Gay-Male ORIGINAL 3 42 xxx Blackwell 1539-0136 Publishing 2006 Perspectives in Psychiatric PPC2006 Couples Who Malden, USAARTICLE Care

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Gay-Male Couples Who Adopt: Challenging Historical and Contemporary Social Trends Toward Becoming a Family
Gay-male couples who adopt children face

Edward R. Lobaugh, MSN, APRN, BC, Paul T. Clements, PhD, APRN, BC, DF-IAFN, Jennifer B. Averill, RN, MSN, PhD, and David L. Olguin, PhD, LPC

TOPIC.

ongoing challenges that stem from both historical and contemporary social issues.
PURPOSE.

To examine and identify key points and

guidance for advanced practice psychiatric mental health nurses regarding multicultural awareness involved in counseling gay-male couples who explore or exercise their right to adopt and raise children.
SOURCES.

Edward R. Lobaugh, MSN, APRN, BC, is a Nurse Manager, Substance Abuse Residential Rehabilitation Treatment Program, The New Mexico Veterans Health Care System, Albuquerque, NM; Paul T. Clements, PhD, APRN, BC, DF-IAFN, is Assistant Professor, Old Dominion University, School of Nursing, Norfolk, VA, and Distinguished Fellow-International Association of Forensic Nurses; Jennifer B. Averill, RN, MSN, PhD, is Assistant Professor, University of New Mexico, College of Nursing, Albuquerque, NM; David L. Olguin, PhD, LPC, is Assistant Professor, University of New Mexico, Counselor Education Program, Albuquerque, NM.

A comprehensive review of the extant

scientific literature and public media, clinical anecdotes, therapeutic experiences, and an examination of Healthy People 2010 as it relates to how community health is profoundly affected by the collective beliefs, attitudes, and behaviors of everyone who lives in the community.
CONCLUSIONS.

Heterosexism, homophobic fears,

oppression, and the general stigma that surround gay-male couples who choose to adopt children are a few of the relevant contemporary issues and community beliefs for which advanced practice psychiatric mental health nurses need to assess, explore, and intervene.
Search terms: Adoption, gay couples, counseling
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number of social and contemporary issues challenge gay-male couples who adopt. In a heterosexual family, adopting a child is stressful enough, and involves changes in the financial, cultural, and family system expectations. For gay-male couples, there is a similar stress, but it is additionally compounded by societal trends that make adoption difficult. As they begin the process to adopt, gay-male couples often realize their own fear of confronting the historical tenets and contemporary trends of heterosexism, homophobic fears, oppression, and the general stigma that surrounds gay-male couples (Herek, 1988, 1990, 2000, 2004). Many gay-male couples can benefit from psychotherapeutic intervention that explicates and explores these issues, identifies adaptive methods of coping and approach, as well as receiving support and guidance, and otherwise normalizing the issues they face. Utilizing the national Determinants of Health model from Healthy People 2010 (U.S. Department of Health and Human Services [USDHHS], 2000) (Table 1), analysis and commentary are important for discussion as these relate to the argument regarding gay males rights to adopt children. Specifically, as noted within the Healthy People 2010 document: Community health is profoundly affected by the collective beliefs, attitudes, and behaviors of everyone who lives in the
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Table 1. Determinants of Health (U.S. Department of Health and Human Services. 2000, p. 18)

and quality of life, and (b) eliminate health disparities (USDHHS). To achieve these two goals, the APRN must conceptualize the barriers that prevent access to health care and other community determinants of health. According to the USDHHS, determinants of health are defined as individual perceptions of health, community and family beliefs, cultural beliefs, and common practices that influence healthy behaviors within a family and its community. The definition of these concepts serves as the basic framework for the Healthy People 2010 model. The first goal is defined by two indicators: life expectancy and quality of life. Healthy People 2010 defines quality of life as: A general sense of happiness and satisfaction with our lives and environment. General quality of life encompasses all aspects of life, including health, recreation, culture, rights, values, beliefs, aspirations, and the conditions that support a life containing these elements. (USDHHS, 2000, p. 10)

