ORIGINAL ARTICLE
Curretit health c&e delivery sites’: Ii,’
are examined, and recommenda- ’
tions are given for improvement
of both practitioner skills and
health care programs targeting
these youth. J Pediatr Health
Care. (1997). 11, 266-274.
Psychosocial Issues in
Primary Care of
Lesbian, Gay,
Bisexual, and
Pansgender Youth
Jennifer L. Kreiss, MN, RN, and
Diana L. Patterson, DSN
T he passage through puberty, peer group acceptance, and
the establishment of a personal identity are all developmental
tasks of the adolescent years. For the youth who is lesbian, gay,
bisexual, or transgender, self-acceptance and identity forma-
tion in the face of a heterosexist society are difficult tasks asso-
ciated with many risks to physical, emotional, and social
health. Gay and bisexual males are at particularly high risk for
acquiring sexually transmitted diseases, including human
Jennifer L. Kreiss is a Pediatric Nurse Practitioner at Children’s Hospital & Medical Center in Seattle,
Washington.
Diana L. Patterson is an Assistant Professor in Family and Child Nursing at the University of Washington and is
Nursing Discipline Head at Adolescent Clinic at the University of Washington in Seattle, Washington.
Reprint requests: Jennifer Kreiss, MN, RN, Children’s Hospital Medical Center, 4800 Sand Point Way NE, P.O.
Box 5371, Seattle, WA 98105-0371.
Copyright 0 1997 by the National Association of Pediatric Nurse Associates & Practitioners.
0891.5245/97/$5.00 + 0 25/l/79212
266 November/December 1997
Kreiss & Patterson
immunodeficiency virus and ac-
quired immunodeficiency syn-
drome (Zenilman, 1988). Lesbian,
gay, bisexual, and transgender
youth are also at increased risk for
low self-esteem, depression, sui-
cide (Remafedi, Farrow, & De&her,
1991), substance abuse, school
problems, family rejection and dis-
cord, running away, homelessness,
and prostitution (Kruks, 1991;
Remafedi, 1990; Savin-Williams,
1994). The psychosocial health con-
cerns faced by sexual minority
youth are primarily the result of
societal stigma, hatred, hostility,
isolation, and alienation (American
Academy of Pediatrics Committee
on Adolescence, 1993). One of the
roles of the primary health care
provider is to recognize adoles-
cents who are struggling with sex-
ual orientation issues and support
a healthy passage through the spe-
cial challenges of the teen years.
In recent years homosexuality
has become increasingly main-
stream. Images of lesbians and gay
men are visible in every venue of
popular culture, from television
shows and films to famous sports
stars and musicians. Presidential
speeches and national debates
occur on questions of gays in the
military, gay marriage and parent-
ing, domestic partnerships, and the
acquired immunodeficiency syn-
drome epidemic. The heightened
public awareness makes it easier
for adolescents to recognize the
meaning of same-sex attractions
and to self-.
Sexual Orientation, Gender Identity And Adolescent Health 10.6.07Knoll Larkin
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The document summarizes research on health disparities faced by LGBT transition aged youth. It finds that LGBT youth experience higher rates of discrimination, rejection, bullying, mental health issues like depression and suicide attempts, drug use, and homelessness due to social stigma and lack of family and social support developing their sexual identities. The social determinants of health, including discrimination, access to healthcare, and social environment disproportionately impact the health of LGBT youth. Developing culturally competent healthcare professionals is key to addressing these issues and disparities.
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This document discusses transgender children and youth. It defines transgender as a set of characteristics that do not conform to conventional gender roles based on biological sex. While some see it as a disorder, being transgender itself does not cause distress - rather, the distress comes from social misunderstandings, negative reactions from others, and hostile environments. The document recommends nurturing, rather than trying to "correct", gender variant children, and educating parents on properly supporting their transgender children.
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Bullying is a relevant issue for this population and we must find ways to advocate for them in order to increase their safety. This presentation will discuss the negative impacts of bullying as well as clinical applications for this population.
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This document provides an overview of key terms and definitions related to sexual orientation and gender identity, with a focus on the experiences and health issues faced by LGBT youth. It discusses concepts like coming out, preferred language, challenges LGBT youth face in schools, homes, and healthcare settings, and health concerns including substance abuse, violence, HIV risk, and mental health issues. The document concludes with standards of care recommendations and resources for creating inclusive environments and supporting LGBT youth.
This document provides guidance for working with LGBTQI2-S youth and young adults. It discusses the unique challenges they face, including higher rates of bullying, violence, suicide, and risky behaviors. It emphasizes the importance of acceptance and support from families and professionals. It defines key terms and recommends professionals enhance their cultural competence, promote safety and communication, and address the emotional and physical health needs of this population.
International Journal of Humanities and Social Science Invention (IJHSSI)inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
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This document summarizes research on the cognitive and social development of LGBTQ adolescents. It finds that LGBTQ youth face unique challenges including difficulty developing a sense of self-identity due to societal expectations. They also experience minority stress from discrimination, which can negatively impact their mental health and physical health through risky behaviors. Their cognitive development may also be impaired if they face harassment or do not have a supportive community. Overall, the document examines how societal and environmental factors can influence the developmental process of LGBTQ adolescents.
This document discusses transgender children and youth. It defines transgender as a set of characteristics that do not conform to conventional gender roles based on biological sex. While some see it as a disorder, being transgender itself does not cause distress - rather, the distress comes from social misunderstandings, negative reactions from others, and hostile environments. The document recommends nurturing, rather than trying to "correct", gender variant children, and educating parents on properly supporting their transgender children.
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This presentation discusses bullying and depression among transgender youth. It begins with an introduction noting high rates of violence and harassment reported by transgender individuals. The presentation then provides definitions and discusses the impacts of bullying on transgender youth, including high rates of depressive symptoms and suicidal ideation. The document outlines several clinical applications for working with transgender youth, such as affirmation, addressing family rejection, enhancing resilience, and treating depression. It emphasizes the importance of parental support and exploring gender transition options.
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This summary provides an overview of LGBT identity development models:
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- More recent research examines identities of bisexuals, people of color, women, and the influence of other social identities. This highlights the diversity within LGBT communities.
- Alternatives to stage models take a life span approach and consider broader social contexts rather than narrow stages, allowing for more fluid and varied experiences.
This document discusses various aspects of adolescent sexuality, including:
- Adolescent sexuality is influenced by culture, sexual orientation, and age of consent laws.
- A 2002 European survey found most 15-year-olds were not sexually active, but those who were mostly used contraception.
- Modern media contains more sexual messages than in the past, but the effects on teen behavior are unknown.
- Teenage pregnancy poses additional medical risks, especially for mothers under 15. Socioeconomic factors also impact risks for mothers aged 15-19.
Abuse and mistreatment in the adolescent period - by Dr. Bozzi Domenico (Mast...dott. Domenico Bozzi
UNICEF has highlighted how children suffer violence throughout all stages of childhood and adolescence, in different contexts, and often at the hands of people they trust and interact with on a daily basis.
Violent corporal punishment, 300 million children between 2 and 4 years old in the world regularly suffer violence from their family/guardians (about 3 out of 4), 250 million of these are punished physically (about 6 out of 10).
Sexual violence, Sexual violence occurs against children of all ages: 15 million girls aged 15 to 19 have experienced incidents of sexual violence in their lives, and 2.5 million young women in 28 European countries report having suffered episodes of sexual violence before the age of 15.
This document summarizes a presentation about preventing health risks and promoting healthy outcomes among LGBTQ youth. It discusses challenges LGBTQ youth face like discrimination, family rejection, and minority stress. It provides data on health risks like substance abuse, HIV rates, and bullying. It also offers recommendations for creating safe and supportive school environments through approaches like gay-straight alliances, addressing identity development, and clear sex education.
1. LGBTQ youth face higher risks of mental health issues like depression and suicide due to challenges with identity development and societal stigma. Family rejection and victimization can significantly increase suicide risks.
2. Mental health providers should offer affirming care to LGBTQ youth, being sensitive to their experiences of discrimination and trauma. Creating a supportive environment, asking non-judgmental questions, and providing resources can help address their needs.
3. Promoting family and social support for LGBTQ youth, in addition to developing their coping skills, can help build resiliency against mental health risks.
This document discusses issues related to providing competent healthcare to lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. It identifies some of the key risk factors LGBTQ youth face like marginalization and increased health risks. It also discusses how lack of provider training and homophobia can negatively impact LGBTQ health outcomes. The document provides guidance on creating an LGBTQ-affirming clinical environment including ensuring confidentiality, using inclusive forms and language, and displaying supportive materials. It also offers suggestions for discussing sensitive topics like gender identity, sexual orientation, and sexuality with LGBTQ youth patients.
This literature review sheds new light on how adolescent boys and girls differ in their health and development needs and what implications these differences have for health interventions. The document takes a gender approach and while assessing the gender specific needs of adolescent males, it provides ideas into how to improve the health and development of adolescent boys and girls.
The document discusses research on health care access disparities among Latino populations and their families. It notes that Latinos are more likely than other groups to have uninsured family members. Research shows socioeconomic factors play a role, but people of color experience different health care even with similar insurance and conditions. The document then outlines several research implications and opportunities for systemic interventions to address barriers Latinos face in accessing health care.
Analysis of LGBT Identity Development Models and Implications for PracticeIim Ibrahim
This summary provides an overview of LGBT identity development models:
- Stage models from the 1970s focused on resolving internal conflicts around gay/lesbian identities and the "coming out" process, though they were limited by only studying small samples of men.
- More recent research recognizes greater diversity in bisexual and transgender identities and how race, culture, gender, and other identities intersect with sexuality.
- Alternative models take a more fluid, lifespan approach rather than rigid stages, recognizing social contexts and a wider range of experiences.
Sex education provides instruction on issues relating to human sexuality, including relationships, anatomy, activity, reproduction and health. While traditionally considered taboo, sex education was introduced in schools in the late 19th century. However, adolescents still received most information informally until the late 20th century. The AIDS epidemic increased the urgency of sex education, seen as vital for public health. While controversial, most parents and students support sex education in schools, though LGBT topics remain divisive due to some viewing them as inappropriate or a violation of religious beliefs.
Family Risk Factors and Conduct Disorder among Committed Male and .docxmydrynan
Family Risk Factors and Conduct Disorder among Committed Male and Female Juveniles in Barbados
Joana Matthews
University of the West Indies, Cave-Hill
Abstract
The differences between juveniles with and without a Conduct Disorder (CD) diagnosis on family risk factors was investigated in a sample of 71 male and female youth, aged 11-16, from a juvenile facility in Barbados. Psychological reports and case notes were coded for presence and absence of a diagnosis of CD and family risk factors. Gender differences were also investigated among those with a CD diagnosis. Results of the Mann-Whitney and Pearson Chi-square analyses revealed that significantly more juveniles with CD compared to those without CD were from low income homes and families characterized by parental conflict and psychopathology. Implications for treatment and rehabilitation are discussed.
Key words: Conduct Disorder; Barbados; Family risk factors; committed youth
Family Risk Factors and Conduct Disorder among Committed Male and Female Juveniles in Barbados
Caribbean reports suggest that high crime rates, including juvenile crime rates, are undermining social growth and threatening human welfare in the region (Rodriguez, 2007; Charles, 2007). Incarceration or custodial punishment of youth inadvertently leads to disruption in family, community ties and education (Singh, 1997) which further leads to increased probability of re-offending. The economic cost of juvenile crime is also high. In 1996 in Barbados, it cost BD$77.42 per day to maintain a juvenile at the Government Industrial School (GIS) (Singh, 1997).
Traditionally in the Caribbean, law enforcement agencies and courts were expected to manage juvenile crime and the problems of at-risk youth. According to a past Regional Director of the Caribbean Youth Programme, Mr. Henry Charles (2007), the regional justice and penal systems were not having the desired impact. Today, young offenders’ cases are still managed through mainly punitive responses in the region (Charles, 2007). Due to the increase in juvenile crime, more countries also lean towards harsher punishment as a deterrent (Charles, 2007). Yet, research clearly indicates that large-scale imprisonment hinders development and uses resources inappropriately (Song & Lieb, 1993; Mash & Wolfe, 2007; Office of the Surgeon General, 2001).
There is a growing sentiment in the Caribbean that alternative methods/services to incarceration are not luxuries, but investments in the security and stability of our region. The current study examines family risk factors related to conduct problems in a sample of committed youth in Barbados. Such a study may increase the focus on alternative methods, prevention and intervention, through scientific analysis of the nature and extent of problem behaviours within this group. More Caribbean helping professionals are becoming aware of the impact of these factors on the prevalence of conduct problems. It should also be useful in determining ...
This document summarizes research on the effects of childhood sexual abuse on mental health and behaviors in adulthood. It discusses how childhood sexual abuse can lead to mental health issues like depression, anxiety, and PTSD. It also explores how abuse survivors are more likely to engage in risky behaviors like substance abuse, unprotected sex, and prostitution. The document examines several studies that found links between childhood abuse and poor physical health and obesity in adulthood. It suggests that early intervention and counseling for abuse survivors could help alleviate medical issues stemming from their trauma.
