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Home health aides and home care agencies, who operate in a high work stress environment under normal conditions, were placed under extraordinary demands during the COVID-19 pandemic. In this paper, we examine the unfolding effort at one agency in New York City to offer phone-based support calls to aides. We used a qualitative, single case study design involving semi-structured interviews with call staff and agency leaders (n = 9) and analysis of one year of thematic notes from the calls. We found that the calls resulted in multidirectional communication between agency staff and aides, an increased sense of empathy among staff, and a greater integration of aides into the agency's overall infrastructure. We explore how these calls might contribute to aide retention, worker voice, and mental health. We note the facilitators and barriers to implementing this type of job-based support to help other agencies that may be considering similar models. [ABSTRACT FROM AUTHOR]

Take-home naloxone (THN) is provided to non-medically trained people to reverse potential opioid overdoses. There is an increasing range of effective intramuscular (IM) and intranasal (IN) naloxone devices and this paper explores the types preferred by people who use opioids, using consumer behaviour literature to interpret the findings. Data derive from two unconnected qualitative studies involving audio-recorded semi-structured interviews. Study 1 was conducted in the United States (n = 21 users of non-medical/illicit opioids). Study 2 was conducted in Australia (n = 42 users of non-medical/illicit or prescribed opioids). Most participants preferred IN naloxone. Preferences were based on the ease, speed, safety and comfort of each device and underpinned by accounts of overdose revivals as being very rushed and frightening situations. Preferences related to complex interactions between the naloxone device ('product'); the knowledge, skills, experience and attitudes of the lay responder ('consumer'), and when, where and how naloxone was to be used ('usage situation'). THN programs should offer choice of device when possible and nasal naloxone if resources permit. Asking people which devices they prefer and why and treating them as valued consumers of naloxone products can generate insights that improve future naloxone technology and increase THN uptake and usage. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: The incidence of hepatitis C (HCV) infection is rising among people who inject drugs (PWID). Even in the context of known HCV prevention and treatment strategies, some PWID remain unengaged in HCV care. This study aimed to identify and characterize experiences and perceptions of PWID regarding the acceptability and effectiveness of HCV testing and treatment at a local syringe service program (SSP). Methods: A total of 36 PWID participated in semi-structured interviews at an SSP in New York City. Interviews were audio-recorded, transcribed, and coded by three coders, following a constructivist grounded theory approach. Relevant themes were identified as they emerged from the data. Results: Interviews with PWID revealed three themes related to the impact of SSPs on HCV care: (1) non-stigmatizing SSP environments, (2) the role of SSPs in improving HCV knowledge, and (3) acceptability of SSPs as sites for HCV care among PWID. Discussion: This paper contributes to the ongoing understanding that SSPs provide a well-accepted source of HCV services for PWID. Participants believed that SSPs are accessible and effective sites for HCV care, and suggested that stigma among PWID continues to affect receipt of HCV care in traditional settings. Conclusions: Understanding attitudes and beliefs of PWID regarding the effectiveness of SSPs as sites for HCV care is crucial for the development of focused strategies to reduce HCV transmission, and to ultimately achieve HCV elimination. Given this, further research is warranted investigating how best to improve HCV care at harm reduction sites such as SSPs. [ABSTRACT FROM AUTHOR]

This study reviews student's perspectives of an American Indian and Alaska Native Indian Studies center in a Master of Social Work degree (MSW) program from the Brown School at Washington University in St. Louis. The article describes the Kathryn M. Buder Center for American Indian Studies many contributions over the years and how it continues to grow in innovative ways. This article begins by considering the social, economic, and historical circumstances that make Native-focused training in social work critical to the future of Indian Country. The article then discusses the founding of the center, the curriculum, program offerings and the effectiveness of the center's services. Additionally, results of the evidence indicates that financial assistance and support programs are strong factors in recruitment, student motivation to pursue a degree, and persistence to completion of a Master of Social Work credential. Lastly, the paper offers recommendations for recruiting, retaining and graduating American Indian and Alaska Native graduate students. [ABSTRACT FROM AUTHOR]

This qualitative study explored the racialized experiences among eight self-identified Caribbean Latinas. Narratives derived from semi-structured interviews revealed their lived experiences and the impact, and negotiation of the everyday occurrences of racial microaggressions, invalidation of Latina identity, intragroup colorism, ascription of intelligence, exoticization and skin color privilege. The findings contribute to the social science literature by highlighting the significance and complexity of race among Latinas. [ABSTRACT FROM AUTHOR]

New York City (NYC) is considered to be one of the world’s most progressive cities and gender and sexuality diversity (GSD)-inclusive education departmental policies appear to reflect these values. However, even within such a context, NYC educators report challenges in their work to meet the needs of trans/gender-diverse students and the visibility of trans/gender diversity more generally within their pre-K - 12 school communities. This paper reports on interview data from 31 school staff members from nine public and independent schools located in the NYC metro region, with a specific focus on their framing of inclusivity and bullying, and reported support of trans/gender-diverse students. Based on educators’ representations of their schools, the nine schooling environments fell into two broad clusters: (1) those framing trans/gender inclusivity as an anti-bullying initiative and working at the minimum policy requirements, and (2) those working beyond bullying discourses and policy frameworks to conceptualise trans/gender inclusivity as integral to the school’s mission and as offering clear whole-community benefit. Findings support the constraints of bullying discourse on even supportive educators’ curricular ‘translation’ of GSD-inclusive policies, reinforcing the need for relevant policy reframing and targeted of professional development opportunities, particularly for school leaders. [ABSTRACT FROM AUTHOR]

