(HEA5b) Turning the Tide Towards Queer Health II: Queering Health Interventions
Thursday Jun 20 3:30 pm to 5:00 pm (Eastern Daylight Time)
Trottier Building - ENGTR 2110
Session Code: HEA5b
Session Format: Paper Presentations
Session Language: English
Research Cluster Affiliation: Gender and Sexuality, Sociology of Health
Session Categories: In-person Session
In 2023, we witnessed increased attacks against 2S/LGBTQIA+ communities, such as the obstruction of Policy 713 in New Brunswick, the passing of Bill 137 in Saskatchewan, and a nationwide social movement targeting Queer-inclusive education. In the face of what Marci Ien, the Minister for Women and Gender Equality and Youth, calls the “rising tide” of anti-2S/LGBTQIA+ rhetoric and policy, Queer vitality is at risk. These sessions offer insights into how we can honour lived experiences in supporting the well-being of Queer communities, and opportunities to “queer” health interventions that transcend reductionist notions of tolerance. Tags: Equality and Inequality, Gender, Health and Care, Sexuality
Organizers: Hannah Crouse, Dalhousie University, Joseph Lahey, Dalhousie University; Chairs: Hannah Crouse, Dalhousie University, Joseph Lahey, Dalhousie University
Presentations
Stephanie Nairn, University of Central Florida; Thomas Jones, University of Central Florida
Polysubstance use among young people has recently become the focus of popular media, public health interventions, and research due to alarming increases in polysubstance use-related morbidity and mortality in younger age groups. Data in Canada and the U.S. indicates that morbidity and mortality due to polysubstance use among youth is increasing. Researchers have shown that adult-focused interventions for polysubstance use cannot simply be ‘mapped onto’ youth, as young people occupy lifeworlds distinct from those of older adults. Adult-focused interventions may be irrelevant and not efficacious for youth. Further, some researchers have argued there need to more gender-targeted interventions to attenuate the impact(s) of polysubstance use arguing that interventions for substance use will be more efficacious if they are gender-targeted. It has been argued that young females/women and young trans women experience and occupy unique lifeworlds that necessitates the development of targeted polysubstance use intervention(s). Our cursory review of the literature on youth/gender-targeted interventions for polysubstance use revealed there have been no systematic (scoping) reviews of the gender-targeted interventions for polysubstance use among young women/females and/or young trans women. The literature we have identified focuses on adult women/females and has highlighted accessibility barriers for adult women seeking substance use services (e.g., a lack of childcare, stigma, concerns about children being taken away, long wait times, etc.) (Elms et al., 2018; Najavits et al., 2018). Several examples of interventions for adult women we have identified include A Woman’s Path to Recovery (female veterans), Helping Women Recover and Beyond Trauma , Breaking the Cycle , female-specific cognitive behavioral therapy, Moment by Moment in women’s recovery. The interventions address pregnant women’s needs, domestic violence needs, and working mothers’ needs (Johnstone et al., 2023). A recently published systematic review of substance use interventions for adult women (Johnstone et al., 2023) indicated several of the interventions they found were efficacious for the treatment of substance use but they noted there were several gaps in the current landscape of female/women-specific substance use interventions including, programs for women with a dual diagnosis (mental health conditions and substance use), integrated treatment for women who experience trauma, programs for homeless women, previously or currently incarcerated women, and institutionalized women. Due to the lack of reviews concerning the landscape of interventions/treatments for young women/females and trans women, this paper will 1) Identify young women/female and trans women-targeted interventions 2) Characterize the nature of the interventions to understand where they have been developed, the rationale for their development and implementation, and the mechanisms through which they impact substance use behaviors, and 3) To identify potential gaps in interventions and areas for improvement. We are undertaking a scoping review of the literature that will map and characterize the young female/women and trans women-targeted interventions for substance use (e.g., opioids, cocaine, alcohol, etc.). Our review follows the protocol for scoping reviews as outlined in the JBI Manual for Evidence Synthesis (2020). The inclusion criteria for this review are, I) Studies including young women/females/trans women (ages 15-25), II) Assessing any treatment or intervention for polysubstance use, and III) Measuring any outcome on substance use. Descriptive statistics will be developed regarding geographic location(s) of the studies, intervention type(s), and substances use outcomes. We will perform a content analysis of the included studies which will summarize the rationale(s) for a female/women/trans woman-targeted approaches, characteristics of the interventions (e.g., inpatient, etc.), and identify what might be ‘missing’ from the interventions or treatments. We are in the process of completing this review and have not yet identified our main argument(s). We anticipate this review will help researchers, policymakers, and professionals working with young women/females and trans women understand which interventions are efficacious and the mechanisms through which they are efficacious. We also anticipate this review will provide an in-depth understanding of the rationale and justifications for gender-targeted/gender diverse intervention(s) and will identify gaps or ‘missing’ considerations in the studies we identify. Despite the fact we are currently in the process of completing this review, our topical focus is aligned with thematic focus of the CSA conference. The results of this review will highlight and emphasize the possibilities of and for gender diverse polysubstance use interventions and highlight the gender-specific needs, desires, and experiences of young people that can be integrated in substance use interventions to attenuate the impacts of the North American polysubstance use health crisis among youth.