OverviewThe US is currently undergoing an energy boom largel.docxjacksnathalie
Overview
The US is currently undergoing an energy boom largely because of the development of the greatly expanded use of a well technique developed over 40 years ago - hydraulic fracking. It can be used for both oil and natural gas wells.. The technique allows previously unrecoverable oil and gas in old, played out wells to be accessed and increases the efficiency of recovery in new wells significantly. The current level of both recovery and new well drilling is dramatically higher than it has been for decades. The dramatic increase in well activity, some of which has been near towns and places no one thought drilling would ever occur. It has brought a great deal of attention to the technique and associated effects on everything from ground water and air pollution, to biodiversity disruption and earthquakes.
One important fact to weave into your opinion about fracking pro or con is that all of the sub-surface mineral rights in the US are owned by someone (a private individual, a business, or the state or federal government) but surface and mineral rights can be separated, i.e. sold. Originally, mineral rights were sold along with the land and then companies or individuals could decide if they wanted to keep or sell the mineral rights. Before mineral rights were so valuable, many people opted to sell their mineral rights to oil & gas companies. It never occurred to many people that someone would actually be drilling on their property or their neighbors. Oil and gas companies have a legal right to exercise their ownership options and if you are going to say "no" to them, then you owe them for what you are not letting them have, i.e. the money that would be produced if they were allowed to drill. This is not a trivial issue.
Instructions
This week’s discussion focuses on the pros and cons of hydraulic fracking and asks for your SCIENCE informed opinion on whether the economics and political fossil fuel issues justify the negative tradeoffs.
Address each of the following in your discussion:
How is fracking done and why are companies doing this action versus traditional drilling?
Are the environmental issues with fracking worse than conventional drilling? Why or why not?
Why are people along the Front Range and in other states where fracking is widespread, so upset about it now even though fracking has been occurring for a long time?
*In your initial post, please provide 3-4 references in APA format with in-text citations.
.
OverviewThe United Nations (UN) has hired you as a consultan.docxjacksnathalie
Overview
The United Nations (UN) has hired you as a consultant, and your task is to assess the impact that global warming is expected to have on population growth and the ability of societies in the developing world to ensure the adequate security of their food supplies.
Case Assessment
As the world’s population nears 10 billion by 2050, the effects of global warming are stripping some natural resources from the environment. As they diminish in number, developing countries will face mounting obstacles to improving the livelihoods of their citizens and stabilizing their access to enough food. The reason these governments are struggling even now is that our climate influences their economic health and the consequent diminishing living standards of their peoples. Climate changes are responsible for the current loss of biodiversity as well as the physical access to some critical farming regions. As such, these changes in global weather patterns diminish agricultural output and the distribution of food to local and international markets. These difficulties will become even more significant for these countries as the Earth’s climate changes for the worse. Temperatures are already increasing incrementally, and polar ice caps are melting, so the salient question is: what does this suggest for developing societies?
The issue before the developing world is not its lack of food, but rather how to gain access to food. Simply put, changes in our climate are affecting the global food chain, and hence, the living standards of entire populations. Added to this is the fact that food is not getting to where it is needed in time to prevent hunger or starvation. In many developing countries, shortages are due to governments’ control over distribution networks rather than an insufficient supply of food itself. In effect, these governments are weaponizing food by favoring certain ethnic or religious groups over others. When added to dramatic climate changes that we are experiencing even now, the future for billions of poor people looks increasingly dim.
Instructions
You are to write a minimum of a 5 page persuasive paper for the UN that addresses the following questions about the relationship between atmospheric weather patterns and food security in the developing world:
Climate change and global warming are often used interchangeably, but they are not the same phenomenon. What are the differences between the two concepts and what leads to the confusion between them?
In 1900, the average global temperature was about 13.7° Celsius (56.7° Fahrenheit) (Osborn, 2021), but as of 2020, the temperature has risen another 1.2°C to 14.9°C (58.9°F). According to the Earth and climate science community, if the Earth’s surface temperature rises another 2°C (3.6°F), we will suffer catastrophic weather patterns that, among other things, will raise sea levels, cause widespread droughts and wildfires, result in plant, insect, and animal extinctions, and reduce agricultura.
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Family Risk Factors and Conduct Disorder among Committed Male and Female Juveniles in Barbados
Joana Matthews
University of the West Indies, Cave-Hill
Abstract
The differences between juveniles with and without a Conduct Disorder (CD) diagnosis on family risk factors was investigated in a sample of 71 male and female youth, aged 11-16, from a juvenile facility in Barbados. Psychological reports and case notes were coded for presence and absence of a diagnosis of CD and family risk factors. Gender differences were also investigated among those with a CD diagnosis. Results of the Mann-Whitney and Pearson Chi-square analyses revealed that significantly more juveniles with CD compared to those without CD were from low income homes and families characterized by parental conflict and psychopathology. Implications for treatment and rehabilitation are discussed.
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Overview
The US is currently undergoing an energy boom largely because of the development of the greatly expanded use of a well technique developed over 40 years ago - hydraulic fracking. It can be used for both oil and natural gas wells.. The technique allows previously unrecoverable oil and gas in old, played out wells to be accessed and increases the efficiency of recovery in new wells significantly. The current level of both recovery and new well drilling is dramatically higher than it has been for decades. The dramatic increase in well activity, some of which has been near towns and places no one thought drilling would ever occur. It has brought a great deal of attention to the technique and associated effects on everything from ground water and air pollution, to biodiversity disruption and earthquakes.
One important fact to weave into your opinion about fracking pro or con is that all of the sub-surface mineral rights in the US are owned by someone (a private individual, a business, or the state or federal government) but surface and mineral rights can be separated, i.e. sold. Originally, mineral rights were sold along with the land and then companies or individuals could decide if they wanted to keep or sell the mineral rights. Before mineral rights were so valuable, many people opted to sell their mineral rights to oil & gas companies. It never occurred to many people that someone would actually be drilling on their property or their neighbors. Oil and gas companies have a legal right to exercise their ownership options and if you are going to say "no" to them, then you owe them for what you are not letting them have, i.e. the money that would be produced if they were allowed to drill. This is not a trivial issue.
Instructions
This week’s discussion focuses on the pros and cons of hydraulic fracking and asks for your SCIENCE informed opinion on whether the economics and political fossil fuel issues justify the negative tradeoffs.
Address each of the following in your discussion:
How is fracking done and why are companies doing this action versus traditional drilling?
Are the environmental issues with fracking worse than conventional drilling? Why or why not?
Why are people along the Front Range and in other states where fracking is widespread, so upset about it now even though fracking has been occurring for a long time?
*In your initial post, please provide 3-4 references in APA format with in-text citations.
.
OverviewThe United Nations (UN) has hired you as a consultan.docxjacksnathalie
Overview
The United Nations (UN) has hired you as a consultant, and your task is to assess the impact that global warming is expected to have on population growth and the ability of societies in the developing world to ensure the adequate security of their food supplies.
Case Assessment
As the world’s population nears 10 billion by 2050, the effects of global warming are stripping some natural resources from the environment. As they diminish in number, developing countries will face mounting obstacles to improving the livelihoods of their citizens and stabilizing their access to enough food. The reason these governments are struggling even now is that our climate influences their economic health and the consequent diminishing living standards of their peoples. Climate changes are responsible for the current loss of biodiversity as well as the physical access to some critical farming regions. As such, these changes in global weather patterns diminish agricultural output and the distribution of food to local and international markets. These difficulties will become even more significant for these countries as the Earth’s climate changes for the worse. Temperatures are already increasing incrementally, and polar ice caps are melting, so the salient question is: what does this suggest for developing societies?
The issue before the developing world is not its lack of food, but rather how to gain access to food. Simply put, changes in our climate are affecting the global food chain, and hence, the living standards of entire populations. Added to this is the fact that food is not getting to where it is needed in time to prevent hunger or starvation. In many developing countries, shortages are due to governments’ control over distribution networks rather than an insufficient supply of food itself. In effect, these governments are weaponizing food by favoring certain ethnic or religious groups over others. When added to dramatic climate changes that we are experiencing even now, the future for billions of poor people looks increasingly dim.
Instructions
You are to write a minimum of a 5 page persuasive paper for the UN that addresses the following questions about the relationship between atmospheric weather patterns and food security in the developing world:
Climate change and global warming are often used interchangeably, but they are not the same phenomenon. What are the differences between the two concepts and what leads to the confusion between them?
In 1900, the average global temperature was about 13.7° Celsius (56.7° Fahrenheit) (Osborn, 2021), but as of 2020, the temperature has risen another 1.2°C to 14.9°C (58.9°F). According to the Earth and climate science community, if the Earth’s surface temperature rises another 2°C (3.6°F), we will suffer catastrophic weather patterns that, among other things, will raise sea levels, cause widespread droughts and wildfires, result in plant, insect, and animal extinctions, and reduce agricultura.
OverviewThis project will allow you to write a program to get mo.docxjacksnathalie
Overview
This project will allow you to write a program to get more practice with object-oriented ideas that we explored in the previous project, as well as some practice with more advanced ideas such as inheritance and the use of interfaces.
Ipods and other MP3 players organize a user's music selection into groups known as playlists. These are data structures that provide a collection of songs and an ordering for how those songs will be played. For this assignment you will be writing a set of PlayList classes that could be used for a program that organizes music for a user. These classes will be written to implement a particular PlayList interface so that they can be easily exchange in and out as the program requires. In addition, you will also be using the SimpleTrack class you wrote for the closed lab on Interfaces - if you did not finish this class before the end of lab, you will need to finish it before starting on this project.
Objectives
Practice with programming fundamentals
Review of various Java fundamentals (branching, loops, variables, methods, etc.)
Review of Java File I/O concepts
Practice with Java ArrayList concepts
Practice with object-oriented programming and design
Practice with Java interfaces
Project Description
The SimplePlaylist Class
Once you have coded and tested your SimpleTrack class, you will need to write a SimplePlaylist class that implements the Playist interface given in the project folder.
The SimplePlayList class stores music tracks in order - the first track added to the play list should be the first one removed from the play list. You should recognize this data structure as a
queue
(or a
first-in, first-out queue
). You do not need to implement the equals, hashCode and toString methods for this class but if you choose to do so make sure you document your implementations properly!
The PlayList Management Program
Once you have written and tested a SimpleTrack class and a SimplePlaylist class, it is time to use them to write a program to manage playlists. This program will simulate the playing of songs from a play list. For the SimplePlaylist, the songs are removed from the playlist as they are played, so you know that you're at the end of the list when your list is empty. This program should be implemented in the file MusicPlayerSimulator.java. Note that we are not defining ANY of the methods you are using for this program - the design is all up to you. You must, however, practice good programming style - make sure you are breaking the program up into smaller methods and aren't just trying to solve everything with one monolithic main method. If you have fewer than 5 methods for this program you are probably trying to fit too much into a single method.
Here is a sample transcript of the output of this program:
Enter database filename:
input.txt
Currently playing: 'Elvis Presley / Blue Suede Shoes / Elvis Presley: Legacy Edition' Next track to play: 'The Beatles / Wit.
OverviewThis week, we begin our examination of contemporary resp.docxjacksnathalie
Overview
This week, we begin our examination of contemporary responses to youths’ illegal behaviors. The goal for this week is to assess pre-adjudication responses to youths’ illegal behavior. Primarily, our focus will be on nonformal responses or diversion. As a prelude to this discussion, we will consider the “school to prison pipeline” as it provides a good way to understand the need for diversion in juvenile justice.
Objectives
Upon completion of this week’s lesson, you should be able to:
Define what is meant by the “school to prison pipeline.”
Explain how the political economy contributes to the school to prison pipeline.
Explain how trends in education, policing, and juvenile justice contribute to the school to prison pipeline
Describe juvenile arrest trends and trends in the willingness of police to refer youths to juvenile court.
Define radical nonintervention or true diversion and assess the role in can play in juvenile justice.
Explain the rationale for diversion and its value in juvenile justice.
Describe diversion programs that appear to be effective and programs that are not effective
Assess arguments that are made in support of diversion.
Assess the potential problems that should be addressed when developing or operating diversion programs
Tasks
View Video Lecture (Part 1 and Part 2 below) on the School to Prison Pipeline. While viewing the videos, use the pause feature to stop the slides when needed so that you can examine the content.
Part 1
Part 2
Watch the video:
Rethinking Challenging Kids-Where There's a Skill There's a Way | J. Stuart Ablon | TEDxBeaconStreet
Read the material below, Juvenile Diversion.
View Video Lecture 3
.
OverviewProgress monitoring is a type of formative assessment in.docxjacksnathalie
Overview
Progress monitoring is a type of formative assessment in which student learning is evaluated
on a regular basis to provide useful feedback about performance to both students and
teachers. Though there are a number of methods for monitoring a student’s progress, the most
widely used is general outcome measurement, sometimes referred to as curriculum-based
measurement (CBM). Progress monitoring consists of the frequent administration (e.g., once
per month, every two weeks) of brief probes or tests, which include sample items from every
skill taught across the academic year. After each probe is scored, the teacher or student plots
the score on an individual CBM graph. The teacher can then use this data to determine a
student’s:
• Rate of growth — Average growth of a student’s mathematics skills over a period of time
• Performance level — An indication of a student’s current mathematics skills, often
denoted by a score on a test or probe.
