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Students minoritised because of their race and/or ethnicity have a different university experience from their peers, which is reflected in degree completion statistics, awarding gaps, and graduate outcomes. One factor influencing these outcomes is students' sense of inclusion and belonging with the university, which is lower in minoritised students. We aimed to identify whether barriers to inclusion were present across students and alumni in one university, and whether this varied according to ethnic and/or racial backgrounds. Three-hundred and twenty-three students and alumni completed an online questionnaire measuring students' belonging, experience of the curriculum and microaggressions, and 14 students and alumni attended focus groups to further explore the barriers to inclusion and belonging, and proposed recommended actions to reduce these barriers. From the questionnaire, ethnicity and/or race did not influence students' sense of belonging, experience of the curriculum or microaggressions, though having a long-term health condition was consistently associated with these outcomes. However, students' culture and ethnicity/race were consistently reported as factors associated with experiencing obstacles in academia and microaggressions. From the focus groups, three key themes emerged: 1) Hidden racism at the university, which included a prevailing nature of microaggressions and 2) Eurocentric curriculum; that representation is valued in the community and curriculum; and 3) The role of diversity and inclusion initiatives for building community. These findings are discussed in terms of their impact for Higher Education institutions. [ABSTRACT FROM AUTHOR]

Speech-language pathologists (SLPs) utilize counseling to support the psychological wellbeing of people with post-stroke aphasia, however, SLPs receive variable, usually limited, counseling education. Counseling education may be effective in improving SLPs' knowledge, skills, and confidence in counseling in post-stroke aphasia. We aimed to evaluate the feasibility and preliminary efficacy of a novel online counseling education program for SLPs working with people with post-stroke aphasia. Our study was a Phase II, two-arm pilot randomized controlled trial with a waitlist control. Participants (n = 49) were stratified by previous counseling training (≥1 day) and co-work with psychologists when addressing psychological wellbeing in post-stroke aphasia, and randomized to either the education program or waitlist control arm. We developed an education program (7-hours self-directed learning; 3-hour online workshop) for the trial. Feasibility outcomes included SLP recruitment, workshop attendance, and participant attrition at follow-up. Participants' counseling self-efficacy and self-rated competency were assessed pre- and post-program (primary endpoint) and at 5-week follow-up. Forty-four (90%) participants attended the workshop with forty-one (84%) participants completing the trial. There was a significant interaction (large effect size) between time and group supporting a positive effect of the program on counseling self-efficacy, F(1,44) = 39.402, p <. 0005, ηp2 =. 472 and self-rated competency for counseling, F(1,44) = 31.824, p <. 0005, ηp2 =. 420. The effects were maintained at follow-up with self-rated competency scores demonstrating further significant improvement. The demonstrated feasibility and preliminary efficacy of this online counseling program warrant a future definitive trial. [ABSTRACT FROM AUTHOR]

There is increasing pressure within universities to address student mental health. From a whole university or settings-based perspective, this could include curriculum-embedded approaches. There is little research about how this should work or what approaches might be most effective. Semi -structured interviews were conducted with fifty-seven undergraduate students from five disciplines (Psychology, English studies, Nursing, International Politics, and War Studies) to understand students' perspectives. Students reflected on wellbeing module content and, more broadly, on curriculum processes (teaching, pedagogy, assessment) within their degree. Reflexive thematic analysis was applied to transcripts, generating three themes: embedding wellbeing in the curriculum; assessment, challenge, and academic support; and social connection and interaction. The findings provide evidence for teaching, pedagogy, and assessment practices supporting higher education student wellbeing. These align with recommended good teaching practices, such as considering appropriate assessment methods followed by effective feedback. Students saw the benefits of being academically challenged if scaffolded appropriately. Strong peer connection, teacher-student interaction, and communication were crucial to learning and wellbeing. These findings provide implications for future curriculum design that can support learning and wellbeing. [ABSTRACT FROM AUTHOR]

Purpose: Although speech-language pathologists have provided genderaffirming voice training for trans women since the 1970s, evidence for this training’s effectiveness remains weak. Our study aimed to redress limitations of earlier studies and evaluate voice training effects on outcomes important to trans women. Method: Seventy-four trans women (19–54 years old) who wanted a more female-sounding voice were recruited through two health facilities and provided with an eight- to 12-session voice training program based on contemporary literature, usual clinical practice, and client-centered care principles. Self-reported outcomes and an audio-recorded reading sample were collected 3 months before, immediately before and after, and 3 months after training. Forty cisgender speakers were audio-recorded reading the same sample material as comparison voices. Seventy-nine naive listeners made gender-related voice ratings of an extract from these audio recordings. Training effectiveness was evaluated using group-level analyses (linear mixed-effects models) and individual-level analyses to establish what proportion of participants improved to a predetermined relevant degree. Results: Group-level analyses demonstrated positive training effects, maintained 3 months posttraining, for trans women’s vocal satisfaction, perceptions of voice-related social participation, and self- and listener perceptions of their voices. Individual-level analyses also demonstrated positive effects. Two thirds of trans women increased vocal satisfaction to a relevant degree, one third who reported restricted social participation before training reduced this restriction to a relevant degree, and all were rated more female-sounding after training (although not all to a relevant degree). Conclusions: All trans women participants made progress toward their voice goals and maintained those gains at follow-up. These findings provide evidence that gender-affirming speech-language pathology services warrant prioritization. Further research is warranted to investigate factors predicting outcomes of voice training for trans women. [ABSTRACT FROM AUTHOR]

In university settings, peer support brings people together based on their student identity. Peer support has been advocated as an innovative intervention to aid student mental health and wellbeing as part of a whole university approach, especially post-pandemic when student support is critical. While the literature describes three types of university peer support for student mental health and wellbeing, peer-led support groups, peer mentoring, and peer learning, the sector lacks agreed definitions for these interventions. Formal reporting on peer support initiatives is rare, suggesting further types of peer support practice may exist. This qualitative study, comprising semi-structured interviews with 16 university staff members at 14 different institutions, aimed to generate comprehensive definitions of the types of peer support used in the sector through template analysis. The study also sought to understand the current practice, experiences, and challenges around implementing peer support interventions for undergraduate and postgraduate students' mental health and wellbeing from the perspective of the staff who support and coordinate these programmes. Five types of peer support were identified and defined. In addition, the challenges of engagement, resource and capacity, and evaluation were highlighted. Finally, lessons learnt provided potential ways to address the challenges outlined and provided sector guidance for further developing peer support as part of a whole university approach to student mental health and wellbeing. [ABSTRACT FROM AUTHOR]

