Shelley Craig | University of Toronto (original) (raw)

Papers by Shelley Craig

Population medicine, Apr 27, 2023

Population Medicine considers the following types of articles: • Research Papers-reports of data ... more Population Medicine considers the following types of articles: • Research Papers-reports of data from original research or secondary dataset analyses. • Review Papers-comprehensive, authoritative, reviews within the journal's scope. These include both systematic reviews and narrative reviews. • Short Reports-brief reports of data from original research. • Policy Case Studies-brief articles on policy development at a regional or national level. • Study Protocols-articles describing a research protocol of a study. • Methodology Papers-papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation. • Methodology Papers-papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation. • Letters to the Editor-a response to authors of an original publication, or a very small article that may be relevant to readers. • Editorials-articles written by the Editorial Board or by invited experts on a specific topic. Research Papers Articles reporting research may be full length or brief reports. These should report original research findings within the journal's scope. Papers should generally be a maximum of 4000 words in length, excluding tables, references, and abstract and key points of the article, whilst it is recommended that the number of references should not exceed 36.

Archives of Gerontology and Geriatrics, Sep 1, 2023

Psychiatric Clinics of North America, Mar 1, 2017

Transgender and gender nonconforming (TGNC) identities are gaining visibility in contemporary soc... more Transgender and gender nonconforming (TGNC) identities are gaining visibility in contemporary society. Although many of the more nuanced experiences of identifying as transgender remain obscured, there is growing recognition among researchers, clinicians, trans activists, and their allies that gender is multidimensional and not binary. 1,2

Children and Youth Services Review, May 1, 2016

This pilot study sought to evaluate the feasibility and effectiveness of a brief, eight module af... more This pilot study sought to evaluate the feasibility and effectiveness of a brief, eight module affirmative cognitive behavioral coping skills group intervention (AFFIRM) with sexual and gender minority youth (SGMY) developed through community partnerships. A diverse sample of SGMY (n = 30) participated in the AFFIRM pilot and completed reliable measures of depression, reflective coping, and stress appraisal at three time points. Over the study duration, significant reductions were found in depression and appraising stress as a threat. Significant increases were found in reflective coping and perceiving stress as a challenge. Participants found the intervention to be valuable and reported high levels of acceptability and skills acquisition. These promising findings suggest that AFFIRM has potential effectiveness as a community-based intervention for SGMY. Implications for practice and research are provided.

Oxford University Press eBooks, Mar 1, 2019

Lesbian, gay, bisexual, and transgender (LGBT) youth exist in a developmental context of emerging... more Lesbian, gay, bisexual, and transgender (LGBT) youth exist in a developmental context of emerging and shifting identities. This chapter reviews the mental health disparities experienced by LGBT youth. It examines their experiences of minority stress and considers the impact of their family and peer relationships on their identities. Also included is a discussion of affirmative cognitive–behavioral therapy (A-CBT) for LGBT youth, containing detailed clinical examples. The chapter concludes with emerging trends for evidence-based mental health practice with LGBT youth, such as a focus on resilience and the use of information and communication technologies.

Journal of Gay and Lesbian Social Services, Jan 2, 2017

Little is known about the experiences of lesbian, gay, bisexual, transgender, and questioning (LG... more Little is known about the experiences of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students attending religious colleges and universities. This study used grounded theory to analyze the narratives (N = 271) of LGBTQ former and current students. The central theme described by LGBTQ students was a fight for survival with five subthemes: (a) institutionalized homo/transphobia (strict school policies, enforcement of heterosexuality and gender conformity through discipline, conversion therapy); (b) a culture of fear (fear of exposure, homophobic panic and code words, seeking cover); (c) marginalization and isolation; (d) struggle (suffering and suicide, reconciling faith and LGBTQ identity); and (e) coping and resilience (surviving through critical thinking and strategic activism). Implications for practice are provided.

Clinical Social Work Journal, Dec 22, 2012

Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depressi... more Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depression, anxiety, substance abuse, and suicidality. However, there has been a disconnect between clinical social work practice and research with SMY, resulting in a lack of rigorous research that demonstrates the use of effective interventions. While cognitive behavioral therapy (CBT) has long been established as a best practice option for the general adolescent population suffering from mental health problems, knowledge about the use of CBT with SMY lags far behind. Thus, the purpose of this article is to present a clearly defined adaptation of CBT for SMY that integrates gay affirmative practices for youth (e.g., coming out, stigma and discrimination, the role of social support and community). Specifically, the authors: (a) discuss the impact of minority stress on SMY; (b) highlight the specific components of CBT that represent a good fit for SMY and also address the criticisms of using such an approach; (c) consider the importance of using gay affirmative practices with SMY; and (d) offer recommendations for incorporating gay affirmative practices into traditional CBT models to better meet the needs of SMY.

