Assessing the Fidelity of an Affirmative Cognitive Behavioral Group Intervention.

Purpose: Support implementation fidelity in intervention research with lesbian, gay, bisexual, transgender, queer, and sexual and gender diverse (LGBTQ+) populations, this study explores the systematic development of a fidelity process for AFFIRM, an evidence-based, affirmative cognitive behavioral therapy group intervention for LGBTQ+ youth and adults. Method: As part of a clinical trial, the AFFIRM fidelity checklist was designed to assess clinician adherence. A total of 151 audio-recorded group sessions were coded by four trained raters. Results: Adherence was high with a mean fidelity score of 84.13 (SD = 12.50). Inter-rater reliability was 81%, suggesting substantial agreement. Qualitative thematic analysis of low-rated sessions identified deviations from the manual and difficulties in group facilitation, while high-rated sessions specified affirmative and effective clinical responses. Discussion: Findings were integrated into clinical training and coaching. The fidelity process provides insights into the challenges of implementing social work interventions effectively with LGBTQ+ populations in community settings.

Riding the wave: pandemic social work in hospitals.

The COVID-19 pandemic significantly impacted social work practice globally. Using a cross-sectional survey, we examined the experiences of hospital social workers (N = 230) in Ontario, Canada during the second wave of the pandemic. Nearly three quarters (73%) of respondents reported workload changes, and 82% had increased responsibilities due to patient care demands. Hospital social workers adapted and made an important contribution to health care during the pandemic by employing virtual resources, supporting interprofessional colleagues, focusing on advocacy, and providing mental health and trauma-focused care. They sought educational opportunities and contributed to the development of procedures. Recommendations to strengthen hospital pandemic social work practice are provided.

The Self-Identification, LGBTQ+ Identity Development, and Attraction and Behavior of Asexual Youth: Potential Implications for Sexual Health and Internet-Based Service Provision.

While often included in the spectrum of sexual minority identities, asexuality receives comparatively little attention. Awareness and understanding remains limited, and knowledge has been generated primarily from adult populations. This paper employs a sample of 711 self-identified asexual youth (aged 14-24, M = 17.43 years) who identified as members of the LGBTQ+ community to consider the implications of a number of different areas for service provision. Two-thirds (66.8%) of participants identified as gender minorities within the spectrum of transgender and non-binary identities. Findings include aspects of participants' LGBTQ+ developmental processes, including that only 14.3% had disclosed their LGBTQ+ status to everyone in their lives. However, just 2.4% had disclosed to no one. Their attraction and sexual activity were also explored, with 27.1% having never experienced any kind of romantic or sexual attraction and 20.6% having ever been sexually active. Findings regarding participants' accessing of LGBTQ+ health information and engagement in a range of offline and online LGBTQ+ community activities are also provided. Participants acquired more health information online than offline-including sexual health information. Recommendations for service provision, particularly implications for sexual health and Internet-based services, are discussed.

Complex families, the social determinants of health and psychosocial interventions: Deconstruction of a day in the life of hospital social workers.

The roles of hospital social workers are delineated in the literature; however, their daily interventions have only been described anecdotally. This study analyzes the daily work of social workers in a pediatric hospital through a survey completed which examined factors related to interventions utilized and time spent per case over a 1-day period. Length and types of interventions were associated with the social determinants of health, time since diagnosis, biopsychosocial issues, and perception of complexity. The study offers a snapshot of the personalized expertise, provided by social workers that addresses complex contextual and biopsychosocial concerns of patient and families.

The intersecting cognitive and aging needs of HIV-positive older adults: Implications for social work practice.

Cognitive impairment is a significant health concern for people aging with HIV/AIDS. Using a community-based participatory research (CBPR) framework, we surveyed (n = 108) and interviewed (n = 20) people living with HIV who were over age 50 about their cognitive concerns and recommendations for social work intervention development. Quantitative findings indicate that our sample was greatly engaged in their HIV care, yet participants had many cognitive concerns. Qualitative findings highlighted fear, shame, and uncertainty concerning HIV and aging alongside a need for increased social work support. This paper provides practical engagement strategies for social workers to support clients concerning HIV, aging, and cognition.