Legions of foreign musicians have toured Australia in an effort to transplant old musical cultures. One such tour was undertaken by Granville Bantock in late 1938 to further the examinations business of Trinity College of Music, London. As argued in this article, however, there was more to his visit than meets the eye: it was an attempt by Bantock to secure new audiences for his music. The press's role in this tour was marked by fawning journalists reporting on the composer's endorsement of local music-making as evidence of Australia's musical maturity. Bantock's music was celebrated by the press except for one journalist, who condemned his peddling of old-fashioned music in a modern Australia. Although Bantock's visit to Australia in late 1938 was designed to promote Trinity College, it was in fact an exercise in cultural mobility, and the replication of a certain style of British music that invoked narratives concerning the cultural cringe in which Bantock, and most of the press, were complicit. [ABSTRACT FROM AUTHOR]

Speech-language pathology practice guidelines recommend competency in counselling to support psychological adjustment and well-being in people with communication disability. However, there is limited information about what counselling education speech-language pathology students need or receive to attain this competency. Speech-language pathologists report that they frequently use counselling to support psychological well-being in people with post-stroke aphasia, a patient group particularly vulnerable to mood disorders, but they also report low knowledge, skill, and confidence in this practice. We aimed to describe the content, methods, duration, and evaluation of counselling education currently offered to Australian speech-language pathology students, including education specifically aimed at supporting the psychological well-being of people with post-stroke aphasia. Directors of all accredited speech-language pathology programs (N = 21) across 15 eligible Australian Universities were invited to participate in an online survey. Responses from 12 of the 21 eligible (57%) programs were obtained. Ten programs (83%) reported offering counselling education with four programs (33%) offering this specifically for people affected by post-stroke aphasia. Most programs provided over 10 hours of counselling coursework but provided less than 3 hours of counselling observation and practicum. Teaching on a variety of counselling topics was reported, most commonly general principles of counselling, while specific approaches included motivational interviewing and cognitive behavioural therapy. Counselling was taught using a range of methods, most frequently problem-based learning and role-play. Student counselling knowledge, skills, and competence were evaluated by written assignment, review of video/written transcripts of role-play, oral presentation, and problem-based learning (case studies) group discussion. Academics had mixed opinions on graduate competency for counselling. While the majority of university programs reported providing counselling education, few offered education to support the psychological needs of people specifically affected by post-stroke aphasia. Some courses offered no counselling education. Minimum standards of counselling education for speech-language pathology students are required to ensure graduates are competent to provide counselling to support adjustment and well-being in people with communication disabilities. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To identify the importance of emergency nurses being able to provide appropriate care for patients who self-harm • To learn about the findings of a systematic review that examined the effects of educational interventions on emergency nurses' attitudes towards patients who self-harm • To recognise the need for improved training for emergency nurses on suicide and self-harm Negative nurse attitudes towards emergency department patients who self-harm may increase the risk of repeated self-harm and suicide. This article details a systematic review that aimed to examine the evidence on the efficacy of educational interventions to improve the attitudes of emergency nurses towards patients who self-harm. Eight articles describing six intervention studies, published between 2001 and 2018, met the criteria for inclusion. The review found that educational interventions for emergency nurses improved their attitudes to patients who self-harm, but there was a lack of consistency in the approaches used and a reliance on self-report measures. Further training for emergency nurses is needed because of their crucial role in self-harm and suicide prevention. [ABSTRACT FROM AUTHOR]

Background/Aim: Scales used to collect perceptual ratings related to a speaker's gender are widely used in gender affirming voice training for trans individuals. Such scales may be used as outcome measures to gain insight into whether training has helped clients meet personal goals related to gender expression. These scales are also widely used in general research investigating the relationship between vocal characteristics and perceptions of speaker gender. However, past studies in these areas have varied in the terminology used to label rating scales and the impact of this variation is currently unknown. Additionally, research has not yet fully explored the relationship between self- and listener ratings of trans participant voices and trans participant satisfaction with voice, and whether or not these relationships change after trans participants undertake gender affirming voice training. This research paper aimed to explore these relationships and address these research gaps. Methods: A group of 34 trans participants were asked to rate their voices before and after participating in gender affirming voice training. Trans participant voice samples from before and after training were also presented to a group of 25 listeners for rating. Perceptual ratings were made on two visual analogue scales (VAS) with anchors "very feminine/very masculine" and "very female/very male." Trans participants also rated their satisfaction with their current voice on a VAS with anchors "very satisfied/very unsatisfied." Correlation coefficients were calculated to investigate the relationship between collected ratings. Results: Differences in scale labels were found to have minimal impact on ratings made by both trans participants and listeners. Trans participant self-ratings were found to correlate with listener ratings, but this correlation was not strong. Trans participant self-ratings had a consistently stronger relationship with their self-rated vocal satisfaction. The study contributed new findings that these differences may be more pronounced after trans participants have completed voice training. Discussion/Conclusion: This study suggests that results from past studies that have used differently labelled scales to collect ratings related to gender perception based on voice are suitable to compare. This study also discusses the implications reported differences between trans participant self-ratings and listener ratings may have for research and clinical practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Work-system participation and factors are associated with occupational vocal health for vocally reliant workers, such as sports coaches. However, there is limited use of systems approaches and worker collaboration to address occupational voice. OBJECTIVE: The current research aimed to cooperatively consider coaches' vocally reliant systems participation, including addressing vocal ergonomic factors that can create barriers for occupational vocal health and voice use. METHODS: Collaborative action inquiries explored vocal ergonomics with coaches (n = 24) from nine professional basketball teams. Across three basketball seasons, coaches and a subject matter expert identified what influenced coaches' voices and trialed approaches to optimize vocally reliant coaching participation. Nine action inquiry methods were used, including search conferences, ergonomic approaches to enhance systems participation, and focus groups. Multi-level analyses were also undertaken. RESULTS: Participants cooperatively generated, implemented, and evaluated different strategies. A cumulative total of 57 strategies were explored within teams (team mean = 6.33, SD = 3, range = 4–14). Cross-case analysis identified 25 different strategy types. Overall, participants appraised 31.58% (18/57) strategies as supportive (i.e., enhanced facilitators for voice), 61.40% (35/57) strategies as somewhat supportive (i.e., some enhanced facilitators and some ongoing barriers), and 7.02% (4/57) strategies as unsupportive (i.e., pervasive ongoing barriers not mitigated by strategies). Further, factors across coaches' work-systems continued to influence coaches' voices in dynamic and complex ways. CONCLUSIONS: Collaboration with coaches enriched vocal ergonomic approaches by providing novel, context-anchored insights. Collaboration should form 'part' of broader mechanisms to support coaches' voice use and vocal health at work. [ABSTRACT FROM AUTHOR]