Groupwork, Dec 4, 2020

The current study examined the efficacy of an affirmative group cognitive behavioral intervention... more The current study examined the efficacy of an affirmative group cognitive behavioral intervention on the sexual self-efficacy level of sexual and gender minority youths (SGMY). SGMY (n=30) between the age of 15 and 18 participated in a series of eight cognitive behavioral-focused groups. They also completed measures on sexual self-efficacy before and after the intervention. Paired sample t-test was chosen as method of analysis. The results indicated a statistically significant increase in protection sexual self-efficacy but not in abstinence sexual self-efficacy post intervention.The current study concluded that affirmative groups that utilize cognitive behavioral therapy show promise for SGMY. Group content and process is detailed, and key components of groups designed to improve the sexual health of SGMY are discussed.

Journal of evidence-informed social work, Apr 29, 2015

When empirically supported treatments (ESTs) are effectively adapted for use with minority popula... more When empirically supported treatments (ESTs) are effectively adapted for use with minority populations, they may be more efficacious. As such, there is a need to adapt existing ESTs for use with diverse sexual and gender minority youth (SGMY). The unique bias-based challenges faced by SGMY require the integration of affirmative practices into ESTs to effectively address the specific needs of this underserved group of youth. The primary purpose of the authors in this article is to present a clearly articulated stakeholder driven model for developing an affirmative adapted version of cognitive behavioral therapy (CBT) for use with diverse SGMY. The authors' approach to adaptation follows the "adapt and evaluate" framework for enhancing cultural congruence of interventions for minority groups. A community based participatory research approach, consistent with a stakeholder driven process, is utilized to develop the intervention from the ground up through the voices of the target community. Researchers conducted 3 focus groups with culturally diverse SGMY to explore salient aspects of youths' cultural and SGM identities in order to inform the intervention and ensure its applicability to a wide range of SGMY. Focus group data is analyzed and integrated into an existing group-based CBT intervention. The following themes emerge as critical to affirmative work with diverse SGMY: (1) the interplay between cultural norms, gender norms, sexual orientation, and gender identity; (2) the complex role of religious community within the lives of SGMY; and (3) consideration of extended family and cultural community as youth navigate their SGM identities.

Children and Youth Services Review, 2021

Abstract Lesbian, gay, bisexual, transgender, or questioning (LGBTQ+) youth are notably overrepre... more Abstract Lesbian, gay, bisexual, transgender, or questioning (LGBTQ+) youth are notably overrepresented in the foster care system, often entering the child welfare system because of abuse or neglect associated with familial rejection of youths’ sexual orientation, gender identity, and/or gender expression. LGBTQ+ foster youth are often exposed to identity-based victimization within the foster care system. There is a call for evidence-informed interventions aimed at improving the well-being of LGBTQ+ youth in systems of care. This study examines the initial effectiveness of AFFIRM Caregiver, a 7-session, manualized intervention aimed at enhancing affirmative parenting practices among foster parents. AFFIRM Caregiver was delivered to foster parents (n = 103) at two U.S. sites. Findings indicate significant improvements in affirmative caregiving attitudes, behaviors, and self-efficacy at post-test, as well as at the 3-month follow-up assessment. Given positive preliminary results, AFFIRM Caregiver represents a promising option to address a particularly notable challenge to the safety and well-being of LGBTQ+ youth in care.

British Journal of Social Work, Oct 24, 2020

Party-n-Play (PNP) refers to sex between gay and bisexual men that occurs under the influence of ... more Party-n-Play (PNP) refers to sex between gay and bisexual men that occurs under the influence of drugs. Growing evidence suggests gay and bisexual men who PNP experience significant stigma and social exclusion. Less is known about the resilience of this population. Utilising critical discourse analysis, this study examined how gay and bisexual men who PNP talk about social exclusion and resilience in their lives. In-depth one-hour interviews were conducted with forty-four gay and bisexual men who lived in Toronto, and who used various drugs before or during sex with another man in the previous month. Study findings revealed that social exclusion was perpetuated through discourses of stigma, deviance, morality, heteronormativity, homophobia, racism, classism, risk and policing. These discourses also negatively affected participants’ interactions with health care providers. However, many participants evoked resilience discourses and described social bonds, friendships and relations of care in their networks. Social work professionals would benefit from examining the roles of social exclusion, as well as stigmatising and pathologising discourses in their practice. These findings also underscore the need for culturally sensitive social work interventions for this population that address social exclusion and foster resilience.