Non-presenting authors: Jason Phillips, University of Central Florida; Debbie Schmill, Becca Schmill Foundation
Victory Angeli, Dalhousie University
Many young Canadians struggle with their mental health, and these struggles can be severe. Suicide is a leading cause of death for people aged 15-25, and rates are higher for equity-deserving communities. 2SLGBTQIA+ youth are more likely to report poor mental health, and queer and trans youth are four times more likely to die by suicide than their cisgender and straight peers. Poor mental health for 2SLGBTQIA+ youth is attributable to experiences of homophobia, transphobia, and barriers to help-seeking. Despite this, public narratives that denigrate 2SLGBTQIA+ identities remain persistent in Canada. Non-governmental agencies and citizen-led social movements play a critical role in shaping public health discourse, services, and policy. Yet mental health movements struggle to incorporate 2SLGBTQIA+ youths into decision-making, and their absence has lingering effects. Mainstream mental health interventions appeal less to struggling 2SLGBTQIA+ youth, and those who seek services report fewer benefits than cis-straight peers. Social initiatives to uplift 2SLGBTQIA+ communities must engage queer and transgender youth as leaders, experts, and co-creators. What can adult allies and institutions do to empower 2SLGBTQIA+ youth? This presentation highlights findings from a Joanna Briggs Institute (JBI) scoping review on youth empowerment in adult-led mental health advocacy efforts. The JBI method is an internationally recognised research framework, most applied to environmental scans and meta-analyses of health literature. The JBI review informing this presentation includes academic literature published since 2000 and accessible in English, made available across three databases (PsycInfo, SAGE, and Wiley). Victory Angeli (they/them) identifies themes of LGBTQ+ youth engagement in mental health service review, charity administration, and political networking. Three objectives are identified in organizations that responsibly engage LGBTQ+ youth: empathising with youth, engaging youth, and empowering queer and trans people. Adult allies are better able to serve 2SLGBTQIA+ youth when they receive ongoing cultural humility training. Introspection, candid discussions of intersectional social (dis)privilege, and recognition of past mistakes are promising practices. Adults can further engage 2SLGBTQIA+ youth by facilitating: 1) physically and psychologically accessible events; 2) knowledge translation workshops; and 3) formal political advocacy. Organisations who invite youth into internal meetings may further redistribute power to benefit 2SLGBTQIA+ voices, where quorums are set for 2SLGBTQIA+ participants and veto powers are distributed to equity-deserving members. Such themes are consistent across case studies featured in existing literature. Victory Angeli, the lead researcher, applies these findings to their own work as a queer, trans + non-binary youth advocate. They bring their findings to prominent Canadian mental health charities, among which they are recognised as a community advisor with 6+ years of leadership experience. Victory is consulted by non-profits including Kickstand, Foundry, and Jack.org, as a person with lived experience of mental health struggles, a member of equity-deserving groups, and an emerging social science researcher. This proposal is a part of Victory’s efforts to share evidence-based practices, and otherwise engage in knowledge translation, to uplift 2SLGBTQIA+ communities. Civil initiatives to empower queer and trans youth in Canada are crucial to supporting 2SLGBTQIA+ communities. Institutions that share power with queer and trans youth are better able to meet 2SLGBTQIA+ needs, and to provide young leaders with resources that support systemic change. Efforts informing equitable mental health services are buffers against the ongoing discrimination facing queer and trans youth, and safeguards 2SLGBTQIA+ wellness.