You will determine the rate of growth for the two students listed on page 3 using the data provided.
.
OverviewThe work you do throughout the modules culminates into a.docxjacksnathalie
The document outlines the components of a customer service plan, including examining the customer perspective, quality recognition, and proactive practices. The plan incorporates analyzing the company, customer service, quality, and modern customer service practices. It provides instructions to observe aspects of the business from the customer's point of view like appearance, greeting speed, transaction pace, parking, hours and staff courtesy and knowledge. It also asks to identify important communication criteria, how staff are evaluated and trained, and expectations for technology interactions. Lastly, it prompts an evaluation of practices to respect customers' time, maintain positive attitudes, recognize regulars, communicate professionally, and show initiative.
OverviewThis discussion is about organizational design and.docxjacksnathalie
Overview
This discussion is about
organizational design and leadership
, as well as
global leadership issues and practices
. Conduct research on current events relating to one of the unit concepts of interest to you. Then, share your findings in an initial post. Try to choose a concept that has not been, or is rarely, addressed by your classmates. Review peers' findings and then engage in an active discussion to learn more about the topic at hand.
Resources
Park LibraryLinks to an external site.
Click on the Library Sources tab.
Enter your topic in the search box.
Click on full text, and you will find one, or several, articles to analyze.
.
OverviewScholarly dissemination is essential for any doctora.docxjacksnathalie
Overview
Scholarly dissemination is essential for any doctoral level student. Posters are often a way to ease into scholarly communication. Building a poster is one of the ways scholars participate in the dissemination of knowledge.
Instructions
1. Your poster submission must have a central focus, as developed from the topic selected in Module 2, and that focus must be evident throughout the poster. Specifically, your introduction, analysis, and results must be focused on a set of research questions and/or hypotheses that are obvious in your theoretical diagram.
2. The focus must comprehensively place the problem/question in appropriate scholarly context (scholarly literature, theory, model, or genre).
.
OverviewRegardless of whether you own a business or are a s.docxjacksnathalie
Overview:
Regardless of whether you own a business or are a stakeholder in a business, understanding basic contract terms is important. Businesses enter into contracts with many areas, from shipping to suppliers to customers. As a business owner or manager knowledge of these basic terms will assist you in the day to day operations of the business, regardless of the field.
Instructions:
• Fill in the attached template.
• For each term, define the term with citation to authority, define the term in your own words and provide an example of each term.
Requirements:
• Use APA format for non-legal sources such as the textbook. Use Bluebook citation format for any legal citations.
• Submit a Word document using the template.
• Maximum two pages in length, excluding the Reference page.
.
OverviewImagine you have been hired as a consultant for th.docxjacksnathalie
Overview
Imagine you have been hired as a consultant for the United Nations. You have been asked to write an analysis on how global population growth has caused the following problem and how it affects
TURKEY
A growing global population that consumes natural resources is partially to blame for the release of greenhouse gases since human consumption patterns lead to deforestation, soil erosion, and farming (overturned dirt releases CO2). However, the critical issue is the burning of fossil fuels (hydrocarbons) such as coal oil and natural gas to produce energy that is used for things like electricity production, and vehicle, heating, and cooking fuels.
Instructions
Content
The U.N. has asked that your paper contain three sections. It has asked that each section be one page (or approximately 300 words) in length and answer specific questions, identified in the outline below. It also asks that you use examples from Turkey when answering the questions.
Introduction
Provide an introduction of half a page minimum that addresses points
points
1–5 below:
Explain the problem the U.N. has asked you to address in your own words.
Identify the three sections your paper will cover.
Identify the developing country (TURKEY) you will consider.
Telly
the U.N. which causes of greenhouse gases you will explore.
Provide a one-sentence statement of your solutions at the end of your introduction paragraph.
Section I. Background
What are greenhouse gases?
How do greenhouse gases contribute to global warming?
Section II. How Emissions Causes Problems for the Developing World
Which countries produce the most greenhouse gases?
What are the economic challenges of these emissions in Turkey?
What are the security challenges of these emissions in Turkey?
What are the political challenges of these emissions in Turkey?
Section III. Causes and
Solution
s of Greenhouse Gases
Name two causes of greenhouse gases.
What are potential solutions to address each of the causes you identified?
What is the relationship between population control and greenhouse gases?
Conclusion
Provide a conclusion of half a page minimum that includes a summary of your findings that the United Nations can use to inform future policy decisions.
Success Tips
In answering each question, use examples from Turkey to illustrate your points.
The U.N. needs facts and objective analysis on which to base future policy decisions. Avoid
personal opinion
and make sure your answers are based on information you find through research.
Formatting Requirements
Make sure your paper consists of 4–6 pages (1,200 words minimum, not including the cover page, reference page, and quoted material if any).
Create headings for each section of your paper as follows:
Section I. Background.
Section II. How Emissions Causes Problems for the Developing World.
Section III. Causes and
.
OverviewDevelop a 4–6-page position about a specific health care.docxjacksnathalie
Overview
Develop a 4–6-page position about a specific health care issue as it relates to a target vulnerable population. Include an analysis of existing evidence and position papers to help support your position. Your analysis should also present and respond to one or more opposing viewpoints.
Note
: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.
Position papers are a method to evaluate the most current evidence and policies related to health care issues. They offer a way for researchers to explore the views of any number of organizations around a topic. This can help you to develop your own position and approach to care around a topic or issue.
This assessment will focus on analyzing position papers about an issue related to addiction, chronicity, emotional and mental health, genetics and genomics, or immunity. Many of these topics are quickly evolving as technology advances, or as we attempt to push past stigmas. For example, technology advances and DNA sequencing provide comprehensive information to allow treatment to become more targeted and effective for the individual. However as a result, nurses must be able to understand and teach patients about the impact of this information. With this great power comes concerns that patient conditions are protected in an ethical and compassionate manner.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Design evidence-based advanced nursing care for achieving high-quality population outcomes.
Evaluate the evidence and positions of others that could support a team's approach to improving the quality and outcomes of care for a specific issue in a target population.
Evaluate the evidence and positions of others that are contrary to a team's approach to improving the quality and outcomes of care for a specific issue in a target population.
Competency 2: Evaluate the efficiency and effectiveness of interprofessional interventions in achieving desired population health outcomes.
Explain the role of the interprofessional team in facilitating improvements for a specific issue in a target population.
Competency 3: Analyze population health outcomes in terms of their implications for health policy advocacy.
Explain a position with regard to health outcomes for a specific issue in a target population.
Competency 4: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.
Communicate an initial viewpoint regarding a specific issue in a target population and a synthesis of existing positions in a logically structured and concise manner, writing content clearly with correct use of grammar, punctuation, and spelling.
Integrate .
Overview This purpose of the week 6 discussion board is to exam.docxjacksnathalie
Overview:
This purpose of the week 6 discussion board is to examine social class and global stratification. Answer prompt 1. Then select and answer one prompt from prompts 2-4. Refer to Chapters 7 and 8 to answer the prompts.
Instructions:
Respond to prompts in paragraph form (200-400 words
Prompt 1:
Describe 3 topics from Chapters 7 and 8 that you found interesting. Three topics I found interesting from Chapter 7 and 8 were the Dependency Theory, World Systems Theory, and Modernization Theory.
Prompt 2:
Describe 3 different social classes and criteria for membership in each.
Prompt 3:
Describe the effect of social inequality upon dominant and minority groups.
Prompt 4
: Describe social mobility regarding how to rise up the social class ladder, if it is possible.
Prompt 5:
Apply a functionalist or conflict theory perspective to social inequality.
.
Overall Scenario Always Fresh Foods Inc. is a food distributor w.docxjacksnathalie
Overall Scenario
Always Fresh Foods Inc. is a food distributor with a central headquarters and main warehouse in Colorado, as well as two regional warehouses in Nevada and Virginia. The company runs Microsoft Windows 2019 on its servers and Microsoft Windows 10 on its workstations. There are 2 database servers, 4 application servers, 2 web servers, and 25 workstation computers in the headquarters offices and main warehouse. The network uses workgroups, and users are created locally on each computer. Employees from the regional warehouses connect to the Colorado network via a virtual private network (VPN) connection. Due to a recent security breach, Always Fresh wants to increase the overall security of its network and systems. They have chosen to use a solid multilayered defense to reduce the likelihood that an attacker will successfully compromise the company’s information security. Multiple layers of defense throughout the IT infrastructure makes the process of compromising any protected resource or data more difficult than any single security control. In this way, Always Fresh protects its business by protecting its information.
Scenario 1
Assume you are an entry-level security administrator working for Always Fresh. You have been asked to evaluate the option of adding Active Directory to the company’s network.
Tasks
Create a summary report to management that answers the following questions to satisfy the key points of interest regarding the addition of Active Directory to the network:
1. System administrators currently create users on each computer where users need access. In Active Directory, where will system administrators create users?
2. How will the procedures for making changes to the user accounts, such as password changes, be different in Active Directory?
3. What action should administrators take for the existing workgroup user accounts after converting to Active Directory?
4. How will the administrators resolve differences between user accounts defined on different computers? In other words, if user accounts have different settings on different computers, how will Active Directory address that issue? (Hint: Consider security identifiers [SIDs].)
.
OverviewCreate a 15-minute oral presentation (3–4 pages) that .docxjacksnathalie
Overview
Create a 15-minute oral presentation (3–4 pages) that examines the moral and ethical issues related to triaging patients in an emergency room.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
· Competency 1: Explain the effect of health care policies, legislation, and legal issues on health care delivery and patient outcomes.
. Explain the health care policies that can affect emergency care.
. Recommend evidence-based decision-making strategies nurses can use during triage.
· Competency 3: Apply professional nursing ethical standards and principles to the decision-making process.
. Describe the moral and ethical challenges nurses can face when following hospital policies and protocols.
. Explain how health care disparities impact treatment decisions.
· Competency 4: Communicate in a manner that is consistent with expectations of nursing professionals.
. Write content clearly and logically, with correct use of grammar, punctuation, and mechanics.
. Correctly format citations and references using APA style.
Context
Working in an emergency room gives rise to ethical dilemmas. Due to time restraints and the patient's cognitive impairment and lack of medical history, complications can and do occur. The nurse has very little time to get detailed patient information. He or she must make a quick assessment and take action based on hospital protocol. The organized chaos of the emergency room presents unique ethical challenge, which is why nurses are required to have knowledge of ethical concepts and principles.
Questions to consider
To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community.
· How does a triage nurse decide which patient gets seen first?
· How does health disparity affect the triage nurse's decision making?
· What ethical and moral issues does the triage nurse take into account when making a decision?
· What are triage-level designations?
Resources
Suggested Resources
The following optional resources are provided to support you in completing the assessment or to provide a helpful context. For additional resources, refer to the Research Resources and Supplemental Resources in the left navigation menu of your courseroom.
Capella Resources
· APA Paper Template.
· APA Paper Tutorial.
Library Resources
The following e-books or articles from the Capella University Library are linked directly in this course:
· Tingle, J., & Cribb, A. (Eds.). (2014). Nursing law and ethics (4th ed.). Somerset, NJ: John Wiley & Sons.
· Cranmer, P., & Nhemachena, J. (2013). Ethics for nurses: Theory and practice. Maidenhead, UK: Open University Press.
· Aacharya, R. P., Gastmans, C., & Denier, Y. (2011). Emergency department triage: An ethical analysis. B MC Emergency Medicine, 11(1), 16–29.
· Guidet, B., H.
Overall CommentsHi Khanh,Overall you made a nice start with y.docxjacksnathalie
Overall Comments:
Hi Khanh,
Overall you made a nice start with your U06a1 assignment; however, many of the required objectives have not been addressed in the first version of your assignment. Please carefully review the scoring guide, and review my feedback below, and be sure to contact me if you have any questions about my comments. You can reach me at: [email protected] or 813-417-0860.
Sincerely,
Dr. Marni Swain
COMPETENCY: Assess approaches for recruiting, selecting, and retaining talent.
CRITERION: Explain why and when candidate background checks will be authorized.
DISTINGUISHED
PROFICIENT
BASIC
NON-PERFORMANCE
Basic
Explains why but not when candidate background checks will be authorized.
Faculty Comments:“
You made a nice start with this discussion; however, it is important to develop your content further to address the legalities involving when a background check can be conducted during the interview process, and the other steps employers have to follow to be in compliance with the law.
”
CRITERION: Identify the top three candidates to interview for the position.
DISTINGUISHED
PROFICIENT
BASIC
NON-PERFORMANCE
Non-Performance
Does not identify the top three candidates to interview for the position.
Faculty Comments:“
Please develop your content further to address this topic in your assignment.
”
CRITERION: Explain rationale for why the selected candidates should be interviewed.
DISTINGUISHED
PROFICIENT
BASIC
NON-PERFORMANCE
Non-Performance
Does not explain rationale for why the selected candidates should be interviewed.
Faculty Comments:“
Please develop your content further to address this topic in your assignment.
”
CRITERION: Identify pre-employment screening tests for the position being recruited.
DISTINGUISHED
PROFICIENT
BASIC
NON-PERFORMANCE
Basic
Identifies a pre-employment screening test for the position being recruited.
