Chest reconstructive surgeries in transmasculine youth: Experience from one pediatric center

Background: For many trans males, having chest reconstruction is a very important part of the transitioning process. Guidelines from WPATH and the Endocrine Society suggest 16 to 18 years old as an acceptable age for this surgical intervention. In clinical practice, the decision depends on factors such as a person's desires, insurance coverage, and availability of local surgical experts. We present data about chest reconstructive surgeries in transgender youth from a Pediatric Gender Management (GeM) clinic.

Methods: For this retrospective, observational study, data were collected from GeM clinic patients seen from 10/1/2011 to 1/31/2017. All subjects consented or assented to being included in an IRB-approved clinical database.

Results: Of 210 patients from our clinic, 167 consented to being added to an institutional review board–approved database and followed prospectively. The average age at the initial visit was 15.2 years (range, 4.7–20.9). Among consenting subjects, 55 were trans females, 108 were trans males, and four identified as nonbinary. Fourteen subjects had chest reconstruction with the mean age being 17.2 years (range, 13.4–19.7); three subjects were under age 16. For five subjects, including the youngest one, insurance paid for the procedure. All participants but one were receiving testosterone treatment. Per the surgeons' preferences, testosterone was usually not temporarily stopped prior to the procedure. Six subjects had the procedure done locally; others sought surgical care out of the town, state, or country. All subjects were very satisfied with the aesthetics of the surgical outcome. The self-reported complication rate was low. Many more GeM clinic patients wish to have breast/chest surgery but lack of insurance coverage makes the surgery cost prohibitive.

Conclusion: For many trans males, chest reconstructive surgery is an integral part of the transition process. Patients' age at the time of surgical procedure varies greatly; some have chest surgery before age 16. In the United States, chest reconstruction surgery is usually not covered by insurance. Therefore, many patients seeking surgical care are forced to pay out of pocket.     

HIV/AIDS and immigrant Cape Verdean women: Contextualized perspectives of Cape Verdean community advocates

This research explored Cape Verdean community advocates’ understandings of the structural and social realities that contribute to the increased HIV/AIDS risk of Northeastern U.S.-based immigrant Cape Verdean women. A community perspective informed the analysis of the multi-layered contextual barriers that these advocates identified as limiting the effectiveness of individual-level HIV/AIDS prevention and intervention models. Qualitative content analysis of interviews with nine community advocates revealed several thematic clusters including challenges to (1) perceived institutional and community realities; (2) traditional gender relations; and, (3) traditional ways of thinking. These findings challenge universalist cognitive-behavioral change models of HIV/AIDS prevention and intervention and are critically discussed to better understand the complex realities faced by Cape Verdean immigrant women. A liberatory community psychology perspective framed the research process and contributed to reconceptualizing HIV/AIDS risk as a community problem that requires interventions not simply at the individual and relational levels, but also at the structural level.     

Parent Motivation to Participate in Treatment: Assessment and Prediction of Subsequent Participation

Treatment motivation is required for virtually all psychosocial treatments because clients must participate actively in the treatment process. In child and family treatments, it is the parent who must be motivated to manage treatment participation; however, no measures are currently available for evaluating parent motivation for treatment. The authors developed and evaluated a brief rating scale, the Parent Motivation Inventory (PMI), to measure parent motivation to participate in treatment. Results supported a uni-dimensional measure with strong internal consistency and test-retest reliability. Increases in parent motivation predicted the perception of fewer barriers to treatment participation, which was significantly associated with greater treatment attendance. The PMI provides a reliable and valid method of assessing parents’ motivation to participate in treatment and has implications for the prediction and potential modification of barriers to treatment and treatment participation.     

Developing comprehensive,individualized community-based services for children and youth with emotional and behavior disorders: Direct service providers' perspectives

Increased attention to the plight of children and youth with emotional or behavioral disorders (EBD) and their families has led to innovations in the manner in which these individuals are served. Two such innovations have been the development of public systems of comprehensive, community-based care and individualized wraparound services. This study was part of one community's attempt to merge these two innovations and provide individualized wraparound services to children and youth with EBD through the auspices of public agencies. Direct service providers were surveyed to gather their input into how such services could best be developed and implemented. The survey focused on existing barriers to providing services and specific service priorities for system development. Methods and results are presented. Implications for the local system and future research needs are discussed.     

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Objective

Treatment decision‐making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side‐effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision‐making, unmet patient needs for (b) decision‐support and (c) information.

Method

Qualitative semi‐structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self‐report professional experience, and clinician preferences for patient decision‐making involvement were also assessed.

Results

Qualitative analyses yielded two inter‐related themes: (a) challenges and barriers to decision‐making and (b) facilitators of clinician decision‐making. Symptom severity, negative family attitudes, system‐based factors, and information gaps were thought to pose challenges to decision‐making. By contrast, decision‐making was supported by patient information, family involvement and patient‐centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist.

Conclusions

Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision‐making, active patient participation is hampered by unmet informational and decision‐support needs. Current findings inform a number of bipolar II disorder‐specific, clinician‐endorsed strategies for facilitating patient decision‐making, which can inform the development of targeted patient decision‐support resources for use in this setting.     

Mapping Juvenile Justice: Identifying Existing Structural Barriers to Accessing Probation Services

The majority of justice‐involved youth are placed on probation; however, many of those same youth struggle to comply with probation requirements and are subsequently confined. In Baltimore, 20% of newly committed youth were detained for violations of probation. While there are various reasons youth fail to comply with probation requirements, there have been recent calls to consider the impact of structural and spatial barriers to accessing probation programs and services. Centering the goals of community psychology, we aim to identify how existing structural barriers in Baltimore City may be contributing to social injustice through inequitable access to probation services for youth and their families. In this study, we take a novel, interdisciplinary approach to identify structural or spatial barriers facing justice‐involved youth in Baltimore, MD. Specifically, we explore transportation barriers (i.e., vehicle access) and spatial disparities between youth residences and probation office locations. Our findings suggest that there are several barriers facing Baltimore’s justice‐involved youth that may impact access to and engagement with juvenile probation. Specifically, we found that 1 in 3 youths reside in areas with extremely low levels of vehicle access and where the median household income is 25% below the city median. We also find that the majority of youth live beyond walking distances; many would require lengthy transit commutes. These findings highlight the structural and spatial barriers facing justice‐involved youth that may impact access to and engagement with probation services.     

The Crying Clinic: Increasing accessibility to Infant Mental Health services for immigrant parents at risk for peripartum depression

Peripartum depression (PPD) is considered a major public health concern due to its profound impact on families, including infants. In this paper, we report on a pilot initiative designed to reduce barriers and stigma related to the use of traditional infant mental health services for immigrant parents deemed at high risk of PPD. The Crying Clinic (CC) is an innovative walk‐in service offered in a culturally diverse Canadian community to support maternal well‐being and healthy parent–infant relationships. The CC was designed to be a gateway to existing infant mental health services, through its emphasis on accessibility and cultural sensitivity. Support for concrete concerns, such as anxiety about normative infant behaviors like crying, is underscored in this approach to attract vulnerable families who would otherwise not access mental health support. A review of 44 users, utilization, plans for the use of additional services, and client evaluations suggests that the CC accomplished most of its goals. We conclude that gateway service models such as the CC have the potential to enhance traditional infant mental health programs by creatively addressing the challenge of engaging highly vulnerable parents from culturally diverse backgrounds.