Purpose: Health-care student resilience is a well-researched topic, although the concept continues to evolve, not least as "resilience-building" has become an expected feature of health-care student professional education. The study aimed to understand the concept of resilience from the point of view of student nurses and midwives. Design/methodology/approach: The study used a novel arts-informed method, informed by Miller's and Turkle's work on "evocative objects." A total of 25 student nurses and midwives from a London-based university selected "resilience objects" which were photographed and discussed during interviews with an artist-researcher. Findings: Analysis of the interviews revealed that "resilience" was founded on identity, connection, activity and protection. "Resilience objects" were used in everyday rituals and "resilience" was a characteristic that developed over time through the inhabiting of multiple identities. Practical implications: Given that resilience is intertwined with notions of identity, health-care faculties should enhance students' sense of identity, including, but not exclusively, nursing or midwifery professional identity, and invite students to develop simple rituals to cope with the challenges of health-care work. Originality/value: To the best of the authors' knowledge, this is the first study to locate health-care students' resilience in specific material objects. Novel insights are that health-care students used everyday rituals and everyday objects to connect to their sense of purpose and manage their emotions, as means of being resilient. [ABSTRACT FROM AUTHOR]

Objective: To determine whether treatment effectiveness can be established for a range of vocal cord dysfunction (VCD) interventions in adolescents and adults. Design: A systematic review of the literature and risk of bias appraisal was completed using the Joanna Briggs Institute Critical Appraisal Tools. Data were qualitatively synthesized in the broad intervention groups of glottic airway and respiratory retraining, pharmacological therapies, airway device therapies and psychological therapies. Data sources: Nine electronic databases, two clinical trial registries and the grey literature were searched from inception to September 2021 for articles on VCD interventions or equivalent terms. Eligibility criteria: Studies were included if they were randomized controlled trials, non‐randomized controlled trials, quasi‐experimental pre‐ and post‐test studies and within‐subject repeated measure designs, participants were 13 years or older, VCD was diagnosed using laryngoscopy or CT larynx, VCD intervention was provided and outcome measures reported on VCD symptoms. Results: The search yielded no randomized controlled trials. There were 17 quasi‐experimental studies that met the eligibility criteria, and these studies reported on glottic airway and respiratory retraining, botulinum toxin injections, inspiratory muscle strength training and amitriptyline; all were associated with VCD symptom reduction. In addition, 2 within‐subject repeated measure studies reported inspiratory muscle strength training and respiratory retraining to be effective in reducing symptoms in participants with exertional VCD. The included studies were reported in full‐text publications (11) and conference proceedings (8). There was a high risk of bias and low quality of evidence across all intervention areas. Conclusion: Glottic airway and respiratory retraining, botulinum toxin injections, low‐dose amitriptyline and inspiratory muscle strength training devices have been associated with symptom reduction in adults and adolescents with vocal cord dysfunction. Limited objective data exist to support the effectiveness of these interventions, and robust controlled trials are needed in this area. Systematic Review Registration: CRD42018092274 (PROSPERO). [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present a thematic analysis of student nurses' experiences of an innovative collaboration between a mental health Recovery College and a nursing faculty, where Recovery College trainers' expertise in co-production and peer facilitation were foregrounded. The aim of this study is to understand how nursing students experienced being peer facilitators of well-being workshops for fellow students following training with Recovery College trainers. Design/methodology/approach: Thematic analysis of qualitative data from eight semi-structured interviews and a focus group with 15 participants. Findings: The overarching theme that emerged was "The process of being a student Peer Facilitator". Six themes emerged from the data: "What we brought"; "Conceptualisation"; "Adaptation"; "we're giving them the tools"; "What we gained"; and "Development". Practical implications: Mental health nurse educators could forge collaborative relationships with Recovery College colleagues with a broader remit than service users' "lived experience" of mental distress. Student nurses should be given opportunities to be peer facilitators and draw on their lived experience as student nurses as means of addressing their and their peers' mental health. Originality/value: Original findings were that the student experience of being a peer facilitator was different to their other experiences in education and clinical practice. They drew on their lived experience throughout and found that they learned skills to address their well-being through supporting other students to improve theirs. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There are insufficient nurses to meet current demand for mental health care. This is an international concern. Within England, the impact of staff shortages on the quality of patient care in forensic high secure settings has been highlighted by the national regulatory body for hospitals.Forensic hospital nursing is a distinct specialism within mental health. Forensic nurses must negotiate the therapeutic, ethical and practical challenges of caring for high‐risk patients in a locked environment. What this paper adds to existing knowledge?: There has been no previous study to ask frontline high secure forensic nurses, union representatives, senior nurses and workforce leads about what factors may be affecting recruitment and retention in their setting.As well as the specialized and challenging nature of the work, participants identified that workforce sustainability was affected by unequal working terms and conditions, the hospital locations and wider national factors, such as changes to how nurse training was funded.They also identified that some strategies that were employed to address workforce shortages, such as day‐to‐day movement of staff within the hospital and incentive packages for new recruits could be demotivating for established staff. What are the implications for practice?: Forensic high secure nursing workforce strategies should include training, development and career pathways that are specific to the specialism and extend beyond preceptorship for newly qualified staff.There should be clear and equitable employment terms and conditions with remuneration packages that are consistent within and between organizations.Hospital managers should address the effect that movement of staff between wards may have on nurses' morale, therapeutic relationships and safety culture. Introduction: There has been no previous study of stakeholders' views on recruitment and retention concerns in high secure forensic settings. Aim: To identify factors affecting recruitment and retention in high secure hospitals, from the perspectives of stakeholders with experience in forensic mental health nursing. Method: Framework analysis of data from fifteen interviews and three focus groups with frontline nurses, nurse leaders, recruitment leads and union representatives from three high secure hospitals in England. Results: Six themes emerged from the data: (a) the unique nature of high secure nursing; (b) the impact of short staffing; (c) wider factors affecting the high secure nursing workforce; (d) the location; (e) staff being on different terms and conditions of work; (f) recruitment strategies. Discussion: Multiple factors are likely to simultaneously affect high secure hospital recruitment and retention. Findings on the unique nature of high secure work reflect previous qualitative research. The themes of location, working terms and condition and recruitment strategies have not been previously identified in forensic nursing research. Implications for practice: Employers should ensure that employment terms and conditions are equitable and consistent. Furthermore, hospital managers should address the effect that movement of staff between wards may have on morale and therapeutic relationships. [ABSTRACT FROM AUTHOR]

