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BackgroundTransgender and nonbinary (TNB) individuals assigned female sex at birth experience discrimination, misgendering, problems with insurance, and denial of services when accessing health care. This study aimed to understand the experiences of TNB young adults in accessing "women's" health care-a form of care that is structurally gendered that few studies have investigated.MethodsIn 2015, we conducted in-depth interviews with 20 TNB young (ages 18-29) adults assigned female sex at birth. We thematically analyzed the data.ResultsParticipants described feelings of comfort and trust-and lack thereof-at every step of the health care-seeking process, including scheduling, checking in, waiting, and interactions with clinicians and other staff. Gendered language served as a constant stressor; participants-especially nonbinary participants-noted few opportunities to provide their correct pronouns and names. Participants relayed negative experiences associated with waiting rooms in "women's" health care spaces, where TNB patients are forced to disclose their identity simply through their presence or owing to actions of staff that out them. These concerns deterred some from seeking care, with most expressing discomfort or anxiety that caused them to feel unsafe. Participants described "women's" health care providers making assumptions about their anatomy, reproductive desires, sexual orientation, and sexual practices, as well as inappropriately and harmfully emphasizing their bodies and TNB identities during health care interactions. Clinician competence and humility engendered participants' feelings of safety and undergirded their interest in engaging with "women's" health care.ConclusionsA lack of patient-centered, TNB-competent care in structurally gendered health settings exacerbates health care and health inequities for TNB young adults.

Social workers have an ethical obligation to the consumers and communities they serve to draw on practice-relevant research evidence in planning and executing interventions. A model for using evidence in social work practice is proposed, which rests on a foundation of competence in the common factors of helping relationships. The model integrates the use of evidenced-informed resources in executing a treatment plan created through a modified evidence-based practice process. This practice framework is presented, followed by a discussion of how relevant training can be incorporated into generalist and specialist educational curricula while fulfilling requirements of the Council on Social Work Education accreditation standards.

Services for youth experiencing homelessness (YEH) are designed with limited input from the youth themselves. This study explored the experiences and recommendations for services aimed at mitigating the negative effects of homelessness among youth. A total of 45 interviews were conducted with YEH (ages 15 to 24, M = 21.5 years) who experienced at least one night of homelessness. Transcripts were coded by using a modified constructivist grounded theory approach. YEH reported myriad challenges to navigating disjointed programming and misguided policies. Recommendations from YEH for policy and programmatic change include peacekeeping and diffusion training for program staff, trauma-informed approaches, and conflict resolution among agency staff; and integrate creative outlets and transitional services into existing programs. Programming supporting YEH must extend beyond meeting only basic needs to creating opportunities for safety, autonomy, and growth. Programs targeting youth homelessness need input from YEH in their design and implementation. [ABSTRACT FROM AUTHOR]

Childhood abuse is a common experience for youth in the child welfare system, increasing their risk of bullying perpetration and victimization. Little research exists that has examined the rates of bullying perpetration and victimization for child welfare–involved adolescent girls. The study addressed the following aims: (a) to generate frequency estimates of physical, nonphysical, and relational forms of bullying perpetration and victimization; (b) to identify the frequency of bully-only, victim-only, bully-victim, and noninvolved roles; and (c) to identify risk and protective factors that correlate with these bullying role types. Participants were 236 girls (12-19 years) in the child welfare system from a Midwestern urban area. Participants were referred to the study to join a trauma-focused group program. Seventy-five percent of the total sample were youth of color, with the remaining 25% identifying as White, non-Hispanic. Data were collected through baseline surveys that assessed childhood abuse, bullying perpetration and victimization, posttraumatic stress, substance misuse, aggression-related beliefs and self-efficacy, placement type, placement instability, and mental health service use. Child welfare–involved adolescent girls were found to assume all four major role types: bully-only (6.4%, n = 15), victim-only (20.3%, n = 48), bully-victim (44.1%, n = 104), and nonvictims (29.2%, n = 69). The bully-victim rate was approximately 7 times higher than the rate found in a nationally representative sample of non–child welfare–involved youth. The current study identified posttraumatic stress disorder (PTSD) symptoms, anger self-efficacy, and alcohol use as significant correlates of bullying roles. The identification of a substantially higher rate of bully-victims has important practice implications, suggesting child welfare and school systems adopt trauma-informed systems of care. Bully-victims are very likely traumatized children who are in need of effective trauma treatment rather than punitive sanctions. [ABSTRACT FROM AUTHOR]