Referring to the resource entitled: “Serving transgender and gender nonconforming persons” what current challenges do transgender and gender non-conforming individuals face when dealing with health or human services? What are some guidelines set forth by the National Health Care for the Homeless Council (authors of this resource) that can aid health or human services providers in creating an inclusive environment for those who have transitioned their gender or are outside of the traditional genders of men and women?
You must support your response with scholarly sources in APA format. Simply stating your opinion is not enough, back up your opinion with citations. Refer to the DB Grading Rubric for more details.
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Textbook or eBook:Diller, J. V. (2018). Cultural diversity: A primer for the human services (6th ed.). Cengage Learning.
- Chapter 18: Working with American Male Clients
Articles, Websites, and Videos:This resource examines the specific behavioral health needs of men, why they abuse substances, and social issues they may confront during treatment.
- Center for Substance Abuse Treatment (US). Addressing the Specific Behavioral Health Needs of Men. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013. (Treatment Improvement Protocol (TIP) Series, No. 56.) 3, Treatment Issues for Men.
This resource examines masculinity, social support networks, and the mental health of men.
- McKenzie, S. K., Collings, S., Jenkin, G., & River, J. (2018). Masculinity, Social Connectedness, and Mental Health: Men's Diverse Patterns of Practice. American journal of men's health, 12(5), 1247–1261. https://doi.org/10.1177/1557988318772732
World Health Organization’s look at gender and the status of women’s mental health.
- Gender and women's mental health. (n.d.) SAMHSA
This resource reviews the Domestic Violence Act and major revisions since its creation in 1994.
- What is the violence against women act? (n.d.). National Domestic Violence Hotline.
National Association of Social Worker’s social justice brief on social workers’ roles in responding to intimate partner violence.
- Wilson, M. & Webb, R. (n.d.). Social Work’s Role in Responding to Intimate Partner Violence. National Association of Social Workers.
Myers and Fitzgerald (2011) examine types of violence against women and their implications for the workplace.
- Chen, S. (2011). Diversity Management: Theoretical Perspectives and Practical Approaches. Nova Science Publishers, Inc.
This resource from the National Health Care for the Homeless Council reviews best practices for healthcare centers in caring for Transgender and Gender Non-Confirming People experiencing homelessness.
- National Health Care for the Homeless Council. (2016, Sept). Serving transgender and gender nonconforming person: Establishing and improving models of care for those without homes.
Yasmeen Hamza, associate director of client services at the New York Asian Women’s Center, discusses the importance of cultural appropriate services and highlights the work the Center does for victims of domestic violence and human trafficking.
Watch VideoDomestic Violence & Human Trafficking among Asian Americans: New York Asian Women's Center (NYAWC)Duration: 10:13
User: Asian American Mental Health – Added: 4/23/14Supplementary Materials:A 2013 National Association of Social Workers’ discussion on the feminization of poverty.
- Feminization of poverty revisited. (2013, Mar 20). National Association of Social Workers.
Transgender, Gender Identity, and Gender Non-Conforming Terminology and Definitions.
- Sexual Orientation and Gender Identity Definitions. (2020). Human Rights Campaign.
CH. 18 Working with American Male Clients: An Interview with Jon Davies
Men have a profound effect on American society and make many positive contributions to our culture. However, there is strong evidence that men, as a group, are struggling and experiencing a health crisis. At the crux of this crisis is male behavior, which can be detrimental to themselves, others, and society at large. Men are more likely than women to engage in risk-taking behavior, abuse alcohol and other drugs, and commit suicide, and are less likely to engage in health-promoting behavior, such as maintaining a healthy diet, using sunscreen, or wearing seat belts (Courtenay, 1998, 2000). Despite all the issues they face, men are much less likely than women to seek help, and their life expectancy is four years less than that of women (National Center for Health Statistics, 2017).
Males make up 49.2 percent of the population of the United States (Spraggins, 2005). While more male than female babies are born each year (Howden and Meyer, 2011), by the 35- to 39-year-old age range, women begin to outnumber men. By age 65, women significantly outnumber men and, finally, by age 85, women outnumber men by 2.5 to 1. These numbers reflect men’s limited life expectancy in comparison to women, which might be attributed to men’s tendency to take risks, be aggressive, and avoid seeking help (Courtenay, 1998).
