Health and Social Services for Male-to-Female Transgender Persons of Color in San Francisco

SUMMARY

This article presents findings from an investigation of health needs, service utilization, and perceived barriers to services among male-to-female (MtF) transgender persons of color in San Francisco. Focus groups (n = 48) and survey interviews (n = 332) were conducted with convenience samples recruited from the community. Participants reported a range of health and social services needed during the previous year, with African-Americans and Latinas showing particularly strong service needs. Rates of utilizing services were high for basic health care but lower for social services, substance abuse treatment, psychological counseling, and gender transition-related medical services. No significant ethnic group differences in health service utilization were found. Qualitative findings evinced the call for transgender-specific programs and advanced provider training on transgender issues such as hormone use, gender transition, HIV/ AIDS care and prevention, substance abuse, and mental health problems.     

Job Satisfaction of Child Welfare Workers in an Urban Setting: Status and Predictors

Large urban areas present many challenges to those children and adults who reside in those settings. The social service workers in urban areas have clients with complex, multiple needs. Reliable and consistent workers are essential to successfully working with these families. In the current study, the job satisfaction of 29 social service workers in an urban child welfare agency was assessed using the Job Satisfaction Scale (JSS). The JSS measures satisfaction in 7 areas of one's job (i.e., work, supervision, coworkers, pay and promotion, work environment, training, and position). Data indicated that the staff were relatively satisfied, that satisfaction did not vary by staff position (family worker vs. social worker/supervisor), and that neither demographic factors nor prior experiences were predictors of job satisfaction. Implications for agency management and the provision of social services to urban families are discussed.     

Identifying and understanding gaps in services for adults experiencing homelessness

Gaps between service needs and availability often prevent individuals with a history of homelessness from accessing services and reestablishing permanent housing. This paper examines self‐identified service utilization and service needs based on data collected from an urban sample (N = 577) of adults experiencing homelessness. This study found that individuals differ in their use and continued need of services depending on the reasons they identified as contributing to their homelessness. The majority reported that they learned of services through word of mouth, had difficulty accessing services due to limited transportation options, and were most likely to use services that were in convenient locations that fulfilled their needs and where they were treated with respect. These findings have implications for developing coordinated intakes and the development and dissemination of services aimed at assisting individuals experiencing homelessness.     

Factors Affecting Employer Preference for Female Managerial Applicants

This study examines aspects of job interview behavior that influence employer preference for a female applicant for a managerial position in the human service field. The authors used an analogue methodology simulating videotaped job interview vignettes to present a female applicant exhibiting varying leadership and personality styles, ranging from a “warm” cooperative style to a “cold” task-oriented style. Employers in the human services field rated their preference for the simulated applicants. There were significant differences in preference for the various types of applicants; the most preferred were those who combined warmth with goal-oriented leadership skills.     

Community-based services and resources: The significance of choice and diversity

Conclusions We are reminded by the growth of consumer-run approaches of the value of diversity and individual choice in community support of persons with severe mental illness. These ideas are evident in the alternative approaches that have been developed to serve persons who have not been reached by more traditional services. The ACT program, described by Bond et al. (1990), is an example of a service approach designed to be responsive to individuals' day-to-day needs as they define them. Continued development of this type of alternative service should be encouraged.Persons coping with severe mental illness benefit from a variety of community supports and resources. Strategies that encourage consumer involvement, ownership, and control help to provide diversity of services and to empower the consumer. Our efforts, as professionals, to provide community services can be enhanced by (a) supporting diversity of service and resource options, both inside and outside of the professional mental health system; (b) developing services that are responsive to individuals needs as they define them; and (c) facilitating the process of consumer choice in selecting resources options.The author expresses thanks to Marc A. Zimmerman and Richard H. Price for comments on earlier drafts of this paper.     

LINKING EMPLOYEE PERCEPTIONS OF SERVICE CLIMATE TO CUSTOMER SATISFACTION

Although a common theme in the service quality literature is that organizations must create and maintain a climate for service in order for employees to effectively deliver service, few studies exist that evaluate climate for service components against a criterion of customer satisfaction. The effectiveness of different aspects of a climate for service is evaluated by determining the relationships between service climate components and facets of customer satisfaction, as rated by 538 employees and 7,944 customers across 57 branches of a large bank. All service climate components were significantly related to at least one facet of customer satisfaction (e.g., teller service). Seeking and sharing information about customers' needs and expectations, training in delivering quality service, and rewarding and recognizing excellent service were the practices that were most highly related to satisfaction with service quality.     

