TIP 57: Trauma-Informed Care in Behavioral Health Services

Objectives. We examined associations of individual, psychosocial, and social factors with unprotected anal intercourse (UAI) among young men who have sex with men in New York City.Methods. Using baseline assessment data from 592 young men who have sex with men participating in an ongoing prospective cohort study, we conducted multivariable logistic regression analyses to examine the associations between covariates and likelihood of recently engaging in UAI with same-sex partners.Results. Nineteen percent reported recent UAI with a same-sex partner. In multivariable models, being in a current relationship with another man (adjusted odds ratio [AOR] = 4.87), an arrest history (AOR = 2.01), greater residential instability (AOR = 1.75), and unstable housing or homelessness (AOR = 3.10) was associated with recent UAI. Although high levels of gay community affinity and low internalized homophobia were associated with engaging in UAI in bivariate analyses, these associations did not persist in multivariable anal...

Individual, Psychosocial, and Social Correlates of Unprotected Anal Intercourse in a New Generation of Young Men Who Have Sex With Men in New York City

In both primary care and consultative practices, patients presenting with fibromyalgia (FM) often have other medically unexplained somatic symptoms and are ultimately diagnosed as having central sensitization (CS). Central sensitization encompasses many disorders where the central nervous system amplifies sensory input across many organ systems and results in myriad symptoms. A pragmatic approach to evaluate FM and related symptoms, including a focused review of medical records, interviewing techniques, and observations, is offered here, giving valuable tools for identifying and addressing the most relevant symptoms. At the time of the clinical evaluation, early consideration of CS may improve the efficiency of the visit, reduce excessive testing, and help in discerning between typical and atypical cases so as to avoid an inaccurate diagnosis. Discussion of pain and neurophysiology and sensitization often proves helpful.

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Central Sensitization Syndrome and the Initial Evaluation of a Patient with Fibromyalgia: A Review

Objectives (1) To assess the HIV incidence rate among men who have sex with men (MSM) in a large cohort study in Beijing, China and (2) to identify sociodemographic and behavioural risk factors of HIV seroconversion among MSM in Beijing, China. Design A prospective cohort study. Setting Baseline and follow-up visits were conducted among MSM in Beijing, China. Participants A cohort of 797 HIV-seronegative MSM was recruited from August to December 2009, with follow-up occurring after 6 and 12 months. Primary and secondary outcome measures At baseline and follow-up visits, participants reported sociodemographic and sexual behaviour information, and were tested for HIV, herpes simplex virus-2 (HSV-2) and syphilis with whole blood specimens. Cox regression analysis was used to identify factors associated with HIV seroconversion. Results Most study participants (86.8%) were retained by the 12-month follow-up. The HIV, HSV-2 and syphilis incidence rates were 8.09 (95% CI 6.92 to 9.26), 5.92 (95% CI 5.44 to 6.40) and 8.06 (95% CI 7.56 to 8.56) cases per 100 person-years, respectively. HIV seroconversion was significantly associated with being 1 male sex partner in the past 6 months, and being syphilis positive or HSV-2 positive. Conclusions The HIV incidence among MSM in Beijing is serious. Interventions and treatment of sexually transmitted diseases (STD) should be combined with HIV control and prevention measures among MSM.

https://bmjopen.bmj.com/content/bmjopen/2/6/e001829.full.pdf

HIV incidence among men who have sex with men in Beijing: a prospective cohort study

Black men who have sex with men (MSM) carry a disproportionate burden of HIV in the United States. Such disparities cannot be attributed to individual behavioral risk factors alone, prompting the exploration of social and contextual factors experienced by minority MSM. Societal homonegativity and the internalization of those attitudes by Black MSM may play an important role in understanding racial and ethnic disparities in HIV incidence and prevalence. This study explores the correlates of internalized homonegativity in a large multi-site sample of Black MSM. Findings reveal a number of significant contextual and psychosocial factors related to internalized homonegativity including religiosity, resilience, and gay community acculturation, which have important implications for HIV risk, HIV testing, and social and psychological wellbeing for Black MSM.

/pdf/correlates-of-internalized-homonegativity-among-black-men-4lj596y0tp.pdf

Correlates of internalized homonegativity among black men who have sex with men

HIV disproportionately affects African American men who have sex with men (MSM) in the United States. To inform this epidemiological pattern, we examined cross-sectional sexual behavior data in 509 African American MSM. Bivariate logistic regression analyses were conducted to examine the extent to which age, education, and sexual identity explain the likelihood of engaging in sex with a partner of a specific gender and the likelihood of engaging in unprotected sexual behaviors based on partner gender. Across all partner gender types, unprotected sexual behaviors were more likely to be reported by men with lower education. Younger, non-gay identified men were more likely to engage in unprotected sexual behaviors with transgender partners, while older, non-gay identified men were more likely to engage in unprotected sexual behaviors with women. African American MSM do not represent a monolithic group in their sexual behaviors, highlighting the need to target HIV prevention efforts to different subsets of African American MSM communities as appropriate.