Men in the United States are a heterogeneous group of people who vary in terms of age, sexual orientation and identity, racial and/or ethnic background, socioeconomic background and/or status, and power. Men’s racial and/or ethnic background in the United States mirrors the general population. General population estimates for the United States are White, 62 percent; Hispanic/Latino, 17 percent; African American, 12 percent; Asian American, 5 percent; and Native American, 0.7 percent (U.S. Census Bureau, 2013).
With regard to mental health, men are more likely than women to abuse alcohol and drugs, receive a dual diagnosis, and are almost four times more likely than females to commit suicide (Curtin, Warner, and Hedegaard, 2016). While most men are not violent, most acts of violence in the United States are committed by men, including 79 percent of hate crimes in the United States (Harlow, 2005). Approximately 20 percent of women and 1.7 percent of men will be raped in their lifetime, with the majority of perpetrators in most of these assaults being male (Breiding et al., 2014). Not only are men more likely to commit violence, but they are also more likely to be victims of violence—four times more likely to die from homicide than women (National Center for Health Statistics, 2017). Men are also more likely than women to commit intimate partner violence resulting in serious physical and emotional harm (Black, et al., 2011). Additionally, 94 percent of mass shootings in the United States have been committed by males (Blair, Martindale, and Nichols, 2014).
Although the majority of men do not break the law, men represent 93 percent of the adults incarcerated in state and federal institutions (Carson, Markman, Kaeble, Maruschak, and Alper, 2016). In comparison to their representation in the general population, men of color, particularly African American and Latino men, are overrepresented in the U.S. prison population.
Despite all these differences, most men engage in behavior to “prove” or enhance their manliness. The specific actions that they take may vary greatly across different groups of men. To prove one’s masculinity, an inner-city youth might be tempted to join a gang, a suburban teenager may drive recklessly, a man in his forties might ignore his family responsibilities to spend more time working, and a male in his sixties might seek sexual performance–enhancing medication.
In order to increase men’s life expectancy and reduce violence, particularly violence towards women, more effective ways to engage men in counseling must be implemented. To accomplish these goals, many psychologists have called for the development of counseling strategies that are congruent with the culture of men and masculinity (e.g., Brooks, 1998; Liu, 2005; O’Neil, 2008; Wester, 2008).
For centuries, men in Europe and many other parts of the world have had significantly more power than women (Thornton and Young-DeMarco, 2001). From the beginning of U.S. history until the 1950s, men’s primary role was to be the provider, responsible for hunting, farming, and/or producing income. Throughout history, women have demonstrated a willingness to do whatever tasks were needed; however, their primary role was taking care of household duties, including gathering, gardening, and raising children. Despite the changing times, the historic gender role differences and inequality between men and women continue in the United States.
Gender role socialization, men’s physical strength and stature, and the role of being a provider gave men control over their families, power, and privilege in American society. Women did not gain the right to vote until 100 years ago. However, the last 80 years have seen a remarkable change in women’s roles in our society. During World War II, many women entered the workforce, performing jobs traditionally held by men. As a group, women were highly successful in their work, demonstrating to employers (and themselves) that they were capable and valuable employees.
In the 1960s, women’s ability to earn money and have access to birth control significantly changed their roles in society (Thornton and Young-DeMarco, 2001). No longer needing men for survival, and inspired by the Women’s Rights Movement of the 1970s, women became increasingly independent as they grew more aware of the social, economic, and political inequalities that they were experiencing. During this time period, divorce rates increased, as did the number of women who were single heads of household. Women, therefore, experienced a rapid change in their gender roles.
Unlike women, men’s role in society has been much slower to change. In fact, many men are currently struggling to understand what their role should be in society. While women continue to excel in many aspects of life, many men seem confused about if, how, and in what ways they should change.
18-2aFamily and Cultural Values
Cultural values regarding manhood are first learned though interactions with one’s family. The dominant view of masculinity in American culture is that a man should be an individual, independent of others. Emotionally, he should be stoic and in control of his feelings and his environment, while not allowing others to control him, as that will threaten his sense of being a man. He should also be aggressive and able to defend himself, strive to be successful, seek and initiate sexual experiences, and last of all, he should avoid any activity that could be perceived as feminine (Mahalik, Good, and Englar-Carlson, 2003; O’Neil, 2008). Compliance to these role expectations is strictly enforced; men who don’t subscribe to traditional gender roles risk experiencing ridicule, shame, bullying, and even more serious forms of violence.