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Neoliberal ideology champions privatization, personal responsibility, and entrepreneurship, and public health practice under neoliberalism channels this individualized focus. Though this ‘new public health’ may be seen as a liberalizing practice of governance, in which individuals are free to maximize health and autonomy, this privatization also embeds responsibility within the individual without regard to existing or resulting inequalities. This paper examines the presence of neoliberal ideology in the narratives and subjectivities as it relates to HIV prevention in the lives of young gay and bisexual men living in New York City. We also seek to further the critique of neoliberalism in HIV prevention. The men often saw themselves or others as rational, autonomous agents, yet there were also clear instances where social and structural factors were at play. These factors influenced a subjectivity existing outside the narrow, atomistic framework of neoliberalism. Implicit moral hierarchies arose from notions of personal responsibility and recklessness, pitting men against each other and potentially inhibiting social and community prevention efforts. Further, neoliberal ideology obscured the social and structural mechanisms at play, such as racial inequality, economic inequality, homophobia, and sexual shaming. In contrast to the ideology of neoliberal public health, we must explicitly consider the resources, opportunities, and social conditions that shape autonomy and subjectivity among young gay and bisexual men. [ABSTRACT FROM PUBLISHER]

Available evidence suggests that young former Soviet Union immigrants in New York City have high rates of non-medical prescription opioid and heroin use, drug injection and injection-related risk behavior, making them vulnerable to hepatitis C virus (HCV)/human immunodeficiency virus (HIV) infection, overdose and associated harms. This group has been the focus of little research, however. This paper presents quantitative and qualitative data from 80 former Soviet immigrants (ages 18-29) to characterize their opioid use trajectories, injection risk behavior, HCV/HIV testing histories and self-reported HCV/HIV serostatus, and provides clinically meaningful data to inform tailored education, prevention and harm reduction interventions. [ABSTRACT FROM PUBLISHER]

Community pharmacies offer a population-wide approach to scale opioid overdose prevention programs (OOPP). This qualitative study identified factors influencing implementation of New York State's OOPP to inform the uptake of naloxone dispensation in rural and small metro area pharmacies. In-person interviews were conducted among licensed retail, independent, or supermarket pharmacists (n = 60) in the mid-Hudson valley area of New York in high- and medium-overdose regions. The semi-structured 29-item survey captured attitudes and experiences related to pharmacy participation in naloxone dispensation. Data revealed pharmacist support for naloxone dispensation. Barriers to OOPP success included: (1) Insufficient retail pharmacy leadership support for administrative and clinical tasks for OOPP tasks; (2) excessive opioid analgesic prescribing by physicians; (3) limited uptake of naloxone by prescribers and patients; (4) out-of-pocket costs for patients to obtain naloxone; (5) lack of time, staffing, and space to provide opioid overdose prevention counseling; (6) concern for increased overdose fatalities and injection drug use in the pharmacy premises if pharmacists dispensed sterile syringes, naloxone, and/or Buprenorphine-naloxone; and (7) stigmatizing attitudes toward persons who use opioids. Multi-level intervention efforts that include pharmacist-prescriber communication and training, and stigma-reducing efforts in rural and small metro area regions are needed. [ABSTRACT FROM AUTHOR]

This qualitative investigation explored how 18 chronically homeless adults with serious mental illness residing in emergency and temporary supportive housing facilities in Glasgow, Scotland, and New York City conceptualized personal recovery. Thirty-six interviews were conducted and analyzed using interpretative phenomenological analysis. The analysis produced four superordinate themes revealing how participants engaged with, envisioned, or disidentified with, the recovery idea, in the context of chronic life adversity, co-occurring conditions, a precarious present and an uncertain future. Health and social care providers should be responsive to clients' diverse ideas about recovery and facilitate their exploration of authentic pathways to a "good life." [ABSTRACT FROM AUTHOR]

Introduction: Substance use disorder (SUD) peers provide support and navigation through a fragmented treatment system for people who use drugs (PWUD) and those in recovery. While barriers to peers' work are well established, from role ambiguity to stigma surrounding substance use, little research has focused on factors that facilitate peers' work. Methods: We conducted in-depth semi-structured interviews (N=20) with peers as part of an evaluation of a larger project related to the opioid crisis in Western New York. Participants were recruited from a regional peer network via flyers, emails, and a brief presentation. Interviews were conducted in person or by phone, audio recorded, and transcribed. Transcripts were analyzed using thematic content analysis. Results: Peers emphasized two factors: healthy personal coping strategies and strong workplace supports. Coping strategies included a sense of community, setting appropriate boundaries, and self-care routines. At the workplace, peers valued mental and emotional support, as well as professional relationships and organizational policies that made their work easier and supported self-care. For a few peers, professional relationships included advocating on behalf of PWUD by sharing personal experiences of SUD. Conclusions: Peers valued peer colleagues and peer-led organizations, noting how shared experiences of substance use and recovery enabled a unique support system. For peers who lack such support at work, the authors suggest peer networks as an alternative. We also recommend organizational policies and practices to facilitate peers' work, such as promoting peer input and feedback, but further research is needed to measure effects on peer retention and job satisfaction. [ABSTRACT FROM AUTHOR]

Despite having higher rates of HIV testing than all other racial groups, African-Americans continue to be disproportionately affected by the HIV epidemic in the United States. Knowing one's status is the key step to maintaining behavioral changes that could stop the spread of the virus, yet little is known about the individual- and socio-structural-level barriers associated with HIV testing and communication among heterosexual African-American men. To address this and inform the development of an HIV prevention behavioral intervention for heterosexual African-American men, we conducted computerized, structured interviews with 61 men, focus group interviews with 25 men in 5 different groups, and in-depth qualitative interviews with 30 men living in high HIV prevalence neighborhoods in New York City. Results revealed that HIV testing was frequent among the participants. Even with high rates of testing, the men in the study had low levels of HIV knowledge; perceived little risk of HIV; and misused HIV testing as a prevention method. Factors affecting HIV testing, included stigma, relationship dynamics and communication, and societal influences, suggesting that fear, low perception of risk, and HIV stigma may be the biggest barriers to HIV testing. These results also suggest that interventions directed toward African-American heterosexual men must address the use of “testing as prevention” as well as correct misunderstandings of the window period and the meaning of HIV test results, and interventions should focus on communicating about HIV. [ABSTRACT FROM AUTHOR]