Mental Health and Incarcerated Youth. II: Service Utilization

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the level of prior service utilization in incarcerated youth versus youth receiving community mental health services. We randomly recruited youth from middle South Carolina served by a local community mental health center (CMHC; n = 60), hospitalized in the state adolescent inpatient program (n = 50), and incarcerated in the S.C. Dept. of Juvenile Justice facilities (n = 75). We used a Services History to evaluate episodes of prior utilization of mental health, social service, educational, residential, and volunteer services, as well as the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and symptoms and the CBCL and YSR to evaluate behavioral symptomatology. Incarcerated, hospitalized, and CMHC youth utilized similar levels of educational services and social services. Incarcerated youth had a significantly lower lifetime utilization of outpatient and acute mental health services and significantly higher utilization of out-of-home residential services than the other groups. These services utilization variables, along with gender and age, significantly distinguish incarcerated youth from the clinical groups, with clinical variables not serving to significantly distinguish them. Our results indicate the need to develop programs to prevent the entry of mentally ill/emotionally disturbed youth into the juvenile justice system. Youth who are at risk for incarcenation may benefit from intensive mental health services to prevent out-of-home placement and later incarceration.     

The Impact of Couple Therapy on Service Utilization among Military Veterans: The Moderating Roles of Pretreatment Service Utilization and Premature Termination

Couple therapy reduces relational and individual distress and may affect utilization of other health services, particularly among higher service utilizers. Although average decreases in service utilization are predicted among recipients of couple therapy, low utilizers of services may appropriately increase use. The relationship between couple therapy and service utilization was examined among a sample of 179 U.S. military veterans who received treatment in Veterans Affairs (VA) specialty couple therapy clinics. Consistent with hypotheses, overall mental and physical health visits decreased from the 12 months preceding couple therapy to the 12 months following treatment. Moderator analyses showed that decreases were greatest among individuals who were rated by their therapist as having completed a full course of couple therapy, suggesting that change was attributable to intervention. Pretreatment service utilization also moderated observed change—higher utilizers’ use of services decreased substantially, whereas lower utilizers’ slightly increased. Cost analyses revealed that the estimated per person mean cost in our sample decreased by $930.33 in the year following compared to the year prior to couple therapy, as per 2008 VA cost data. As service utilization data were only available for one partner and only for 1 year posttherapy, the true magnitude of this effect may be underestimated. Our findings are relevant to policy makers as they demonstrate that couple therapy reduces average service utilization and associated costs and addresses calls for analyses of cost effectiveness of systemic interventions.     

Effects of the beholder's age on the perception of facial attractiveness

Children have been shown to prefer faces rated as highly attractive by adults over faces rated as quite unattractive. We investigated to what extent this agreement holds not only for the general direction of preferences but for preference strengths as well. In a choice experiment, we presented 40 nine-year-old girls and their mothers and 40 twelve-year-old girls and their mothers with pairs of women's and girls' faces and asked the subjects to pick the face that appeared prettier to them. Preference frequencies and simple attractiveness scales derived from these preference frequencies by fitting the Bradley-Terry-Luce rule (Luce, D. R. (1959). Individual choice behavior: a theoretical analysis. New York: Wiley) were compared across subject groups. For the women's faces, we found no difference in preferences between nine-year-olds, twelve-year-olds, and adults, neither in direction nor in strength. For the girls' faces, we also found no major differences in preference direction, however, we did find reliable differences in preference strengths. To a considerable part these differences were due to the fact that the children showed less pronounced preferences between face stimuli than the adults. These results suggest a role of developmental factors in the perception of facial attractiveness.     

A study of families' satisfaction with a family interventions in psychosis service in Somerset

Although research has shown the efficacy of family interventions in psychosis, there has been little research into families' own experience of services in routine clinical settings. Fifteen of the first twenty-two referrals to a Somerset Family Interventions Service agreed to take part in semi-structured interviews regarding family satisfaction and clinical outcome. High levels of engagement and satisfaction with the service were reported in spite of initial apprehension regarding family sessions. Family members thought that the sessions had helped them deal more effectively with problems and relatives' symptoms. They valued the opportunity for open discussion, developing new perspectives and problem-solving, as well as liaison/closer working with mental health services. Positive therapeutic qualities/skills (e.g. empathic, non-judgemental approach; mutually agreed goals) were highlighted. This study also indicated that successful engagement in family work requires referral at an early stage. The findings of this study, particularly those relating to the therapeutic relationship, are discussed, including their relevance for future research.     