BACKGROUND: Coaches critically rely on voice for occupational functioning, which has associated risks to vocal health. However, vocal occupational health and safety (OHS) and vocal ergonomics are not typically considered for, by, or with coaches. OBJECTIVE: This study piloted a participatory approach to vocal ergonomics, aiming to collaboratively (i) understand coaches' vocally reliant occupational participation, and (ii) consider vocal ergonomic factors. METHODS: This research was undertaken at an international tournament for floorball (also known as 'Innebandy', 'Salibandy', or 'Unihockey'). Three national coaches (n = 3) and the lead researcher undertook cooperative action inquiry. This piloted a participatory vocal ergonomics programme. Action inquiry methods included fieldnotes, interviews, observations, a workshop, ergonomics approaches, and a focus group. Multi-level analyses supported the findings, including categorical aggregation, direct interpretation, and reflexive thematic analysis. RESULTS: Participants identified vocal ergonomic factors present at the tournament; including personal, activity, physical environmental, and organisational factors. Participants developed four vocal ergonomic approaches responsive to factors. These were: (1) player consultation, (2) ongoing feedback discussions, (3) movement and postural change, and (4) specific task adaptation. Approaches 1–2 directly supported coaches' voices. Coaches posited limitations to other strategies, but made recommendations for future use. Coaches also reflected that this collaboration provided actionable voice insights and opportunities to address vocal ergonomics. They advocated for extended engagement with coaches, increased focus on vocal health, and inclusion of early career coaches in future programmes. CONCLUSIONS: These findings support engagement of coaches, and other vocally reliant workers, in addressing voice use and vocal health at work. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore how student nurses conceptualise their well-being and their views on how to improve student nurses' well-being. Design/methodology/approach: Qualitative inquiry using semi-structured interviews with 17 final year students. Tran-scripts were thematically analysed using Braun and Clark's six-phase approach. Findings: Three themes were identified as follows: "student nurses" "experience of the university", "the meaning of student nurse well-being" and "how the faculty could improve student well-being". The findings are interpreted with reference to notions of social capital and a sense of belonging. Practical implications: University nursing programmes should embed approaches to student well-being. Higher education institutions should ensure that their social and pastoral offer is accessible and relevant to nursing students. Originality/value: The study offers unique insight into student nurses' self-concept as "university students" in the context of their well-being. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to examine associations between speaking fundamental frequency (fos), vowel formant frequencies (F), listener perceptions of speaker gender, and vocal femininity--masculinity. Method: An exploratory study was undertaken to examine associations between fos, F1-F3, listener perceptions of speaker gender (nominal scale), and vocal femininity-masculinity (visual analog scale). For 379 speakers of Australian English aged 18-60 years, fos mode and F1-F3 (12 monophthongs; total of 36 Fs) were analyzed on a standard reading passage. Seventeen listeners rated speaker gender and vocal femininity--masculinity on randomized audio recordings of these speakers. Results: Model building using principal component analysis suggested the 36 Fs could be succinctly reduced to seven principal components (PCs). Generalized structural equation modeling (with the seven PCs of F and fos as predictors) suggested that only F2 and fos predicted listener perceptions of speaker gender (male, female, unable to decide). However, listener perceptions of vocal femininity--masculinity behaved differently and were predicted by F1, F3, and the contrast between monophthongs at the extremities of the F1 acoustic vowel space, in addition to F2 and fos. Furthermore, listeners' perceptions of speaker gender also influenced ratings of vocal femininity-- masculinity substantially. Conclusion: Adjusted odds ratios highlighted the substantially larger contribution of F to listener perceptions of speaker gender and vocal femininity--masculinity relative to fos than has previously been reported. [ABSTRACT FROM AUTHOR]

In this paper, we share the results of a cross-institutional study considering the impact serving as a peer mentor has on upper-level undergraduate students. Using a focus group methodology, we interviewed students in peer mentoring programs at two universities with the goal of identifying commonalities between the two sites regarding the benefits and challenges associated with serving in a peer mentoring capacity. Findings indicate that students acquired benefits in three broad categories: relational knowledge, self-awareness, and career development. Students faced challenges in three broad categories: learning the mentor role, relating to students, and student engagement. While differences in results can be attributed to programmatic variations, similarities suggest outcomes that could be generalizable to multiple programs and universities. [ABSTRACT FROM AUTHOR]

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Background: Fibreoptic endoscopic evaluation of swallowing (FEES) is an imaging technique used by speech-language pathologists (SLPs) and some other health professionals to assess swallowing. Objectives: The primary aim was to gain an insight into FEES practices in Australia by characterising SLPs who use FEES and identifying areas of consistency and variation in practice. The secondary aim was to explore factors associated with variation in practice. Method: Cross-sectional survey methodology was used. The link to a web-based survey was e-mailed to 351 SLPs who practised in adult dysphagia. Results: The participation rate for the study was 18.8% (n = 66). Twenty-two SLPs (38.6%) used FEES. These SLPs represented a cross-section of workplace settings, caseloads, clinical and training experiences. Consistency and variation in FEES procedural and assessment practices were identified. Some procedural aspects of FEES varied according to whether a medical practitioner was present, type of FEES training, and number of FEES conducted per month. Conclusion: This research represents a benchmark in the knowledge of how FEES is used in Australia. Despite the small number of participants, the findings provide a foundation from which future research questions can be generated. More extensive examination of the use of FEES by SLPs is warranted. Further research is also required to establish methods for attaining and maintaining competency and to achieve consensus on which aspects of swallowing are assessed when using FEES and how the examination should be conducted. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore occupational health (OH) clinicians' perspectives on employee mental health in the mental health workplace in the English National Health Service. Design/methodology/approach: Thematic analysis of data from seven semi-structured interviews is performed in this paper. Findings: Three themes emerged under the core theme of "Situating OH services": "the Uniqueness of the mental health service setting", "the Limitations of OH services" and "the Meaning of mental health at work". An important finding came from the first theme that management referrals in mental health may be due to disputes about workers' fitness to face violence and aggression, a common feature of their working environment. Research limitations/implications: This was a small scale study of a previously unresearched population. Practical implications: These findings should be used to refine and standardise OH provision for mental healthcare workers, with a particular focus on exposure to violence and workers' potential "lived experience" of mental illness as features of the mental health care workplace. Originality/value: This is the first study to explore OH clinicians' perspectives on the mental health service working environment. [ABSTRACT FROM AUTHOR]