Introduction: Many trans women of color communities experience high HIV seroprevalence, extreme poverty, high rates of victimization and substance use, and poor mental health. Greater knowledge of trans women of color social capital may contribute toward more effective services for this marginalized population. Methods: These data come from a mixed-methods study that examined trans/gender-variant people of color who attended transgender support groups at harm reduction programs in NYC. The study was conducted from 2011 to 12, total N = 34. The qualitative portion was derived from six focus group interviews. Results: Two support groups stood out as exhibiting very strong alternative kinship structures. One group was comprised of immigrant trans Latinas, and the other group were trans women of African descent living with HIV. Both groups demonstrated ample cultivation of "trust capital" in the form of "thick trust" (bonding capital) and "thin trust" (bridging/linking capital) both inside and outside/beyond the support groups. Thick trust included the cultivation of intimacy, support in primary romantic relationships, and community leadership. Thin trust included networking with a variety of organizations, increased educational opportunities, and cultural production. Discussion: Participants "opened up to social capital" through the process of trusting as a series of (1) risks; (2) vulnerabilities; and (3) reciprocities. A solid foundation of thick trust resulted in a social, psychological, and emotional "base." Upon this foundation, thin trust was operationalized resulting in positive material, economic, and quality-of-life outcomes, leading to an expanded space of capabilities. [ABSTRACT FROM AUTHOR]

The underutilization of pre-exposure prophylaxis (PrEP) among cisgender women in the U.S. limits this population's ability to reduce their risk for HIV infection, especially within the unique individual, social and structural systems they navigate. There is a need to identify the relevant multi-level barriers and facilitators to PrEP use among cisgender women to inform theory-guided efforts that address HIV disparities by race/ethnicity among cisgender women. Guided by the Integrated Behavioral Model and the Behavioral Model of Vulnerble Populations we conducted 41 interviews with PrEP eligible cisgender women in New York City and Philadelphia. Directed content analysis identified 11 modal behavioral beliefs crucial to PrEP uptake, including anticipated negative social consequences, 5 normative beliefs centered on available social supports, and 9 control beliefs such as anticipated barriers such as cost. Awareness and knowledge of PrEP as a biobehavioral HIV prevention method is limited for this sample. Through conventional content analysis we identified interpersonal and structural barriers to PrEP uptake including lack of partner support, transportation, mental health challenges, and challenges in accessing PrEP care. Potential solutions to structural barriers were enumerated along with implications for future intervention work and public health programming. [ABSTRACT FROM AUTHOR]

This study investigated the resilience of a growing but largely underserved and understudied population—Chinese American dementia caregivers, whose experience is embedded in their development throughout the life span, process of migration, and sociocultural contexts. Narrative data were collected from in-depth interviews with 27 Chinese caregivers in New York City. Based on the hybrid grounded theory model, a three-steps coding procedure was implemented to identify themes emerged from the data. 16 themes emerged from the data and fit two categories, challenge and resilience, in each of the four principles—time and place, timing in lives, linked lives, and agency—of the developmental life course perspective. Physical and emotional exhaustion is the challenge theme that was the most frequently mentioned followed by limited knowledge of dementia, navigating the U.S. health care system, and limited time for self-development. Three aspects of resilience—sense of mastery, access to formal and informal support, and commitment to care—were salient among the Chinese American caregivers. This study shed important light on the multifaceted challenges and resilience of Chinese American caregivers. The findings indicate the necessity of developing culturally meaningful services for immigrant caregivers to address their complex challenges and improve their multifaceted resilience. [ABSTRACT FROM AUTHOR]

Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in New York City including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call schedules, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers. [ABSTRACT FROM AUTHOR]

Adult day centers (ADCs) are nonresidential settings that support the health and social needs of vulnerable older adults. Due to ADCs' congregate nature and participants' compromised health status, many ADCs have been forced to close during the COVID-19 pandemic. It is unknown how closures have impacted service delivery at ADCs. Guided by the Resiliency Activation Framework, we (a) identified consequences resulting from closures of ADCs during the COVID-19 pandemic and (b) described factors that have enabled the ADC community to remain resilient in the wake of challenges brought on by the pandemic. We conducted 2 focus groups in California (n = 12), and individual interviews with ADC staff members (n = 8) in 7 other states. The results of a directed content analysis revealed perceived declines in physical, cognitive, and mental health of ADC users and increased caregiver strain. Access to human, social, economic, and political capital were essential for supporting ADCs in buffering the impacts of the pandemic on the older adults they serve but were not consistently available. Research is urgently needed that quantifies the impacts of the pandemic on ADC users and their caregivers to inform policy and advocacy efforts in the wake of the pandemic. [ABSTRACT FROM AUTHOR]