Pamela Lamb, McGill University
The LGBT+ Family Coalition is a Quebec-based community rights organization that aims for the social and legal recognition of families from sexual diversity and gender plurality. For nearly a decade, Coalition trainers have been delivering 2S/LGBTQIA+ awareness and inclusion training sessions to thousands of educators and public health professionals across Quebec, to help demystify and shed light on the realities of 2S/LGBTQIA+ communities and provide measures for support. This past year, trainers have reported a rise in verbal microaggressions from training participants, such as discriminating or stigmatizing comments or questions directed at the trainers themselves or towards 2S/LGBTQIA+ communities. These testimonies indicate that the rise in anti-2S/LGBTQIA+ rhetoric in society seems to be having a corresponding expression among professionals in health and social services. This theoretical study addresses the social and affective forces that underlie anti-2S/LGBTQIA+ rhetoric. I take an affective-discursive practice approach (Calder-Dawe and Martinussen, 2021) to examine the nature of social and anti-social engagement in 2S/LGBTQIA+ awareness and inclusion training. I examine how affective-discursive dimensions of social identity are articulated and how they generate feelings of (dis)identification and (un)belonging. The objective of my study is to understand the working of social power through affective/discursive practices (Wetherell, 2013) that mobilize outgroup derogation and ingroup celebration (Van Dijk, 1996). My study foregrounds feminist epistemologies of empathy (Collins, 2000; Meyers, 1994; Tong, 1997), and the importance of feeling as knowledge (Hemmings, 2012). The gap between ways of knowing and ways of being in education and public health—as in everyday life—resonates in issues surrounding what evokes and what inhibits compassionate social action. I define compassionate social action as responding compassionately to the suffering of others in an embodied and inclusive way of caring (Lamb, 2023). The study’s overarching research question is, How can 2S/LGBTQIA+ awareness and inclusion trainings be developed and implemented in ways that mobilize participants’ individual experiences towards collective capacity for solidarity with 2S/LGBTQIA+ communities? As measures to reduce heath disparities are being integrated into health programs and services (Health Disparities Task Group, 2004), training health and social care professionals on unequal social relations has been seen as key to promoting more equitable health outcomes (Canadian Medical Association, 2013). Yet in 2023, anti-2S/LGBTQIA+ bias is still at the root of inequities that result in a high burden of poor health in 2S/LGBTQIA+ communities (Comeau et al., 2023). Health and social care professionals, policymakers, and educators are therefore key participants in the Coalition’s trainings, as they play a critical role in reducing disparities rooted in anti-2S/LGBTQIA+ rhetoric and policy. However, the affective elements that underlie their professional practice, like implicit biases, can produce barriers to their clinical, legislative, and educational effectiveness. Recognizing what feelings are evoked in anti-2S/LGBTQIA+ rhetoric is critical to understanding why those feelings matter for knowing and acting differently. Attending to the affective-discursive dynamics of 2S/LGBTQIA+ awareness and inclusion training—such as how it feels for participants to notice and challenge implicit biases—offers ethical foundations for meeting participants where they are at, which can produce a politicized impetus to change (Hemmings, 2012).Moreover, it is imperative for attitudinal and behavioural change, so that educators and public health professionals take compassionate social action to protect and improve the health and wellbeing of 2S/LGBTQIA+ communities. This paper contributes to research in gender and sexuality, and to the sociology of health, by shedding light on how public health professionals’ affective-discursive practices in 2S/LGBTQIA+ awareness and inclusion training may reveal (1) anti-2S/LGBTQIA+ bias corresponding with the rise in anti-2S/LGBTQIA+ rhetoric in society; and (2) personal accountability and shared responsibility for challenging hate and sustaining shared futures.