community (USDHHS, p. 3). State statutory law with regard to gay marriage and adoption and the implications of the law must necessarily be considered. Background and Significance A review of the extant scholarly literature, as well as the mass media in the United States, is imperative in order for advanced practice psychiatric mental health nurses (APRNs) to be multiculturally aware and sensitive to the issues of and resources for gay-male couples who desire to adopt children and to guide therapeutic interventions. Providing assistance and addressing this populations needs are based, in part, on the Healthy People 2010 goals (USDHHS, 2000). Specifically, the Healthy People 2010 paradigm for Determinants of Health (Table 1), designed by scientists, clinicians, public health providers, mental health providers, substance abuse clinicians, national health, and state health organizations, seeks to achieve two overarching goals for the United States. The two goals are to (a) increase ones life expectancy
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This statement acknowledges the holistic nature of people as it recognizes the impact that culture, rights, values, beliefs, and aspirations have on an individuals and a familys quality of life. These terms are based on individual behaviors and biology that interface and interact with a physical and social environment. Thus, the operational definition for quality of life is the set of interactions that influence perception regarding happiness. Values, culture, rights, beliefs, and aspirations are all key terms that help define heterosexism and homophobia. Heterosexist values, beliefs, and cultural practices have negatively imposed upon the rights of gay males to adopt children. Health disparities have been created as these families have been discriminated against when they seek access to health care, employment, and housing (USDHHS, 2000). Policies such as these need to be changed to ensure equal access to health care, equal opportunity for housing and employment, and equal access to adoption. One way to eliminate health disparities in order to improve the quality of life is to assess a populations
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needs. The assessment should include actual and perceived methods of discrimination, shared results from community and family assessments, coupled with qualitative studies on gay-male families, all of which will help demystify myths about gay-male families. As people eventually accept the evidence provided by research, public opinion can be positively changed and help shape a more tolerant and accepting public policy. Conducting scientifically rigorous and auditable qualitative studies that involve this population may suggest interventions that can be applied to all levels of the Determinants of Health model. Behaviors can be influenced by changing perceptions. The long-range goal is that discriminatory practices diminish and disappear in all communities, thus favorably altering the social and physical environments. Communities can then influence a nation or a state to change public policy and legislation to promote equality for all citizens, regardless of sexual orientation. Healthy People 2010 states that policies and interventions can improve health by targeting factors related to individuals and their environments (USDHHS, 2000, p. 18). Although the goals of Healthy People 2010 do not address any specific population based on ethnicity or sexual orientation, they are intended to serve all populations. Based on this application, the objectives of Healthy People 2010 are to influence (a) multicultural awareness, (b) equal access to health care, (c) family planning assistance, (d) development of healthy communication, (e) education and community-based programs, and (f) responsible sexual health behavior (Office of Disease Prevention and Health Promotion, 2004). It is posited that meeting these goals helps all families establish healthy communication patterns, recognize how belief systems can discriminate against gay males, and impact their physical and mental health (USDHHS, 2000). Before these objectives can be met, the nature and history of trends and issues confronting adoption by gay-male couples must be explored and reviewed. In this way, reflection on the content and impact of such practices may serve to awaken a more humane consciousness to promote positive social change.
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Historical Implications of Homophobia, Heterosexism, and Sexual Prejudice Issues related to the lifestyle of gay males overtly appeared in U.S. history in the 1940sduring World War II (Carr, 1961; Chauncey, 1994; Duberman, 1993). Male couples that label themselves as gay have long been stigmatized and oppressed by a heterosexist society. Although gay males and other groups experienced freedom for a brief moment during the Second World War, when the war ended, this reverted to significant oppression. Gay males who did not enlist or who were not drafted into the U.S. military were less scrutinized because the focus of the American media and other national efforts were diverted to wartime news and support. After World War II, the persecution of gays began with witch hunts when Senator Joseph McCarthy initiated a scare tactic and labeled homosexuals as communists (Herkman, Oosterhuis, & Steakley, 1995). After President Eisenhower was inaugurated, an executive order was passed that prevented the federal government