There is growing consensus that sexual health education should be inclusive of lesbian, gay, bisexual, transgender and questioning students, and students of various identities on the spectrums of sexuality and gender (LGBTQ+). However, to date, the perspectives of LGTBQ+ teenagers of colour remain under-investigated. Twenty-five in-depth interviews were conducted in 2017–2018 in New York City with LGBTQ+ high school students of colour. Thematic analysis was used to conceptualise the barriers LGBTQ+ students of colour face in learning about sexual health education in school. Students were Latino/a/x (n = 15), non-Latino Black (n = 8), or Asian (n = 2) and self-identified in varied ways in terms of sexuality and gender. Students reported receiving inadequate sexual health education in school due to feeling: 1) unrepresented, 2) unsupported, 3) stigmatised, and 4) bullied. Students filled needed gaps by seeking information and support from external sources. Many students proposed institutional changes or shifts in the school environment to address identified issues, including modifying curricula to incorporate information about consent, mental health and pronouns from the viewpoints of LGBTQ+ teenagers, and to highlight the role of culture, religion and race/ethnicity to represent different experiences. Incorporating the unique experiences of LGBTQ+ students of colour is needed to ensure that all students receive relevant sexual health education. [ABSTRACT FROM AUTHOR]

Prescription drug monitoring programs (PDMPs) are databases that track controlled substances at the provider, patient, and pharmacy levels. While these databases are widely available at the state level throughout the United States, several jurisdictions in recent years have mandated the use of these systems by health care providers. This study explores the implementation of mandatory PDMP technology in primary care practice and the effects on treatment of people with possible substance use disorders. Findings are based on 53 in-depth interviews with primary care providers in New York City, collected shortly following the passage of legislation mandating use of a PDMP by health care providers in New York State. Findings suggest that use of the PDMP highlighted tensions between provider stigma toward substance use disorders and the clinical care of people who use drugs, challenging their stereotypes and biases. The parallel clinical and law enforcement purposes of PDMP technology placed providers in dual roles as clinicians and enforcers and encouraged the punitive treatment of patients. Finally, PDMP technology standardized the clinical assessment process toward a "diagnosis first" approach, consistent with prior scholarship on the implementation of emerging medical technologies. [ABSTRACT FROM AUTHOR]

This study is based in a mid-size city in New York State, where the immigrant and refugee population is steadily growing as a result of the U.S. federal resettlement program and secondary migration. These transformations pose challenges to service providers. Women of immigrant and refugee status who experience domestic violence constitute a particularly vulnerable, yet underserved population. This study is based on 25 in-depth interviews with program users and service providers within organizations that serve domestic violence survivors. It examines service needs and paths to help-seeking among these women through an intersectional and trauma-informed lens. Recommendations to improve service delivery and policies for this population are discussed. [ABSTRACT FROM AUTHOR]

Objective: To determine barriers and opportunities to health insurance enrollment among an undergraduate students at a large urban university. Participants: Participants were 31 college students enrolled in 4-year and community colleges in the City University of New York (CUNY), and six health services and insurance enrollment specialists who facilitate and assist in the health insurance enrollment process for CUNY students. Methods: Focus groups were conducted with students and in-depth interviews with key informants in May 2017. Results: The research revealed important insights into how students perceive and value insurance and yielded recommendations for the university to improve enrollment of its students. Conclusions: Many colleges can increase student enrollment in health insurance by informing and educating students about the process. Improving enrollment processes can increase insurance rates and improve student population health. [ABSTRACT FROM AUTHOR]

Nearly half of patients with serious mental illness (SMI) lack friends and social connectedness-building blocks of recovery. While support groups have been found to promote friendship-building, there is little information about the process. This study examined the use of nurse-facilitated support groups by Psychosocial club members with SMI. Participation, core members, therapeutic factors, content discussed, and satisfaction with the intervention were measured. Perception of unmet need for a friend and membership in a group was measured before and after the intervention. Participation increased over time. Core members emerged. Yalom's therapeutic factors evolved. Discussion included sexually transmitted diseases, safety, making friends, health problems, problems with landlords, and adverse events such as victimization. The unmet need for a friend decreased. Two-thirds were satisfied with the groups. Support groups are low-cost psychosocial interventions that can be used to help patients with SMI move toward recovery. [ABSTRACT FROM AUTHOR]

The incarceration of mothers affects 1.7 million minor children who are at high risk of behavioral problems, emotional trauma, and future incarceration. The jail setting removes women from society for brief periods of time providing an opportunity to offer essential interventions for those who will be returning to the community, and possibly their children, rather quickly. Utilizing a pre- and post-test quasi-experimental design, we measured the self-reported treatment effects for female inmates, housed in a county jail in the New York metropolitan area, who completed an evidence-based parenting program. Program participants reported reduced depression, increased parental knowledge, and increased communication with their families and fellow inmates. The results indicated that alternative ways of measuring program success are needed – particularly for populations who present with long histories of criminal justice involvement and drug use. [ABSTRACT FROM AUTHOR]

Background: The primary charge of Emergency Medical Services (EMS) is to save lives. However, EMS personnel are frequently called to scenes where prolonging life may not be the primary goal. When someone is nearing death, family members may feel compelled to call 9-1-1 because they are feeling uncertain about how to manage symptoms at the end of life. Objective: We sought to explore prehospital providers' perspectives on how the awareness of dying and documentation of end-of-life wishes influence decision-making on emergency calls near the end of life. Methods: The study design was exploratory, descriptive, and cross-sectional. Qualitative methods were chosen to explore participants' perspectives in their own words. In-depth in-person interviews were conducted with 43 EMS providers. Interviews were audio recorded and professionally transcribed. Interview transcripts were entered in Atlas.ti for data management and coding. The analysis was deductive and guided by a conceptual model of 4 contexts of end-of-life decision-making that is not setting-specific, but has been applied to prehospital care in this study. Results: The findings illustrate the relationship between awareness of dying and documentation of wishes in EMS calls. The 4 decisional contexts are: (1) Awareness of Dying-Wishes Documented: Families were prepared but validation and/or support was needed in the moment; (2) Awareness of Dying-Wishes Undocumented: EMS must initiate treatment, medical control guidance was needed; (3) Unaware of Dying-Wishes Documented: Shock, expectation that EMS can stop the dying; and (4) Unaware of Dying-Wishes Undocumented: Families were unprepared, uncertain, frantic. Each context is illustrated by representative quotes from participants. Discordance and conflict was found in each decisional context. Conclusions: This study illustrates that EMS providers are acutely aware of the impact of their decisions and actions on families at the end of life. How emergency calls near the end of life are handled influences how people die, whether their preferences are honored, and the appropriate use of ambulance transport and ED care. The findings highlight how the intersection of awareness of dying and documentation of wishes influence prehospital decision-making in end-of-life emergencies and demonstrate the key role EMS providers have in this critical period. [ABSTRACT FROM AUTHOR]

