Development of the Ableist Microaggression Scale and Assessing the Relationship of Ableist Microaggressions with the Mental Health of Disabled Adults

Approximately 20% of U.S. residents are currently living with a disability. Ableism values a specific type of physical, mental and/or emotional capital as well as supports socially constructed expectations of ability, valuing these expectations over different types of ability and disability. One way in which ableism is perpetuated is through microaggressions, at the more interpersonal, or micro level. Microaggressions are everyday interactions that perpetuate inequalities and stereotypes against people who belong to marginalized communities. Experiencing multiple microaggressions has been referred to as death by a thousand paper cuts, indicating the severity of the sum total of these casual types of prejudice and oppression. Research demonstrates that experiences of identity-related microaggressions can negatively impact mental health outcomes, increase somatic symptoms, and increase negative affect. Informed by social dominance theory, critical race theory and stigmatization theory, this study explores how to measure ableist microaggressions by developing the Ableist Microaggression Scale, and follows this up with a survey using this same scale to better under the relationship between experiences of ableist microaggressions and mental health outcomes among people with disabilities. This mixed methods study consists of three phases. The first phase uses qualitative interviews with disabled stakeholders (people with disabilities, disability researchers, and disability activists/advocates) to explore more of the nuances of ableist microaggressions, and to co-create items for the Ableist Microaggressions Scale. The second phase uses a quantitative cross-sectional survey of 984 U.S. adults and a split-sample exploratory factor analysis and principal components analysis to validate the Ableist Microaggression Scale (AMS-65). The final phase uses a second quantitative cross-sectional survey of 311 U.S. adults who identify as disabled or having a disability to examine the correlation between ableist microaggressions and mental health, as assessed by the Mental Health Inventory (MHI-18). Findings indicate that experiencing ableist microaggressions are negatively correlated with positive mental health outcomes, and that visibility of disabilities/impairments are correlated with experiencing ableist microaggressions. These findings can inform the work of social workers and other human service professionals when supporting disabled individuals, recognizing that their mental health may be related to these common and often unintentional oppressive interactions

Exploring the Experiences of Transgender and Gender Diverse Adults in Accessing a Trans Knowledgeable Primary Care Physician

Transgender and gender diverse individuals face a variety of barriers when attempting to access healthcare, from discrimination to lack of access to lack of knowledgeable providers. Using data from the 2015 United States Trans Survey (N = 27,715), this study looks at the differences within the TGD population regarding having seen a doctor in the past year, having a primary care provider, and having a primary care provider who is knowledgeable about trans health. Logistic regressions indicate that even within an all transgender and gender diverse sample, a variety of identities and experiences are related to increased or decreased likelihood of each of these outcomes, with significant differences across gender, race/ethnicity, age, sexual orientation, disability status, educational attainment, annual income, disability status, religiosity, military status, overall health, housing status, and insurance coverage. Not only should there be an effort to support transgender and gender diverse individuals in accessing care, but there is a clearly indicated need for additional education for healthcare providers, especially those doing primary care, on how to offer knowledgeable, affirming, and intersectional care to their patients

Identifying with the Rebel of the Past

This article explores the ways in which the subcultural community of rockabilly revivalists use music as a vehicle for expressing their nostalgia for a specific moment in the 1950s, when rockabilly reflected a countercultural rebellion. As most of the participants feel marginalized and alienated from mainstream culture, they perform their identification with the rockabilly rebel of the 1950s, and demonstrate their refusal of modern culture through their attentiveness to the music, cars, and fashion of the past. Drawing on ethnographic research, this article explores the contradictory tendencies of nostalgic subcultures which can be simultaneously regressive and progressive, reactionary and rebellious, as subversive values of the past can help improve present and future experiences.Cet article explore les façons dont la communauté des revivalistes rockabilly expriment leur nostalgie pour un moment bien précis des années 1950, lorsque la subculture d’origine reflétait une révolte contre-culturelle. Dans la mesure où la plupart d’entre eux se sentent marginalisés, voire étrangers à la culture mainstream, ils mettent en scène leur identification à cette figure du passé et affirment leur refus de la culture contemporaine par leur fascination pour la musique, les voitures et la mode de cette époque. Ce travail, basé sur en enquête ethnographique, explore les tendances contradictoires des subcultures nostalgiques, qui peuvent être simultanément régressives et progressives, réactionnaires et rebelles : des valeurs subversives du passé peuvent contribuer à l’amélioration des expériences présentes et futures

Trans Men’s Access to Knowledgeable Providers and Their Experiences in Health Care Settings: Differences by Demographics, Mental Health, and Degree of Being “Out” to Providers

Transgender adults face a health care system rife with stigma, including a lack of culturally responsive providers and high likelihood of discrimination and mistreatment. However, there is a gap in knowledge about trans men—those assigned a female sex at birth who identify as men or as transmasculine—including subgroups, such as trans men of color. Using data from the U.S. Transgender Survey, the largest transgender survey conducted in the United States, this study analyzes whether trans men’s access to knowledgeable providers and their experiences of mistreatment in health care were related to demographic and mental health characteristics and degree of being “out” to providers. Among 7,950 trans men, respondent race and ethnicity, education level, disability status, psychological distress, suicidality, and being less “out” were associated with assessing one’s health care provider as not knowledgeable about trans-related care. Mistreatment in health care was more common among Alaska Native/American Indian trans men; those who lived in or near poverty; those who were queer, pansexual, bisexual, or an orientation not listed; those with a disability; those experiencing distress or suicidality; and those who were more “out.” This article discusses how findings can inform culturally responsive health care interventions with trans men

Does it get better? LGBTQ social work students and experiences with harmful discourse

Although the field of social work is grounded in social justice, the social work educational experience, including classrooms, may not live up to this value, especially for lesbian, gay, bisexual, transgender, and queer (LGBTQ) students. Using a qualitative phenomenological approach, this study examined the experiences of harmful discourse in social work classrooms for LGBTQ students. Findings indicate that students experienced being misgendered, tokenized, and erased through cis-/heteronormative language and classroom teachings. Although social work is guided by frameworks of social justice, microaggressions and discrimination may be vaguely glossed over, if addressed at all. This study highlights the gap between the values social work teaches and how social work education is delivered

Predictors of Healthcare Mistreatment Among Transgender and Gender Diverse Individuals: Are There Different Patterns by Patient Race and Ethnicity?