from employing people who were gay because they fell into the category entitled sexual perversion (Johnson, 2000). Laws enacted within New York prohibited men from dancing with each other and from wearing fewer than three gender-specific clothing garments that were congruent with their biological gender (Carr; Chauncey; Duberman). This law specifically targeted transsexuals. Gay men were being specifically targeted for civil liberty injustices. Many Americans feared that Germanys persecution camps would be reenacted on U.S. soil (Carr; Chauncey; Duberman). Although most knew that Hitler ordered the persecution of Jewish people (Britannica Concise Encyclopedia, 2005), fewer knew that homosexuals were labeled with pink triangles and also persecuted in the same fashion (Nash, 2000). From World War II to the 1960s, the United States experienced a time of civil unrest and civil liberty injustices. Women were denied the right to vote, and African Americans were being denied rights otherwise afforded to Caucasians (DeFrance, 1988; Microsoft
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Encarta Online Encyclopedia, 2005). These groups had similar goals and sometimes united in force to fight for integration, equal housing, employment, and educational opportunities (DeFrance; Microsoft Encarta Online Encyclopedia). Discriminating against these groups was viewed differently by mainstream society, just as for all other citizens. Gender and skin color were observable traits that were easy to target. Being gay was often viewed as a perverted sexual behavior (Herek, 1988), but unlike skin pigmentation, it was more easily hidden or ruled away as conjecture. Of significance, however, was the common factor among these groups in their desire for equal opportunities without discrimination (Dimkova & Whitman, 2004). On Friday night, June 27, 1969, in Greenwich Village, New York, at the Stonewall Sheridan Inn, a riot took place that involved members of the gay community (Dimkova & Whitman, 2004). This riot was one of many for civil liberty, but the first for gay rights. Dimkova and Whitman, as well as many members of the gay community, acknowledge this militant riot as demarcating the beginning of the gay rights movement in the United States and the fight for equal civil rights. From that time forward, gays have fought for the right to marry and the right to adopt children (Dimkova & Whitman). On a more basic level, in terms of Maslows Hierarchy of Needs, gay people continue to fight for equal housing, education, and employment opportunities throughout the nation (Huitt, 2004). Most of all, gay people want to feel safe and not fear being persecuted (Dimkova & Whitman). Although the challenges continue, there have been legal victories in the struggle for gay rights. In 1973, the American Psychiatric Association (APA) discontinued homosexuality as a mental health diagnostic category in the Diagnostic and Statistical Manual (DSM). Another success took place on May 20, 1996, when the U.S. Supreme Court struck down Colorados Amendment 2 in a case entitled Romer v. Evans. This amendment denied lesbians and gays protection from discrimination (Bull, 2002a). On November 18, 2003, the U.S. Supreme Court struck down Texas antisodomy law with the
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motion acknowledging the privacy rights for consenting adults engaging in sexual activity behind closed doors (Texas Antisodomy, 2001). The most recent and significant actions included July 1, 2000, when Vermont granted gay couples the right to civil unions (Saucier & Cawman, 2004), providing legal access to 300 privileges usually accorded only to persons in traditional heterosexual marriages. This victory was followed soon after by the November 20, 2003, Massachusetts decision to grant the right for same-sex marriage (Moats, 2004), edging even closer to all of the rights and roles that have been exclusively reserved for matrimony between a man and a woman. Of particular note was that the Massachusetts state legislature based its decision on finding that any amendment to the state constitution that would have defined marriage as between one man and one woman was discriminatory (Gajewski, 2005). Granting these rights in these two states have provided not only landmark decisions, but also an overarching momentum, for gay men and lesbians toward the full privileges of being a couple, which includes adopting and raising children (Cullum, 1993; Eskridge, 2001). However, such monumental victories are not unidirectional in intent or content (nor should they be); specifically, of significance and importance to all American citizens, is that in addition to the rights afforded to alternative couples, are also all of the same responsibilities inherent to traditional married couples. In this same light, Paquette (2001) noted: The benefit to society is that such a union would not only bestow privileges and protection but also would require the partners to have legal responsibilities that spouses have for each others support, care, debts, and so forth . . . [with] a way to legally create a relationship that would be recognized the world over the same way marriage is . . . and at the same time, promote stable and lasting families, even if nontraditional. (p. 39) Table 2 illustrates information regarding the states that allow gay males to adopt. Column 1 lists states that
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Table 2. Adoption Regulations Among the States