Using qualitative interviews, this study explored the barriers and facilitators of health care providers (HCPs) in initiating PrEP conversation with patients. Twenty-eight HCPs in two counties listed in the New York State Department of Health PrEP/PEP Voluntary Provider Directory were asked to participate in the study. Five themes evolved from the interview, each theme acting as both barriers and facilitators to initiating PrEP conversations: (a) providers comfort levels, (b) taking sexual histories, (c) time, (c) patients comfort levels discussing sexual health, and (c) HCPs' perceptions of patients' risk of sexually transmitted infection (STI) acquisition. These findings demonstrate the need for evidence-based interventions for initiation of PrEP conversations in health care settings. [ABSTRACT FROM AUTHOR]

Sexual assault is a part of many students’ experiences in higher education. In U.S. universities, one in four women and one in ten men report being sexually assaulted before graduation. Bystander training programmes have been shown to modestly reduce campus sexual assault. Like all public health interventions, however, they have unintended social consequences; this research examines how undergraduate men on one campus understand bystander interventions and how those understandings shape their actual practices. We draw on ethnographic data collected between August 2015 and January 2017 at Columbia University and Barnard College. Our findings show that university training and an earnest desire to be responsible lead many men to intervene in possible sexual assaults. However, students’ gendered methods target more socially vulnerable and socially distant men while protecting popular men and those to whom they are socially connected. Students’ actual bystander practices thus reproduce social hierarchies in which low prestige may or may not be connected to actual risks of sexual assault. These results suggest that understanding intragroup dynamics and social hierarchies is essential to assault prevention in universities and that students’ actions as bystanders may be effective at preventing assaults in some circumstances but may lead to new risks of sexual assault. [ABSTRACT FROM AUTHOR]

South Asian women's organizations have been established nationwide to meet the unique needs of South Asians impacted by domestic violence. Although services at these community-based agencies are primarily delivered by providers who are South Asian themselves, research into their experiences is sparse and fails to address how sharing facets of their identity affects them and their ability to care for clients. Based on a phenomenological research design, semi-structured interviews were conducted to describe the lived experience of eight South Asian therapists who were currently working at South Asian women's organizations in the New York metropolitan area. Four essential themes emerged from the analysis: (a) disrupting the status quo, (b) navigating psychological distress, (c) examining assumptions of identity, and (d) pushing professional boundaries. The relational complexities of ethnically similar therapeutic dyads revealed deeper issues related to the inseparability of therapy and advocacy, the questioning of cultural norms, the limiting aspects of standard agency procedures, and the straining of professional boundaries. [ABSTRACT FROM AUTHOR]

This study investigated Home Health Aides' (HHAs) experiences in the immediate aftermath of client death. Semi-structured in-person interviews with 80 HHAs explored how notification of death and reassignment to a new client were handled. Only 42.5% of HHAs were notified of the death; 40% had to notify the agency; 17.5% were not notified at all and had a negative experience. Reassignment preferences varied, but HHAs had a better experience when their preferences were taken into consideration. Study findings suggest that more mindful approaches to transitions following client death would be valued by HHAs and could improve their work experience. [ABSTRACT FROM AUTHOR]

Racial disproportionality has been a longstanding issue within child welfare. The continued overrepresentation of black children in the foster care system is troubling. The authors of this article conducted a case study of two counties in New York State that have steadily decreased the number of black children in foster care in an effort to identify what aspects of their child welfare practice impacted the decline. The case study employed document analysis, in-depth interviews, and focus groups with child removal decision makers. Utilizing a grounded theory approach to content organization and analysis, several themes emerged as noticeable factors. Some of the most salient themes included preventive services and resources, community collaborations, case practice development, family meetings, workforce diversity, the court system, and, the most unique, blind removal meetings. The themes found in this study present promising practices to assist in decreasing the racial disparity in child welfare removal decisions. [ABSTRACT FROM AUTHOR]

Despite the increased recognition of how neighborhood conditions bear on cognitive and academic outcomes, no studies have examined the influences of objective and subjective neighborhood indices on specific areas of cognitive functioning among youth living with perinatal HIV (PHIV). In the United States (US), this is of particular concern as HIV has disproportionately affected African American youth living in economically disadvantaged and racially segregated communities. Thus, based on a longitudinal cohort study of psychosocial and behavioral health outcomes in 340 perinatally HIV-exposed but uninfected (PHEU) and PHIV youth residing in New York City, ages 9-16 years at enrollment, we analyzed data from baseline and multiple follow-up (FU) quantitative interviews with youth and their primary caregivers, from when they were at least 13-years-old (approximately 4--6 years post enrollment). We examined the association between baseline neighborhood indices (2000 US census data and caregiver's perception of neighborhood stressors) and youth receptive language skills (PPVT; Peabody Picture Vocabulary Test) at FU2 and FU3. Census data (percentage of families in neighborhood living below the national poverty rate, median neighborhood household income, and percentage of residents professionally employed) were not independently associated with PPVT scores at both follow-ups. However, in the logistic regression model, the more caregivers perceived their neighborhood as stressful and subjected to violence, the stronger the relationship between census data indicators of low resource neighborhoods and lower PPVT scores for both groups. Findings support "place-based" policies and practices that alleviate caregiver experiences of neighborhood stressors which may contribute to improved cognitive outcomes for youth living with and affected by PHIV. [ABSTRACT FROM AUTHOR]