Social Work in Health Care, Jul 11, 2017

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

Social Work Education, Mar 4, 2016

Background There has been substantial progress and momentum related to lesbian, gay, bisexual, tr... more Background There has been substantial progress and momentum related to lesbian, gay, bisexual, transgender, and queer (LGBTQ) equality and civil rights in the United States over the past four decades. In June 2015, the US Supreme Court ruled that the right to marriage is a fundamental right for all, and that bans on marriage for LGBTQ individuals are unconstitutional ABSTRACT Social work programs must effectively meet the needs of their diverse lesbian, gay, bisexual, transgender, and queer (LGBTQ) student populations as well as effectively train all students to work with minority groups including the LGBTQ community. While many undergraduate and graduate social work programs provide open, supportive, and affirming experiences for LGBTQ students, there remain ongoing challenges related to hostility, stigma, heterosexism, and homophobia within classroom settings across programs in the US and Canada. This study examines classroom experiences of homophobia among 1,018 social work students. Qualitative data associated with three optional open-ended questions were analyzed utilizing grounded theory. Main qualitative findings identified several major themes associated with social work student experiences of homophobia in the classroom including: (1) Coming out; (2) Faculty inaction; (3) Implicit and explicit content; (4) Direct language and actions; and (5) Religious rationalizations and non-affirming positions. Conclusions and recommendations for social work education are discussed that center around creating safe and affirming classroom settings; the vital role of out faculty, students, and allies; impactful integration of diversity content within curricula, policies, and accreditation standards; ongoing training and mentorship; understanding the role of power and oppression; and a call to action among social work educators and the profession.

Background: Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to the... more Background: Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential. Objective: The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY. Methods: SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol. Results: Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre-and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed.

Social Work Education, Feb 28, 2021

Social work students are expected to engage diversity and difference in practice, yet few approac... more Social work students are expected to engage diversity and difference in practice, yet few approaches in social work education explicitly focus on strengthening skills required for such allyship eng...

Social Work in Health Care, Jul 11, 2017

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

Social Work in Health Care, May 18, 2015

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

Social Work in Health Care, Apr 1, 2013

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

Clinical Social Work Journal, Feb 5, 2013

Although transgender clients seek services in a number of settings in which social workers practi... more Although transgender clients seek services in a number of settings in which social workers practice, there is a dearth of scholarly literature available to guide effective clinical practice with this population. When transgender issues are included in the practice literature, the trend has been to consolidate the needs of transgender clients with those of the larger lesbian, gay, and bisexual community or to simply focus on increasing the comfort level of clinicians working with this population. This is concerning because transgender individuals represent a vulnerable subgroup of clients with unique and specific treatment needs related to the transition experience. Social workers play a critical role; they may serve transgender clients and their families in many ways: as advocate, educator, diagnostician, and individual, couples or family therapist. The purpose of this article is to identify several key components of trans-specific clinical practice and the role of social workers in supporting and facilitating client transition. Specifically, the authors will discuss: (a) relevant definitions and terminology, (b) emerging issues related to depathologizing the needs and experiences of transgender individuals, (c) the critical elements of transspecific clinical assessment, and (d) clinical advocacy associated with the medical legal and social aspects of the transition process. Specific recommendations for transaffirmative social work practice will be offered.

Health & Social Work, Jan 30, 2013

Social workers delivering services in health care settings face unique challenges and opportuniti... more Social workers delivering services in health care settings face unique challenges and opportunities. The purpose of this study was to solicit input from social workers employed in urban hospitals about their perceptions of the roles, contribution, and professional functioning of social work in a rapidly changing health care environment. Using qualitative methods, the university and hospital-based research team conducted seven focus groups (n = 65) at urban hospitals and analyzed the data using an interpretive framework with ATLAS.ti software. Seven major themes emerged from the participants' description of their roles: bouncer, janitor, glue, broker, firefighter, juggler, and challenger. Along with descriptions of the ways social workers fulfilled those roles, participants articulated differences in status within those roles, the increasing complexity of discharge planning, and expectations to provide secondary support to other health care professionals on their teams. Implications for practice and research are discussed.

