Sailing through social LA GRRAACCEESS: tool for deconstructing and facilitating reflective and reflexive practice

Reflective and reflexive practice has become an integral component of practitioner professional training, particularly within professions associated with psychology and nursing. One way of facilitating reflective and reflexive practice is to integrate sensitivity of social interrelated constructs and social differences in relation to Gender, Race, Religion, Age, Abilities, Class, Culture, Ethnicity, Education, Sexual orientation and Spirituality as outlined in the GRRAACCEESS acronym. Inspired from the eighteen-century sailing vessel replica ‘La Grace’, this paper extends Burnham’s original GRRAACCEESS acronym by adding ‘Language’ and ‘Anatomy’ to form the ‘LA GRRAACCEESS’ model. This paper explores the merits and implications of the LA GRRAACCEESS model in order to assist practitioners with unravelling or deconstructing reflective practice and encourage ongoing mindful reflective practice.     

Non-binary youth: Access to gender-affirming primary health care

ABSTRACT

Background: Transgender (trans) youth who identify outside the gender binary are a growing subpopulation. In this article, we document differences in access to gender-affirming health care between binary and non-binary identified trans youth and explore ways of meeting the health needs of non-binary youth within primary care settings.

Methods: The Canadian Trans Youth Health Survey is a national online survey of trans youth, 14–25 years, conducted in 2013–2014. Among the 839 participants who responded to gender identity items in the survey, 41% identified as non-binary. We compared demographic, health outcome, and health care access responses between non-binary and binary (trans girls/women and trans boys/men) youth.

Results: Non-binary and binary youth were similar in most demographics, including age, geographic distribution, and ethnocultural backgrounds, however a larger proportion (82%) of non-binary youth were assigned female at birth. Older non-binary youth (aged 19–25) were significantly more likely to forego needed healthcare than older binary youth; no significant differences were found between younger (14–18) non-binary and binary youth in foregoing healthcare. Overall, non-binary youth (13%) were significantly less likely than binary youth (52%) to access hormone therapy, but they were more likely than binary youth to report experiencing barriers to accessing hormone therapy when needed.

Conclusions: Non-binary trans youth in Canada report challenges in accessing needed gender-affirming healthcare. Primary care providers are well-situated to integrate a broad range of gender-affirming care services into practice in order to address the unique needs of non-binary youth. Future research is warranted to explore experiences of non-binary youth related to barriers to care and to explore how services can be designed and delivered to better meet the needs of non-binary youth seeking gender-affirming primary care.     

Informal care in social context: A social psychological analysis of participation,impact and intervention in care of the elderly

Abstract

Concern about the provision and effects of care to elderly people by unpaid family, relatives and friends has arisen in the contexts of changing demographic structures of populations and, in Britain at least, explicit policy by Government which seeks to promote familial responsibility for the financial, physical and emotional needs of elderly populations. The present review examines the extent and nature of informal care to elderly people, assesses the evidence to support sociological models of care work participation and the extent to which such models are reflected in beliefs concerning care of elderly people and intentions to cease direct provision of care. Studies of the psychological impacts of care work and of interventions to modify carer wellbeing are critically reviewed. It is suggested that future psychological research should focus on modeling the modifiable psychological processes which explain variance in care work participation, impact and uptake of services, and on the impacts of changing social policy on social perception and wellbeing of elderly people.     

Stigma modifies the association between social support and mental health among sexual violence survivors in the Democratic Republic of Congo: implications for practice

Background and Objectives: The aim of this study was to further understanding of the relationship between social support, internalized and perceived stigma, and mental health among women who experienced sexual violence in the eastern Democratic Republic of Congo (DRC).

Methods: Drawing from baseline survey data collected in eastern DRC, researchers conducted a secondary cross-sectional analysis using data from 744 participants. Regression and moderation analyses were conducted to examine associations between social support variables, felt stigma, and depression, anxiety and posttraumatic stress disorder (PTSD).

Results: Emotional support seeking and felt stigma were positively associated with increased symptom severity across all three mental health variables. Stigma modified associations between emotional support seeking and depression (t?=??2.49, p?=?.013), anxiety (t?=??3.08, p?=?.002), and PTSD (t?=??2.94, p?=?.003). Increased frequency of emotional support seeking was associated with higher mental health symptoms of anxiety and PTSD among women experiencing all levels of stigma.

Conclusions: Enhancing understanding of social support and stigma may inform research and intervention among Congolese forced migrant populations across circumstances and geographic locations. Implications for practice and research are discussed.     