Primary objective: To gather information about brain injury (BI) survivors' long-term healthcare needs, quality, barriers and facilitators. Research design: Qualitative content analysis of data gathered in focus groups using semi-structured interviews. Methods: Forty-four community-dwelling adults participated at two clinical research centres in Seattle, Washington and New York, New York. Participants were asked open-ended questions about their experiences with healthcare in the community with regard to care needs, utilization, access, barriers and facilitators to health management. Results: Central themes emerged across three categories: 1) barriers to healthcare access/utilization, 2) facilitators to healthcare access/utilization, and 3) suggestions for improving healthcare after BI. The importance of communication as both a facilitator and barrier to care was mentioned by most participants. Compensatory strategies and external tools were identified as key facilitators of medical self-management. Finally, improving clinicians' knowledge about BI emerged as a potential solution to address health needs of individuals with chronic BI. Conclusions: Additional efforts need to be made to improve access to appropriate healthcare and increase the ability for individuals to successfully navigate the healthcare system. Findings suggest several specific, low-cost modifications to healthcare delivery and strategies for improving medical selfmanagement that can maximize long-term health maintenance for BI survivors. [ABSTRACT FROM AUTHOR]

This study addresses health literacy among patients at a free clinic in Syracuse, NY. Researchers conducted chart reviews of 600 patients and qualitative interviews with 22 patients and 7 providers. Most clinic patients had a high school, or higher, level education and no difficulty with reading comprehension. Nevertheless, a majority had at least some difficulty with comprehending and following through on health information. For many interviewees, the greatest difficulty was completing the required forms for entitlement programs. The findings demonstrate that low health literacy may occur even among well-educated patients and recommend that health literacy be assessed for all patients. [ABSTRACT FROM AUTHOR]

Background: In 2011, revised Field Triage Guidelines were released jointly by the Centers for Disease Control and Prevention (CDC) and the American College of Surgeons – Committee on Trauma (ACS-COT). It is unknown how the modifications will affect the number of injured children identified by EMS providers as needing transport to a trauma center. Objective: To determine the change in under- and over-triage rates when the 2011 Field Triage Guidelines are compared to the 2006 and 1999 versions. Methods: EMS providers in charge of care for injured children (<15 years) transported to pediatric trauma centers in 3 mid-sized cities were interviewed immediately after completing transport. Patients were included regardless of injury severity. The interview included patient demographics and each criterion from the Field Triage Guidelines' physiologic status, anatomic injury, and mechanism of injury steps. Included patients were followed through hospital discharge. The 1999, 2006, and 2011 Guidelines were each retrospectively applied to the collected data. Children were considered to have needed a trauma center if they had non-orthopedic surgery within 24 hours, ICU admission, or died. Data were analyzed using descriptive statistics. Results: EMS interviews were conducted for 5,610 children and outcome data was available for 5,594 (99.7%). Average age was 7.6 years; 5% of children were identified as needing a trauma center using the study outcome. Applying the 1999, 2006, or 2011 Guidelines to the EMS interview data the over-triage rate was 32.6%, 27.9%, and 28.0%, respectively. The under-triage rate was 26.5%, 35.1%, and 34.8%, respectively. The 2011 Guidelines resulted in an 8.2% (95% CI 0.6–15.9%) absolute increase in under-triage and a 4.6% (95% CI 2.8–6.3%) decrease in over-triage compared to 1999 Guidelines. Conclusion: Use of the Field Triage Guidelines for children resulted in an unacceptably high rate of under-triage regardless of the version used. Use of the 2011 Guidelines increased under-triage compared to the 1999 version. Research is needed to determine how to better assist EMS providers in identifying children who need the resources of a trauma center. [ABSTRACT FROM AUTHOR]

This article argues that document analysis can add a more nuanced understanding of student ethical reasoning and enhance current approaches to cheating research. To demonstrate the benefits of this approach, I examine the cheating epidemic at Stuyvesant High School through editorials in their school newspaper. Stuyvesant is known for academically talented students focused on elite college admission. My findings suggest that the influence of achievement culture on cheating is more complex than what was captured by the school’s internal cheating survey or in traditional cheating research. Further, contrary to existing expectations, students do not collaborate purely to boost their own academic performance. In a system they define as unfair and rigged, they collaborate even when it puts them at an academic disadvantage. The finding that there is a sense of communal rebellion against their achievement-oriented context demonstrates the efficacy of document analysis as a complementary approach for understanding student cheating. [ABSTRACT FROM PUBLISHER]

Research in the field of animal-assisted therapy has shown that therapy dogs have a positive social-emotional impact on individuals in hospitals, nursing homes, and counseling. Recently, the literature has suggested that therapy dogs can yield positive psychological, social, and academic outcomes in schools, although this research is quite limited. The intent of this study was to examine perceptions on the effectiveness of therapy dogs in schools for promoting students’ psychological well-being, and an overall positive school climate. Preliminary evidence shows faculty and students from four rural school districts across Western New York indicated support for this emerging and viable school intervention. This qualitative and quantitative insight can help guide future research. [ABSTRACT FROM PUBLISHER]