Population medicine, Apr 27, 2023

Population Medicine considers the following types of articles: • Research Papers-reports of data ... more Population Medicine considers the following types of articles: • Research Papers-reports of data from original research or secondary dataset analyses. • Review Papers-comprehensive, authoritative, reviews within the journal's scope. These include both systematic reviews and narrative reviews. • Short Reports-brief reports of data from original research. • Policy Case Studies-brief articles on policy development at a regional or national level. • Study Protocols-articles describing a research protocol of a study. • Methodology Papers-papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation. • Methodology Papers-papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation. • Letters to the Editor-a response to authors of an original publication, or a very small article that may be relevant to readers. • Editorials-articles written by the Editorial Board or by invited experts on a specific topic. Research Papers Articles reporting research may be full length or brief reports. These should report original research findings within the journal's scope. Papers should generally be a maximum of 4000 words in length, excluding tables, references, and abstract and key points of the article, whilst it is recommended that the number of references should not exceed 36.

Archives of Gerontology and Geriatrics, Sep 1, 2023

Psychiatric Clinics of North America, Mar 1, 2017

Transgender and gender nonconforming (TGNC) identities are gaining visibility in contemporary soc... more Transgender and gender nonconforming (TGNC) identities are gaining visibility in contemporary society. Although many of the more nuanced experiences of identifying as transgender remain obscured, there is growing recognition among researchers, clinicians, trans activists, and their allies that gender is multidimensional and not binary. 1,2

Children and Youth Services Review, May 1, 2016

This pilot study sought to evaluate the feasibility and effectiveness of a brief, eight module af... more This pilot study sought to evaluate the feasibility and effectiveness of a brief, eight module affirmative cognitive behavioral coping skills group intervention (AFFIRM) with sexual and gender minority youth (SGMY) developed through community partnerships. A diverse sample of SGMY (n = 30) participated in the AFFIRM pilot and completed reliable measures of depression, reflective coping, and stress appraisal at three time points. Over the study duration, significant reductions were found in depression and appraising stress as a threat. Significant increases were found in reflective coping and perceiving stress as a challenge. Participants found the intervention to be valuable and reported high levels of acceptability and skills acquisition. These promising findings suggest that AFFIRM has potential effectiveness as a community-based intervention for SGMY. Implications for practice and research are provided.

Oxford University Press eBooks, Mar 1, 2019

Lesbian, gay, bisexual, and transgender (LGBT) youth exist in a developmental context of emerging... more Lesbian, gay, bisexual, and transgender (LGBT) youth exist in a developmental context of emerging and shifting identities. This chapter reviews the mental health disparities experienced by LGBT youth. It examines their experiences of minority stress and considers the impact of their family and peer relationships on their identities. Also included is a discussion of affirmative cognitive–behavioral therapy (A-CBT) for LGBT youth, containing detailed clinical examples. The chapter concludes with emerging trends for evidence-based mental health practice with LGBT youth, such as a focus on resilience and the use of information and communication technologies.

Journal of Gay and Lesbian Social Services, Jan 2, 2017

Little is known about the experiences of lesbian, gay, bisexual, transgender, and questioning (LG... more Little is known about the experiences of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students attending religious colleges and universities. This study used grounded theory to analyze the narratives (N = 271) of LGBTQ former and current students. The central theme described by LGBTQ students was a fight for survival with five subthemes: (a) institutionalized homo/transphobia (strict school policies, enforcement of heterosexuality and gender conformity through discipline, conversion therapy); (b) a culture of fear (fear of exposure, homophobic panic and code words, seeking cover); (c) marginalization and isolation; (d) struggle (suffering and suicide, reconciling faith and LGBTQ identity); and (e) coping and resilience (surviving through critical thinking and strategic activism). Implications for practice are provided.

Clinical Social Work Journal, Dec 22, 2012

Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depressi... more Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depression, anxiety, substance abuse, and suicidality. However, there has been a disconnect between clinical social work practice and research with SMY, resulting in a lack of rigorous research that demonstrates the use of effective interventions. While cognitive behavioral therapy (CBT) has long been established as a best practice option for the general adolescent population suffering from mental health problems, knowledge about the use of CBT with SMY lags far behind. Thus, the purpose of this article is to present a clearly defined adaptation of CBT for SMY that integrates gay affirmative practices for youth (e.g., coming out, stigma and discrimination, the role of social support and community). Specifically, the authors: (a) discuss the impact of minority stress on SMY; (b) highlight the specific components of CBT that represent a good fit for SMY and also address the criticisms of using such an approach; (c) consider the importance of using gay affirmative practices with SMY; and (d) offer recommendations for incorporating gay affirmative practices into traditional CBT models to better meet the needs of SMY.