Faculty Comments:“
I would like to see your content developed further to clearly identify your rationale for the pre-employment screening tests you selected, as this is not clear based on the limited information provided.
”
CRITERION: Select assessment methods to use based on the job being recruited and the budget available.
DISTINGUISHED
PROFICIENT
BASIC
NON-PERFORMANCE
Non-Performance
Does not select assessment methods to use based on the job being recruited and the budget available.
Faculty Comments:“
I would like to see your content developed further to clearly identify the assessment methods you will use for CapraTek's Regional Sales positions based on the available budget, as this is not identified in your work.
”
CRITERION: Develop the sequence in which methods will be used to screen applicants.
DISTINGUISHED
PROFICIENT
BASIC
NON-PERFORMANCE
Non-Performance
Does not develop the sequence in which methods will be used to screen applicants.
Faculty Comments:“
Please develop your content further to address this topic in your assignment.
”
CRITERION: Design a final candidate selection process for the CapraTek.
Overall CommentsHi Khanh,Overall you made a nice start with.docxjacksnathalie
Overall Comments:
Hi Khanh,
Overall you made a nice start with your U03a1 assignment; however, your content still does not address the required objectives. For this assignment you will need to focus the content on Capra Tek's regional sales position, and for objective #1 analyze the KSAs for this position, and for objective #2 you will need to analyze wage trends related to this position as well. Objectives 3 & 4 focus on job description and the job analysis so please carefully review what is required for these two objectives.
Please see my feedback below and be sure to let me know if you have any questions about my comments.
Sincerely,
Dr. Marni Swain
COMPETENCY: Describe how hiring practices support an organization's strategy.
CRITERION: Articulate the components of a job description for a position.
DISTINGUISHED
PROFICIENT
BASIC
NON-PERFORMANCE
Non-Performance
Does not articulate the components of a job description for this position.
Faculty Comments:“
Please see feedback above.
”
COMPETENCY: Assess approaches for recruiting, selecting, and retaining talent.
CRITERION: Identify the knowledge, skills, and abilities required for this position.
DISTINGUISHED
PROFICIENT
BASIC
NON-PERFORMANCE
Non-Performance
Does not identify the knowledge, skills, and abilities required for this position.
Faculty Comments:“
Please see feedback above.
”
COMPETENCY: Explore technology tools that support recruiting and staffing management.
CRITERION: Identify wage information and employment trends for this position in a selected state.
DISTINGUISHED
PROFICIENT
BASIC
NON-PERFORMANCE
Non-Performance
Does not identify wage information and employment trends for this position in a selected state.
Faculty Comments:“
Please see feedback above.
”
COMPETENCY: Analyze the impact of legal and regulatory issues on staffing management.
CRITERION: Explain why a job analysis is a requirement for any recruiting and selecting process.
DISTINGUISHED
PROFICIENT
BASIC
NON-PERFORMANCE
Non-Performance
Does not explain why a job analysis is a requirement for any recruiting and selecting process.
Faculty Comments:“
Please see feedback above.
”
COMPETENCY: Communicate in a manner that is scholarly and professional.
CRITERION: Communicate in a professional manner that is appropriate for the intended audience.
DISTINGUISHED
PROFICIENT
BASIC
NON-PERFORMANCE
Non-Performance
Does not communicate in a professional manner that is appropriate for the intended audience.
Faculty Comments:“
Please see feedback above.
”
Dysphagia .
Dysphagia is a serious problem and contributes to weight loss, malnutrition, dehydration, aspiration pneumonia, and death. Careful assessment of risk factors, observation for signs and symptoms, and collaboration with speech-language pathologists on interventions are essential.
Dysphagia, or difficulty swallowing, is a common problem in older adults. The prevalence of swallowing disorders is 16% to 22% in adults older than 50 years of age, and up to 60% of nursing ho.
Overall feedbackYou addressed most all of the assignment req.docxjacksnathalie
The document provides feedback on an assignment submitted by a student. It notes that while the student addressed most requirements, the introduction could have better identified the key areas to be covered. Additionally, only one scholarly peer-reviewed journal article was included when two were required. The feedback recommends reviewing instructions carefully and including an introduction describing coverage areas and the required number of scholarly sources in the future.
Overall Comments Overall you made a nice start with your U02a1 .docxjacksnathalie
This document provides feedback from a faculty member on an assignment analyzing legal and regulatory issues related to staffing management. For most criteria evaluated, the faculty member provided basic or non-performance feedback, noting the student did not sufficiently analyze the key aspects of the case such as important issues, outcome, evidence of discriminatory effects, and how guidelines help avoid issues. The faculty member recommended developing more in-depth content on the case analyzed and ensuring it is a disparate impact case. Minor errors in formatting references were also noted.
Overview This purpose of the week 12 discussion board is to e.docxjacksnathalie
Overview:
This purpose of the week 12 discussion board is to examine health, healthcare, and disability status. Answer prompt 1. Then select and answer one prompt from prompts 2-4. Refer to Chapter 13 to answer the prompts.
Instructions:
Respond to prompts in paragraph form (200-400 words)
Prompt 1:
Describe 3 topics from Chapter 13 that you found interesting.Three topics I found interesting in Chapter 14 was "A Functionalist Perspective: The Sick Role", "A Symbolic Interactionist Perspective:
Prompt 2:
Describe how stereotypes regarding disability status may lead to prejudice and discrimination.
Prompt 3:
Describe how access to healthcare is associated with social class location (e.g., socioeconomic status).
Prompt 4:
How is culture associated with attitudes towards health and healthcare.
Prompt 5:
Compare how the United States pays for health care with how other nations provide health services for their citizens.
.
Over the years, the style and practice of leadership within law .docxjacksnathalie
Over the years, the style and practice of leadership within law enforcement agencies has gradually changed. In the past, leadership was primarily relegated to one individual within the department. However, there has been a transformation in leadership theory resulting in a more dynamic, multifaceted nature of teamwork, inclusion, and dispersed leadership. More and more, police chiefs are being encouraged to move toward a more participatory leadership style of management, one that encourages collaboration and cooperation in the decision-making process.
Based on your readings in the text and credible Internet research, respond to the following:
What does the term
shared leadership
mean? What advantages or disadvantages do you see in this leadership approach?
What direction should law enforcement leaders take for the future, related to leadership styles?
What does the term
visionary leadership
mean?
2-3 pages
.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
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ORIGINAL ARTICLE Curretit health c&e delivery sites’ Ii,’.docx
1. ORIGINAL ARTICLE
Curretit health c&e delivery sites’: Ii,’
are examined, and recommenda- ’
tions are given for improvement
of both practitioner skills and
health care programs targeting
these youth. J Pediatr Health
Care. (1997). 11, 266-274.
Psychosocial Issues in
Primary Care of
Lesbian, Gay,
Bisexual, and
Pansgender Youth
Jennifer L. Kreiss, MN, RN, and
Diana L. Patterson, DSN
T he passage through puberty, peer group acceptance, and
the establishment of a personal identity are all developmental
tasks of the adolescent years. For the youth who is lesbian, gay,
bisexual, or transgender, self-acceptance and identity forma-
tion in the face of a heterosexist society are difficult tasks asso-
ciated with many risks to physical, emotional, and social
2. health. Gay and bisexual males are at particularly high risk for
acquiring sexually transmitted diseases, including human
Jennifer L. Kreiss is a Pediatric Nurse Practitioner at Children’s
Hospital & Medical Center in Seattle,
Washington.
Diana L. Patterson is an Assistant Professor in Family and Child
Nursing at the University of Washington and is
Nursing Discipline Head at Adolescent Clinic at the University
of Washington in Seattle, Washington.
Reprint requests: Jennifer Kreiss, MN, RN, Children’s Hospital
Medical Center, 4800 Sand Point Way NE, P.O.
Box 5371, Seattle, WA 98105-0371.
Copyright 0 1997 by the National Association of Pediatric
Nurse Associates & Practitioners.
0891.5245/97/$5.00 + 0 25/l/79212
266 November/December 1997
Kreiss & Patterson
immunodeficiency virus and ac-
quired immunodeficiency syn-
drome (Zenilman, 1988). Lesbian,
gay, bisexual, and transgender
youth are also at increased risk for
low self-esteem, depression, sui-
cide (Remafedi, Farrow, & De&her,
3. 1991), substance abuse, school
problems, family rejection and dis-
cord, running away, homelessness,
and prostitution (Kruks, 1991;
Remafedi, 1990; Savin-Williams,
1994). The psychosocial health con-
cerns faced by sexual minority
youth are primarily the result of
societal stigma, hatred, hostility,
isolation, and alienation (American
Academy of Pediatrics Committee
on Adolescence, 1993). One of the
roles of the primary health care
provider is to recognize adoles-
cents who are struggling with sex-
ual orientation issues and support
a healthy passage through the spe-
cial challenges of the teen years.
In recent years homosexuality
has become increasingly main-
stream. Images of lesbians and gay
men are visible in every venue of
popular culture, from television
shows and films to famous sports
stars and musicians. Presidential
speeches and national debates
occur on questions of gays in the
military, gay marriage and parent-
ing, domestic partnerships, and the
acquired immunodeficiency syn-
drome epidemic. The heightened
public awareness makes it easier
for adolescents to recognize the
meaning of same-sex attractions
and to self-identify as lesbian, gay,
4. bisexual, or transgender (hereafter
referred to as LGBT) at younger
ages than ever before (Savin-
Williams & Rodriguez, 1993). What
,this means for health care pro-
viders is that all health histories
must include questions about sexu-
al preference and practices without
making heterosexist assumptions.
This is considered standard assess-
ment to be covered with all adoles-
cent clients.
POPULATION AND
PREVALENCE
Homosexuality is defined as the
persistent sexual and emotional
attraction to person(s) of one’s own
sex. The American Academy of
Pediatrics’ Committee on Ado-
lescence (1993) has twice issued a
policy statement on homosexuality
and adolescence, stating that it is a
part of the continuum of sexual
expression. Homosexuality is not a
mental disorder, nor is it a choice
for individuals. The American
Psychiatric Association removed
homosexuality from its list of men-
tal disorders in 1973 (American
Academy of Pediatrics’ Committee
on Adolescence, 1993). People do
not choose to be attracted to per-
sons of their own sex, nor can peo-
ple choose not to be attracted to
persons of their own sex if they are
5. homosexual. Bisexual persons are
attracted to both their own and the
opposite sex. Transgender persons
identify as being members of the
opposite of their biologic sex, as,
for example, a man who feels that
he is actually a woman trapped
inside the body of a man. Most
transgender persons are biological-
ly male but have internalized a
female identity. Transgenderism is
described in the Diagnostic and
Statistical Manual of Mental Dis-
orders as a gender identity dis-
order (American Psychiatric Asso-
ciation, 1994). The incidence of
transgenderism in adolescents is
unknown but is presumed to be
very low because it has not been
captured in demographic studies
of adolescent sexual orientation.
Most research on sexual minority
youth does not include transgen-
der youth as part of the sample
because of the difficulty of finding
subjects in this tiny subset of the
population. Therefore inclusion of
the transgender population when
discussing health concerns of sexu-
al minority youth is a considered
appraisal of the health needs of a
heretofore unstudied group.
Projections of homosexuality in
adult men and women range from
6. 1% to 10% (Remafedi, Resnick,
Blum, & Harris, 1992). Among ado-
lescents, the 1992 survey by
Remafedi and colleagues of 35,000
Minnesota junior and senior high
school students found that 1.4%
described themselves as having a
homosexual or bisexual identity.
The prevalence of bisexual and
homosexual experiences and be-
havior was higher than the per-
centage of youth who self-identi-
fied as gay or bisexual, supporting
the idea that many adolescents
who experiment with same-sex
behavior later identify as hetero-
sexual in adulthood. Similarly, 54%
of gay males and 81% of lesbians
between the ages of 14 and 23 years
reported engaging in heterosexual
sex. The number of heterosexually
and homosexualIy identified ado-
lescents who engaged in heterosex-
ual sexual behavior was nearly
identical, at 65% (Remafedi et al.,
1992). Both homosexual and het-
erosexual attractions, behaviors,
and identities increased with age.
Adolescents in general tend to
become more sexually active with
the increasing physical and emo-
tional maturity that accompanies
the later teen years.
The age at which youths self-
identify as gay or lesbian may be
7. younger today than in previous
decades. In the past the average
age of self-disclosure of LGBT sex-
ual identity to non-gays (i.e., “com-
ing out”) has been reported to be in
the early to mid 20s. Current re-
search shows that age to be falling
rapidly, and it is now estimated to
be in the late teen years. The
younger age of coming out may
be attributable to the increased visi-
bility of homosexuality in our pop-
ular culture (Savin-Williams &
Rodriguez, 1993).
JOURNAL OF PEDIATRIC HEALTH CARE
November/December 1997 2 6 7
ORIGINAL ARTICLE Kreiss & Patterson
SEXUAL IDENTITY
DEVELOPMENT AND THE
COMING OUT PROCESS
Many gay and lesbian adults say
retrospectively that they knew
from early childhood that they “felt
different” from their peers and that
they were able to recognize that
their primary attractions were to
people of their same sex. Troiden
(1988) has constructed a model of
individual homosexual identity
development (Figure 1). Age pro-
gression through the stages of
8. the model varies by individual.