The USA faces disproportionate and increasing HIV incidence rates among Black men who have sex with men (BMSM). New biomedical technologies such as pre-exposure prophylaxis (PrEP) have been developed to address their HIV risk. Very little consideration, however, has been given to the diversity obscured by ‘BMSM’ as a category, to how this diversity relates to men's sexual partnering strategies, or to the relevance of these issues for new HIV prevention methods. We conducted a community-based ethnography from June 2013 to May 2014 documenting factors that affect the acceptance of and adherence to PrEP among BMSM. We conducted in-depth interviews with 31 BMSM and 17 community stakeholders, and participant observation. To demonstrate the diversity of social identities, we present a taxonomy of indigenous categories organised along the axes of sexual identity, sexual positioning, and gender performance. We analyse how HIV prevention strategies, such as PrEP, may be more effective if programmes consider how gender, sexuality, and sexual desire shape sexual partnering strategies. This article underlines the importance of attending to the diversity of sexual and social subjectivities among BMSM, of bringing the study of sexuality back into HIV prevention, and of integrating biomedical prevention approaches into community-based programmes. [ABSTRACT FROM AUTHOR]

This article examines the challenges experienced by very old individuals and their consequences for well-being and mental health. In order to capture unique issues experienced in very old age, 75 participants of the population-based Fordham Centenarian Study answered open-ended questions on everyday challenges. Theme-based coding was then used to categorize and quantify responses. The challenges mentioned most often were challenges faced in the functional (e.g., physical health/activities of daily living restrictions, mobility, sensory impairment), psychological (e.g., loss of well-liked activity, dependency, negative emotions, death), and social (e.g., family loss) life domains. Functional challenges were negatively associated with aging satisfaction and positively associated with loneliness. Psychological challenges were positively linked to aging satisfaction. Social challenges were marginally related to loneliness. Notably, challenges were not related to depression. In conclusion, the challenges experienced in very old age are multidimensional and multifaceted, unique in nature, and have differential relations to mental health. Functional, psychological, and social challenges affect very old individuals' lives and therefore need to be better understood and addressed. Given their consequences, it is imperative for policy makers to develop an awareness for the different types of challenges faced by centenarians, as there may be unique policy implications related to each. [ABSTRACT FROM AUTHOR]

This article explores the congregation as a conduit for civic engagement. Specifically examined are the effects of participation in congregations engaged in faith-based community organizing (FBCO). Civic engagement is examined by comparing FBCO-affiliated congregation members to non-FBCO-affiliated congregation members, local school participants, neighborhood association members, and those without such affiliations. Findings reveal that those engaged in FBCO evidence higher rates of civic engagement than members of the other groups. Implications for the field and future study are discussed. [ABSTRACT FROM AUTHOR]

In May 2013, a space initiative project was launched in an effort to answer the following question posed by the Memorial Sloan Kettering (MSK) Library staff: With the increased use of mobile devices and the availability of information anywhere, anytime, what activities or tasks does our user community engage in while at the Library? Data were gathered in several ways— daily counts to determine client workstation occupancy, an informal survey interview conducted three times a day with walk-in clients, and staff observations. Data collection periods were scheduled in summer 2013, fall 2013, and winter 2014. Analysis of the information collected revealed that for many survey respondents, the space represents an extension of their work environment. Although most of the MSK Library’s collection is available electronically, the physical space is important and valued by this user community as a “go-to” place for leisure, work, or library-related activities. [ABSTRACT FROM AUTHOR]

Aims: With this article, we aim to use students’ moral ambivalence towards prescription stimulants and the doctor’s who prescribe them to problematize the distinction between enhancement and treatment. We do this by investigating a case in which students obtain legitimate prescriptions for (covert) enhancement purposes.Methods: The study is based on ethnographic fieldwork and in-depth interviews with 20 university students from multiple universities in New York City, from which the case is drawn.Findings: Three main themes were identified in the analysis. “The doctor prescribed them” illustrates how these students use doctors as easy access to study drugs, and legitimize their use of stimulants because they were prescribed. The second theme, “A good cause”, shows that the purpose is what counts as a measure for whether stimulant use is considered morally acceptable or not. The third theme, “Being responsible” refers to how they regard themselves as responsible stimulant users, particularly when not following the doctor’s directions.Conclusions: Through an ethnographic approach, we gain a more nuanced understanding of non-medical stimulant use that takes into account the context in which it occurs. We suggest that students’ moral ambivalence reflects the increasingly blurred boundaries between what is considered treatment and enhancement in contemporary society. [ABSTRACT FROM PUBLISHER]

Although alcohol use continues to be a major problem, when high-risk users enter social services, they are not provided with empirically supported treatments (ESTs). This study investigates predictors of successful implementation in agencies not specializing in addiction services. Fifty-four frontline workers in six organizations were enrolled in the study. After completing self-administered surveys of organizational culture and climate and attitudes toward ESTs, workers were trained to implement a brief intervention. The results indicate that organizational factors and attitudes may not be related to implementation. Although high implementers had similar traits, further research is needed to characterize successful EST implementers. [ABSTRACT FROM AUTHOR]

This randomized, controlled, mixed-methods pilot study examined the effectiveness and experiences of grief-specific music therapy, in addition to standard care, with adults (N = 10) who have complicated grief (CG) and mental illness, as compared to standard care alone. The study tested Worden's (2009) theories of grief therapy as well as a new grief-specific music therapy intervention, based on Shear, Frank, Houck, and Reynolds' (2005) imaginal dialogue intervention and Austin's (2008) method of vocal psychotherapy. Results demonstrated that participants in the experimental group had a greater decrease of grief symptoms, as measured by the ICG-R, as compared with the control group. [ABSTRACT FROM PUBLISHER]