Kimberly Seida, Egale Canada
Queering mental health supports in Canada: Developing a training program for service providers
A robust evidence base has confirmed the presence of socioeconomic and health inequities among 2SLGBTQI people in Canada due to exclusion, discrimination, and a lack of affirming healthcare (Bettergarcia et al., 2021). The COVID-19 pandemic has exacerbated these inequities, disproportionately impacting numerous social determinants of mental health for 2SLGBTQI individuals, including access to primary and mental healthcare, housing, food, and employment (Seida, 2023). Alongside these deepened disparities wrought by the pandemic, the last few years have been characterized by troublesome rises in gender-based and anti-2SLGBTQI violence (Women and Gender Equality Canada, 2022). In the current context of national anti-2SLGBTQI movements and rhetoric, 2SLGBTQI people are being systematically marginalized and excluded from Canadian mental health care and social services. To address these challenges, Egale Canada’s researchers and instructional designers co-developed a cost-free and self-led virtual training program for mental health and social service providers across Canada. The bilingual training program is based on research conducted between 2021 - 2022, which included a national survey ( N = 304) and virtual focus groups ( N = 61) with 2SLGBTQI service seekers as well as queer and allied service providers, giving participants a space to share their experiences regarding the pandemic’s wide-ranging impacts on mental health and well-being. Queer and allied service providers similarly shared the challenges they faced in delivering inclusive care for 2SLGBTQI people during the pandemic. The training is entirely rooted in the experiences, challenges, and priorities for change shared by research participants. The Queering Mental Health Supports in Canada training is a four-module interactive program incorporating both service recipients’ and providers’ experiences. Specifically, it builds on the needs identified by service providers in earlier phrases of the research, including: strategies on how to provide safer, more affirming care and services; incorporating rural and remote experiences; using socio-ecological and intersectional modalities; adapting to more virtual care provision; and responding to the needs of 2SLGBTQI service providers (e.g., burnout prevention). The first module reviews content from the “Inclusion 101” trainings Egale already provides. The second module puts forward the theoretical foundations of the training program: social determinants of mental health, intersectionality, minority stress, and trauma-informed care. The intent is to move beyond biomedical, individualistic, and westernized understandings of mental health to wholistically address 2SLGBTQI mental health disparities. The third module aims to create safer mental health care with a focus on cultural safety, anti-oppression, and neurodiversity-affirming care. In the final module, learners will explore how the field responded to pandemic-related challenges by adopting alternate strategies and modes of delivery, and how to dismantle financial, proximity, and physical barriers to care. Egale’s training challenges existing frameworks of “cultural sensitivity” or “cultural competency”, which risk reducing safe and appropriate care to a finite set of practices or knowledge canons which, if applied, will result in better healthcare experiences and decreased disparities. Instead, it invites learners to focus on approaching care through the lens of cultural humility, an approach which places the service seeker at the centre and which understands provider and organizational improvement and growth as ongoing processes. Going beyond the typical risk discourses which only serve to pathologize and further marginalize 2SLGBTQI care and service seekers, our training highlights the strengths and resilience of 2SLGBTQI people in their efforts to navigate and optimize their healthcare, health, and well-being. Our training also builds on the adaptive approaches already being employed by 2SLGBTQI and allied service providers to provide a roadmap for new learners. Incorporating both provider and seeker perspectives in the same training is key to mapping out collaborative approaches to improve health care delivery and to maximize learners’ application and integration of the training. Egale Canada’s training serves as a critical intervention to support the health and well-being of 2SLGBTQI communities. Addressing key training and knowledge gaps among frontline service providers, managers, and decision-makers 2SLGBTQI communities’ health and healthcare needs is urgent within a shifting sociopolitical landscape increasingly marred by anti-2SLGBTQI behaviours, discourse, and legislation.
Non-presenting author: Krista Ceccolini, Egale Canada