Finding new ways to practise critically: applying a critical reflection model with Australian health promotion practitioners

Greater support is required in health promotion for practitioners to adopt critical approaches to their practice. Despite recognition of the role that critical reflection can play in supporting critical practice, it is underdeveloped in health promotion. This pilot study aimed to explore the use of critical reflection with health promotion practitioners. Critical postmodernism provided the theoretical perspective and critical reflection methodology guided the study. The data collection method involved the application of a critical reflection model via in-depth semi-structured interviews with two health promotion practitioners who were recruited using purposive sampling. Critical postmodernism and critical health promotion values and principles were the thematic frameworks used to analyse the data. Four types of assumptions were identified across both participants’ narratives: binary opposites and dichotomous thinking; identity and othering; professionalism; and power. Two key themes that evidenced these assumptions were conceptualising power as a commodity, and identity in the Aboriginal and Torres Strait Islander context. Both traditional and critical health promotion practice approaches were evident in participants’ practice. The process of engaging in critical reflection resulted in positive outcomes for the practitioners, including the identification of new, more critical ways of practising. Critical reflection provides a process for developing critical health promotion practice. The designation of critical reflection as a core health promotion competency may enhance the development of critical health promotion. Further research is needed to develop and test a critical reflection model incorporating the values and principles of health promotion with a larger sample of practitioners.     

Pathways to mental health care by members of a rural community in South Africa

This study explored mental health help seeking pathways followed by Black South African rural community dwellers in the Limpopo province of South Africa. Ten participants (5 females and 5 males) aged between 18 and 59 years receiving services from a rural mental health care facility in the Limpopo province were the informants. They presented with psychotic disorders?=?50%, substance-use mental disorders?=?20%, mood disorders?=?20% and epilepsy?=?10%. They completed a semi-structured one-to-one interview on their pathways to mental health care services. Data were content analysed. The results showed that help seeking pathways for mental health involve several entry points. These include the utilisation of western medicine when experiencing acute symptoms, and a preference for traditional medicine when faced with chronic but manageable symptoms. The findings suggest that families and significant others are important facilitators for individuals navigating the mental health care pathways.     

Clinical psychology in medical settings: Psychology's role in health care

The number of clinical psychologists working in medical settings has grown along with the range of services provided by psychologists to patients with a multitude of medical problems across the lifespan. Medical care cost savings brought about by these psychological interventions is highlighted along with issues of public policy and specialization of training. The opportunity for ongoing development of clinical psychology in medical settings is described as unlimited and the mission of the newJournal of Clinical Psychology in Medical Settings is presented as supporting that growth.     

The ethics of everyday practice in primary medical care: responding to social health inequities

Background  

Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities.     

Community as practice: social representations of community and their implications for health promotion

Health promotion researchers and practitioners have increasingly turned to community-based approaches. Although there has been much work around the diverse understandings of the term in areas such as community psychology and sociology, I am concerned with how such understandings relate directly to community health research and practice. From a discursive perspective ‘community’ is seen as a socially constructed representation that is used variously and pragmatically. However, from a wider view, community can be seen as a matter of embodied practice. This paper draws on social representations theory to examine the shifting constructions of ‘community’, the functional use of those understandings in social life, and the practices that suggest that it is important to attend to their use in particular contexts. Accordingly, the paper argues that meanings of community in the health promotion or public health context must be seen as representations used for specific purposes in particular situations. Furthermore, the broader notion of embodied practice in social life has implications for community participation in health promotion. Copyright © 2007 John Wiley & Sons, Ltd.     

Health care practitioners' perceptions of public mental health care in the Eastern Cape,South Africa

This qualitative study explored the perceptions of health care practitioners (HCPs) concerning public mental health care in the Eastern Cape Province of South Africa. Data were collected from thirteen purposively selected HCPs using in-depth unstructured interviews (males?=?6, females?=?7). Data were transcribed verbatim and later thematically analysed. The findings suggest that mental health professionals perceive mental health services to be both inadequate and of suboptimal quality. Specifically, they perceived public mental health care to have lower priority, to be poorly resourced and lacking in patient-oriented care qualities.     

Subjective health complaints and health related quality of life in a population of health care workers

The aim of this study was to assess whether Subjective Health Complaints (SHC), demands and coping are associated with health-related quality of life in a population of health care workers. One hundred and nineteen employees in two nursing homes for the elderly filled in a questionnaire on health, exercise, psychological factors, and work conditions. Main outcome measures were SHC and quality of life measured by SF-36. High level of SHC was associated to low health-related quality of life. Low coping and high demands were related to low scores (low quality of life), and high coping and low demands to high scores on mental health. Pseudoneurological complaints (e.g. tiredness, sadness), high demands and low coping were associated with low mental health. The expected negative association between SHC and health-related quality of life was found. There was a positive association between coping and quality of life.     