Groupwork, Dec 4, 2020

The current study examined the efficacy of an affirmative group cognitive behavioral intervention... more The current study examined the efficacy of an affirmative group cognitive behavioral intervention on the sexual self-efficacy level of sexual and gender minority youths (SGMY). SGMY (n=30) between the age of 15 and 18 participated in a series of eight cognitive behavioral-focused groups. They also completed measures on sexual self-efficacy before and after the intervention. Paired sample t-test was chosen as method of analysis. The results indicated a statistically significant increase in protection sexual self-efficacy but not in abstinence sexual self-efficacy post intervention.The current study concluded that affirmative groups that utilize cognitive behavioral therapy show promise for SGMY. Group content and process is detailed, and key components of groups designed to improve the sexual health of SGMY are discussed.

Journal of evidence-informed social work, Apr 29, 2015

When empirically supported treatments (ESTs) are effectively adapted for use with minority popula... more When empirically supported treatments (ESTs) are effectively adapted for use with minority populations, they may be more efficacious. As such, there is a need to adapt existing ESTs for use with diverse sexual and gender minority youth (SGMY). The unique bias-based challenges faced by SGMY require the integration of affirmative practices into ESTs to effectively address the specific needs of this underserved group of youth. The primary purpose of the authors in this article is to present a clearly articulated stakeholder driven model for developing an affirmative adapted version of cognitive behavioral therapy (CBT) for use with diverse SGMY. The authors' approach to adaptation follows the "adapt and evaluate" framework for enhancing cultural congruence of interventions for minority groups. A community based participatory research approach, consistent with a stakeholder driven process, is utilized to develop the intervention from the ground up through the voices of the target community. Researchers conducted 3 focus groups with culturally diverse SGMY to explore salient aspects of youths' cultural and SGM identities in order to inform the intervention and ensure its applicability to a wide range of SGMY. Focus group data is analyzed and integrated into an existing group-based CBT intervention. The following themes emerge as critical to affirmative work with diverse SGMY: (1) the interplay between cultural norms, gender norms, sexual orientation, and gender identity; (2) the complex role of religious community within the lives of SGMY; and (3) consideration of extended family and cultural community as youth navigate their SGM identities.

Children and Youth Services Review, 2021

Abstract Lesbian, gay, bisexual, transgender, or questioning (LGBTQ+) youth are notably overrepre... more Abstract Lesbian, gay, bisexual, transgender, or questioning (LGBTQ+) youth are notably overrepresented in the foster care system, often entering the child welfare system because of abuse or neglect associated with familial rejection of youths’ sexual orientation, gender identity, and/or gender expression. LGBTQ+ foster youth are often exposed to identity-based victimization within the foster care system. There is a call for evidence-informed interventions aimed at improving the well-being of LGBTQ+ youth in systems of care. This study examines the initial effectiveness of AFFIRM Caregiver, a 7-session, manualized intervention aimed at enhancing affirmative parenting practices among foster parents. AFFIRM Caregiver was delivered to foster parents (n = 103) at two U.S. sites. Findings indicate significant improvements in affirmative caregiving attitudes, behaviors, and self-efficacy at post-test, as well as at the 3-month follow-up assessment. Given positive preliminary results, AFFIRM Caregiver represents a promising option to address a particularly notable challenge to the safety and well-being of LGBTQ+ youth in care.

British Journal of Social Work, Oct 24, 2020

Party-n-Play (PNP) refers to sex between gay and bisexual men that occurs under the influence of ... more Party-n-Play (PNP) refers to sex between gay and bisexual men that occurs under the influence of drugs. Growing evidence suggests gay and bisexual men who PNP experience significant stigma and social exclusion. Less is known about the resilience of this population. Utilising critical discourse analysis, this study examined how gay and bisexual men who PNP talk about social exclusion and resilience in their lives. In-depth one-hour interviews were conducted with forty-four gay and bisexual men who lived in Toronto, and who used various drugs before or during sex with another man in the previous month. Study findings revealed that social exclusion was perpetuated through discourses of stigma, deviance, morality, heteronormativity, homophobia, racism, classism, risk and policing. These discourses also negatively affected participants’ interactions with health care providers. However, many participants evoked resilience discourses and described social bonds, friendships and relations of care in their networks. Social work professionals would benefit from examining the roles of social exclusion, as well as stigmatising and pathologising discourses in their practice. These findings also underscore the need for culturally sensitive social work interventions for this population that address social exclusion and foster resilience.