Objectives: This study explored healthcare professionals' accounts of being practitioner trainers in a mental health Recovery College, where they worked with peer trainers, who were people with lived experience of mental illness, to co-produce workshops for mental health service users and staff. The aim of this study was to understand the process of co-production in the Recovery College from the perspective of practitioner trainers. Design: Single-site case study. Setting: A Recovery College in the South of England, open to staff and service users from one mental health care provider organisation. Methods: Semi-structured interviews with eight mental healthcare professionals. Transcripts were thematically analysed. Results: A central image of 'the workshop as crucible' emerged from the three themes derived from the analysis. Co-facilitating the workshop was a 'structured' encounter, within which health professionals experienced 'dynamism' and change. For them, this involved experiences of 'challenge and discomfort'. Conclusion: Findings from this study contribute to the evidence base for the evaluation of Recovery Colleges by focusing on the training impact on staff. Findings suggest that taking on a trainer role in Recovery College co-production is beneficial for healthcare professionals as well as mental health service users, especially if healthcare professionals are open to the dynamism and possible discomfort of these workshop encounters. Future research, however, should expand beyond single-site case studies to test the extent to which this metaphor and themes are appropriate to describing the 'transformative' element of co-production. [ABSTRACT FROM AUTHOR]

In 2017 more than 2,000 unaccompanied children sought asylum in the UK. This article summarises the policy and research literature on the mental health needs and experiences of unaccompanied asylum-seeking children (UASC) in the UK, with the aim of suggesting how to enhance practice and improve outcomes for this vulnerable group. UASC have significant mental health needs with high rates of post-traumatic stress disorder, depression and anxiety; the asylum process greatly affects their well-being. Higher levels of distress in older adolescents who are seeking asylum suggests that lower levels of social support have detrimental outcomes for their mental health. Barriers to service use include mistrust, stigma and service providers' lack of cultural awareness which affect UASC's help-seeking behaviours and identification of their needs. This indicates that mental health services should be available in the spaces commonly used by UASC, such as schools and community centres, to provide psychoeducation, training to other agencies and to inform culturally sensitive interventions. [ABSTRACT FROM AUTHOR]

This study used data from Early Childhood Longitudinal Study – Birth Cohort (ECLS-B) and examined the relations between children's Head Start exposure and their early academic skills (i.e., language, literacy, and math skills) in the United States. Two groups of children who shared similar socio-economic status and disability status but received different types of early child care services (i.e., Head Start programs vs. any other arrangement) were identified from the ECLS-B dataset. Multiple regression analyses identified unique relations between the length of time that children experienced Head Start programs and their early academic skills after controlling for child and family characteristics. The results showed that children's Head Start enrollment duration was a significant, positive predictor of their early receptive language, literacy, and math skills. No significant relation was found between Head Start enrollment and children's expressive language skills. Limitations of the study and suggestions for future research were discussed. [ABSTRACT FROM AUTHOR]

Internships and other work-based learning experiences provide significant learning and professional development opportunities for students at both high school and college levels. Work-based learning has been shown to have positive effects on retention and graduation rates as well as career development and motivation (Davis & Snyder, 2009). Employers report valuing internship experiences highly when filling entry-level positions, and surveys indicate that students find internships to be valuable and satisfying experiences (Brooks & Simpson, 2014). [ABSTRACT FROM AUTHOR]

Background: Speech–language therapists use counselling to address the psychological well‐being of people affected by post‐stroke aphasia. Speech–language therapists report low counselling knowledge, skill and confidence for working in post‐stroke aphasia which may be related to a lack of counselling training specific to the needs of this client group. Aims: To identify current training in counselling for speech–language therapists to address psychological well‐being in people affected by post‐stroke aphasia. Specifically, the intent was to establish the objectives, content, amount, teaching methods and outcomes of counselling training provided to speech–language therapists working with people affected by post‐stroke aphasia. Methods & Procedures: Eleven databases were searched from inception to January 2018 using terms relating to counselling, psychological well‐being, speech–language therapy, stroke, aphasia and training. Studies using any research methodology and design were included. Nine studies were critically appraised and synthesized as a systematic review using the Search, AppraisaL, Synthesis and Analysis (SALSA) framework. Main Contribution: Information on counselling training came from the UK, United States and Australia. Student speech–language therapists received training in goal‐setting and generic counselling skills. After qualification, speech–language therapists received counselling training from mental health professionals within stroke workplaces, from external providers and further education. A range of teaching techniques and counselling approaches were described. Self‐report and themes from qualitative data were the primary measures of counselling training outcomes. Moderate correlations were reported between counselling training and levels of speech–language therapists' knowledge, comfort, confidence and preparedness to counsel people affected by post‐stroke aphasia. Conclusions: Research in counselling training for speech–language therapists working in post‐stroke aphasia is limited, with a small number of primarily low‐quality studies available. Training in generic counselling skills and brief psychological approaches with support from mental health professionals in the stroke workplace enabled speech–language therapists to feel knowledgeable, skilled and confident to address the psychological well‐being of people affected by post‐stroke aphasia. Evidence about the effectiveness of counselling training on speech–language therapists' confidence and competence in practice and on client outcomes in psychological well‐being in post‐stroke aphasia is required. [ABSTRACT FROM AUTHOR]