Expressly approved California Connecticut Delaware District of Columbia Illinois Indiana Iowa Maryland Massachusetts New Jersey New York Pennsylvania Vermont Approved by lower courts Alabama Alaska Georgia Hawaii Michigan Minnesota Missouri Nevada New Mexico Oklahoma Oregon Rhode Island Texas Washington Not yet approved Arizona Arkansas Florida Idaho Kansas Kentucky Louisiana Maine Mississippi Montana Nebraska New Hampshire North Carolina North Dakota South Carolina South Dakota Tennessee Utah Virginia West Virginia Wyoming Disapproved Colorado Ohio Wisconsin

Adapted from Lambda Legal, 2005.

legally express approval. Column 2 lists the states that have supported gays who adopt through lower court decisions, however, some states remain vague and provide no explicit law that permits or denies adoption. For the states listed in Column 3, labeled Not Yet Approved, Lambda Legal is currently seeking approval for adoption by gay men and lesbians. Column 4 lists states that have explicit laws denying gays and lesbians the right to adopt children either by a single or second parent adoption. Currently, more than half the states permit gays and lesbians to adopt. Some permit single parent adoption, while others permit second parent adoption and fewer permit both parents to adopt concurrently. Table 2 is helpful to visualize how the United States is legally and morally divided in allowing gay males to adopt and raise a family. Not having a national policy that legalizes gay parents to adopt creates family
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instability and inconsistency. When gay-male couples choose to adopt, they are often forced to make a choice between living in a state that approves of gay males who adopt and a state that does not approve, regardless of other criteria that affect their choice of residence. To date, gay-male couples are adopting children despite lack of approval by legislation. The choices they are forced to make include (a) to continue to live in a state that may disapprove so they can continue to have support from their family and community, or (b) to leave the state where they have a support system in order to live in a state that approves adoption by gay-male couples. Contemporary Trends and Issues for Consideration Allowing gay males to marry and raise a family continues to be a controversial issue. There are arguments
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in support of preventing gay males from adopting children. The most common argument is that gay males have an agenda to influence their children to become gay (Green, Mandel, Hotvedt, Gray, & Smith, 1986). Others argue that gay-male couples have poorer than average parenting skills, relative to accepted social norms (Bigner & Jacobsen, 1992; Maney & Cain, 1997; Mooney-Somers & Golombok, 2000). There are others who question the mental health of gay male because of their sexual orientation (Stakelbeck & Frank, 2003). Another claim is that children raised by gay males are more likely to be suicidal (Cochran & Mays, 2000). These arguments are well publicized, albeit poorly empirically evidenced in research and literature reviews. According to the literature, there are terms that appear ambiguous and are defined differently depending on the cultural and religious lenses applied. To provide clarification an operational definition of each of these terms is provided. Homosexual behavior is interpreted as sexual behavior occurring between two members of the same species and gender (Spitzer, 2003). Sexual orientation is defined as sexual attraction, affection, and erotic behavior that are elicited in one gender by the same or opposite gender (Spitzer). Heterosexism is a system of beliefs that provides the rationale to discriminate against any sexual orientation other than heterosexuality (Herek, 2005). Homophobia is a psychopathology defined by an actual fear of homosexuals (Herek). Sexual stigma is a negative community-shared belief for any nonheterosexual behavior, identity, relationship, or community (Herek, 2005). Sexual Orientation: Development in Terms of Nature versus Nurture The pervasive stereotype and claim that gay males have an agenda to raise children in an environment that promotes only homosexual orientation is based on significant supposition and assumption. The supposition is that sexual orientation is a choice that can be influenced by the nurturing from a parent. Another
