“Home Away from Home”: Affirmative Care Practices Among Leading LGBTQ+ Organizations Serving Youth

LGBTQ+ youth suffer from a greater burden of adverse mental health outcomes, including higher rates of depression, substance use, and suicidal behavior, compared to the general population (Liu & Mustanski, 2012; Day et al., 2017; Scannapieco, Painter, & Blau, 2018). Community-based services, such as LGBTQ+ specific organizations, are integral to supporting the well-being of LGBTQ+ youth and are often viewed as the frontline for service provision and support for community members, providing client-centered and affirming services (Allen et al., 2012). However, access to these organizations is contingent on one’s proximity to and comfort in entering LGBTQ+ spaces, leaving the majority of care provision to general practitioners. Unlike LGBTQ+ organizations, general practitioners frequently do not meet the same standard of cultural awareness and competency, creating undue burden on LGBTQ+ clients navigating the healthcare system (Shelton & Delgado-Romero, 2013). While training exists on affirmative language and the application of minority stress theory, truly inclusive cultural competency requires more than awareness of terminology and extends to both organizational policy and practitioner behavior (Boroughs et al., 2015; O’Grady, 2017). Thus, this study sought to identify aspects of affirmative care that extend beyond current practice guidelines through a qualitative evaluation of service provision (e.g. types of services offered, staff background, approach to service delivery, participant experiences) and the service environment (e.g. agency policies, geographic location, interior décor) at four LGBTQ+ youth-focused agencies located in two large urban centers in the Northeast. In-depth qualitative interviews and focus groups were conducted with both service providers (staff) and service recipients (youth) at each organization. A template analysis approach was used to analyze data whereby an existing (a priori) theory was used to guide and organize qualitative data (Brooks et al., 2014). The affirmative practice guidelines developed by Hadland, Yehia, and Makadon (2016) were used as an overarching template to organize data. A total of (n=30) youth and (n=12) staff participated in focus groups and interviews across four agencies. Results from the study found that all aspects of Hadland et al. (2016)’s affirmative practice guidelines were present in both agency and staff practices, however, there were differences in how agencies described the systems-level principles and practitioner behaviors in their practices. At the organizational level, staff and youth emphasized the importance of organizations offering “queer centric” programming that responded to youths’ intersectional identities and providing youth with referrals to meet their diverse needs (e.g., referrals to primary care, mental health services). At the practitioner level, youth and staff emphasized the importance of using trans+ inclusive language, collaborating with youth around decision making, using a non-judgmental stance, providing space for youth to explore their identities, and having “just for fun” activities. In addition to the findings from the template analysis, several other concepts were found to be integral to affirmative care including the development of community guidelines. From the qualitative findings, affirmative care practice recommendations were identified, and a case example is provided to describe how one agency might consider aspects of implementation theory to evaluate readiness for and implement such guidelines in their practice. Findings from this study will increase knowledge of best practices in affirmative care for LGBTQ+ youth. These findings may be disseminated across practice settings to improve cultural competency among general practitioners

A Pilot Study of the Effects of Mindfulness-Based Cognitive Therapy on Positive Affect and Social Anxiety Symptoms

Randomized controlled trials have demonstrated that mindfulness-based cognitive therapy (MBCT) is efficacious in reducing residual depressive symptoms and preventing future depressive episodes (Kuyken et al., 2016). One potential treatment effect of MBCT may be improvement of positive affect (PA), due to improved awareness of daily positive events (Geschwind et al., 2011). Considering social anxiety disorder (SAD) is characterized by diminished PA (Brown et al., 1998; Kashdan, 2007), we sought to determine whether MBCT would reduce social anxiety symptoms, and whether this reduction would be associated with improvement of PA deficits. Adults (N = 22) who met criteria for varied anxiety disorders participated in a small, open-label trial of an 8-week manualized MBCT intervention. Most participants presented with either a diagnosis (primary, secondary, or tertiary) of generalized anxiety disorder (GAD) (N = 15) and/or SAD (N = 14) prior to treatment, with eight individuals meeting diagnostic criteria for both GAD and SAD. We hypothesized participants would demonstrate improvements in social anxiety symptoms, which would be predicted by improvements in PA, not reductions in negative affect (NA). Results of several hierarchical linear regression analyses (completed in both full and disorder-specific samples) indicated that improvements in PA but not reductions in NA predicted social anxiety improvement. This effect was not observed for symptoms of worry, which were instead predicted by decreased NA for individuals diagnosed with GAD and both decreased NA and increased PA in the entire sample. Results suggest that MBCT may be efficacious in mitigating social anxiety symptoms, and this therapeutic effect may be linked to improvements in PA. However, further work is necessary considering the small, heterogeneous sample, uncontrolled study design, and exploratory nature of the study

sj-docx-1-tva-10.1177_15248380221122815 – Supplemental material for Intimate Partner Violence Among Sexual Minority Women: A Scoping Review