Thinking big, supporting families and enabling coping: the value of social work in patient and family centered health care.

Patient and family-centered care has become a focus in health services. Social work has a rich history of providing responsive patient care. This study identified the contribution and value of social work to PFCC from the key stakeholder perspectives of health social workers (n = 65). Utilizing interpretive description, four themes emerged: (1) Thinking big and holistically, (2) Intervening with families, (3) Enabling patient and family coping, and (4) Maximizing hospital and community resources. Barriers included a lack of power, professional isolation and role creep. Implications for research and practice are provided.

Can information and communication technologies support patient engagement? A review of opportunities and challenges in health social work.

Despite becoming a prerequisite for participation in an information-based society, the use of information communication technologies (ICT) within social work and health care remains in its infancy. Currently, there is a push to adopt newer technologies to enhance practice. This article aims to highlight some of the innovative ways in which ICT have been adopted and adapted to augment social work practice. The need for social workers to become proficient in the use of newer technologies, opportunities for implementing ICT within a health care setting, and potential challenges at the professional, ethical, and systemic level are explored. Using the available literature as a guide, recommendations and strategies to strengthen implementation of ICTs into health social work are provided.

Sexual orientation and cognition in aging populations: Results from the Canadian Longitudinal Study on Aging.

The current study utilized the Canadian Longitudinal Study on Aging (CLSA) data to investigate the relationship between sexual orientation and cognitive health of the aging population. Cognitive flexibility and verbal fluency were examined as outcome variables in the study. A total of 45,993 respondents were included in the analyses. Each model had social support or social participation as a mediator. A series of mediation analysis, stratified by gender, revealed that aging gay men performed better in cognitive tasks related to cognitive flexibility when compared to their heterosexual counterparts. The results also indicated that social support is a protective factor for cognitive health in aging lesbian women. This study provides an opportunity to consider how clinical and social services can strategize to build inclusive environments for the aging sexual minority population.

Making the invisible visible: are health social workers addressing the social determinants of health?

This study explored the ways in which health social workers (HSW) address the social determinants of health (SDH) within their social work practice. Social workers (n = 54) employed at major hospitals across Toronto had many years of practice in health care (M = 11 years; SD = 10.32) and indicated that SDH were a top priority in their daily work; with 98% intentionally intervening with at least one and 91% attending to three or more. Health care services were most often addressed (92%), followed by housing (72%), disability (79%), income (72%), and employment security (70%). Few HSW were tackling racism, Aboriginal status, gender, or social exclusion in their daily practice.

Trauma-informed and affirmative mental health practices with LGBTQ+ clients.

People with diverse sexual orientations, gender identities, and gender expression are at greater risk for trauma, discrimination, and victimization than heterosexual and cisgender populations. Trauma-informed care (TIC) provides a framework for providing lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ +) mental health services. Substance Abuse and Mental Health Services Administration (SAMHSA)'s principles of TIC guide practitioners to create safety, trust, transparency, collaboration, and empowerment in helping relationships, and to ensure that services have cultural and gender relevance. This article first explores the role of trauma in contributing to behavioral health concerns presented by LGBTQ + clients. The application of TIC to mental health counseling and social services for LGBTQ + clients will then be described, with specific suggestions for translating TIC principles into affirmative practice. Through the lens of trauma, clinicians can improve clinical case conceptualization and effective treatment strategies for LGBTQ + clients. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Experiences of COVID-19 pandemic-related stress among sexual and gender minority emerging adult migrants in the United States.

There is a dearth of research that examines COVID-19-related stress among multiply marginalised individuals who are in the developmental phase of emerging adulthood. This qualitative study investigated how the intersection of emerging adulthood, sexual and gender minority (SGM) identity, and migrant status were reflected in the experiences of SGM individuals (n = 37; ages 20-25 years old) who migrated to various parts of the United States in the last 5 years. Data were collected online using semi-structured interviews. Thematic analysis revealed that participants' developmental processes (e.g., identity exploration, building financial independence) were shaped by pandemic-related stressors, especially unemployment and financial instability. Participants who were able to maintain employment did so but at the risk of their health and safety. Findings also showed that participants experienced feelings of anxiety and depression due to social isolation, but online communication played an important role in combatting loneliness. Findings highlight the potential for trauma-informed and intersectional approaches to practice with SGM emerging adult migrants and expanded health services and temporary entitlement programs to mitigate the pandemic's effects on this population's psychosocial and financial well-being.

