An Exploratory Study of Resilience to Stressful Life Events in Autistic Children.

Background: Autistic children experience more stressful life events (SLEs) than their neurotypical peers, which are related to poor mental health outcomes in both neurotypical and autistic individuals. However, there is a lack of longitudinal research assessing the perceived impact of stressful life events on autistic children's mental health. Method: Utilizing a novel statistical technique (Ratcliff et al., 2019), called 'area of resilience to stress events' or ARSE in R, we aimed to quantify aspects of resilience, growth, and non-resilience for 67 autistic children (6-13 years old) enrolled in a larger longitudinal study who experienced a SLE. Parents reported demographic information (e.g., child age, biological sex, household income) as well as the child's internalizing and externalizing symptoms and autism characteristics across multiple time points spaced one year apart (baseline, T2, T3, T4). Results: There was substantial variability in the resilience process within the sample. Older children exhibited a less adaptive resilience process (i.e., higher total scaled scores or arsets). Perceived stress of the disruptive event was not correlated with resilience; however, there was a significant child age x stress severity interaction, suggesting that younger children in households that perceived the disruptive event as highly stressful exhibited more efficient resilience, or lower arsets scores, compared to other children. Conclusions: This study introduces an innovative methodological approach to understanding the effects of stressful life events on the mental health of autistic children. Results have implications for family-based policy and practice and highlight for whom services may be most beneficial.

Parental Depression Symptoms and Internalizing Mental Health Problems in Autistic Children.

Autistic youth are at risk for internalizing mental health problems such as depression and anxiety. Similarly, parents of autistic youth report higher levels of depression than parents of typically developing children. The goal of this study was to examine bidirectional associations between parent depression symptoms and the internalizing problems of autistic youth in 188 families across four time points (T1-T4; spaced 12 months apart). A cross-lagged panel model revealed that mother (T1 and T2) and father (T1) depression symptoms positively predicted the youth's internalizing problems 12 months later. The youth's internalizing problems at T3 positively predicted maternal depression symptoms at T4. Future research should explore genetic and environmental pathways that link parent depression and internalizing problems in autistic youth.

Empty Nest Status, Marital Closeness, and Perceived Health: Testing Couples' Direct and Moderated Associations with an Actor-Partner Interdependence Model.

Building on previous examinations of marital outcomes in the empty nest phase that have been based on surveys of individuals (primarily wives), the current study examined the direct effect of no longer living with children in the home (versus continuing to live with children) on husbands and wives' ratings of marital closeness as well as their perceived health. The study also tested whether couples' empty nest status moderated the associations between spouses' marital closeness and health. Analyses were based on 3,765 mixed-sex couples drawn from the Wisconsin Longitudinal Study. Dyadic multilevel modeling and actor-partner interdependence models (APIM) were used to test hypotheses. Results indicated that, accounting for known covariates, being in the empty nest was directly linked with both husbands and wives reporting higher levels of marital closeness and with wives (only) reporting better health. Moderating findings were less consistent, with the single reliable moderation result indicating that wives' perceived health was improved at higher levels of their husbands' marital closeness only among couples who were still living with children in the home. Clinical implications and future research directions are discussed.

Changes in social work students' attitudes and knowledge following opioid overdose prevention training.

Background: Opioid use disorders are widespread, commonly occurring, and have serious impacts on individuals, families, and communities. When adequately trained, social workers play a pivotal role in treating populations impacted by opioid use through the provision of high-quality services and the shifting of negative attitudes related to opioid use. However, workforce projections indicate a growing shortage of behavioral health professionals qualified to work with such populations and, presently, social work programs are not equipped to meet these workforce needs. Emerging evidence suggests opioid overdose education is associated with improved attitudes and knowledge among health professions; however, less information exists on the outcomes of such training among social work students. Schools of social work must develop and evaluate curricular components related to opioid use prevention and management to adequately prepare students for clinical work as social work practitioners. Methods: Thirty-three advanced-year MSW students received opioid overdose training as part of a day-long seminar on substance use. Content included acute effects of opioids, withdrawal symptoms, risk factors, signs of overdose, naloxone training, and harm reduction principles. Using a single-group pretest-posttest design, students completed the Opioid Overdose Attitudes Scale (OOAS) and the Opioid Overdose Knowledge Scale (OOKS). To evaluate students' attitudes and knowledge, investigators compared overall and subscale means before and after the training via paired samples t-tests. Results: Findings indicated statistically significant improvements in the "concerns" and "competence" domains of the OOAS. Likewise, findings indicated statistically significant improvements in the "risk," "signs," "action," and "naloxone use" domains of the OOKS. Conclusion: Students reported improved opioid overdose-related knowledge and attitudes when assessed after the training as compared to before the training. Due to the nature of the study design, causality cannot be inferred from the training outcomes. Findings may help other social work programs develop curricular components related to opioid use.