Other theorists have expanded on
differences in identity develop-
ment between gay males and les-
bians. Browning (1987) believes
that young women develop lesbian
identities within a relational con-
text and that the establishment of a
same-sex intimate relationship en-
hances identity formation. Differ-
ences have been noted between
males and females in the coming-
out process (Gonsiorek, 1988). For
males the process seems to be more
abrupt and more likely to be asso-
ciated with symptoms such as de-
pression or suicide attempts. For
women the process is character-
ized by greater fluidity and am-
biguity, perhaps because histori-
cally women have been allowed
a broader range of emotional ex-
pression and behavior with other
women. Coming out is always an
individual choice, and some people
never make this choice. Others
come out, establish same-sex rela-
tionships, and reach the stage of
identity commitment while still in
their teen years. For youths there
is a greater risk of psychosocial
problems associated with earlier
age of self-identification. Younger
youth seem developmentally least
equipped to deal with the com-
plex social and behavioral con-
9. sequences of acquiring a gay iden-
tity (Remafedi, Farrow, & Deisher,
1991). (
49 years
oeeurs before puberty
1 2 - 1 8 years 1 5 - 2 2 years adulthood
opment (stages and ages variable).
The coming out process is not
solely applicable to the individual.
Once the individual discloses an
LGBT identity to his or her family,
the family faces a not dissimilar
process of adaptation to the news.
As with individuals, some families
choose never to complete or even
begin this process of adaptation,
and the youth is rejected by the
family. It must be pointed out that
individuals within the family usu-
ally have different time frames for
adaptation to the youths disclo-
sure, with some individuals mov-
ing to an acceptance stage before
others. A model of family adapta-
tion is shown in Figure 2.
SPECIAL HEALTH
CONCERNS
Youth who reach the identity as-
sumption stage of Troiden’s (1988)
model and come out to others dur-
ing the teen years have been identi-
10. fied as facing a number of special
health challenges. The primary
care provider can best assess the
needs of LGBT adolescents by con-
sidering the concerns frequently
encountered by these youth.
School problems. Contributing to
school difficulties are the friendship
loss and peer rejection usually asso-
ciated with the disclosure of an
LGBT identity to schoolmates. Peer
rejection and loss of friends is a dev-
FIGURE 1. Troiden’s model of individual lesbian and gay
identity devel-
astating event for the adolescent,
whose normal developmental tasks
involve a movement away from
parents and family and toward the
peer group as a growing source
of support. Peer group rejection
has a powerfully negative effect
on the self-esteem and coping of
the adolescent. Peers may engage
in name-calling and may ridicule,
ostracize, or physically abuse the
disclosed individual. Youths most
abused by peers are those with the
most gender-atypical appearance,
mannerisms, and behavior. Indi-
viduals who failed to incorporate
cultural ideals of gender-appropri-
ate behavior and roles were most
likely to experience peer rejection
(Savin-Williams, 1994). Verbal and
11. or physical harassment of the ado-
lescent at school along with in-
adequate support by teachers and
staff contributed to a school drop-
out rate of 28% in one study of gay
and bisexual boys, with 80% of re-
spondents reporting deteriorating
school performance (Smith & Mc-
Claugherty, 1994).
Family conflict and rejection. Pa-
rental rejection, at least initially,
is a common outcome of youth
self-disclosure (Borhek, 1988; Mat-
tison & McWhirter, 1995). Families
frequently hold antihomosexual
attitudes based on homophobia,
prejudice, and ignorance. .Family
2 68 Volume 11 Number 6 JOURNAL OF PEDIATRIC
HEALTH CARE
ORIGINAL ARTICLE Kreiss & Patterson
INITIAL REJECTION IDENTITY ACCEPTANCE
COMMITMENT
youth discloses homosexual *family gradually comes to family
able to disclose
identity to family accept youth’s identity (may not son or
daughter’s
*homosexuality msy be in conflict
extend approval) homosexual identity to
12. with family’s cultural or religious w-establishment of family
others
beliefs communication
wmmon parental reactions are
denial, confusion, guilt, anger,
fear, grief
*initial rejection of youth common
*stage may last months to years
*family-youthcommunication
disrupted
FIGURE 2. Kreiss’ model of family adaptation to a gay son or
lesbian
daughter (stages of family variable, usually lags behind youth’s
development).
difficulties are clearly linked to
stigmatization (Herrick & Martin,
1987). Just as individuals struggle
with the risks, pain, anguish, and
fear of coming out, so must fami-
lies face the same emotions when a
loved family member discloses a
homosexual identity. In the most
commonly recognized pattern of
coming out, the individual first dis-
closes his or her identity to a few
13. carefully chosen friends and only
later to family members. Thus by
the time a youth comes out to par-
ents and family, he or she has
already been involved in an in-
ternal identity acceptance process
that has occurred over months or
years. Families may require vary-
ing amounts of time to accept the
youth’s disclosure. For youth who
come out to parents and family
before attaining financial indepen-
dence, nonsupportive family re-
sponses can lead to the youth being
‘thrown out of the home either per-
manently or temporarily or to the
youth leaving home voluntarily
because of isolation, confusion,
shame, or family discord.
Homelessness. Once a youth is out
of the home, an additional set of
psychosocial risks is encountered.
Homeless youth face multiple prob-
lems including substance abuse, vic-
timization by violent hate crimes,
conflict with the law, participation
in survival sex, poverty and de-
creased access to health care ser-
vices (Kruks, 1991).
Out-of-home LGBT youth are
among the hardest to place of all
youth because of their older age at
admission to care (adolescents are
harder to place than younger chil-
14. dren), a genera1 lack of culturally
congruent foster homes, and the
difficulty of finding group homes
that can incorporate overt sexual
minority youth (Sullivan, 1994).
Substance abuse. The use of drugs
and alcohol is a common coping
mechanism of gay-identified youth.
Traditionally, one of the few social
gathering places for gays and les-
bians, both youth and adults, has
been in bars. Particularly in rural
areas, bars are the only place to see
other gay and lesbian people. Alco-
hol and drug use among LGBT
youth occur at considerably higher
rates than the general adolescent
population. Nearly 60% of gay and
bisexual males in one study were
currently abusing substances and
met psychiatric criteria for sub-
stance abuse (Savin-Williams, 1994).
Substance abuse occurs concurrent
to school dropout, homelessness,
and criminal activity and is asso-
ciated with higher rates of suicide
attempts (Remafedi et al., 1991;
Savin-Williams, 1994).
Depression and suicide. The in-
creased incidence of depression
and suicide has been well docu-
mented for LGBT youth (American
Academy of Pediatrics Committee
on Adolescence, 1993; Remafedi,
1991; Savin-Williams, 1994; Smith
15. & McClaugherty, 1994). Forty per-
cent of homosexual men and
women have seriously considered
or attempted suicide, with nearly
all of the reported attempts occur-
ring during the teenage years. Gay
adolescents are two to three times
more likely to attempt suicide than
non-gay peers, and attempts made
are more serious and lethal. It is
estimated that gay youth account
for 30% of completed youth sui-
cides each year. LGBT youth of
color face a double stigma and
have higher rates of suicide at-
tempts than white youth. Remafedi
and colleagues (1991) reported that
one third of first attempts occurred
in the first year that subjects identi-
fied their homosexuality or bisexu-
ality, and most other attempts oc-
curred soon thereafter. Compared
with LGBT peers, youths who at-
tempted suicide recognized same-
sex attractions and told others
about them at younger ages. At-
tempters were also younger at the
age of first homosexual experience
than peers. For each year’s delay in
homosexual self-labeling, the odds
of a suicide attempt decreased
by 80%. Remafedi and colleagues
(1991) concluded that, “Compared
with older persons, early and mid-
dle adolescents may be generally
less able to cope with the isolation
16. and stigma of a homosexual iden-
tity” (p. 874).
A perspective on health care for
LGBT youth. When thinking about
provision of health care to LGBT
JOURNAL OF PEDIATRIC HEALTH CARE
November/December 1997 2 69
ORIGINAL ARTICLE Kreiss & Patterson
BOX 1 Survey of LGBT youth clinics
Method
Subjects: Directors of LGBT youth
clinics in the United States
Sample size: 5
Measure: Self-administered 21 -item
questionnaire (see appendix)
Response rate: 80%
Results
Average age of clients seen: 18.3 years
Sexual orientation of clients:
Gay male 50%-97% (average,
70.5%)
Lesbian I%-30% (average, 13%)
Bisexual 2%-l 5% (average, 9%)
17. Access:
100% arrive at clinics on foot/by
bike or by public or private trans-
port
Two clinics pick up youths at vari-
ous locations and transport them
Funding:*
100% of clinics provide all services
free of charge
Two clinics report private and grant
funding
One clinic reports private donations
and volunteers
One ciinic reports fundraising and
grants
*A// of the clinics providing physical
health care (3 of 4 clinics surveyed)
disagreed that their current funding
is adequate to meet their service
goals
Frequency of clinic operation:
Average 2.2 times per week
Type of health care providers:
Medical doctor-l 00% of the three
18. clinics providing physical health
care
Nurse practitioners-66%
Physician assistants-33%
Nurses-33%
Medical assistants-33%
Type of services provided:
Minor illness-ne clinic
Minor injury-one clinic
Sports medicine-one clinic
HIV testing-three clinics
STD testing/treatment-two clinics
Drug/alcohol counseling-two clinics
youth, it is useful to keep the fol-
lowing points in mind. One per-
cent to 10% of the adult population
is homosexual. The average age of
homosexual self-definition, based
on retrospective studies of adult
gays and lesbians, is between 19
and 21 years for males and 21 to 23
years for females (Troiden, 1988).
Only after self-definition occurs do
individuals begin the process of
disclosure to others, known as
coming out, which usually occurs
over several years during the third
decade of life. Therefore of all the
people who will eventually dis-
close a homosexual identity, less
than half will have done so by their
twenty-second birthday. Most will
19. come out as adults. This does not
mean that youth who have not yet
come out are insensitive to hetero-
sexist assumptions by health care
providers and others-quite the
opposite. The prevalence of the
youth’s exposure to these assump-
tions may be a contributing factor
to the youth’s delay in attaining
identity assumption. Health care
providers cannot know which of
the youth they see may one day
self-identify as LGBT; thus gender-
neutral language and avoidance of
gender stereotypes and heterosex-
ist assumptions for all persons seen
in the clinical setting are important.
CURRENT HEALTH CARE
DELIVERY TO LGBT YOUTH
Survey of LGBT Youth Health Clin-
ics. The authors conducted a study
of health clinics specifically target-
ing the LGBT youth population.
The purpose of the study was to (a)
identify clinics currently serving
LGBT youth and (b) evaluate the
effectiveness of the clinics currently
in existence (Box 1).
Currently only four major metro-
politan cities have clinics specifical-
ly designed to meet the health
needs of LGBT youth. Cities with
20. specialized LGBT youth clinics are
Seattle, Minneapolis, Los Angeles,
and New York. Other metropolitan
areas (Boston, Chicago, San Fran-
cisco, and Washington, D.C.) have
LGBT youth centers that coordi-
nate referrals to health services
familiar with LGBT youth issues.
The self-described mission of the
health clinics varies in focus, from
“human immunodeficiency virus
prevention and treatment” to “safe
supportive space” to “provision of
culturally sensitive care.” Special-
ized metropolitan free clinics ad-
dress the need for affordable, acces-
sible, culturally congruent services
in areas with significant popula-
tions of high-risk urban LGBT
youth, many of whom have multi-
ple risk factors including poverty,
homelessness, substance abuse,
and positive human immunodefi-
ciency virus status. However, most
of the health services needs of
LGBT youth can be provided in
general adolescent health care set-
tings by a primary care provider
who is familiar with adolescent
issues, sexual health, LGBT specific
issues, and community resources
for LGBT youth (Box 2).
Survey of LGBT Youth Regarding
Quality of Health Care Received.
Blanc0 (1995) surveyed LGBT
youth in Washington State to assess
21. their access to health care and the
quality of care they received. The
study found that 66% of youth stat-
ed that their health provider had
never brought up issues of sexual
orientation. Many received inap-
propriate treatment and health ed-
ucation based on their provider’s
heterosexual assumption and igno-
rance of their true sexual orienta-
tion. The youth also rated health
care provider qualities that were
important to them. Most important
2 70 Volume 11 Number 6 JOURNAL OF PEDIATRIC
HEALTH CARE
ORIGINAL ARTICLE Kreiss & Patterson
BOX 2 Coordination of
care for LGBT youth content
referral I ist
l Peer support groups (gay, les-
bian, transgender, youth of
color, HIV+)
l Counseling (individual and
family)
l Emergency housing
l Food assistance
l Clothing assistance
l Drug and alcohol recovery ser-
22. vices
l Legal assistance
l Education programs
l Job training
l Prostitution diversion
to youth were that the provider
be skilled, be supportive of the
youth’s sexual orientation, be the
same sex as the youth, and share
the same sexual orientation. Other
considerations were the provider’s
age and ethnic background, with
youth preferring providers that
were most like themselves.
