LGBT Youth, Mental Health, and Spiritual Care: Psychiatric Collaboration With Health Care Chaplains.

Lesbian, gay, bisexual, and transgender (LGBT) youth have unique medical and mental health needs. Exposure to stigma such as family non-acceptance is associated with adverse mental health outcomes that are important sources of morbidity and mortality in this population. These include depression, anxiety, substance abuse, suicidality, and risk behaviors that mediate exposure to human immunodeficiency virus and sexually transmitted infections. Different religious and/or spiritual traditions hold various beliefs and attitudes about LGBT people. These can be a factor influencing a youth's risk of experiencing stigma. Other unique developmental challenges of LGBT youth, such as conflicts over identity integration and disclosure, also can be influenced by religious/spiritual factors. Health care chaplains could collaborate with clinicians to support mental health by helping LGBT youth and families integrate religious with other aspects of identity, decreasing religiously based stigma, and supporting family connectedness. This article discusses professional aspects of health care chaplaincy and ways in which health care chaplains can work with psychiatrists and other clinicians to support LGBT youth mental health, including case vignettes. It was developed from a conference at the Pediatric Ethics Committee of the Columbia University Medical Center addressing chaplaincy for LGBT youth.

Evidence-based spiritual care: a literature review.

PURPOSE OF REVIEW: As spiritual care has increasingly been considered an integral component of a healthcare treatment plan, spiritual care practitioners have been encouraged to adopt an evidence-based orientation, just as evidence-based practice is encouraged in every other aspect of healthcare. Though the notion of 'evidence-based spiritual care' is still developing, increasingly research is conducted in order to provide an evidence base to the practice of spiritual care. This article reviews spirituality and spiritual care literature from June 2010 to December 2011 that employ empirical research methods. RECENT FINDINGS: The majority of patient-focused studies concentrate on oncology and palliative care patients. In the review period, studies of care giver perceptions and experience came from multiple disciplines, including medicine, nursing, and chaplaincy. A discrepancy exists between the provision of spiritual care and the theoretical commitment of practitioners to offer such care. Practitioners continue to view spiritual care as part of their role to a greater extent than they provide it. This is often attributed to the absence of consensus in the field regarding the definition of spirituality, a lack of clarity of disciplinary role, and inadequate education for nurses and doctors about spiritual care. Research has further indicated that care givers' explorations of their own spirituality correlate with the provision of spiritual care. Although historically spiritual care has been most integrated into the care of palliative and oncology patients, researchers are developing and testing spiritual care assessment tools with other medical populations. In addition, they are evaluating these tools in diverse religious, cultural and national contexts. SUMMARY: Conceptual analysis combined with empirical study of care giver understandings of spiritual care will assist in developing clarity and consensus about the definition of spirituality and spiritual care. Investigation and conceptualization of interdisciplinary roles and provision of spiritual care is needed for optimizing collaborative care. More knowledge is needed about how to effectively teach spiritual care.