Some researchers believe that masculinity is largely a social construct, based more on what one’s culture believes a man should be, as opposed to reflecting actual biological or genetic differences between genders (Courtenay, 2000; Pleck, 1995). Families and our culture communicate this construct to boys by teaching them how they are expected to behave. The messages that boys and men hear can be confusing and conflict with other messages that they receive. Boys are encouraged by health-care providers to take care of themselves, yet male athletes frequently receive the admiration of sports announcers and fans for playing while injured. Men are increasingly hearing a message from their romantic partners to be more vulnerable in expressing their feelings, yet many men can point to examples in which they were ridiculed for crying or criticized for expressing feelings that their partner did not want to hear. Boys and men also receive conflicting messages concerning what a man’s role in his family should be, particularly with regard to being a father.
Over 23 million children, specifically boys, grow up without a biological father in the household (U.S. Census Bureau, 2010). This absence can have a profound effect on a child’s identity as a male or female and one’s feelings of self-worth. Conversely, there may be circumstances in which a father’s absence creates a safer and more positive environment for a child.
There are several reasons for men’s absence. The first is the high divorce rate and tendency for the children to reside with their mother. Also, many men adopt a view of masculinity that values their success as a provider more than being present for their children. Finally, there are some men who are unable or unwilling to meet the responsibilities of fatherhood due to mental illness, substance abuse, incarceration, and/or lack of a sense of responsibility.
18-2bMale Socialization and Role Expectations
A common belief about men is they are less emotional than women. However, research has shown that at birth, male babies are actually more emotionally expressive than female babies (Brody and Hall, 1993, Weinberg, Tronick, Cohn, and Olson, 1999). Unfortunately, messages such as “Boys don’t cry” quickly teaches boys that emotional expression is to be avoided. Anger often becomes the only acceptable emotion that boys and men can express (Pollack, 1998).
As early as three years old, boys begin hearing the message, “Don’t be a mama’s boy,” meaning “Don’t be dependent on your mother.” Notwithstanding, what three-year-old child does not need his mother? Boys are frequently taught, through the use of shame, to avoid appearing weak and dependent; this early socialization often encourages premature separation from one’s mother and contributes to men’s lifelong reluctance to seek help (Pollack, 1998).
Many boys are reinforced for taking risks, being competitive, and aggressive and initiating sexual contact. Much time and energy in youth are spent “proving one’s manhood”; thus, engaging in health-promoting behavior, such as routinely seeking health care, wearing seat belts, and using sunscreen, is seen as feminine and therefore discouraged. While what is considered manly may vary due to cultural or socioeconomic class differences, most boys experience some aspects of this socialization.
When boys leave home in late adolescence, many do so without societal permission to express emotion constructively or ask for help. These societal restrictions can interfere with young men’s ability to navigate life transitions.
18-2cGender Role Conflict and/or Gender Role Strain
Rigid adherence to masculine norms can result in an emotional condition known as men’s gender role conflict (GRC) (O’Neal, 2008). In addition to harming one’s well-being and human potential, GRC is harmful to everyone—boys and men, girls and women, transgendered people, and society at large. Extensive research has found a relationship between men’s GRC and behavioral problems, including sexism, violence, homophobia, depression, substance abuse, and relationship issues. Gender role strain (GRS) is the state of tension that occurs from a gender role conflict (Pleck, 1995). GRS occurs when there is a discrepancy between a man’s self-perception and his masculine ideal.
Male Power and Privilege
Men, as a group, have had considerable power in our society. The disparity of power between men and women is clearly visible in U.S. political history. As of 2018, there has not been a female president in the United States, and 80 percent of senators and representatives are male.
While men continue to have great power and privilege, this power is not equally experienced by all men. Collectively, white heterosexual men tend to have greater power and privilege than men of color or gay, bisexual, transgendered, and queer men, reflecting the racism and homophobia that exists in our society. Despite men’s power and privilege overall, men, as individuals, are more apt to feel some level of inadequacy rather than great powerfulness.