Overcoming Barriers to Care De-
livery. Practitioners working with
teens must address access issues
relevant to all adolescent health
care. Services must be available,
visible, affordable, flexible, confi-
dential, coordinated, and of high
quality (Society for Adolescent
Medicine, 1992). Many LGBT youth
fear that the provider will tell their
parents about their sexual identity;
therefore health care providers
should inform the youth what in-
formation can and will be kept con-
fidential. Also, practitioners should
have LGBT resources to offer teens
and keep lists updated as new ser-
vices become available. In addition,
providers must keep their knowl-
edge current on issues affecting the
23. LGBT community including legis-
lation and health and actively dis-
pel myths and correct stereotypes
with clients and families. Providers
can advertise their services in gay
and lesbian publications and at
meeting places to encourage youth
to seek them out as a provider.
Many youth have difficulty making
and keeping appointments; drop-in
hours can add to the clinic’s flexibil-
ity. Barriers such as lack of trans-
portation can be addressed by of-
fering bus tokens or coordinating
with other local youth services to
provide a van service. A system-
atic outreach strategy is necessary
to bring adolescents into care. Ex-
amining barriers related to both
LGBT adolescents (client barriers)
and to the particular care setting
(institutional barriers) can result in
better access to care for this at-risk
population (Dilorenzo et al., 1993).
Institutional barriers include rais-
ing provider awareness of LGBT is-
sues, support for ongoing provider
training, solicitation of community
support for the clinic’s mission and
service goals, and adequate clinic
funding to provide cost-effective
yet comprehensive service.
ROLE OF THE PRIMARY
HEALTH CARE PROVIDER
24. The goal of health care provision to
LGBT youth is to provide care sen-
sitive to the unique needs of this
population within a safe, accept-
ing, and supportive environment.
To achieve this goal providers must
first, create a safe space for youth to
seek health care, second, incorpo-
rate knowledge of LGBT health
issues into designing a care plan
unique to the needs of the youth,
and third, coordinate comprehen-
sive service delivery (Box 3).
Creating a Safe Space for Care. Prac-
titioners working with children can
start early to create a safe, trusting,
and unbiased setting for care deliv-
ery. With only gender-neutral lan-
guage in history-taking and the
avoidance of gender stereotyping,
practitioners never assume any cli-
ent is heterosexual including and
especially children and adolecents,
who have yet to define their sexual
BOX 3 The role of the
pediatric nurse practitioner
in provision of health care
services for LGBT youth
l Health promotion
* Complete assessment
* Minor illness care
l Minor injury care
l Sports health care
l Dental care referral
25. l Mental health screening and
referral
l STD testing and treatment
l HIV testing, including partner
testing
l Risk reduction counseling
l Barriers and contraceptives
l Drug/alcohol counseling
l Crisis intervention
preference. Total avoidance of het-
erosexual assumptions during con-
versation with youth is a cue to
them that the provider is aware of
nonheterosexual options. For exam-
ple, few teenage lesbians will bother
to correct the practitioner who asks
only whether they have a boy-
friend; the question will only add to
the sense of isolation and different-
ness the teen already feels. The key
to quality service delivery for LGBT
youth is to ask the right questions
and to assess the known risk areas
of LGBT youth (Table). Health care
providers must assess their client’s
sexual preferences and practices to
give appropriate treatment and ed-
ucation. A relaxed attitude about
sexual development and an open-
ness to exploring issues of sexuality
with youth are essential for build-
ing the trust it will take for a youth
to discuss such personal matters
26. with the health care provider.
Practitioners must be prepared to
articulate their philosophy of sexu-
al health care to parents, explaining
their use of gender-neutral lan-
guage and conscious avoidance of
gender stereotypes. Practitioners
IOURNAL OF PEDIATRIC HEALTH CARE
November/December 1997 2 7 1
‘34 ORIGINAL ARTICLE Kreiss & Patterson
TABLE Psychosocial interventions for gay, lesbian, bisexual
and transgender youth: A clinical path
Timeline: Initial Visit
Functional
health pattern Outcomes Assessment Intervention/Referral
Coping/stress
tolerance
1. Adolescent recognizes
that heterosexuality,
homosexuality, and
bisexuality are all nor-
mal expressions, and all
can be practiced within
the context of healthy,
normal lives
27. 2. Adolescent can identify
sources of stress
3. Adolescent effectively
manages stress through
use of coping techniques
that promote health,
growth and develop-
ment
4. Adolescent can identify
resources to assist in
coping/stress reduction
Roles/relation-
ships
1. Adolescent has the abil-
ity and opportunity to
form healthy relation-
ships with family, peers,
and community
Sexuality 1. Adolescent develops
positive feelings and ex-
periences satisfaction re-
garding sexual identity
2. Adolescent demon-
strates responsible deci-
sion-making re: sexual
behavior and health
1. Assess stereotypic ideas and
attitudes
28. 2. Assess adolescent’s internal
concerns re:
l Comfort with perceived
identity
l Comfort in communicating
sexual-preference concerns
with health provider
3. Assess degree of isolation
4. Assess evidence of depression,
i.e. social withdrawal, declin-
ing school performance, sub-
stance abuse, disrupted family
relationships, runaway behav-
ior, health risk-taking (unsafe
sex, promiscuity, self-harm,
suicide ideation)
1. Assess adolescent’s external
concerns re:
l Family relationships and
family member’s knowledge
of sexual-orientation issues
l Interaction at school/job
. Peer friendships and peer
knowledge of sexual orienta-
tion
l Community involvement
29. 1. Assess concerns re:
l Sexual experiences and
practices
l Experiences with uncomfort-
able touch or abuse
2. Assess awareness of options
related to sexual activity,
knowledge of reproduction,
disease transmission, and con-
traception/barrier methods
Interventions:
l Assure confidentiality
l Be supportive and nonjudgemental
l Avoid labels by discussing the spec-
trum of sexual orientation
l Provide accurate and unbiased infor-
mation-correct stereotypes
l Allow time for self-definition
l Validate homosexual, heterosexual,
and bisexual behaviors as compatible
with a healthy, normal life
l Assist in identifying stressors and
exploring coping strategies
. Teach a variety of coping strategies
l Provide sources of information and
support (keep a complete referral list of
30. gay and lesbian resources for your
area)
Referrals:
9 Youth LGBT support groups if youth
desires for evidence of depression,
refer to mental health counseling
Interventions:
l Assist youth to identify supportive
adult(s)
l Assist youth to identify supportive fam-
ily member(s) (explore extended family
if necessary)
l Assist youth to identify supportive
peer(s)
l Assist youth to identify supportive
community (i.e., youth groups/youth
centers/gathering places, books, news-
papers, internet resources)
interventions:
l Provide unconditional acceptance of
the youth
l Validate sexual preference as legiti-
mate
l Explore sexual decision-making and
assertiveness techniques
31. l Teach facts about safer sex practices,
disease transmission, reproductive bar-
rier/contraceptive choices
Referrals:
l Refer to counseling for unresolved
abuse issues
2 72 Volume 11 Number 6 JOURNAL OF PEDIATRIC
HEALTH CARE
Kreiss & Patterson
TABLE Psychosocial interventions for gay, lesbian, bisexual
and transgender youth: A clinical path-confti
Timeline: Follow-up visit(s)-Two weeks to two months
depending on risk profile
Functional
health pattern Outcomes Assessment Intervention/Referral
Coping/stress
tolerance
1. Adolescent can begin to
verbalize own process of
self-acceptance
2. Adolescent begins to
effectively manage stress
through use of coping
32. techniques that promote
health, growth and
development
Roles/relation-
ships
1. Adolescent has the abili-
ty and opportunity to
form healthy relation-
ships with family, peers
and community
2. Adolescent can identify
supportive adult(s), fami-
ly member(s), peer(s)
and has knowledge of
available community
resources
Sexuality 1. Adolescent begins to
develop positive feelings
and verbalizes accep-
tance of sexual identity
of self and others
2. Adolescent begins to
demonstrate responsible
decision-making regard-
ing sexual decision-
making and sexual
health
1. Assess level of identity devel-
opment (seeTroiden, 1988),
i.e., sensitization, identity con-
33. fusion, identity assumption,
commitment
2. Assess coping techniques for
identified current stressors
3. Assess whether stressors ex-
ceed current coping strategies
1. Assess supportive and nonsup-
portive factors in current rela-
tionships
1. Continue ongoing assessment
of feelings, experiences, and
values regarding own sexuality
and that of others
2. Assess sexual knowledge and
behavior
Interventions:
l Assist youth to identify own goals for
personal physical and mental health
l Validate the youth’s process of identity
development, emphasizing that indi-
vidual timelines for acceptance vary,
that individual timelines for accep-
tance vary, and that the process is life-
long
l Assist in identifying coping strategies
Referrals:
9 Suggest appropriate community
34. resources for support (see referral list in
Box 2)
Interventions:
* Assist in identifying and improving
supportive relationships
* Offer to meet with parents/family to
facilitate family communication
Referrals:
l Individual counseling
l Family counseling (referrals to counsel-
ing agencies with philosophical con-
gruence to youth and family)
Interventions:
l Validate the individual and his/her
feelings
l Validate the youth’s experience
9 Identify progress the youth is making
toward achieving safe, satisfying rela-
tionships
* Assist in problem-solving ways to
make the youth‘s experiences healthier
and/or more satisfying
l Reinforce teaching of disease transmis-
sion and risk-reduction techniques
can explain the spectrum of sexual
35. orientation to families. As a pri-
mary care provider, speak openly
and matter-of-factly about sexual
health, incorporating age-appro-
priate discussion into al1 well-child
visits. “Creating a safe space” also
entails such efforts as having gay
and lesbian books on your shelf
and fliers on your wall. It includes
having office staff and colleagues
who are comfortable, friendly, and
accepting of LGBT youth in the
care setting.
The pediatric nurse practitioner
can be an ideal care provider for
this population and can function in
the role of case manager to ensure
appropriate, comprehensive, and
cost-effective care delivery. It is the
role of the practitioner to provide
accurate, unbiased information,
support, resources, and uncondi-
tional acceptance. It is not the role
JOURNAL OF PEDIATRIC HEALTH CARE
November/December 1997 2 73
ORIGINAL ARTICLE Kreiss & Patterson
of the practitioner to “diagnose”
sexual orientation; sexual orienta-
36. tion is not a disease to diagnose.
Nor is it the practitioner’s role to
encourage the youth to come out to
self or others; only the adolescent
can decide what his or her sexual
orientation is and both when and
how much of that information will
be shared with others. The Table is
an example of a clinical path based
on selected functional health pat-
terns particularly relevant to the
health care of LGBT youth.
Steps to a Healthy Future. With in-
creasing visibility of LGBT persons
in our communities and an ongo-
ing societal dialogue regarding gay
and lesbian issues, the shame and
stigma of being lesbian, gay, bisex-
ual, or transgender in our society is
decreasing. A better awareness on
the part of health care providers of
LGBT youth health issues will im-
prove the quality of services of-
fered and may improve the health
status of LGBT youth. With the
growing acceptance of all types of
sexual expression as compatible
with a healthy lifestyle, an increase
in the quality and availability of
appropriate health services for
LGBT youth is now both a reason-
able expectation and a goal for both
the present and near future. Health
care providers acting as youth ad-
vocates in the health care and legal
arenas can make a positive con-
37. tribution to achieving this goal.
Homosexuals are among the last
groups in our society to still suffer
legal discrimination. The support
of equal rights and antidiscrimina-
tion legislation for all people will
ease the burden of stigma and help
the young people of today to be-
come healthy, contributing mem-
bers of society.
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2 74 Volume 11 Number 6 JOURNAL OF PEDIATRIC
HEALTH CARE
Counselling Psychology Review, Vol. 31, No. 1, June 2016 67
42. T
his Year’s diVision oF Counselling
Psychology conference theme, Positive
Approaches, Challenging Contexts,
provides perspective on the substantive
professional gains we have achieved in creat-
ing lesbian, gay, bisexual, and transgender
(lGBt) affirmative psychological theory,
practice, and education. it also exposes how
our professional past interconnects with
present psychosocial problems that continue
to vex lGBt people. lGBt individuals in
both the united kingdom and united states
share strikingly similar types and rates of
mental health disparities and psychosocial
problems. moreover, applied psychologists
(i.e., counselling, clinical, education/school,
and health) and other mental health profes-
sionals can be one piece of the puzzle when
trying to redress lGBt mental health dispar-
ities. research conducted in the united
Research Paper
Mind our professional gaps: Competent
lesbian, gay, bisexual, and transgender
mental health services1
Markus P. Bidell
Applied psychology has a complex relationship with lesbian,
gay, bisexual, and transgender (LGBT) matters. As
part of the religious, legal, and scientific triumvirate, we played
a central part in developing discriminatory, biased,
43. and stereotypic perspectives castigating LGBT individuals as
immoral, deviant, disordered, and even dangerous.
Such perspectives not only begot and reinforced legal and social
oppression, but also fuelled the creation of LGBT
psychological theories and malevolent treatments – since
discredited. In a historic and perhaps even redemptive
reversal, professional psychological bodies now reject the
notion that being LGBT is representative of a mental
disorder, immorality, or social deviancy and affirm that LGBT
people have a sexual orientation or gender identity
that is normal, healthy, and legitimate. In fact, applied
psychologists have become ardent advocates for LGBT
human rights. In our post-triumvirate role, we might reason that
our LGBT work is done or nearing completion
with the proffering of LGBT-affirmative professional ethics,
public policies, standards, and treatment guidelines.