Emotions, Agency, and Materiality: Embodiment of Homophobic Discrimination Amongst Mexican LGBTQ+ Youth.

Embodiment refers to understanding the body as the object and subject of culture, a process that allows an understanding of political, cultural, social, and emotional processes in the assemblage of a particular identity. We describe a qualitative-narrative study utilizing focus groups and interviews in three Mexican cities with 75 LGBTQ+ youth to understand the effects of discrimination and how this impacts subjectivity through embodied affection. Through axial and line-by-line analysis, we describe the process of embodiment through four dimensions: violence, emotions, agency, and materiality. Violence operates as the sediment for LGBTQ+ youth's subjective, social, and political life, and paves the way for particular emotions, such as guilt, shame, fear, sadness, and pain, that directly relates to material aspects such as gender expression and body presentation, beauty standards and a discourse around perversion and promiscuity. Finally, the combination of emotions and materiality prove relevant for certain expressions of agency and resilience.

Impact of Neighborhood Deprivation on Aging Sexual Minority People's Depression: Results from the CANUE and CLSA data.

As the aging population grows across the world, exploring the impact of social environment on minority populations' aging and well-being would be an essential step towards building an inclusive society. Using the Canadian Longitudinal Study on Aging (CLSA) and Canadian Urban Environmental Health Research Consortium (CANUE) data, the study investigated the relationship between deprivation and depression level in aging sexual minority people to examine how neighborhood level social and material deprivation influence mental health. 48,792 survey respondents were included in our analyses and the average age was 62.9. The study had 47,792 heterosexual, 760 gay/lesbian, and 240 bisexual individuals (23,977 men and 24,815 women). Regression analyses were conducted while controlling for age in each model. Results revealed that neighborhood material deprivation has a significant impact on mental health outcomes of aging lesbian women and bisexual men. The study provides an opportunity for intervention considerations for materially deprived neighborhoods to serve the aging sexual minority people residing in such areas.

Perceived Social Support and Mental Health Indicators of a Mexican LGBT Sample During the COVID-19 Pandemic.

The COVID-19 pandemic created mental health challenges for LGBTQ + communities worldwide, however there is a paucity of research on Mexican populations. Existing data show that LGBTQ + people in Mexico experience acute forms of violence and discrimination that impact their mental health. This article explores the relationship between social support, discrimination, and mental health for LGBTQ + populations in Mexico (N = 1525) during the COVID-19 lockdown. Utilizing social media recruitment strategies, participants answered an online survey exploring five mental health indicators: depression, anxiety, stress, suicidal ideation, and suicide attempt during lockdown. Mediating, and multiple regression analyses revealed that neuroticism is the most important variable in predicting poor mental health, and that perceived social support plays a mediating role in the case of depression. Discomfort with one's own family holds positive correlations with mental health indicators, showing that the greater the discomfort, higher levels of depression, anxiety, stress, and suicidal ideation. Results also showed that discrimination, and drug use hold significant relationships to suicidal attempt. Practice recommendations for Mexican LGBTQ + communities are offered.

Factors associated with a drive for muscularity among gay and bisexual men.

Among gay and bisexual men, body dissatisfaction can manifest itself in the form of a desire for increased muscularity. Possibly in response to homophobia, the socio-sexual culture of gay and bisexual men privileges muscularity and may help to perpetuate a sense of body dissatisfaction. Little is known about factors associated with a drive for muscularity among gay and bisexual men. This study recruited participants (n = 400) at Toronto's 2008 lesbian, gay, bisexual and transgender festival to provide data used to examine the relationship between a drive for muscularity and demographics (age, race, education, HIV status), psychological factors (depression, disordered eating, internalised homophobia, substance use), body mass, a history of childhood sexual abuse and sexual risk. Multivariate analyses revealed that a drive for muscularity was associated with age, disordered eating, depression, sexual risk and internalised homonegativity. These findings can be used to advance the health and wellbeing of gay and bisexual men, particularly interventions designed to mitigate the effects of internalised homonegativity and policies aimed at reducing homophobia.

