions of staff that out them. These concerns deterred some from seeking care, with most expressing discomfort or anxiety that caused them to feel unsafe. Participants described "women's" health care providers making assumptions about their anatomy, reproductive desires, sexual orientation, and sexual practices, as well as inappropriately and harmfully emphasizing their bodies and TNB identities during health care interactions. Clinician competence and humility engendered participants' feelings of safety and undergirded their interest in engaging with "women's" health care. CONCLUSIONS: A lack of patient-centered, TNB-competent care in structurally gendered health settings exacerbates health care and health inequities for TNB young adults.

Contraceptive Beliefs, Needs, and Care Experiences Among Transgender and Nonbinary Young Adults.

PURPOSE: This qualitative study explores the contraceptive health-care needs of transgender and nonbinary young adults assigned female sex at birth. METHODS: Qualitative interviews were conducted with 20 transgender and nonbinary young adults assigned female sex at birth (ages 22-29 years), recruited via online platforms and community agencies. Semistructured interviews elicited information on participants' gender and reproductive histories, health-care experiences, sexual practices, and contraceptive use and decision-making processes. Interviews were transcribed and coded using thematic analysis. RESULTS: Primary thematic domains centered on contraceptive experiences and needs, testosterone as contraception, and experiences with reproductive health care. Participants generally did not use hormonal contraception to prevent pregnancy; in situations where pregnancy was possible, participants relied on condoms. Some participants believed testosterone use would prevent pregnancy and subsequently did not use a contraceptive method. Participants described the lack of knowledge, among themselves and providers, of the impacts of testosterone on pregnancy risk and interactions with hormonal contraception. They described reproductive health-care experiences in which providers were unfamiliar with the needs of transgender and nonbinary patients; made assumptions about bodies, partners, and identities; and lacked adequate knowledge to provide effective contraceptive care. CONCLUSIONS: Patient-centered reproductive care requires that providers be sensitive to the stress of gender-affirming care and engage with contraceptive counseling that addresses patients' behavior, risks, and reproductive functions. In particular, providers should understand and communicate the impacts of testosterone therapy on pregnancy risk.

Exploring Bullying Perpetration and Victimization Among Adolescent Girls in the Child Welfare System: Bully-Only, Victim-Only, Bully-Victim, and Noninvolved Roles.

Childhood abuse is a common experience for youth in the child welfare system, increasing their risk of bullying perpetration and victimization. Little research exists that has examined the rates of bullying perpetration and victimization for child welfare-involved adolescent girls. The study addressed the following aims: (a) to generate frequency estimates of physical, nonphysical, and relational forms of bullying perpetration and victimization; (b) to identify the frequency of bully-only, victim-only, bully-victim, and noninvolved roles; and (c) to identify risk and protective factors that correlate with these bullying role types. Participants were 236 girls (12-19 years) in the child welfare system from a Midwestern urban area. Participants were referred to the study to join a trauma-focused group program. Seventy-five percent of the total sample were youth of color, with the remaining 25% identifying as White, non-Hispanic. Data were collected through baseline surveys that assessed childhood abuse, bullying perpetration and victimization, posttraumatic stress, substance misuse, aggression-related beliefs and self-efficacy, placement type, placement instability, and mental health service use. Child welfare-involved adolescent girls were found to assume all four major role types: bully-only (6.4%, n = 15), victim-only (20.3%, n = 48), bully-victim (44.1%, n = 104), and nonvictims (29.2%, n = 69). The bully-victim rate was approximately 7 times higher than the rate found in a nationally representative sample of non-child welfare-involved youth. The current study identified posttraumatic stress disorder (PTSD) symptoms, anger self-efficacy, and alcohol use as significant correlates of bullying roles. The identification of a substantially higher rate of bully-victims has important practice implications, suggesting child welfare and school systems adopt trauma-informed systems of care. Bully-victims are very likely traumatized children who are in need of effective trauma treatment rather than punitive sanctions.

Social Ecological Correlates of Polyvictimization among a National Sample of Transgender, Genderqueer, and Cisgender Sexual Minority Adolescents.

Polyvictimization is a common experience for youth in the United States, with 20% nationally experiencing five or more different forms of victimization in the last year. Utilizing a large, national convenience sample of sexual and gender minority adolescents (N = 1177, 14-19 years old), the current study aimed to (a) generate the first estimates of last year polyvictimization (including nine victimization subtypes) for transgender, genderqueer, and cisgender (i.e., assigned birth sex aligns with gender identity) sexual minority adolescents and (b) identify social ecological correlates of last year polyvictimization. The study utilized an online survey advertised through Facebook and community organizations across the United States. Approximately, 40% of participants experienced ten or more different forms of victimization in the last year and were classified as polyvictims. A significantly higher percentage of transgender female (63.4%), transgender male (48.9%), genderqueer assigned male at birth (71.5%) and genderqueer assigned female at birth (49.5%) were polyvictimized in comparison to cisgender sexual minority males (33.0%). Polyvictimization rates for cisgender sexual minority females (35.1%) were not significantly different from male counterparts (33.0%). Several significant risk factors for polyvictimization were identified: genderqueer identity for participants assigned male at birth and higher-levels of posttraumatic stress, family-level microaggressions, and peer rejection. The manuscript concludes with recommendations for future research including the exploration of factors (e.g., lack of community support, gender-role policing) associated with higher polyvictimization rates for genderqueer adolescents. Additionally, professionals (e.g., foster care, homeless shelters, schools) require new tools to assess for polyvictimization among sexual and gender minority adolescents.