Using data from the 2015 United States Transgender Survey, this study investigates which patient sociodemographic characteristics and psychosocial risks are associated with likelihood of transgender mistreatment in healthcare and how patterns vary for patients of color. Numerous predictors, including alignment of identity documents, were associated with healthcare mistreatment. Among subgroups of transgender patients of color, psychosocial risks were more consistently significant than sociodemographic characteristics in predicting mistreatment. National and international health organizations are called to enact clear policies that affirm transgender patients and patients of color and establish a commitment to effectively serving these populations within their ethical codes

A Comparison of Health Disparities among Transgender Adults in Colorado (USA) by Race and Income

Transgender individuals face heightened risks for discrimination, harassment, and violence that impact their psychosocial well-being and physical health. However, few studies have thoroughly examined the general physical and mental health of transgender adults or within-group health differences by race/ethnicity and income. To that end, after controlling for health insurance status, age, and engagement in exercise, this study asks: (a) are transgender people of color more likely than White transgender individuals to experience poor health outcomes?, and (b) is lower annual household income among transgender adults associated with poorer health outcomes? The current study analyzes secondary data from a survey of transgender adults (N = 417) in one state in the Western United States using multiple linear regression and logistic regression models. Transgender people of color had significantly greater odds than their White counterparts of having arthritis/ rheumatoid arthritis/gout/lupus/fibromyalgia, or having asthma, but lower odds of being told by a provider that they had depression. Having a lower income was significantly associated with worse general health as well as multiple indicators of poor physical and mental health, including depression, anxiety, and suicidal ideation. We discuss implications for health care delivery for transgender people and for future research

A comparison of health disparities among transgender adults in Colorado (USA) by race and income

Transgender individuals face heightened risks for discrimination, harassment, and violence that impact their psychosocial well-being and physical health. However, few studies have thoroughly examined the general physical and mental health of transgender adults or within-group health differences by race/ethnicity and income. To that end, after controlling for health insurance status, age, and engagement in exercise, this study asks: (a) Are transgender people of color more likely than White transgender individuals to experience poor health outcomes? and (b) Is lower annual household income among transgender adults associated with poorer health outcomes? The study analyzes secondary data from a survey of transgender adults (N = 417) in one state in the western United States using multiple linear regression and logistic regression models. Results showed that transgender people of color had significantly greater odds than their White counterparts of having arthritis/rheumatoid arthritis/gout/lupus/fibromyalgia, or asthma but lower odds of being told by a provider that they had depression. Having a lower income was significantly associated with worse general health as well as multiple indicators of poor physical and mental health, including depression, anxiety, and suicidal ideation. We discuss implications for health care delivery for transgender people and for future research

Transgender Noninclusive Healthcare and Delaying Care Because of Fear: Connections to General Health and Mental Health Among Transgender Adults

Purpose: There are many barriers to reliable healthcare for transgender people that often contribute to delaying or avoiding needed medical care. Yet, few studies have examined whether noninclusive healthcare and delaying needed medical care because of fear of discrimination are associated with poorer health among transgender adults. This study aims to address these gaps in the knowledge base. Methods: This study analyzed secondary data from a statewide survey of 417 transgender adults in the Rocky Mountain region of the United States. Independent variables included noninclusive healthcare from a primary care provider (PCP) and delay of needed medical care because of fear of discrimination. Dependent variables assessed general health and mental health. Results: Transgender individuals who delayed healthcare because of fear of discrimination had worse general health in the past month than those who did not delay or delayed care for other reasons (B = 0.26, p \u3c 0.05); they also had 3.08 greater odds of having current depression, 3.81 greater odds of a past year suicide attempt, and 2.93 greater odds of past year suicidal ideation ( p \u3c 0.001). After controlling for delayed care because of fear of discrimination, having a noninclusive PCP was not significantly associated with either general health or mental health. Conclusion: This study suggests a significant association between delaying healthcare because of fear of discrimination and worse general and mental health among transgender adults. These relationships remain significant even when controlling for provider noninclusivity, suggesting that fear of discrimination and consequent delay of care are at the forefront of health challenges for transgender adults. The lack of statistical significance for noninclusive healthcare may be related to the measurement approach used; future research is needed to develop an improved tool for measuring transgender noninclusive healthcare

Defund the Police: Moving Towards an Anti-Carceral Social Work

This paper addresses social work’s place in the movement to “defund the police.” We argue that social work’s collaboration with police and use of policing constitutes carceral social work. In defining carceral social work, we specify the ways in which coercive and punitive practices are used to manage Black, Indigenous, other people of color and poor communities across four social work arenas – gender-based violence, child welfare, schools, and health and mental health. To inform anti-carceral social work, we provide examples of interventions in these arenas that dismantle police collaborations and point to life-affirming, community-centered, and mutual aid alternatives