Social Work in Health Care, Jul 11, 2017

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

Social Work Education, Mar 4, 2016

Background There has been substantial progress and momentum related to lesbian, gay, bisexual, tr... more Background There has been substantial progress and momentum related to lesbian, gay, bisexual, transgender, and queer (LGBTQ) equality and civil rights in the United States over the past four decades. In June 2015, the US Supreme Court ruled that the right to marriage is a fundamental right for all, and that bans on marriage for LGBTQ individuals are unconstitutional ABSTRACT Social work programs must effectively meet the needs of their diverse lesbian, gay, bisexual, transgender, and queer (LGBTQ) student populations as well as effectively train all students to work with minority groups including the LGBTQ community. While many undergraduate and graduate social work programs provide open, supportive, and affirming experiences for LGBTQ students, there remain ongoing challenges related to hostility, stigma, heterosexism, and homophobia within classroom settings across programs in the US and Canada. This study examines classroom experiences of homophobia among 1,018 social work students. Qualitative data associated with three optional open-ended questions were analyzed utilizing grounded theory. Main qualitative findings identified several major themes associated with social work student experiences of homophobia in the classroom including: (1) Coming out; (2) Faculty inaction; (3) Implicit and explicit content; (4) Direct language and actions; and (5) Religious rationalizations and non-affirming positions. Conclusions and recommendations for social work education are discussed that center around creating safe and affirming classroom settings; the vital role of out faculty, students, and allies; impactful integration of diversity content within curricula, policies, and accreditation standards; ongoing training and mentorship; understanding the role of power and oppression; and a call to action among social work educators and the profession.

Background: Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to the... more Background: Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential. Objective: The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY. Methods: SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol. Results: Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre-and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed.

Social Work Education, Feb 28, 2021

Social work students are expected to engage diversity and difference in practice, yet few approac... more Social work students are expected to engage diversity and difference in practice, yet few approaches in social work education explicitly focus on strengthening skills required for such allyship eng...

Social Work in Health Care, Jul 11, 2017

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

Social Work in Health Care, May 18, 2015

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

Social Work in Health Care, Apr 1, 2013

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

Clinical Social Work Journal, Feb 5, 2013

Although transgender clients seek services in a number of settings in which social workers practi... more Although transgender clients seek services in a number of settings in which social workers practice, there is a dearth of scholarly literature available to guide effective clinical practice with this population. When transgender issues are included in the practice literature, the trend has been to consolidate the needs of transgender clients with those of the larger lesbian, gay, and bisexual community or to simply focus on increasing the comfort level of clinicians working with this population. This is concerning because transgender individuals represent a vulnerable subgroup of clients with unique and specific treatment needs related to the transition experience. Social workers play a critical role; they may serve transgender clients and their families in many ways: as advocate, educator, diagnostician, and individual, couples or family therapist. The purpose of this article is to identify several key components of trans-specific clinical practice and the role of social workers in supporting and facilitating client transition. Specifically, the authors will discuss: (a) relevant definitions and terminology, (b) emerging issues related to depathologizing the needs and experiences of transgender individuals, (c) the critical elements of transspecific clinical assessment, and (d) clinical advocacy associated with the medical legal and social aspects of the transition process. Specific recommendations for transaffirmative social work practice will be offered.

Health & Social Work, Jan 30, 2013

Social workers delivering services in health care settings face unique challenges and opportuniti... more Social workers delivering services in health care settings face unique challenges and opportunities. The purpose of this study was to solicit input from social workers employed in urban hospitals about their perceptions of the roles, contribution, and professional functioning of social work in a rapidly changing health care environment. Using qualitative methods, the university and hospital-based research team conducted seven focus groups (n = 65) at urban hospitals and analyzed the data using an interpretive framework with ATLAS.ti software. Seven major themes emerged from the participants' description of their roles: bouncer, janitor, glue, broker, firefighter, juggler, and challenger. Along with descriptions of the ways social workers fulfilled those roles, participants articulated differences in status within those roles, the increasing complexity of discharge planning, and expectations to provide secondary support to other health care professionals on their teams. Implications for practice and research are discussed.