Abstract: The effects of mental health nurses’ own experience of mental illness or being a carer have rarely been researched beyond the workplace setting. This study aimed to explore how the experience of mental illness affects mental health nurses’ lives outside of and inside work. A sample of 26 mental health nurses with personal experience of mental illness took part in semistructured interviews. Data were analysed thematically using a six‐phase approach. The analysis revealed the broad context of nurses’ experiences of mental illness according to three interwoven themes: mental illness as part of family life; experience of accessing services; and life interwoven with mental illness. Participants typically described personal and familial experience of mental illness across their life course, with multiple causes and consequences. The findings suggest that nurses’ lives outside of work should be taken into account when considering the impact of their personal experience of mental illness. Similarly being a nurse influences how mental illness is experienced. Treatment of nurses with mental illness should account for their nursing expertise whilst recognizing that the context for nurses’ mental illness could be much broader than the effect of workplace stress. [ABSTRACT FROM AUTHOR]

Accessible summary?: What is known on the subject: Analysis of co‐production in mental health and specifically Recovery Colleges has not previously considered the impact on clinicians and their clinical practice. Co‐production as a concept is open to multiple interpretations. Core components of co‐produced work are as follows: a focus on assets, mutuality, peer support and the use of a facilitative approach. What this paper adds to existing knowledge?: Senior clinicians who have chosen to become Practitioner Trainers describe the experience of collaboration with service users in an educational rather than clinical context. Working together in this educational environment led to some shifts in their perceptions of professional power and authority, in some cases leading to personal disclosures about their mental health. This study suggests the mechanisms by which co‐production may transform professional practice: being in an educational rather than clinical context, the experience of being supported, the challenge of negotiating multiple roles (including that of being a colleague to someone with mental health needs) and experiencing a gradual shift of role emphasis as co‐trainer relationships develop. The practical challenge of holding a simultaneous role as clinician for and co‐trainer with Peer Trainers has been articulated, with the caveat that mental health support may be a feature of collegiate as well as clinical roles. What are the implications for practice?: Being a Practitioner Trainer could be a professionally transformative experience. Ground rules for how to support colleagues’ mental health needs should be established and refined during co‐produced working. Negotiating personal disclosure and professional role identity must be explored further in both co‐production research and practice. Abstract: Introduction: Co‐production between service users and clinicians is a desirable element of recovery‐oriented practice in mental health, but the effect of co‐production on clinicians has not been explored thoroughly. Aim: To explore the meaning of co‐production for clinicians based on their experience of co‐production in a Recovery College. Method: Thematic analysis of eight semi‐structured interviews with clinicians who have co‐produced and co‐delivered workshops with a Recovery College Peer Trainer. Results: The “meaning of co‐production” had four themes: definitions, power dynamics, negotiating roles and influence on practice. Clinicians’ experience of co‐production meant a reassessment of their expert role and power. They said that this altered their clinical practice, particularly the language they used and the personal information they shared. Discussion: Role negotiation between Practitioner and Peer Trainers is an iterative process, whereby clinicians may revise their perspectives on personal disclosure, professional identity and collegiate support. The Peer and Practitioner Trainer relationship is characterized by reciprocity and mutuality, and there is some evidence that Practitioner involvement in a co‐produced activity has the potential to transform service user and provider relationships beyond the Recovery College setting. Implications for practice: Engaging in co‐produced educational workshops can alter clinicians’ perspectives on roles, power and clinical expertise. Findings from this case study must be tested against research on other Recovery Colleges. [ABSTRACT FROM AUTHOR]

This study explored the experiences of university students who identified as always having had reading difficulties. Thirty-three participants, all from one Australian university, were surveyed and 10 were also interviewed. Findings revealed that many shared academic challenges related to studying, along with a belief that their difficulties were not well understood by staff or peers. While participants disclosed many similar personal struggles related to completing their studies, positive attributes such as determination and time management strategies were frequently mentioned as instrumental in allowing them to reach university. Experiences were more variable regarding awareness of, access to, and satisfaction with university-based support and academic adjustments. To facilitate optimal inclusive educational practices, this study supports the need for greater awareness among staff about challenges faced by these university students along with a more individualised and targeted approach to providing them with academic supports and accommodations. [ABSTRACT FROM AUTHOR]

Aim The aim of this article is to present selected findings from a doctoral study on the subjective well-being and subjective experience of mental health problems in UK mental health nurses. Here the concept of 'nurses' well-being' is explored. Method Data were drawn from a survey of 237 mental health nurses about their mental health and well-being and from interviews with 27 mental health nurses with personal experience of mental health problems and high subjective well-being. Results While nurses' subjective well-being is relatively low, some use strategies to support their well-being in and outside the workplace. Activities outside work that improved their wellbeing were physical exercise, mindfulness practice, spending time in nature and listening to music. Well-being was associated with clear boundaries between home and work life, regular clinical supervision and translating learning from work with patients to nurses' own lives. Conclusion Healthcare employers' staff health and well-being strategies should be informed by nurses' insights into what works for them. This may mean offering opportunities to take part in well-being activities. There are also opportunities to improve staff well-being through shared initiatives open to nurses and patients, and through an inclusive and empowering approach to staff engagement. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to provide a systematic review of the aspects of verbal communication contributing to listener perceptions of speaker gender with a view to providing clinicians with guidance for the selection of the training goals when working with transsexual individuals. Method: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines were adopted in this systematic review. Studies evaluating the contribution of aspects of verbal communication to listener perceptions of speaker gender were rated against a new risk of bias assessment tool. Relevant data were extracted, and narrative synthesis was then conducted. Meta-analyses were conducted when appropriate data were available. Results: Thirty-eight articles met the eligibility criteria. Meta-analysis showed speaking fundamental frequency contributing to 41.6% of the variance in gender perception. Auditory-perceptual and acoustic measures of pitch, resonance, loudness, articulation, and intonation were found to be associated with listeners' perceptions of speaker gender. Tempo and stress were not significantly associated. Mixed findings were found as to the contribution of a breathy voice quality to gender perception. Nonetheless, there exists significant risk of bias in this body of research. Conclusions: Speech and language clinicians working with transsexual individuals may use the results of this review for goal setting. Further research is required to redress the significant risk of bias. [ABSTRACT FROM AUTHOR]