It takes two to tango: Research and practice as an amazing dance

This paper offers an appreciative critique of Kim Etherington's recent book, Narrative Approaches to Working with Adult Male Survivors of Male Child Sexual Abuse. I discuss the issues raised in the book with reference to one of my current clients. Etherington does not produce new substantive theory: the power of this work is in the narrative. Her important contribution lies in the reflexivity with which she encounters her material. The use of critical reflexivity challenges the subject/object dichotomy inherent in much positivistic research, and presents a much‐needed approach to process that is congruent with the lived experience of counselling. I would suggest that research is more likely to succeed in informing practice if the material is open to personal interpretation by the reader/therapist. Further, I would claim that the activity of using research creatively is itself a heuristic process: useful learning is most likely to occur if the dialogic relationship with the client and therapist is mirrored in the relationship between the therapist and the research text.     

Interdisciplinary research and interprofessional collaborative care in a memory clinic for rural and northern residents of western Canada: Unique training ground for clinical psychology graduate students

Abstract: In Canada, interprofessional education (IPE) and interdisciplinary health research initiatives are beginning to transform the academic health sciences, including graduate training programs for clinical psychologists. In response to mandates and directives from national health policy and research funding bodies, academic training programs are re‐structuring course offerings, practicum training experiences, and research activities to better prepare students for their future roles within interdisciplinary research groups and collaborative patient‐centred clinical teams. As an example of this transformative movement in IPE, described herein are the recent training initiatives in the Graduate Program in Clinical Psychology at the University of Saskatchewan, and the role of clinical neuropsychology in an innovative interprofessional rural and remote memory clinic.     

Critical thinking as cooperation and its relation to mental health and social welfare

The purpose of this theoretical investigation was to examine critical thinking as a realization of human cooperation, affecting both mental health and social welfare. Although critical thinking contains a critical stance toward any asserted standpoint, such a critical stance appears, paradoxically, to have developed from cooperation and the shared goals of human beings. Moreover, although critical thinking has been seen in academic literature to be anchored on culturally developed rules and principles of rational dialogue as well as on effective learning methods, investigators have not interconnected critical thinking and human cooperation comprehensively enough. To solve the dilemma, we will use available scientific knowledge to examine how cooperation and socially shared goals are realized in critical thinking, especially in a critical stance. The view of critical thinking as cooperation places it ontogenetically and phylogenetically into a wider theoretical framework which also provides a novel perspective on mental health and social welfare. The deterioration of rational thinking in the context of mental disorders may be explained by failures of cooperation, which can contain epistemic distrust and an inability to mentalize the viewpoints of others. These features may clarify some causes why some contemporary dialogues and critical contributions are divisive in worldwide, especially in social media.     

Moving beyond reflection in a hall of mirrors: developing critical reflective capacity in teachers and teacher educators

Using reflection to merely affirm existing beliefs rather than engaging in confrontation and examination of beliefs is like reflecting in a hall of mirrors. This study explores the process of critical reflective development of practicing teachers through program reflections written to prompts during master’s-level coursework, seeking to understand: How does critical reflective capacity develop and change in practicing teachers enrolled in advanced coursework in an M.Ed. program? Researchers used a three-level reflective practice pyramid as a frame for examining teachers’ reflective writings. Specifically, 103 reflections from 26 PK-12 teachers were available for analysis. Where finding a clear trajectory in teacher’s reflective development was an anticipated outcome in which teachers would progress from the technical to contextual to dialectical levels of reflection, findings did not indicate such linear development for most teachers. As faculty analyzed the data, they engaged in critical reflection, also questioning purposes and program outcomes. This paper reports on both our study’s findings in response to the research question and on the results of faculty reflective engagement. Results reinforce the understanding that reflection is an individual journey for teachers and faculty alike; results also highlight the importance for engagement in critical reflection for both teachers and teacher educators.     

Establishing psychological services in a community-based,health care setting: A 3-year case study

Health care practitioners are being challenged to reorganize service delivery and psychology providers are emerging as important participants in shaping the development of primary health care practices. The article outlines the 3-year process of a community/academic/health care center partnership to develop a new model for providing interdisciplinary health care services. The authors describe the process of integrating psychological services into an interdisciplinary, primary care community-based health care center, outline specific planning strategies, and identify the roadblocks and barriers encountered.