Why don’t most men feel powerful? Vandello and Bosson (2013) described the phenomenon of “precarious masculinity,” which depicts men’s struggles in achieving and maintaining social status. Proving to others and yourself that you are a man today does not guarantee that you will achieve manhood tomorrow. Some cultures conduct rites of passage signifying a boy’s permanent transition into manhood. However, there are no widely accepted rites of passage for males in the United States. A man’s perception of his own manhood may vary due to the available avenues he has for achieving status in our society. Men who come from marginalized groups—men of color, gay, bisexual, or transgender, as well as lower-class men—generally have fewer constructive options to achieve a strong sense of manhood.
While men continue to face significant problems and challenges, there is reason to feel cautiously optimistic about their future. In the last 30 years, there has been a growing amount of research conducted on men’s issues, which includes an education in counseling strategies congruent with the culture of men. The American Psychological Association (APA) now has an entire division dedicated to examining and enhancing men’s health, known as the Society for the Study of Men and Masculinities.
Despite these gains, more research and programming is needed in order to continue to design counselor training programs and educate society on the importance of addressing men’s issues to create a safer society. On a positive note, training programs are slowly beginning to recognize the need for greater focus on counselor competence in addressing men’s issues. Our society is starting to awaken to the vast amount of violence that men perpetrate, the necessity to address men’s issues, and the importance of increasing men’s involvement in violence prevention as more men participate in counseling and other therapeutic activities. Finally, with the help of the younger generation of men, males are slowly challenging some of the harmful masculine norms and are striving to find healthier ways of being men.
Jon Davies is a licensed psychologist who earned his Ph.D. in counseling psychology from the University of Oregon. He has worked in multiple settings with a wide variety of clients, including low-income adults, prisoners, veterans, children and families, college students, and older white men. He is the cofounder of the University of Oregon Men’s Center and the founder and current director of the McKenzie River Men’s Center. Both centers are dedicated to helping men lead healthy lives and reducing male violence, particularly toward women. In addition, he is the cocreator of the Men’s Center Approach (Davies, Shen-Miller, and Isacco, 2010) to working with college men to offer strategies to provide culturally congruent services to men.
Davies has shared his expertise through his supervision of master and doctoral student practicum students and interns and has provided training regarding counseling men for mental health and health-care professionals. He is active in Division 51 of the APA’s Society for the Study of Men and Masculinities. In 2011, Division 51 selected him as Practitioner of the Year.
Can you begin by talking about your own gender background and how it has impacted your work?
My parents were both Euro-American, my father’s family emigrated from Wales. My mother was of English and German heritage. Both my parents were born into lower income families. When my father became an ordained minister, our family became middle-class. However, after ten years as a minister, my father developed health issues and had to leave the ministry. As a result, our family lost our middle-class status and my parents worked for the rest of their lives in food service and/or janitorial positions.
My parents had a very non-traditional relationship. My mother was overtly the most dominant parent while my father was more nurturing, focusing on emotions and relationships. Ironically, I learned the traditional aspects of masculinity—stoicism, assertiveness, and taking charge—from my mother and learned about the importance of feelings, being warm, and relationships from my father. I struggled as an adolescent with what I perceived was my mother’s controlling nature. In order to help me understand my mother, my father revealed to me that my mother had been a survivor of childhood sexual abuse and needed to be in control to feel safe.
My only sibling was my older brother. After graduating from college, he came out as a gay man. He worked for years as a counselor and mental health administrator. In his early forties, he contracted AIDS and died in 1991. His death had a profound effect on my life and piqued my interest in men’s health. When I returned to college to work on my doctorate in Counseling Psychology, I had a supervisor who specialized in working with men. He encouraged me to learn more about men’s issues. As I reflected upon his suggestion, I soon realized that I didn’t even know what men’s issues were! I later learned that, despite seeing myself as a non-traditional man, I had many issues that other men faced, such as a strong reluctance to seek help, difficulty crying and/or expressing deep emotion, and feeling conflicted about romantic intimacy. Through my own counseling and self-examination, I became aware that many aspects of my behavior were unconsciously being influenced by my beliefs about masculinity.