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supposition is that gay males can biologically procure actuality, meaning that the majority of gay males are offspring of heterosexuals. Nevertheless, this brings up the following question: Is being gay a choice, or is being gay biologically predetermined? To date, there have been studies on children who were adopted (Bailey, Dunne, & Martin, 2000) and comparisons between heterosexual and homosexual fathers raising children (Bailey, Bobrow, Wolfe, & Mikach, 1995). Studies reveal that development of ones sexual orientation is complex and is affected by multiple variables. Money (1987) studied homosexual behaviors in both animals and in humans. Money postulated that homosexual behaviors are influenced by prenatal hormones. After birth these hormones are further influenced by socialization. Another factor that influences sexual orientation is maturation of hormones. Money stated that humans are more influenced by their socialization as they evaluate their behavior, as, unlike animals, humans are affected by social pressure. This social pressure may extinguish primal instincts, resulting in behavior approved by society, possibly at the expense of the individuals desires. Patterson (1995) presents a different theory on sexual orientation. She postulates that human sexual orientation is best viewed on a continuum known as multidirectionality. Prior to the nineteenth century, same-sex attractions and behavior existed throughout history. The notion that a person was either heterosexual or homosexual emerged in more recent times as a result of sociocultural influences. Yarhouse (2001) states that a valuative framework influences sexual orientation and refers to the first valuative influence as identity confusion. This is signaled by a person who experiences a same-sex attraction. The person then progresses to the next stage, identity attribution. During this stage, the person may be in crisis due to cultural influences. The next stage marks the point of resolution, and is characterized by the question: does the person choose foreclosure or expansion? Foreclosure occurs when the person denies his same
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sex-attractions and decides not to act on these feelings. Expansion denotes the choice to include homosexuality as part of the persons identity; in essence, the person moves through a coming out or public acknowledgment process. Identity reappraisal is the next stage, during which a person reevaluates his choice after being challenged by heterosexist views. Finally, when a person has chosen to identify as being either homosexual or heterosexual, the person is able to synthesize ones experiences for self-acceptance; this is known as identity synthesis. The most important advancement made by this theory is the recognition of cultural influences on the development of sexual orientation. Several studies of twins reviewed the dichotomy created by nature versus nurture and its influence on sexual identity. Bailey and Bell (1993) studied unseparated twins and found that the suggestion of a biological familial link predetermines sexual orientation. Another study noted that there is some evidence that male sexual orientation is influenced by a gene on the X chromosome (Hamer, Hu, Magnuson, Hu, & Pattatucci, 1992, p. 321). Bems theory (1995) speculates that some children are genetically predetermined to become nonconformist. When children behave in a nonconformist manner, they are said to rebel. One form of rebellion is to engage in socially unacceptable behaviors. Engaging in homosexual or nonheterosexual activity is interpreted as a form of rebellion. This hypothesis has been examined through a neuro-hormonal approach but has not yet been empirically tested (Berenbaum & Hines, 1992). Ellis and Ames (1987) examined the possibility that sexual orientation is influenced by atypical levels of hormones to which the fetus is exposed that cause sex-atypical neural differentiation. LeVay (1991) found that the size of a gay males hypothalamus is equivalent to the size of a heterosexual females hypothalamus; these particular research findings give some credence and support to Ellis and Ames research. One overarching resulting hypothesis that is a result of this correlation is that gay males have feminine personality characteristics similar to those of heterosexual females.
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Speculation and posited theories exist on the determinants and cultural variables that influence sexual orientation development. Finding a large enough population to study this subject is difficult because of the fear of repercussions and the stigma of coming out of the closet (Decrescenzo, 1997). Researchers advertise in journals as an avenue to attract gay-male parents and their children. Consequently, researchers realize that their population demographics do not reflect a random or true population sample, but instead a convenience sample. Therefore, the study findings are difficult to generalize and apply to the larger population, particularly in relation to those who are colloquially noted as being in the closet (Decrescenzo, 1997) or living life on the down-low (King, 2004). Studies regarding development of sexual orientation, gay parenting skills, and gay males mental health have proven to be valuable. To date, multiple studies have found that whether parents are either heterosexual or homosexual, they have minimal influence on the childs sexual orientation (Green et al., 1986). Research has also shown that parents are unable to significantly influence their childs sexual orientation by providing gender-specific toys for play (Green et al.). From these studies, gay couples can presume that their behavior will not impact their childs sexual orientation. There are gay-male couples who are concerned about how their parenting skills and attitudes toward fatherhood compare to their heterosexual counterparts. In a recent study (Bigner & Jacobsen, 1992), both gay and heterosexual fathers were found to have a developmental orientation toward their role as fathers, and no discernible parenting style could be found to distinguish one group from the other (p. 99). Thus, gay and non-gay fathers were found to be more similar than different with regard to parenting styles and attitudes toward fathering. In a study where mental health was the focus, researchers found few variations between gay and heterosexual males. Ridge and Feeney (1998) compared gay and heterosexual males in a retrospective study to see if there were any differences in attachment to their