Introduction: There is growing literature about the experiences of social integration and wellbeing of transgender individuals. However, there has been no synthesis across this body of research. Accordingly, the aim of this review was to aggregate, interpret, and synthesize findings from qualitative studies pertaining to the social integration and wellbeing of transgender individuals. Methods: This study synthesized findings from 18 qualitative and mixed method studies which had explored the social integration and wellbeing of transgender individuals, using Noblit and Hare's meta-ethnography method. The Critical Appraisal Skills Programme was also used to appraise the 18 included studies. Results: Data from the included 18 individual studies ranged from moderate to strong in quality. Data analysis revealed five major themes which influenced transgender individuals' daily lives. These were gender transition and disclosing gender identity, health and self-isolation, living with stigma and discrimination: health care, leisure and work, the importance of relationships, and last, overcoming adversity: stories of what can work. Conclusion: This meta-synthesis reinforces many preconceived notions about transgender individuals. These include being at high risk of social exclusion, experiencing discrimination and stigma across many social situations, and last, being at high risk of poor wellbeing. This study also found that there is further need for studies that investigate the self-isolation of transgender individuals as well as this group's relationship and experiences with health care professionals and providers. [ABSTRACT FROM AUTHOR]

Background The Transsexual Voice Questionnaire (TVQMtF) was designed to capture the voice-related perceptions of individuals whose gender identity as female is the opposite of their birth-assigned gender (MtF women). Evaluation of the psychometric properties of the TVQMtF is ongoing. Aims To investigate associations between TVQMtF scores and (1) self-perceptions of voice femininity and (2) acoustic parameters of voice pitch and voice quality in order to evaluate further the validity of the TVQMtF. A strong correlation between TVQMtF scores and self-ratings of voice femininity was predicted, but no association between TVQMtF scores and acoustic measures of voice pitch and quality was proposed. Methods & Procedures Participants were 148 MtF women (mean age 48.14 years) recruited from the La Trobe Communication Clinic and the clinics of three doctors specializing in transgender health. All participants completed the TVQMtF and 34 of these participants also provided a voice sample for acoustic analysis. Pearson product-moment correlation analysis was conducted to examine the associations between TVQMtF scores and (1) self-perceptions of voice femininity and (2) acoustic measures of F0, jitter (%), shimmer (dB) and harmonic-to-noise ratio (HNR). Outcomes & Results Strong negative correlations between the participants' perceptions of their voice femininity and the TVQMtF scores demonstrated that for this group of MtF women a low self-rating of voice femininity was associated with more frequent negative voice-related experiences. This association was strongest with the vocal-functioning component of the TVQMtF. These strong correlations and high levels of shared variance between the TVQMtF and a measure of a related construct provides evidence for the convergent validity of the TVQMtF. The absence of significant correlations between the TVQMtF and the acoustic data is consistent with the equivocal findings of earlier research. This finding indicates that these two measures assess different aspects of the voice-related experience. Conclusions & Implications Evidence supporting the validity of the TVQMtF is strong and indicates that it is a sound measure for capturing the MtF woman's self-perceptions of her vocal functioning and how her voice impacts on her everyday life. [ABSTRACT FROM AUTHOR]

Nurses' mental health is of paramount importance, both in terms of patient safety and the sustainability of the workforce. Age, years in the profession, in post and personal experience or exposure to mental health problems are relevant to the mental health nursing workforce crisis in the United Kingdom. This study aimed to determine the relationship between age, years in the profession and post and self-reported experience of mental health problems using an online cross-sectional survey of 225 UK mental health nurses. Number of years in post was inversely correlated with overall experience of mental health problems, particularly living with someone else with mental health problems. Those with experience of living with someone with mental health problems had significantly fewer years of professional experience than those without. This article discusses possible explanations for this phenomenon and makes the case for future research on the topic. [ABSTRACT FROM AUTHOR]

The aim of the present study was to measure the subjective well-being of a group of 225 UK registered mental health nurses (MHN) using three survey measures, and to identify whether certain demographic and workplace factors correlated with subjective well-being measure scores. An online survey incorporating the subjective well-being questions used by the Office for National Statistics, the Satisfaction with Life Scale, and the Warwick Edinburgh Mental Well-Being Scale was administered to members of two professional bodies for MHN. There was good consistency between the three subjective well-being measures, each demonstrating that UK MHN had a relatively low subjective well-being. Apart from the Office for National Statistics question, 'Overall, to what extent do you feel the things you do in your life are worthwhile?', demographic and workplace factors did not correlate with subjective well-being measure scores, although the characteristics of being male, living alone, and being aged 40-49 years were associated with lower mean scores on all three measures. The findings of the exploratory study suggest that a similar study should be undertaken with a larger representative population of MHN, and that qualitative research should explore why and how UK MHN have relatively low subjective well-being. The limitations of this study, namely the response rate and sample representativeness, mean that the results of the present study must be tested in further research on the MHN population. [ABSTRACT FROM AUTHOR]

Because of the increasing number of transgender people requesting speech-language pathology services, because having gender-incongruent voice and communication has major negative impacts on an individual's social participation and well-being, and because voice and communication training is supported by an improving evidence-base, it is becoming more common for universities to include transgender-specific theoretical and clinical components in their speech-language pathology programs. This paper describes the theoretical and clinical education provided to speech-language pathology students at La Trobe University in Australia, with a particular focus on the voice and communication training program offered by the La Trobe Communication Clinic. Further research is required to determine the outcomes of the clinic's training program in terms of student confidence and competence as well as the effectiveness of training for transgender clients. [ABSTRACT FROM AUTHOR]

Objective: To summarize and evaluate evidence for the effect of yoga on menstrual disorders. Methods: PubMed, CINAHL/MEDLINE, Web of Science, AMED, and Scopus were searched for English-language literature relevant to the review question. All primary research studies were included. Results: Fifteen studies described in 18 papers were included in the review. A range of yoga interventions were used. Some studies used a combination of Asana, Pranayama, and other yogic relaxation or meditation techniques. All included studies reported some change in their outcome measures, suggesting reduced symptoms of menstrual distress following a yoga intervention; however, the heterogeneity and intensity of the interventions and outcome measures meant that findings have limited generalizability and applicability in practice settings. Conclusions: Further research on the relationship between yoga practice and menstrual disorders is warranted, but there must be both consistency in the methods, measures, and quality of studies and a shift toward research on yoga practices that are replicable outside of the clinical trial setting. [ABSTRACT FROM AUTHOR]