Supplemental material, sj-docx-1-tva-10.1177_15248380221122815 for Intimate Partner Violence Among Sexual Minority Women: A Scoping Review by Lauren M. Porsch, Mariah Xu, Cindy B. Veldhuis, Lauren A. Bochicchio, Sarah S. Zollweg and Tonda L. Hughes in Trauma, Violence, & Abuse</p

Health disparities in one of the world’s most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands

Abstract Background Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands—a country with a long-standing reputation as a pioneer in SGM equality. Methods Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands. Results Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience. Conclusions Findings of persistent health disparities—despite the relatively long history of SGM supportive policies in the Netherlands—highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors

The Chicago Health and Life Experiences of Women Couples Study: Protocol for a Study of Stress, Hazardous Drinking, and Intimate Partner Aggression Among Sexual Minority Women and Their Partners

BackgroundLarge gaps exist in research on alcohol use and intimate partner aggression (IPA) among sexual minority women (SMW; eg, lesbian, bisexual). Dyadic research with SMW and their partners can illuminate how couple-level factors operate in conjunction with individual-level factors to shape well-being in this understudied and vulnerable population. Given the traditionally gendered lens with which women are primarily viewed as victims and men as perpetrators, understanding the dynamics of IPA in same-sex female couples can also advance research and practice related to IPA more generally. ObjectiveGuided by a recent extension of the minority stress model that includes relational (couple-level) sexual minority stress and the I-cubed theoretical perspective on IPA, we will collect individual and dyadic data to better characterize the links between hazardous drinking and IPA among SMW and their partners. First, this study aims to examine the associations among minority stress, hazardous drinking, and IPA in SMW and their partners. Minority stressors will be assessed as both individual and couple-level constructs, thus further extending the minority stress model. Second, we aim to examine potential mediators and moderators of the associations among minority stress, hazardous drinking, and IPA. Finally, we aim to test models guided by the I-cubed theoretical perspective that includes instigating (eg, relationship conflict), impelling (eg, negative affect and trait anger), and inhibiting (eg, relationship commitment and emotion regulation) or disinhibiting (eg, hazardous drinking) influences on IPA perpetration. MethodsThis United States National Institutes of Health–funded project will draw from a large and diverse cohort of SMW currently enrolled in the Chicago Health and Life Experiences of Women (CHLEW) study—a 21-year longitudinal study of risk factors and consequences associated with SMW hazardous drinking. SMW currently enrolled in the CHLEW and their partners will be invited to participate in the CHLEW Couples Study. By analyzing dyadic data using actor-partner interdependence models, we will examine how each partner’s minority stress, hazardous drinking, and IPA experiences are associated with both her own and her partner’s minority stress, hazardous drinking, and IPA perpetration. ResultsData collection began in February 2021 and will likely continue through 2023. Initial results should be available by mid-2024. ConclusionsThe CHLEW Couples Study will fill important gaps in knowledge and provide the basis for future research aimed at clarifying the causal pathways linking hazardous drinking and IPA among SMW. This will support the development of culturally appropriate targeted individual and dyadic prevention and intervention strategies. International Registered Report Identifier (IRRID)DERR1-10.2196/2808

Parent-teacher agreement on children's problems in 21 societies

Parent-teacher cross-informant agreement, although usually modest, may provide important clinical information. Using data for 27,962 children from 21 societies, we asked the following: (a) Do parents report more problems than teachers, and does this vary by society, age, gender, or type of problem? (b) Does parent-teacher agreement vary across different problem scales or across societies? (c) How well do parents and teachers in different societies agree on problem item ratings? (d) How much do parent-teacher dyads in different societies vary in within-dyad agreement on problem items? (e) How well do parents and teachers in 21 societies agree on whether the child's problem level exceeds a deviance threshold? We used five methods to test agreement for Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) ratings. CBCL scores were higher than TRF scores on most scales, but the informant differences varied in magnitude across the societies studied. Cross-informant correlations for problem scale scores varied moderately across societies studied and were significantly higher for Externalizing than Internalizing problems. Parents and teachers tended to rate the same items as low, medium, or high, but within-dyad item agreement varied widely in every society studied. In all societies studied, both parental noncorroboration of teacher-reported deviance and teacher noncorroboration of parent-reported deviance were common. Our findings underscore the importance of obtaining information from parents and teachers when evaluating and treating children, highlight the need to use multiple methods of quantifying cross-informant agreement, and provide comprehensive baselines for patterns of parent-teacher agreement across 21 societies