Health and cultural determinants of voluntary HIV testing and counseling among middle-aged and older Latina women.

The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people with HIV/AIDS is over age 50. This study describes the correlates of HIV Voluntary Counseling and Testing (VCT) using structural equation modeling techniques for a sample of 135 middle-aged and middle-aged and older Latinas in South Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to be the strongest predictor of VCT (odds ratio [OR] = 6. 38), followed by having a clinic as a regular source of healthcare (OR = 3.88). Social work implications are provided.

Suicidality Among Transgender Youth: Elucidating the Role of Interpersonal Risk Factors.

Data indicate that 82% of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth. Using minority stress theory and the interpersonal theory of suicide, this study aims to better understand suicide risk among transgender youth. The present study examines the influence of intervenable risk factors: interpersonal and environmental microaggressions, internalized self-stigma, and adverse childhood experiences (ACEs), and protective factors: school belonging, family support, and peer support on both lifetime suicide attempts and past 6-month suicidality in a sample of transgender youth (n = 372). SPSS 22 was utilized to examine the impact of the independent variables on both suicidality and lifetime suicide attempt through two separate logistic regressions. Fifty six percent of youth reported a previous suicide attempt and 86% reported suicidality. Logistic regressions indicated that models for both lifetime suicide attempts and suicidality were significant. Interpersonal microaggressions, made a unique, statistically significant contribution to lifetime suicide attempts and emotional neglect by family approached significance. School belonging, emotional neglect by family, and internalized self-stigma made a unique, statistically significant contribution to past 6-month suicidality. Results have significant practice and policy implications. Findings offer guidance for practitioners working with parents and caregivers of trans youth, as well as, for the creation of practices which foster interpersonal belonging for transgender youth.

Cultural consideration for cognitive-behavioural therapy for sexual minority young people in Chinese societies: Perspectives from practitioners and target users.

Although cognitive-behavioural therapy has demonstrated effectiveness in improving mental health outcomes for sexual minority young people (SMYP), existing interventions are primarily designed and evaluated in Western contexts, and their acceptability and responsiveness to culturally relevant issues in the Chinese contexts is uncertain. This study aimed to address this gap by exploring how a manualised community-based cognitive-behavioural intervention (AFFIRM) could be culturally reconsidered for SMYP in Taiwan and Hong Kong and suggest recommendations for future adaptation. Following an empirical, community-based participatory approach, qualitative data were collected between August and September 2018 through five focus groups with 15 SMYP and 18 frontline practitioners in Taiwan and Hong Kong. Thematic analysis revealed that at the surface structural level, translation and examples, and promotion strategies can be fine-tuned to better fit the Chinese context. On the deep structural level, self-differentiation and a pragmatic plan to come out to parents were identified as two concerns of cultural importance for Chinese SMYP. This study exemplifies an empirical, collaborative approach to identifying areas of cultural adaptation for mental health intervention for SMYP in the Chinese cultural milieu. The rationale and strategy for adapting existing intervention protocols to accommodate divergent cultural values are described.

Demonstrating LGBTQ+ Affirmative Practice in Groups:: Developing Competence through Simulation-Based Learning.

Lesbian, gay, bisexual, transgender, queer, and other sexual and/or gender minority (LGBTQ+) populations experience significant mental and behavioral health disparities. Social workers are uniquely positioned to address these vulnerabilities. However, clinical graduate education has not effectively promoted or taught competent practice with LGBTQ+ populations. This qualitative study details the foundational competencies required for affirmative practice in group therapy with LGBTQ+ populations and describes a simulation-based learning activity designed to develop these competencies in graduate students. The following themes were identified as critical to affirmative practice, as identified through student reflections on their simulation-based learning experiences: deeply engaging in a strengths-based stance, keeping the group in group therapy, avoiding the expert trap, and managing identity assumptions. Implications for clinical social work education and practice are discussed.