Through my work with children, families, and college students, I learned that sexual violence happens frequently and that men are responsible for over 95 percent of the sexual violence that occurs in the U.S. Being the son of a survivor of sexual violence, I decided to use my power and privilege as a male psychologist to reduce sexual violence. To accomplish this goal, I needed to step out of my familiar surroundings of my counseling office and venture into the campus community where men congregated to engage them in the prevention of sexual violence. Additionally, if men were not going to seek help to improve themselves, I needed to take the services to them.
Can you discuss some of the factors that influence the ways men seek mental health services?
Men have a history of underutilizing medical and psychological care. One of the reasons for avoiding seeking help is the fear of appearing weak. Another reason is men’s fear of being judged or misunderstood by the care provider. This is particularly true for men of color and men who identify as gay, bisexual, transgendered, or queer. Additionally, some men avoid seeking help because of the financial cost of services. They also may not be aware of the scope of services that are available to them. Since men are reluctant to seek help voluntarily, by the time they pursue services, they often have already exhausted all of their other coping strategies (Davies et al., 2001).
Some men only seek help when they are forced to come to counseling by a partner, family member, employer, or the legal system. While some counselors feel that being mandated to seek services is not an ideal source of motivation for help, many men who benefit from counseling would not have initially attended had they not been externally motivated. It is important, however, to address this issue to reduce the ambivalence and possible resistance that often accompanies mandatory counseling.
What are the kinds of problems with which male clients might present?
Men will present with a variety of different issues. However, the problems that seriously motivate men include difficulty with a romantic relationship, problems at work, and sexual performance concerns—all issues that affect a man’s self-worth. Given men’s socialization to be stoic, issues of grief and loss are common in men who seek counseling. Experiencing depression and anxiety can additionally threaten one’s sense of adequacy, resulting in a man feeling he should be able to cope with those feelings. Issues that often accompany men presenting problems are:
· Difficulty expressing emotions (alexithymia)
· Struggles with intimacy
· Social isolation
· Feeling shame for needing help
· Uncomfortableness being in a counseling relationship
Do class and/or other socioeconomic issues play a role in these various problems?
Yes definitely. Money and wealth can bring a sense of power and status to one’s life. Conversely, having limited resources can result in a sense of loss of control and power and, in extreme poverty, threaten one’s survival. These circumstances can reduce one’s feelings of manliness and hope in developing a more prosperous life. Not having socially acceptable ways to achieve success can lead to seeking power through ways that are harmful to oneself and one’s society. In addition to wealth and status, being accepted into a group is an important human need; gang involvement is often motivated by a need to belong and gain greater status in one’s community. How one defines masculinity is partially based on the norms of the peer group in which one is a member.
In making an initial assessment, what kinds of information are important to collect from a male client?
Given men’s uncomfortableness with formal therapy, it is important to conduct the assessment in a friendly, natural, and matter-of-fact manner. Here are some important questions to consider when assessing male clients.
· Is he taking care of himself (e.g. eating, sleeping, exercising, seeking routine medical care)?
· What is his social support system? Does he have people he can rely on? Is he able to access that support?
· What is his current romantic and/or sexual relationship status?
· How is he coping with stress? Does he routinely engage in positive stress reducing activities?
· What is his drug and/or alcohol use?
· What provides him meaning in his life?
· What are his strengths and growing edges?
· How congruent is the way he currently sees himself with the person he wants to become?
· How long does he plan to stay in counseling?
· Who are men he admires?
· What is his history of loss (e.g. job/career, status, esteem, loved ones, romantic relationships)?
· What is his depression level? Men’s depression is often underdiagnosed by clinicians because their depression can appear as anger and/or irritability (Cochran and Rabinowitz, 1999).
· What is his risk for suicide? Given men’s high rate of suicide, it is a crucial area to assess. Is he having current or recent suicidal ideation? Has he made previous attempts? Does he have access to a means to kill himself?
· What is his risk for harming others? Is there a history of violence? Has he had current or recent thoughts of harming others? Does he have access to weapons?
(I have included only a partial list of considerations when conducting suicide or homicidal risk assessment. Seek consultation with your supervisor and follow your organization’s and your profession’s best practices for risk assessment).
Are there subgroups of men that are particularly at risk?