Sexual Risk Taking in Relation to Sexual Identification, Age, and Education in a Diverse Sample of African American Men Who Have Sex with Men (MSM) in New York City

Once relegated to the experiences of a supposedly derelict minority, national studies of prevalence, and profundity solidly position addiction as a central experience in the lives of many Americans. As indicated by evidence in the professional literature and encounters of health care providers, alcohol and drug abuse are embedded within complex familial networks and dynamic social environments. Though its impact on intimate relations is differently distributed, children of substance–abusing individuals, in particular, are deleteriously affected by addiction. Reporting heightened lifetime risks for mental health problems, psychosocial maladies, and their ownmisuse of addictive substances, children of addicts are especially exposed to the hazards of substance abuse. A variety of factors are routinely examined to understand the effects of a primary caretaker’s substance abuse on children. Diversity in data regarding age at onset of substance abuse, presence of supportive mentors, styles of attachment, and parent– level characteristics such as gender, relational status, and drugs of choice suggest a multiplicity of circumstances surrounding misuse and consequences resulting from it. Children of individuals who abuse alcohol and drugs, though, remain under– served by the systems of care that are relegated to respond to disturbances catalyzed by addiction in the family. Lacking within the health professions are approaches to service delivery and a proliferation of treatment options that attend to the concerns of this group. Addressing these shortcomings in systematic knowledge and evidence–based intervention, Straussner and Fewell contribute to the disparate scholarship about the wellbeing of the offspring of individuals with addiction. In 13 chapters, this edited volume contextualizes substance abuse within family systems, advances an inquiry into the risk and resilience of children of addicts throughout the lifespan, and supports the ongoing development of clinical practices that can best support the wellbeing of these individuals. Rarely accessible in a singular text, this 288–page collection includes a review of conceptual issues, development across the lifespan, and programs relevant to the children of substance–abusing parents. Penned by approximately 20 experts employed in a variety of clinical and research settings nationwide, most contributors have a background of training in social work. Indeed, professionals in direct practice—in addition to students and scholars, respectively—will find value in this book. Further, the breadth of topics explored will surely appeal to a multidisciplinary readership; the far-reaching implications have relevance for a great number of disciplines, including social policy, public health, nursing, and the counseling professions. Additionally, the editors’ inclusion of community-based resources’ contact information and practice-informed case studies as supplemental material promote portability of content, illuminating key information from the chapters therein. Of particular interest, several contributors to this compendium feature careful consideration of under-examined and innovative content. For instance, Dayton’s integration of the latest findings in neurobiology, modish traumainformed perspectives, and classical analytic notions allows for an exciting explication of psychodramabased interventions for adults. Importantly, Begun and Rose provide critical information about the criminal justice system, identifying opportunities and obstacles for service provision with children of incarcerated, substance-abusing parents. Constrained by the nation’s punitive laws privileging prison over rehabilitation for many offenders, practitioners providing services to individuals who use or sell illicit drugs will identify with the challenges described in the review of literature identified in this chapter. Not to be missed, health care providers will find co-editor Fewell’s explanation of attachment theories and mentalization-based therapies of remarkable rigor, generating refreshing alternatives to paradigms of practice that are remiss to offer more sophisticated analyses of the environment. The propositions of these specific chapters are quite original, enriching programs and practices with their context-attuned conclusions. The variety of topics addressed is a strength of this collection, but also places limitations on this publication. Shifting from critiques of conceptual frameworks to reviews of interventions, the assortment of subjects addresses an array of information. A more unified purpose—for instance, focusing solely on lifelong developmental stressors encountered by children of substanceabusing individuals—might have enabled the volume to feature emerging ideas in the literature. Similarly, more narrowly defined aims could have heightened the propensity of ramifications regarding needed advancements in research and practice.

Children of Substance-Abusing Parents: Dynamics and Treatment.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released an extensive library of Treatment Improvement Protocols (TIPs) since its inception of the series in 1993. Althoug...

Addressing the Specific Behavioral Health Needs of Men, by Substance Abuse and Mental Health Services Administration (SAMHSA)

ABSTRACT When the COVID-19 pandemic began, many 12-step meetings rapidly transitioned from an in-person to an online format. In this qualitative focus group study, 17 attendees of 12-step programs from six U.S. states participated in one of two focus groups on Zoom platform in August 2021 in which their experiences of attending online versus in-person meetings were explored. Respondents praised the accessibility and convenience of online meetings, and the ability to interact with members from different geographic locations. However, they noted the loss of intensive social support found at in-person meetings and technological/procedural challenges that remain unsolved online.

The Experiences of 12-Step Program Attendees Transitioning to Online Meetings during the COVID-19 Pandemic

ABSTRACT Over 5800 licensed social workers in 13 U.S. states responded to questions in an online survey regarding their use of mental health and substance use disorder (SUD) services during different periods of their lives. As many as 69% of respondents reported ever having accessed mental health treatment, with only 6% having utilized SUD treatment. Among participants reporting a history of mental health problems, 89% utilized mental health treatment. However, only 35% of respondents who indicated a history of substance use problems reported using SUD services, with a much larger proportion of this cohort (84%) reporting use of mental health services.

Jeff T. Steen

Papers

Sexual Risk Taking in Relation to Sexual Identification, Age, and Education in a Diverse Sample of African American Men Who Have Sex with Men (MSM) in New York City

Children of Substance-Abusing Parents: Dynamics and Treatment.

Addressing the Specific Behavioral Health Needs of Men, by Substance Abuse and Mental Health Services Administration (SAMHSA)

The Experiences of 12-Step Program Attendees Transitioning to Online Meetings during the COVID-19 Pandemic

Utilization of mental health and substance use disorder services by social workers in 13 U.S. states