Yet LGBT individuals on both sides of the Atlantic continue to
be negatively affected by alarming and
disproportionate rates of serious mental health and psychosocial
problems. These disparities are compounded by
practitioner and trainee concerns regarding their competence
with LGBT clients. Moreover, complex issues arise
when applied psychologists’ personal beliefs run contrary to our
professional LGBT standards of care. Based on a
keynote address (Bidell, 2015) and research paper presentation
(Bidell, Milton, Chang, Watterson, & Deschler,
2015) - both given at the annual conference of the British
Psychological Society Division of Counselling Psychology
- this paper juxtaposes our troubled past with current LGBT
psychosocial issues. It weaves past with present as well
as personal with professional to underscore the continued need
to advance LGBT-affirmative psychological services.
Keywords: sexual orientation, gender identity, LGBT counsellor
competence, religious conservatism,
applied psychology.
44. 1 this paper is based on an invited keynote address (treating
transgressors: our complicated relationship with
lesbian, gay, bisexual, and transgender issues) and research
paper presentation (examining positive patterns
and current challenges: lGBt affirmative counsellor competency
and training in the united kingdom) given
at the annual conference of the British Psychological society
division of Counselling Psychology, harrogate,
uk., June 2015.
68 Counselling Psychology Review, Vol. 31, No. 1, June 2016
AuthorMarkus P. Bidell
states documents critical concerns with
lGBt counsellor competence and profes-
sional training. it is not uncommon for
mental health providers and trainees in the
united states to report being poorly trained
and feeling minimally competent to work
with lGBt clients (Bidell, 2014a; Bidell &
Whitman, 2013; Graham, Carney, & kluck,
2012; Grove, 2009; hope & Chappell, 2015;
mcGeorge, Carlson, & toomey, 2013a;
o’hara, dispenza, Brack, & Blood, 2013;
rock, Carlson, & mcGeorge, 2010). and
those in the mental health professions can
and do hold prejudicial attitudes towards
lGBt people, most often based on conser-
vative socio-political and religious beliefs
(Bidell, 2012, 2014b; Bidell & Whitman,
2013; henke, Carlson, & mcGeorge, 2009;
mcGeorge et al., 2013a; o’shaughnessy &
spokane, 2013; o’hara et al., 2013).
45. as the 2014–2015 regent’s university
london Fulbright scholar (Bidell, 2014c), i
am drawing on methodology i’ve employed
in the united states. over the past year, i
have been examining lGBt competence
and training in the British isles amongst
mental health practitioners and trainees. an
initial look at the data indicates that defi-
ciencies and problems with mental health
practitioners’ lGBt competence and train-
ing are not dissimilar to those i’ve witnessed
in the united states. Preliminary findings
show that lGBt counsellor competence is
significantly lower among more religiously
conservative British mental health practi-
tioners and students (Bidell, milton, Chang,
Watterson, & deschler, 2015). Comparable
to clinicians in the united states, i’ve found
that the overwhelming majority of British
trainees and practitioners (n = 196; 76.1 per
cent) reported their professional education
either incorporated minimal lGBt training
or none at all (Bidell et al., 2015). Clearly
existing research and my initial Fulbright
data underscore an imperative need for
applied psychologists on both sides of the
pond to improve lGBt clinical competence
and training.
The triumvirate: Religion, state, and
science
across the developmental spectrum, lGBt
people in the united states and united
kingdom have disproportionally high rates
of serious psychosocial and mental health
46. problems such as depression, anxiety, smok-
ing, substance abuse, suicidality, discrimina-
tion, and violence (Chakraborty, mcmanus,
Brugha, Bebbington, & king, 2011; elliott et
al., 2015; haas et al., 2010; institute of medi-
cine, 2011; king et al., 2003; king et al.,
2008; Warner et al., 2004). applied psychol-
ogists are starting to understand these
higher rates of psychosocial problems within
the framework of minority stress (meyer,
2003). the minority stress model views
‘stigma, prejudice and discrimination as
producing a hostile and stressful social envi-
ronment that leads to poor mental health,
and eventually, physical health’ (elliot, et al.,
2015, p.14). lGBt minority stress is not
static or isolated and can be hard to avoid.
impacted broadly by psychosocial factors, it
can wax and wane depending on develop-
mental issues, environment, and social
support. Furthermore, minority stress ‘may
be complicated by additional dimensions of
inequality such as race, ethnicity, and socioe-
conomic status, resulting in stigma at multi-
ple levels’ (iom, 2011, p.1.2).
the shared moral, legal, cultural, and
scientific heritage between the united king-
dom and united states likely explains why
we see such common types of lGBt oppres-
sion along with resultant forms of lGBt
psychosocial disparities. For lGBt people in
both countries, a powerful, interconnected,
and synergistic structure links past to pres-
ent. an omnipotent triumvirate, consisting
of religious, state, and scientific institutions,
47. has castigated lGBt people as immoral,
criminal, and disordered for well over a
thousand years. the roman Catholic
Church was one of the earliest Western insti-
tutions which not only morally condemned
lGBt people, but also developed ecclesias-
tic law punishing them as well. Penalties
changed over ensuing centuries, ranging
Counselling Psychology Review, Vol. 31, No. 1, June 2016 69
from social to physical and included capital
punishment.
as nation states in europe formed,
strengthened, and even broke from rome,
ecclesiastic law became the basis for anti-
lGBt common law. the first British sodomy
law, the Buggery act of 1533, was written
when henry the Viii split from the roman
Church during the english reformation.
Buggery became a felony punishable by
death. attempted buggery was a lesser crime
with penalties ranging from imprisonment
to pillory. the punishment of hanging for
buggery was not lifted until 1861 with the last
two British executions occurring in 1835. at
the turn of the century, lGBt Britons were
prosecuted using the labouchere amend-
ment (Criminal law amendment act, 1885)
stating lGBt behaviours were immoral and
represented gross indecency.
american anti-lGBt laws have primarily
48. been regulated through state criminal
statutes under various forms of sodomy legis-
lation and criminal punishments. as a
former colony, america based its early lGBt
legislation on British law. in most states,
homosexuality was initially categorised as a
felony and later re-codified as crimes against
nature or acts of gross indecency. social
changes starting in the late 1960s ushered in
processes that began the repeal of anti-
lGBt laws in the united kingdom and
united states. these repeals started with the
1967 sexual offences act that decrimi-
nalised homosexuality in england and Wales
and continued until 2003 when the united
states supreme Court in lawrence v. texas
repealed the remaining 14 state sodomy stat-
ues.
Classifying lGBt people as mentally
disordered provided the final component
to the triumvirate. influenced by social,
cultural, and moral discriminatory views
about lGBt people, Bayer (1987) argues
that mental health professionals started
‘serving as guarantor of social order, substi-
tuting the concept of illness for that of sin’
(p.10). Prevailing lGBt moral strictures
and public policies largely shaped emerg-
ing theories and clinical treatments devel-
oped by psychologists. lGBt people were
not only immoral in the eyes of religion and
criminals in the eyes of the law, but now also
viewed as mentally ill by our profession.
Psychiatrists and psychologists drew on
49. their tools of nomenclature to diagnosis
lGBt people as mentally disordered. in the
first edition of the Diagnostic and Statistical
Manual of Mental Disorders (dsm; american
Psychiatric association, 1952), homosexual-
ity was codified as a mental illness and cate-
gorised within the sociopathic personality
disturbances.
Codification of homosexuality within
sociopathy strongly reinforced a view that
lesbian, gay, and bisexual individuals were
not only highly pathological but also
extremely dangerous to society. this type of
categorisation justified the development and
utilisation of cruel measures to extinguish a
person’s homosexuality. Psychiatrists drew
on medical procedures such as electrocon-
vulsive therapy (i.e., electroshock treat-
ment), frontal lobotomies, and chemical
hormonal castration to beat back the
dangerous scourge homosexuality was
thought to present. our professional prede-
cessors employed psychoanalytic, behav-
ioural, and cognitive psychological theories
and treatments in their misguided, ill-fated
attempts at curing homosexuality. Psychoan-
alytical practitioners and researchers were
largely responsible for the idea that same-sex
attraction was an outcome of exposure to
highly pathological parent-child relation-
ships in early development. (Bieber, dain, &
dince, 1962; socarides, 1965). they also
developed psychoanalytic therapies, albeit
ineffectual, to attempt curing same-sex
sexual orientations (British Psychological
50. society, 2012b).
Cognitive and behavioural psychologists
transformed homosexuality from a distor-
tion of the normal pattern of psychosexual
development into the maladaptive behav-
ioural consequence of inappropriate learn-
ing and irrational fears of the ‘opposite’ sex
(Bayer, 1987; Freund, 1977). the technique
TitleMind our professional gaps
70 Counselling Psychology Review, Vol. 31, No. 1, June 2016
behaviourists employed most often was the
coupling of same-sex thoughts and fantasies
with emetics, electric shock, or other aversive
conditions, followed by desensitisation
procedures (i.e., termination of negative
aversion stimulus with the appearance of
heterosexual stimuli). in a later reflection
atypical for most behaviourists engaged in
conversion therapies, Freund stated:
i started a therapeutic experiment,
employing aversion therapy combined
with positive conditioning toward females.
approximately 20 per cent of the homo-
sexual males married and founded fami-
lies. For some time, there seemed to be
reason for guarded optimism. however,
this was a long-term study, and these
marriages were followed for many years.
Virtually not one cure remained a cure. i
51. am not happy about my therapeutic
experiment which, if it has helped at all, it
has helped clients to enter into marriages
that later became unbearable or almost
unbearable. Virtually all the marriages of
these clients had become beset with grave
problems ensuing from their homosexual-
ity (Freund, 1977, p.237).
dr evelyn hooker was one of the first
psychologists to conduct empirical research
on nonclinical lesbian women and gay men.
her landmark study (1957) examined results
from three projective tests administered to
30 gay and 30 heterosexual male study
participants matched along age, education,
and intelligence dimensions. after blinded
analysis of subjects’ responses, experts rated
each participant on a 5-point adjustment
scale. the independent evaluators found no
differences in the adjustment levels between
the two groups. Furthermore, they were not
able to accurately identify which participants
were gay or heterosexual. From her results,
hooker concluded that homosexuality did
not represent a clinical entity nor was it asso-
ciated with pathology. the work of psycholo-
gists like dr evelyn hooker coupled with
lGBt civil rights activism forced mental
health professionals to re-examine their
socially constructed and biased notions
regarding the conceptualisation and treat-
ment of lGBt individuals. in 1974, the
american Psychiatric association voted to
declassify homosexuality as a mental disor-
52. der (Bayer, 1987). however, a new diagnosis,
sexual orientation disturbance, was added
and then replaced with ego-dystonic homo-
sexuality in the dsm iii (american Psychi-
atric association, 1980); both diagnostic
categories described those individuals
conflicted with having a same-sex sexual
orientation. the diagnostic category was
completely removed with the publication of
the dsm-iii-r (american Psychiatric associ-
ation, 1987).
For transgender people, a diagnostic
category remains. introduced relatively late
in the diagnostic statistical manual’s history,
Gender identity disorder was added with the
publication of the dsm-iii (american
Psychiatric association, 1980). the diagnosis
was revised and renamed Gender dysphoria,
with the publication of the dsm-5 (ameri-
can Psychiatric association, 2013). the
continued inclusion of a transgender-based
dsm diagnosis remains controversial. some
advocates of the diagnostic category argue
that needed medical treatments for trans-
gender individuals might be jeopardised
with a complete removal of the diagnosis
from the dsm. others like myself believe the
continuation of categorising non-cisgender
people within a psychiatric diagnosis rein-
forces and even maintains the longstanding
prejudicial views that lGBt people are
fundamentally abnormal and diseased. i
believe healthcare policy can simply be
developed to address insurance and medical
coverage issues potentially resultant from
53. the complete elimination of a non-cisgender
diagnostic category from the dsm.
Mind the professional gap
For those of us born in america during the
1960s, an intact religious, legal, and scien-
tific triumvirate was still largely in place that
socially constructed lGBt people as
immoral, criminal, and mentally disordered.
For example, the socially conservative state
AuthorMarkus P. Bidell
Counselling Psychology Review, Vol. 31, No. 1, June 2016 71
where i grew up criminalised homosexuality
until a 1972 legislative repeal. and the first
edition of the dsm (american Psychiatric
association, 1952) was still in use, categoris-
ing homosexuality as a serious mental illness
within the sociopathic personality distur-
bances. Coming to terms with my sexual
orientation in such an environment was chal-
lenging to say the least.
By the time i entered graduate training
in the early 1990s, lGBt social attitudes
and policies were in flux as the old triumvi-
rate began faltering and struggled to
remain a cohesive front against emerging
lGBt civil rights activism. it was not
uncommon to be confronted with past prej-
udices alongside emerging lGBt advocacy
and public policy gains. so as a graduate
54. counselling student at sonoma state
university in the early 1990s, i didn’t find it
odd that my professors expressed caution
about potential problems i might have as an
openly gay counsellor working with youth
in schools. they were concerned that preju-
dicial stereotypes about gay men coupled
with the existence of discriminatory laws
could make my work in public schools
uncertain at best. Consider that it wasn’t
until 2003 that the united states supreme
Court in lawrence v. texas ruled that state
sodomy laws were unconstitutional. said
another way; i had been an assistant Profes-
sor for three years by the time the supreme
Court made this ruling.