In general, men who are marginalized by our society are at greater risk for self-harm or harm by others than able-bodied, white, heterosexual men. For example, men of color and/or men who identify as gay, bisexual, transgendered, or queer particularly struggle with a variety of issues. Men who are marginalized often feel they have less power, privilege, and status than white, heterosexual men. Men of color are more apt to experience the effects of racism and xenophobia. Gay, bisexual, transgendered, or queer men are at risk for experiencing homophobia. Both men of color and GBTQ men have greater risk of being ostracized and being a victim of violence. African American men are eight times more likely to die from homicide than white men (National Center for Health Statistics, 2017), with many of the victims between the ages of 15 and 24. These concerns are magnified for men who’s sexual identity and/or orientation intersect with one’s racial and/or ethnic identity, as in the case of men of color who identify as gay, bisexual, transgendered, or queer.
However, do not overlook the high suicide risk that single, older, white men experience due to their tendency to socially isolate themselves and engage in alcohol and/or substance abuse to mask their feelings of pain, loss, and hopelessness (Curtin, Warner, and Hedegaard, 2016).
What suggestions do you have regarding building rapport with men?
Many people have been harmed by traditional masculinity resulting in some therapists having negative attitudes about working with men. It is important to reflect on your own attitudes about working with men and address any negative countertransference feelings you might have regarding working with them.
Spending time connecting socially prior to launching into a more professional discussion can help put male clients at ease. A friendly, accepting, and non-judgmental approach is often very helpful in developing rapport with male clients. Creating this atmosphere starts by placing magazines and art work in the waiting room that would be of interest to men. Displaying materials that portray a wide range of men including men of color and gay, bisexual, and/or transgendered men can help create a welcoming and inclusive space. Since men may be fearful about seeking help, it is important for the counselor to reassure the client he made the right decision to seek counseling.
Some beginning female therapists may doubt their ability to provide effective counseling for men, but it is important to recognize that a significant number of men prefer to see female therapists. This can be particularly true for men who had difficult relationships with their father and/or father figures. Additionally, since many heterosexual males have concerns about relationships with women, female therapists can be seen as a valuable and trusted source of feedback about how to improve one’s relationships with women.
What else is important to know in working therapeutically with men?
Many men entering counseling fear being judged negatively and are uncomfortable being in a “one down” relationship with a more powerful therapist. Therefore, engaging with a counselor who expresses unconditional positive regard and a willingness to share power with the client can have a positive impact on the counseling relationship. One way to share power is involving men in any decisions about the counseling process. Additionally, intentionally using self-disclosure can often deepen the therapeutic relationship, equalize the power within the counseling relationship, and normalize the issues the client is facing.
Some men who struggle with talking about emotions may feel more comfortable with cognitive-behavioral techniques; however, I don’t assume that all men prefer this approach. Gaining insight into the underlying motivation for one’s behavior and more deeply understanding one’s relationship patterns can be very helpful for men. An interpersonal process approach can help male clients understand their relationship patterns. Using positive psychology strategies of focusing on the client’s strengths and positive coping strategies is both effective and increases men’s comfort in the counseling process.
Research has shown that men are more apt to seek help when there is a chance to reciprocate or give back to the helper (Addis and Mahalik, 2003). If your male client seems to feel uncomfortable with the counseling process, a simple way of providing an opportunity to reciprocate would be to ask him to share his knowledge, opinions, and/or experiences about a topic you are genuinely interested in. For example, I like to hike, and if one of my male clients is telling me about an enjoyable hike he took, I might ask him some questions about the hike. Many male clients appreciate the recognition that they have something of value to offer the therapist.
Most men appreciate a counseling relationship in which they feel they can be themselves and the therapeutic bond feels like an extension of a natural relationship in the environment. I believe it is important to help men recognize that behaviors they engage in are motivated by a desire to prove one’s masculinity. Often this motivational factor is out of the conscious awareness of the client. Asking a male client what he likes and dislikes about being a man can help reveal some of his struggles with gender role conflict. Asking clients what kind of person and/or man he wants to be in the future, what barriers keep him from becoming the person he wants to be, and what steps he needs take to reach his goals can be very helpful in assisting men become “unstuck” in making positive changes in their lives.
The majority of men value equality, justice, and being helpful to others. Providing men opportunities to serve their community can motivate them to act in ways that provide them personal, emotional, and spiritual fulfillment. Mental health organizations can enhance men’s involvement in treatment by offering therapeutic opportunities in non-therapy settings such as workshops, re
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