Objectives. Cross-cultural mental health researchers often analyze patient explanatory models of illness to optimize service provision. The Cultural Formulation Interview (CFI) is a cross-cultural assessment tool released in May 2013 with DSM-5 to revise shortcomings from the DSM-IV Outline for Cultural Formulation (OCF). The CFI field trial took place in 6 countries, 14 sites, and with 321 patients to explore its feasibility, acceptability, and clinical utility with patients and clinicians. We sought to analyze if and how CFI feasibility, acceptability, and clinical utility were related to patient–clinician communication. Design. We report data from the New York site which enrolled 7 clinicians and 32 patients in 32 patient–clinician dyads. We undertook a data analysis independent of the parent field trial by conducting content analyses of debriefing interviews with all participants (n= 64) based on codebooks derived from frameworks for medical communication and implementation outcomes. Three coders created codebooks, coded independently, established inter-rater coding reliability, and analyzed if the CFI affects medical communication with respect to feasibility, acceptability, and clinical utility. Results. Despite racial, ethnical, cultural, and professional differences within our group of patients and clinicians, we found thatpromoting satisfaction through the interview, eliciting data,eliciting the patient's perspective, andperceiving data at multiple levelswere common codes that explained how the CFI affected medical communication. We also found that all but two codes fell under the implementation outcome ofclinical utility, two fell underacceptability, and none fell underfeasibility. Conclusion. Our study offers new directions for research on how a cultural interview affects patient–clinician communication. Future research can analyze how the CFI and other cultural interviews impact medical communication in clinical settings with subsequent effects on outcomes such as medication adherence, appointment retention, and health condition. [ABSTRACT FROM AUTHOR]

Older adults with major depression may underutilize consumer-directed long-term care. Systematic underutilization would create disparities in outcomes, undermining program effectiveness. The Medicare Primary and Consumer-Directed Care Demonstration included a consumer-directed indemnity benefit that paid for goods and services not financed by traditional Medicare. Overall and for most categories of goods and services there was little difference in use and expenditures between those with and without major depression. However, among those using the benefit to hire in-home workers, arguably the most important consumer-directed purchase, average spending for workers was about 30% lower for depressed persons. While our findings are generally reassuring for public policy, future research is needed to verify that major depression is associated with less spending on in-home workers. [ABSTRACT FROM AUTHOR]

Teens in foster care give birth at more than twice the rate of other teens in the United States. Significant challenges exist for these most vulnerable teens and their babies. To preserve teens’ families, programs and services need to be able to improve teens’ prospects for parenting success, delay subsequent pregnancies, and reduce intergenerational placement in care. The Inwood House theory of change for pregnant and parenting teens is a roadmap for providing the range and types of services that have the potential to improve outcomes for these most vulnerable families. The theory of change builds on insights and data from a demonstration project which took place in the residential program of a New York City foster care agency, with an approach that addressed the developmental needs of adolescents and the practical needs of parenting. Inwood House’s experience provided insights into the role of a theory of change focused on the development of young people, not only their protection, to improve the health and well-being of young mothers and their babies, and reduce intergenerational placement in care. Insights and data derived from this project, which reflect the challenges of research in foster care, are discussed. [ABSTRACT FROM AUTHOR]

Executive functioning is the ability to plan, strategize, organize, and focus on details. Impaired executive functioning plays a significant role in behavior disturbances. Lack of inhibition, impaired abstract reasoning, thought perseverance, rigidity in routine, and lack of insight disrupt social skills and daily life. Autism and schizophrenia present some similar behaviors, including impaired executive functioning, often resulting in pharmacological management as many healthcare professionals receive limited training in executive functioning. Non-pharmacological tools used in autism for behavior management include functional behavioral analysis and social scripting, which help to identify causes of behavior and teach more appropriate behavioral responses. Described here is an educational program for healthcare workers in a long-term care skilled nursing facility, to help them understand the basis for behaviors in individuals with impaired executive function, to use these same tools for behavioral modification techniques, and to help patients learn more appropriate social skills. Program evaluation suggested the educational program was successful in increasing the staff's knowledge and comfort level in addressing the behavioral issues that arise with this population and staff also reported less use of medication as first-line treatment for behavioral issues. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to test three hypotheses involving humility. The first hypothesis specifies that people who are more deeply involved in religion will be more humble than individuals who are not as involved in religion. The second hypothesis predicts that humility will offset the effects of negative interaction in the church on depressed affect scores. The third hypothesis specifies that there will be a positive relationship between age and humility. Methods: The data come from the Religion, Aging, and Health Survey, a nationwide survey of middle-aged and older Christians who attend church on a regular basis (N = 1154). Results: The findings suggest that people who are more committed to their faith tend to be more humble. The results also reveal that negative interaction in the church is greater for people with lower humility scores than individuals with higher humility scores. In contrast, the data indicate that older adults are not more humble than middle-aged people. Conclusions: The findings are noteworthy because they identify a source of resilience that may help middle-aged and older adults cope more effectively with the effects of stress. [ABSTRACT FROM AUTHOR]

Many students with autism spectrum disorders (ASD) are educated separately from their typically developing peers, while others are placed in inclusive classes but without supports that would help them benefit from less restrictive placements. The needs of students with ASD who are in inclusive settings are often not planned for or met appropriately, resulting in continuing problems and movement to increasingly restrictive environments or private placements. There is a critical need for school models to fill the gap in appropriate services for this population of children with ASD. These models should include those that are inclusive and academically challenging, that can be implemented by many school districts, and that are responsive to the unique combination of strengths and deficits in these students. In the current article, the authors describe the development and core components of the model, and implementation of the ASD Nest program in public schools in New York City. [ABSTRACT FROM PUBLISHER]