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parents. Using Shaver and Hazans (1993) attachment model as the framework for this study, no differences were found. Ridge and Feeney concluded that neither group was more likely to suffer from attachment disorder based on sexual orientation. The few variances that were found concerned risk for suicide. Of significance, Cochran and Mays (2000) reported that males who engaged in sex with same-sex partners experienced at least one suicide attempt and four suicidal symptoms. Phiney and Millman (2004) reported that gay males generally are at risk for suicidal ideation due to cultural influences and heterosexist oppression (Russell & Joyner, 2001). The prevalence rate among gay males for suicide is significantly higher than for heterosexual males, with the U.S. Department of Health (2000) reporting: Gay-male adolescents are two to three times more likely than their peers to attempt suicide (p. 16). Cochran and Mays also found that gay males were more at risk for developing affective disorders. Cochran and Mays relied on self-reporting, which inherently may not be a foundation for a reliable study. Furthermore, the study does not account for social stigma and oppression of gay males. Healthy People 2010 suggests that social stigma and oppression, which have been promoted by heterosexist beliefs, may be linked to suicide attempts by gay males because their quality of life is impaired by discrimination (USDHHS, 2000). The credibility of this proposition is uncertain, but it can be empirically evaluated through medical and mental health records, and by collaborating with witnesses and gathering anecdotal information from family members and significant other. Another grave concern for gay-male couples is the perception that adopted children are at risk for attempts of suicide. Moskos, Archilles, and Gray (2004) reported that children are more likely to attempt suicide if they experience significant family stressors or live in dysfunctional home situations. Research does not support that parents sexual identity places their children at risk for higher suicide attempts. Instead, the parents mental health or the familys discord is
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more significant as a contributing risk factor (Moskos et al.). Issues Related to Heterosexism At present, there are no valid arguments to prevent gay-male couples from adopting and raising children. The American Academy of Pediatrics states that the public should be tolerant of alternative lifestyles that can provide children with a stable home environment (Silverman, 2002). Bull (2002b), a pediatrician, is in full support of gay rights permitting adoption. The American Psychological Association (2004) and the American Counseling Association (2002) have endorsed gay males adoption of children (National Association for Research and Therapy of Homosexuality, 2004). Additionally, the American Psychiatric Association (2005) has ultimately endorsed adoption by gay couples as well. The National Association for Social Workers sanctions gay adoption and finds no difference in child rearing between heterosexual and gay-male parents (Crisp & Padilla, 2004). The American Nurses Association (1998) strongly opposes discrimination and is committed to eradicating discrimination based on sex, race, ethnicity, sexual orientation, age, ability, and religion. Of note, this author was unable to find any professional medical, healthcare, or mental health organization that officially opposes adoption by gaymale couple. Professional organizations state their position based on scientific research, rather than societal norms. However, societal norms, stereotypes, and stigma continue to provide significant concern and question the appropriateness of adoption of children by gay-male couples. Heterosexism The most powerful force that continues to oppose gay-male couple adoption is based on the heterosexist view. The professional associations share common beliefs that sexual prejudice, heterosexism, and sexual stigma are the new terms that replace homophobia.