The Association between Hazardous Drinking Indicators and Drinking Problem Concerns among Sexual Minority Women.

Sexual minority women (SMW) report high rates of hazardous drinking (HD), treatment utilization that is not commensurate with need, and low perceived alcohol use severity. This study examined SMW's drinking problem concerns by sexual identity and other demographic characteristics, and the strength of associations between endorsement of unique HD indicators and drinking problem concerns. Data were from a supplemental sample of SMW added in Wave 3 of the longitudinal, community-based Chicago Health and Life Experiences of Women (CHLEW) study. HD was measured using a validated 13-item HD Index (HDI). Multivariable logistic regression models examined independent associations between past-five-year drinking problem concerns and each HD indicator. Twelve HD indicators were significantly associated with past-five-year drinking problem concerns, adjusting for age and sexual identity. Adjusted odds ratios varied from 2.44 for driving drunk to 15.52 for drinking first thing in the morning. After adjusting for number of HD indicators endorsed, associations were no longer significant, indicating that number of endorsed indicators was a more important predictor of drinking problem concerns than were individual HD indicators. Early intervention and harm reduction strategies could support SMW in addressing salient aspects of HD before progression to alcohol use disorder.

The Housing Needs of Sexual and Gender Minority Older Adults: Implications for Policy and Practice.

This study identifies the interconnected needs and concerns of sexual and gender minority (SGM) older adults, with a particular focus on housing, healthcare, transportation, and social support. Data were gathered through seven groups with a sample of SGM-identified adults age 55 and over (N = 50) and analyzed using thematic analysis. The participants seek affordable and inclusive housing options. They identified that access to transportation is paramount in maintaining social support and accessing healthcare. Findings underscore the need for strategies to serve the housing needs of low-income SGM-identified older adults in a nondiscriminatory way, train housing providers in culturally responsive care, meet transportation needs, and provide SGM-inclusive community-based services that reduce isolation.

Use and Benefit of Dyadic Coping for Couple Relationship Satisfaction in Parents of Children with Autism.

Parents of children with autism spectrum disorder (ASD) are at increased risk for unsatisfying and conflict-ridden couple relationships (i.e., marital or romantic partner relationships). There is a critical need to identify the couple-level processes that contribute to this risk. The current study examined the use of dyadic coping, defined as the appraisals and behaviors that partners in relationships use and receive to manage stressors, and to examine whether dyadic coping mediated the association between parenting stress and couple relationship satisfaction in parents who have a child with ASD and in parents who do not have a child with ASD. In total, 184 couples that had a child with ASD (aged 5-12 years) and comparison group of 183 couples who have a child without a neurodevelopmental condition participated in the study. A multivariate analysis of covariance indicated that parents of children with ASD reported less positive and more negative dyadic coping than did parents in the comparison group. Hierarchical linear modeling indicated that dyadic coping mediated the association between parenting stress and couple relationship satisfaction. Findings have important implications for programs aimed at enhancing parent couple relationship in families of children with ASD.

Los padres de niños con trastorno del espectro autista (TEA) corren mayor riesgo de tener relaciones de pareja insatisfactorias y conflictivas (p. ej.: relaciones de pareja o conyugales). Existe una necesidad imperiosa de reconocer los procesos a nivel de la pareja que contribuyen a este riesgo. El presente estudio analizó el uso del afrontamiento diádico, definido como las evaluaciones y las conductas que los integrantes de la pareja usan y reciben para manejar los factores desencadenantes de estrés, y si este afrontamiento sirvió como mediador de la asociación entre el estrés por la crianza y la satisfacción con la relación de pareja en los padres que tienen un niño con TEA y en los padres que no tienen un niño con TEA. Participaron en el estudio un total de 184 parejas que tenían un hijo con TEA (de entre 5 y 12 años) y un grupo comparativo de 183 parejas que tenían un hijo sin un trastorno del desarrollo neurológico. Un análisis multifactorial de la covarianza indicó que los padres de los niños con TEA informaron un afrontamiento diádico menos positivo y más negativo que los padres en el grupo de comparación. Los modelos lineales jerárquicos indicaron que el afrontamiento diádico sirvió como mediador de la asociación entre el estrés por la crianza y la satisfacción con la relación de pareja. Los resultados tienen consecuencias importantes para los programas orientados a mejorar la relación de los padres como pareja en las familias de niños con TEA.