Flow Versus Life Satisfaction: A Projective Use of Cartoons to Illustrate the Difference Between the Evaluation Approach and the Intrinsic Motivation Approach to Subjective Quality of Life

In this paper, differences between life satisfaction and intrinsic motivation (flow) are addressed. Theories are presented on evaluation, flow and openness to experience. Data from a Norwegian panel study are analyzed by means of structural equation modeling. Young adults (n = 264) participated in a projective study with cartoon frames showing Donald Duck in challenging situations. Measures of satisfaction with life and the personality trait of openness to experience were added to the analysis. Subjects scoring high on openness rated Donald Duck's feelings as positive. A slightly opposing tendency was found for persons scoring high on satisfaction with life. The results are discussed with reference to the philosophical distinction between hedonism and eudaemonia.     

Mental health service utilization among Puerto Rican children ages 4 through 16

This paper examines those children receiving mental health services in Puerto Rico, their demographic and psychosocial characteristics, and describes service providers and nature of facilities. The survey was done on a probability sample of children ages 4 through 16 across the island of Puerto Rico (N=777). Need for services was clinically defined as presence of a DSM-III diagnosis and functional impairment. The overall rate of service utilization for Puerto Rican children was 6% (26.2% of definite cases and 5.1% of probable cases). In most cases services were provided by psychologists and/or social workers, and they were mainly provided in schools and general medical facilities. In over 60% of the children assessed as cases, who did not receive services, the reason, given by the parent was that they considered the problem not serious. Factors associated with service utilization were measures of psychopathology, teacher's perceived need, and parental rates of criticism and hostility. These findings suggest that there is a need for more research on the motivating factors for service use (impairment and parental criticism). Teachers could benefit from receiving special training to help them readily recognize behavioral problems in children, communicate them to parents and set up services alternatives.     

An investigation of relative preference for consistency motivation

The present experiment was designed to determine relative preference for fulfillment of consistency motivation. Ninety-two students rated their attraction to, identification with, and idealization of a hypothetical stimulus person who was represented as having fulfilled particular social motives such as approval, power, achievement and consistency. Results confirmed that subjects prefer persons who have satisfied traditional needs more so than others whose consistency desires have been fulfilled. Implications for the role of consistency motivation in social behavior are considered.     

Addressing the Needs of Adolescents and Adults with Autism: A Crisis on the Horizon

The cohort of individuals with autism spectrum disorder (ASD) diagnosed as part of the first wave of what is often referred to as the autism epidemic is rapidly approaching adulthood. This cohort represents only the proverbial tip of the iceberg with some reports noting that 70% of the currently identified individuals with ASD are less than 14-years old. These numbers represent a looming crisis of unprecedented magnitude for adults with autism, their families, and the ill-prepared and underfunded adult service system charged with meeting their needs. A review of the current literature on outcomes for adults with ASD indicates that, independent of current ability levels, the vast majority of adults on the spectrum are either unemployed or underemployed and, further, that large numbers of adults with autism remain without any appropriate services. Many have had inadequate transition programming including little attention to service coordination, minimal direct family involvement and/or absence of treatment based on evidence-based practices. Lastly, issues related to staff and provider recruitment and retention present significant, systemic challenges to the provision of effective services. As such there is a significant and growing need for greater attention to individual needs of adults with ASD if we are provide the opportunity for a positive quality-of-life.     

Judging jury service: results of the North Carolina administrative office of the courts juror survey

This study examined venirepersons' and jurors' levels of satisfaction with jury service. Surveys were distributed to all persons who reported for state court jury service during two one-week periods in each North Carolina county. Questions concerned satisfaction with various aspects of jury service, the effects of service, hardships experienced, details of and reactions to cases heard, and basic demographic information. Responses were obtained from 82 of the 100 counties and 4,654 venirepersons (of whom 1,478 served as jurors). Consistent with prior research on juror experiences, results generally revealed high levels of satisfaction and positive opinions about various aspects of jury service. Service did not influence opinions about the courts for most respondents, and those whose opinions changed tended to become more positive about jury service. Suggestions for future research emphasize giving higher priority to publishing unpublished research on jury experience, explaining the high satisfaction levels observed in samples of jurors, and examining the impact of trial reform on juror satisfaction levels.     