Perhaps the most defining moment of my
professional career happened when i began
my doctoral training in combined applied
psychology (counselling/clinical/school) at
the university of California, santa Barbara.
at the time, i couldn’t have known this expe-
rience would profoundly shape not only my
dissertation, but also my future scholarship
and professional work. my efforts to opera-
tionalise lGBt counsellor competence can
be directly traced back to this pivotal experi-
ence. a professor with ardent beliefs that
being lGBt was morally wrong taught my
first doctoral course. Furthermore, he
supported using reparative or conversion
therapy typically based on conservative and
fundamental religious beliefs about lGBt
people. these pseudo-treatments claim out-
55. dated psychoanalytic, cognitive, and
behaviour principles can be utilised to
convert lGBt people to be heterosexual
and cisgender. in response, the american
Psychological association and the British
Psychological society have issued strong
position statements condemning such
pseudo-treatments as unethical and highly
damaging to lGBt clients (american
Psychological association, 2009; 2012;
British Psychological society, 2012a, 2012b).
however, when i was enrolled in dr Brown’s
course at the university of California, santa
Barbara in the autumn of 1996, the ameri-
can Psychological association or British
Psychological society had yet to issue these
ethical edicts.
For one of the assignments in this profes-
sor’s class, i needed to write a research paper
on a topic and population of my choice. my
proposal focused on lGBt adolescent career
development. after i submitted my topic, the
professor pulled me aside, outlined his reli-
gious fundamentalist beliefs about lGBt
individuals, rejected my proposal topic, and
prohibited me from selecting any lGBt
issues for the assignment. What i found most
disquieting was witnessing how some
students’ beliefs were bolstered by the profes-
sor’s declaration of his conservative religious
views about lGBt issues. my concerns gener-
ated questions regarding the role of educa-
tion and training in addressing lGBt mental
health disparities. in response, i created and
psychometrically established the sexual
56. orientation Counselor Competency scale
(soCCs, Bidell, 2005) for my dissertation
research. drawing on the ternary multicul-
tural counsellor competency model (sue,
arredondo, & mcdavis, 1992), the soCCs is
a self-assessment of counsellors’ lGBt-affir-
mative attitudinal awareness, clinical skills,
and knowledge.
TitleMind our professional gaps
72 Counselling Psychology Review, Vol. 31, No. 1, June 2016
Post-triumviratism: The emergence of
LGBT social science, public policy, and
equality
in over 20 peer-reviewed research papers, the
soCCs has been a basis for not only my
scholarship, but also for other researchers
(Bidell & Whitman, 2013). Based on findings
from these studies, important and often obvi-
ous relationships regarding lGBt compe-
tence have emerged. moreover, lGBt
clinical and counselling competency has
developed into a viable, reliable, and valid
psychological construct based on the resolute
rejection of the historic and biased notions
stigmatising lGBt people as immoral,
mentally disordered, inferior, socially
deviant, or aberrant (american Psychological
association, 1975; 1991; 2009; 2012; British
Psychological society, 2012a; 2012b). instead,
it asserts the fundamental legitimacy and
equality of lGBt people. Based on this foun-
57. dation, lGBt competent psychologists exam-
ine and advance their: (a) self-awareness of
personal and societal lGBt biases, stereo-
types, and prejudices; (b) understanding and
knowledge of lGBt life stage development,
intersectionality, mental health disparities,
theories, and psychosocial issues; and, (c)
clinical, counselling, and psychotherapeutic
skills grounded in professional ethics and
lGBt psychological standards of care (Bidell
& Whitman, 2013).
While it is beyond the scope of this paper
to review the body of soCCs-based research
(see, Bidell & Whitman, 2013), i’d like to
highlight one key area, namely the relation-
ship between lGBt counsellor competence
and clinicians’ conservative lGBt beliefs.
not surprising, mental health professionals
with more conservative socio-political and
religious beliefs consistently report lower
levels of sexual orientation counsellor
competence (Bidell, 2012, 2014b; mcGe-
orge, Carlson, & toomey, 2013b; o’shaugh-
nessy & spokane, 2013). in one study
(Bidell, 2014b) i examined over 200 mental
health practitioners, supervisors, and
students to explore the impact of clinicians’
religious beliefs. my findings showed;
that significantly lower levels of lGB-affir-
mative counselor competence were
related to more religiously conservative
counselors, even when the effects of
education level, political conservatism,
and lGB interpersonal contact were
58. controlled…[and] one in three coun-
selors, educators, supervisors, and trainees
in this study demonstrated a significant
connection between their conservative
religious beliefs and sexual orientation
counselor competency. (p.175)
results from my study highlight both the
ongoing nature and scale of the problem. For
practitioners holding beliefs that lGBt indi-
viduals are immoral or sinful, tension exists
between the personal and professional (Whit-
man & Bidell, 2014). While this can be an
ethical dilemma for clinicians, it’s quite worri-
some for lGBt clients seeking mental health
services. lack of sensitive, affirmative, and
competent clinical services has been identi-
fied as a major structural barrier that can
negatively impact lGBt individuals’ health-
care experiences and clinical outcomes
(iom, 2011). in the united kingdom, elliot
and colleagues (2015) found that lGBt indi-
viduals reported significantly lower health-
care provider satisfaction compared to their
heterosexual counterparts. the researchers
concluded that, ‘discrimination may affect
the quality of care that sexual minorities
receive…and some healthcare workers may
be uncomfortable communicating with
sexual minority patients and insensitive to
their needs’ (p.10).
Personal and professional conflicts
regarding ethical lGBt psychotherapy
services are at the centre of legal cases involv-
ing the dismissal of two united states gradu-
59. ate school counselling students from their
mental health training programs (keeton v.
anderson-Wiley, 2010; Ward v. Wilbanks,
2010; Ward v. Polite, 2012). in the federal
lawsuits, the former students cited their
conservative Christian beliefs and argued
their freedoms of religion and speech were
violated when faculty upheld professional
ethics regarding lGBt-affirmative clinical
AuthorMarkus P. Bidell
Counselling Psychology Review, Vol. 31, No. 1, June 2016 73
standards of care. Both cases not only
connect directly to my personal experiences
and professional work, they also illuminate a
fundamental transformation fuelling recent
advancements in lGBt equality.
in the united states and united king-
dom, conservative politicians, pundits, and
pastors have steadfastly drawn on the moral,
legal, and scientific triumvirate to oppose,
often successfully, lGBt civil and human
rights. as we move into a post-lGBt triumvi-
rate era where lGBt people are no longer
considered immoral, mentally disordered, or
criminal; opponents to lGBt equality can
no longer effectively utilise the tripartite
arguments of past generations. adopting
different tactics, conservative individuals and
organisations are trying to claim they
become victims of lGBt equality, arguing
60. infringement of their religious freedom
when lGBt-affirmative laws, policies, and
professional standards are adopted. as the
new lGBt paradigm tilts toward equality,
such objections and arguments are becom-
ing untenable and ultimately unjustifiable.
this progression is not confined to lGBt
rights. throughout history, the strictures of
the triumvirate have also been utilised in the
subjugation and dehumanisation of other
oppressed groups. as minoritised groups
have sought civil and human rights, advance-
ment must occur in the social justice
discourse making it impossible to withhold
human rights based on prejudicial and
biased moral, legal, scientific, and social
mores.
the two unsuccessful lawsuits brought by
the school counselling students and the
recent united states supreme Court ruling
(obergefell v. hodges, 2015) legalising
same-sex marriage are examples of the shift-
ing landscape for lGBt equality. in the
majority opinion, united states supreme
Court Justice antony kennedy provides an
eloquent exemplar of this paradigm shift,
writing:
until the mid-20th century, same-sex inti-
macy long had been condemned as
immoral by the state itself in most West-
ern nations, a belief often embodied in
the criminal law. For this reason, among
others, many persons did not deem
61. homosexuals to have dignity in their own
distinct identity. a truthful declaration by
same-sex couples of what was in their
hearts had to remain unspoken…[and]
the argument that gays and lesbians had
a just claim to dignity was in conflict with
both law and widespread social conven-
tions. same-sex intimacy remained a
crime in many states. Gays and lesbians
were prohibited from most government
employment, barred from military serv-
ice, excluded under immigration laws,
targeted by police, and burdened in their
rights to associate…[and]…for much of
the 20th century, moreover, homosexual-
ity was treated as an illness…the nature
of marriage is that, through its enduring
bond, two persons together can find
other freedoms, such as expression, inti-
macy, and spirituality. this is true for all
persons, whatever their sexual orienta-
tion…there is dignity in the bond
between two men or two women who
seek to marry and in their autonomy to
make such profound choices…as the
state itself makes marriage all the more
precious by the significance it attaches to
it, exclusion from that status has the
effect of teaching that gays and lesbians
are unequal in important respects.
nodding to the past wrongs wrought by the
moral, legal, and scientific triumvirate,
Justice kennedy moves us forward and away
from the viability of denying lGBt individu-
als the dignity of human rights and equality
62. based on out-dated prejudicial justifications.
this ruling, along with similar historic legis-
lation in the united kingdom (marriage act,
2013) and ireland (thirty-fourth amend-
ment of the Constitution Bill, 2015), under-
scores the profound change occurring today.
Conservative religious beliefs or morally
based reasoning can no longer substantiate
lGBt inequality. a paradigm shift of this
magnitude has the power to change hearts,
minds, and deeds. in the case of marriage
TitleMind our professional gaps
74 Counselling Psychology Review, Vol. 31, No. 1, June 2016
equality, acts of lGBt transgression are
rightly transformed into acts of love.
Primum non nocere: First, do no harm
it’s important to acknowledge that many
deeply religious applied psychologists do not
harbour beliefs that lGBt individuals are
sinful or immoral nor do they have any
conflicts between their faith and the provision
of competent lGBt psychological services.
however, emerging research indicates discor-
dance between personal beliefs and lGBt-
affirmative counselling is not as uncommon
as we might hope (Bidell, 2012, 2014b; mcGe-
orge et al., 2013b; o’shaughnessy & spokane,
2013). Whilst we are now crossing a major
societal and professional threshold in the
advancement of lGBt equality, lGBt biases
63. and prejudices are still reaching into today’s
counselling sessions and psychological consul-
tation rooms. the stakes for lGBt clients are
high and even potentially catastrophic.
recent research examining lGBt health
disparities exposes how vulnerable lGBt
people can be to minority stress and resultant
mental health problems, with suicide being
the most tragic consequence (Chakraborty et
al., 2011; elliott et al., 2015; haas et al., 2010;
iom, 2011; king et al., 2003; king et al., 2008;
Warner et al., 2004).
i have contemplated my possible
response if either of the aforementioned
counselling students were enrolled in one of
my classes. When first learning of these
cases, i was torn about the decision to
dismiss them. after all, expulsion is the ulti-
mate action educators can take against any
student. and i believe ardently in the sanc-
tity of religious and speech freedoms.
however, the paradigm shift fuelling historic
advancements in lGBt rights is advancing
my own certainty that freedom of religion
and speech does not mean freedom to
discriminate. more importantly, no legal or
professional protections exist for applied
psychologists that justify the abdication of
our principle duty: first, do no harm. as
such, freedom of speech and religion can
never justify rejecting our ethical duty
regarding lGBt clinical and professional
competence.
64. We remain at a professional crossroads
where paradigm shifts and removal of
students from programs will not eliminate
dilemmas that happen when conservative
personal beliefs conflict with our profes-
sional lGBt ethical standards. While we
cannot, and should not, dictate the personal
beliefs applied psychologists hold about
lGBt issues and individuals; applied
psychologists must search for ways to redress
our past lGBt wrongs by addressing current
lGBt mental health and psychosocial
disparities. multicultural training is a power-
ful tool in our professional arsenal, yet its
potential has not been fully realised for
lGBt clinical competence. the majority of
clinicians and trainees report that their
professional training has not prepared them
to work competently and ethically with
lGBt issues and my Fulbright data under-
scores this fact for practitioners and students
in the united kingdom (Bidell et al., 2015;
Bidell & Whitman, 2011).
We mustn’t let professional gains and
societal progress regarding lGBt equality
obfuscate lGBt psychosocial and mental
health problems that stubbornly remain, nor
our professional responsibility to do no harm.
important work remains for applied psychol-
ogists regarding competent and ethical lGBt
psychological services – the health and well-
being of our lGBt clients depend on it.
Markus P. Bidell,
department of educational Foundations &
65. Counseling Programs, hunter College of the
City university of new York.
the author thanks Charles donovan for
editorial support. Correspondence concern-
ing this article should be addressed to markus
Bidell, department of educational Founda-
tions & Counseling Programs, hunter
College of the City university of new York,
new York, nY 10065.
email: [email protected]
AuthorMarkus P. Bidell
Counselling Psychology Review, Vol. 31, No. 1, June 2016 75
Title
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Markus P. Bidell
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