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These terms accurately describe societys negative attitudes toward gay individuals. There is a strong opposition shrouded in myths and misconceptions based on heterosexist values; however, there are no empirical data to support this opposing groups beliefs. APRNs should acknowledge that personal views and perceptions impact professional practice and may extend to views on gay-male adoption. For example, some social workers who are employed to place children for adoption have been noted to make decisions based on and affected by their own homophobic and heterosexist beliefs and avoid placing children in gay homes (Berkman & Zinberg, 1997). Consequently, gaymale families are affected. If one looks at historical discriminatory practiceswhen adoption agencies base child placement on cultural, race, and ethnicity matchingone could speculate that these same practices exist and effect outcomes for gay-male couples asking to be considered for child placement (Brook, Barth, Bussiere, & Patterson, 1999). Sexual orientation of prospective parents was not addressed by the law entitled In Removal of Barriers to Interethnic Adoption in 1996 by President Clinton which made cultural, race, and ethnicity matching illegal (Brook et al.). However, individual adoption agencies can address this issue by implementing a policy that either denies or accepts gay-male couples as a prospective family for adoption. Although policies of acceptance are employed by some agencies, their placement practices are not always congruent; specifically, some agencies place children in gay-male homes as a last resort. Some of the avoidant practices are reflected when children with preexisting mental and biological health problems are offered to gay-male couples for adoption. Because of these discriminatory practices, children are not always matched with a family, regardless of parental orientation, that can provide the best resources for them. Implications for Research and Nursing Practice implications for APRNs abound. Private practice APRNs who choose to assist couples can
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provide empathetic understanding, unconditional positive regard, and knowledge to share with their clients. This intervention should be applied at the individuals behavioral and biological levels of the Determinants of Health model (Table 1). APRNs have the potential to become valuable resources for referral and other support services for gay-male families in need. APRN counseling services can be offered along the continuum of the adoption process to guide individuals and their environment. On the national level, APRNs can influence a paradigm shift in practice and theory. APRNs have the ability to affect practice on a national level by advocating for gay-male couples who wish to adopt. This paradigm can be informed by credible research. APRNs can influence Congress as well as the U.S. Public Health Department by providing valuable assessments of this population that include systematic and auditable procedures. Methodologically rigorous qualitative interviews and assessments of this population will provide valuable information about the populations needs, goals, and objectives of gay males. Discriminatory practices could be identified when gay-male couples are interviewed. Understanding and dissemination of results of qualitative studies about gay-male cultural practices, belief systems, values, and aspirations will assist in establishing realistic goals and objectives that will preserve and promote healthy gay-male families. Quantitative and qualitative data can be merged to present a more complete picture of gay culture situated in mainstream society. Summary The results of current research are inroads into overcoming prejudices and subsequently changing discriminatory practices. In the words of Chinn and Kramer (2004), Sharing knowledge is important because it creates a disciplinary community, to extend beyond the isolation of individual experience. Once this happens, social purposes form, and knowledge development and shared purposes form a cyclic
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interrelationship that moves us toward prospective, value-grounded change or praxis (p. 3). A great need to advocate exists in attempts to support gay males who choose to adopt. APRNs can choose to be such advocates. When APRNs choose to engage this role, a few key points to consider for enhancing practice include: 1. Become knowledgeable regarding the social challenges that gay-male couples confront when they decide to adopt. 2. Employ effective communication skills that convey empathy, concern, and unconditional positive regard. 3. Remember that being multiculturally sensitive and competent includes being familiar with the terminology and practices of the gay-male population. 4. Most of all, work within the APRN scope of practice and attempt to ethically uphold objectives set by the Healthy People 2010 and other organizations that help define this profession and infuse values of compassion. 5. Know the local and state legislation and whether or not it approves of gay-male couples adopting. 6. Be an advocate by being knowledgeable of support services that can help assist all clients, regardless of their social characteristics.
Author contact: elobaugh@hughes.net with a copy to the Editor: mary@artwindows.com References
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