Balance,agreement, and attraction in hypothetical social situations

Sixty subjects rated hypothetical P-O-X situations involving two persons and an unspecified but important “thing” for pleasantness, tension, and consistency. The situations varied in terms of whether P and O liked or disliked each other and whether P and O agreed or disagreed regarding X. Half of the subjects rated eight situations used by Gutman and Knox (Journal of Personality and Social Psychology, 1972, 24, 351–357) in which a unit relation was induced between P and O by describing them as necessarily having to continue interacting with one another in the future. The other half of the subjects rated situations that were identical to those of the unit condition, except that stipulation of continued interaction was omitted, so that no unit relation was specifically induced. Results showed that preferences for agreement and attraction were stronger for pleasantness and tension ratings than for consistency ratings, while the preference for balance was stronger for consistency ratings than for pleasantness and tension ratings. When no unit relation was specified, the balance preference increased, whereas the attraction preference decreased. Moreover, the effect of attraction decreased more from the unit to the no unit condition for pleasantness than for tension ratings and more for tension than for consistency ratings. The results underscore the need to consider the influence of both the described characteristics of hypothetical social situations and the type of dependent measure employed on the weighting of preferences for balance, agreement, and attraction.     

Adherence to HAART: perspectives from clients in treatment support programs

The development of highly active antiretroviral therapy (HAART) has resulted in dramatic decreases in morbidity and mortality for HIV-infected individuals. Because the long-term efficacy of HAART is dependent on near perfect adherence, many providers offer services to support adherence, including education, regimen review, counseling, and reminder tools. Little is known regarding the utilization or efficacy of these services. In this paper, we report on data collected during 32 open-ended interviews conducted with individuals receiving services through the New York State Treatment Adherence Demonstration Project. Participants in the project reported deriving benefits from a broad range of project activities. Educational efforts helped clients to recognize HIV as a manageable, rather than terminal, illness. Information and tools focused on specific regimens provided clients with concrete knowledge and skills. Effective communication with medical providers and pharmacists was facilitated by adherence staff who proactively advocated for client needs. Program-based social support was particularly valuable for many participants, helping them to retain needed motivation and strength. Educational, practical, and supportive services were all considered valuable to clients participating in adherence support programs. A mix of services may best meet the range of needs found among persons taking HAART.     

Where Have All the Children Gone? Movement from Child to Adult Mental Health Systems

The mental health histories of the 448 children 15 and 16 years of age who were admitted to state-operated children's psychiatric inpatient services in New York during 1982 were reviewed for the 11 year period through April 1993, Thirty-three percent were served as adults (after age 18) in the state-operated adult civil mental health system; 42% of these individuals were still receiving services at the end of the period. 113 of the 146 individuals served as adults were served only in the civil system. Thirteen percent of the cohort received some of their mental health services as adults in the state-operated adult forensic mental health system due to criminal law involvement. This includes nine percent who received mental health services while they were inmates in state prisons. Twenty four of the 57 forensic clients received services as adults only in the forensic system. Diagnostic, demographic, and service history characteristics of the groups were compared to foster an early understanding of policy and programmatic issues related to movement from the child mental health system to the adult system. Baseline (1982) information was used to identify predictors of later service utilization.     

Community mental health services for black and ethnic minorities

An investigation into the provision of community mental health services in one local authority Borough found that facilities for the rehabilitation and resettlement of the recovering mentally ill into the community were very limited and fell far short of ofJicial recommendations and that very little consideration was given to meeting the needs of black and ethnic minorities. An analysis of data porn service providers (Local Authority/Social Services/Health Authority), multidisciplinary teams, voluntary agencies and 120 black and ethnic minorities (users and non-users of mental health services) in the Borough suggested that black and ethnic minorities had little or no say in decisions about the provision of community mental health services to the extent that they feLt excluded. In many instances service providers had limited contact with black and ethnic minorities and some members of the multidisciplinary team had little to do with black people but yet influenced major decisions about the provision of services to meet their needs. The findings drew sharp attention to the diference between the views of service providers and those of service users in terms of the provision of community mental health services to meet the needs of black and ethnic minorities. Ninety six percent of those involved in the study were appalled over the apparent lack of emphasis placed on the provision of services to meet the needs of black and ethnic minorities and felt that nothing was being done to improve the inadequate service which was offered ly the voluntary sector.