Optimizing screening, brief intervention, and referral to treatment (SBIRT) training for nurses and social workers: Testing the added effect of online patient simulation.

Background: Social workers and nurses are critical to the amelioration of substance misuse, making their training in evidence-based practices such as screening, brief intervention, and referral to treatment (SBIRT) particularly pertinent. Online patient simulation (OPS) is one training modality that allows students to develop and practice SBIRT skills that they might not obtain through didactic instruction, but it can be time and resource intensive. The aim of this study was to test the effect of OPS, over and above in-person training, on students' SBIRT attitudes, knowledge, and perceived skills. Methods: Social work and nursing students (N = 308) were recruited from a college in the northeastern United States. Students in the study were randomly assigned to either training as usual (TAU), which included pre-coursework videos, in-person didactic instruction, and role-plays, or the experimental condition (EXP), consisting of TAU plus access to self-paced SBIRT skills practice using OPS by SIMmersion. The SBIRT Attitudes, Self-perception of Skills, and Knowledge (AKS) survey was delivered at baseline, immediately post-training, and at 30-day follow-up (post-30) to assess overall changes as well as changes in the specific domains of SBIRT confidence, importance, and attitudes. Paired t tests were conducted to determine differences in mean scores between time points for the entire sample. Independent-samples t tests were conducted to test differences between EXP and TAU on AKS scores at each time point and to test differences between high and low OPS use. Results: Results showed a significant difference from pre- to post-training on composite AKS scores. There were no significant differences between TAU and EXP in composite scores or by AKS domain, and no differences within the EXP group for those with high and low use. Conclusions: Participants in EXP did not have significantly increased AKS scores, demonstrating that access to OPS did not produce an additive effect on the acquisition of self-perceived SBIRT knowledge, attitudes, and skills.

"Fear Runs Deep:" The Anticipated Needs of LGBT Older Adults in Long-Term Care.

OBJECTIVES: Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults' anticipated needs and fears related to nursing homes and assisted living. METHODS: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. RESULTS: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. DISCUSSION: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training.

Sexual and Gender Minority Youth Suicide: Understanding Subgroup Differences to Inform Interventions.

Sexual and gender minority (SGM) youth are disproportionately affected by suicide-related thoughts and behaviors relative to their heterosexual and/or non-transgender peers. Theory and empirical evidence suggest that there are unique factors that contribute to this elevated risk, with distinguishable differences among SGM subgroups. Although SGM youth suicide prevention research is in its nascence, initial findings indicate that interventions which focus on family support and acceptance may be beneficial. It is critical that we develop and test tailored interventions for SGM youth at risk for suicide, with specific attention to subgroup differences and reductions in suicide-related thoughts and behaviors as outcomes.

"The Wisdom of Age": Perspectives on Aging and Growth among Lesbian Older Adults.

Older lesbian-identified women are a health disparate yet resilient population about whom knowledge is limited and emerging. Among the areas in need of research are older lesbians' experiences of later life and stress-related growth. This article presents the findings from a qualitative study that investigated older lesbians' experiences of adversity and adaptation as they age. In-depth, exploratory interviews were conducted with 12 lesbian-identified women who were between the ages of 65-80. This study applied grounded theory methodology to identify respondents sources of stress and fear, their strengths and coping strategies and how those relate to each other and to their growth in later life. We advance a model of adaptive change that shows how spirituality, social support, and resistance to cultural norms help older lesbian adults cope with loss, illness, and discrimination and develop wisdom in later life. Knowledgeable practitioners can help older lesbian women identify and maintain sources of social support, explore spirituality, and facilitate continuous growth through the end of life. Social workers can advocate for services that are welcoming and affirmative so as to reduce fears of isolation and dependence associated with health decline.

Healthy Aging in Community for Older Lesbians.

PURPOSE: In Boston and Outer Cape, Massachusetts, we explored the expectations of lesbians 60 years and older regarding healthy aging and community importance. METHODS: Focus groups were conducted with participants after completing an anonymous demographic questionnaire. Thematic analysis was used to generate themes and identify how they varied by urban versus rural settings. RESULTS: Group discussions focused on community, finances, housing, and healthcare. Primary concerns included continued access to supportive and lesbian communities as a source of resilience during aging. CONCLUSION: Concerns about discrimination and isolation mirror themes found in national research. The study findings suggest a need for more research into the housing and transportation needs of lesbians approaching later life, with a focus on how those needs relate to affordability, accessibility, and proximity to social support and healthcare. These findings also suggest the need for substantial investments in strengthening the LGBT-related cultural competence of providers of services for the elderly.