Students experiencing disability face many barriers in university education, which are often poorly understood by university teaching staff. This is more likely to be the case regarding students with nonapparent conditions, such as mental health issues and acquired brain injury. This study employed an online survey, supplemented by semi-structured interviews, to investigate the views and actions of teaching staff at one university in relation to supporting these two student groups: those with mental health issues and those with acquired brain injury. Survey responses indicated that university staff generally held positive views about both student groups, but that there was inadequate staff training to assist staff in knowing how to support these groups. Staff most commonly supported students by directly negotiating adjustments with students, maintaining regular contact, and using the university's disability services. The results of this study support previous calls for improved staff training and also draw attention to the competing demands on staff of supporting student learning whilst managing other institutional forces at play in universities. [ABSTRACT FROM AUTHOR]

Students with invisible disabilities such as mental illness or acquired brain injury (ABI) experience multiple barriers that reduce their likelihood of postsecondary course completion. The present study conducted a systematic search of research reporting interventions for students experiencing mental illness or ABI to participate in postsecondary education. Nine databases were searched and a framework for categorising interventions and outcomes was developed. Forty-two studies revealed that most interventions were focused at the individual student level aiming to support students to build skills, grow confidence, or compensate for challenges through educational adjustments. There was wide diversity in research approaches used and a dearth of rigorous research designs. This review offers a more consistent way to define interventions and outcomes to guide future research and facilitate more meaningful comparisons between studies. The impacts of specific interventions on students’ attainment of qualifications and subsequent workforce participation need further investigation. [ABSTRACT FROM PUBLISHER]

The recently developed Transsexual Voice Questionnaire (TVQMtF) is a self-report tool that assesses the perceptions of male-to-female transsexual women (MtF women) regarding their voices and the impact of voice on their everyday lives. Initial psychometric evaluation has demonstrated strong reliability of the TVQMtF, however, there has been relatively little investigation of its validity. There is evidence in the literature to support the notion that MtF women who have undergone gender reassignment surgery (GRS) have different perceptions of their voice than MtF women who have not undergone GRS. This information was used to examine the validity of the TVQMtF using a known-groups analysis. Method: The TVQMtF scores of 26 MtF women who had undergone GRS were compared with the scores of 27 MtF women who had not undergone GRS. A one-way analysis of variance (ANOVA) was used to compare the total TVQMtF scores. Mann Whitney U tests were used for comparison across individual items. Results: Individuals who had undergone GRS perceived that they experienced fewer voice-related difficulties and impacts on their lives than individuals who had not undergone GRS. This difference was significant (F(1, 51) = 8.87, p =.004). MtF women who had undergone GRS reported less impact of voice on their gender identity, however, perceived impact of vocal-functioning and voice-related activity and participation limitations did not differ between groups. The study findings support the construct validity of the TVQMtF. [ABSTRACT FROM AUTHOR]

In many PreK-12 school environments, individuals with a variety of professional identities and roles provide services to students. Typically, these individuals are trained with minimal interaction with each other, yet they must work cooperatively with each other in the schools. Interprofessional education (IPE) provides a model whereby students in different disciplines learn to collaborate. This article describes the origins and current status of IPE in the health professions; suggests strategies for applying IPE to educator training; describes a promising example IPE project involving two distinct school-based professionals, pre-service special educators and school counsellors in training, including outcomes documented through student reflections; and offers implications for implementing and sustaining IPE in schools of education. [ABSTRACT FROM PUBLISHER]

This study investigates potential predictors of teacher-child relationships (i.e., closeness and conflict) focusing on child gender, teacher-child ethnicity match, and teacher education. Additionally, the study explores the possible moderation effect of teacher education on the associations between teacher-child relationships and child gender or teacher-child ethnic match. The participants of this study were 159 preschoolers and their 34 teachers in 20 preschools located in a suburban area in Indiana, USA. Due to the nested structure of the data, hierarchical linear modeling (HLM) was employed. The results showed that teacher-child closeness was explained by teacher- and child-level variables, whereas teacher-child conflict was explained mostly by child-level variables. Additionally, boys were found to establish less close relationships with their teachers compared to girls. On average, teachers having a bachelor’s degree (BA) showed lower teacher-child closeness compared to teachers without a BA. However, teachers with a BA were more likely to report equitable relationships among children regardless of child gender. Teacher-child ethnic match was not significantly related to either teacher-child closeness or conflict. The article also offers a discussion on the implications of these findings. [ABSTRACT FROM AUTHOR]

In this article we discuss the Department of Health's Positive and Safe initiative in the context of one Inner London mental health trust. The goal of the initiative is to reduce the use of restrictive practice in mental healthcare settings and to eradicate the use of prone restraint. We discuss how we are addressing the recommendations of the guidance and the new Mental Health Act 1983: Code of Practice. Implementation of the core elements of the approach are considered: these are behavioural support planning, reducing the use of restraint and post-incident reviews. [ABSTRACT FROM AUTHOR]

The professional development discussion (PDD) will be an essential component of revalidation with the Nursing and Midwifery Council. The Unite/CPHVA professional officers who participated in the pilot found the PDD to be the most beneficial part of the revalidation process. This article explores the experience of a PDD from both the revalidatee and the fellow registrant perspective. It goes on to make recommendations for ensuring an effective PDD. [ABSTRACT FROM AUTHOR]

Transsexual clients seek speech-language pathology services to achieve voice characteristics congruent with their true gender. Male-to-Female Transsexual Women (MtF women) make up the majority of transsexual clients on clinicians' caseloads. For many MtF women, achieving gender congruent voice is critical to psychosocial and financial wellbeing and quality of life. It is incumbent on clinicians who offer voice services to MtF women to use the best evidence available for effective voice training. There is strong evidence that voice feminization should target increasing fundamental frequency to approximately 180 Hz and increasing formant frequencies close to biological female (cisfemale) levels, as well as some evidence that increasing fundamental frequency variability and minimum and maximum fundamental frequency, decreasing vocal effort and intensity, and increasing breathiness are an important focus of intervention. While further research is required, the evidence base is increasing. It is encouraging that studies indicate that most MtF women achieve vocal improvements and that most are satisfied with voice training. Important next steps are to increase the quality of research designs, increase sample sizes, and measure long-term voice outcomes. Expert clinicians in collaboration with MtF women's self-advocacy groups will then be able to develop clinical guidelines for this expanding area of practice. [ABSTRACT FROM AUTHOR]