LGBTQ Culture Change: Toward Institutional Inclusion Mandi Chapman, Taylor Patton, Allison Harvey & Jennifer Bires
Disclosures and Acknowledgements Content adapted with permission from www.cancer-network.org and Mandi Pratt-Chapman, Associate Center Director, Patient-Centered Initiatives & Health Equity GW Cancer Center
How many are we? There are more than 9 MILLION LGBTQ people in the United States. It’s fair to assume you see LGBTQ people regularly.
(Gates, 2011)
Why Do We Need to Know Who Our LGBTQ Clients and Patients Are? Improve service delivery Increase knowledge Encourage trust Patients/clients who don’t come out to their providers are more likely to LIE or LEAVE. (Margolies, McDavid, & Joo, 2014)
Overview of LGBTQ Well Being
LGBTQ people report lower “well being” in five areas: FINANCIAL SECURITY PHYSICAL HEALTH SENSE OF PURPOSE SOCIAL LIFE COMMUNITY ATTACHMENT
(Gates, 2014)
CMS Standards for Participation
-American Health Lawyers Association and Human Rights Campaign, Revisiting Your Hospital’s Visitation Policy, 2012
Joint Commission
Section 1557 of the ACA • Law “extends nondiscrimination protections to individuals participating in: o Any health program or activity any part of which received funding from HHS o Any health program or activity that HHS itself administers o Health Insurance Marketplaces and all plans offered by issuers that participate in those Marketplaces.” • When passed it also protected people from discrimination “on the basis of gender identity and pregnancy termination.” • These two provisions are currently not being enforced due to a court ruling in 2016. (HHS.gov, 2017)
Healthcare Equality Index • Healthcare Equality Index (HEI) is the national LGBTQ benchmarking tool that evaluates healthcare facilities’ policies and practices related to the equity and inclusion of their LGBTQ patients, visitors and employees. • Scoring criteria domains: o Non-Discrimination & Staff Training o Patient Services & Support o Employee Benefits & Policies o Patient & Community Engagement o Responsible Citizenship (Human Rights Campaign, 2017)
Culture Change at GW
Culturally Sensitive Cancer Care for LGBTQ Individuals Educational Campaign
GW (Institution)
Health care providers
Health professions students
DC Community
Non-clinical staff
Individuals at risk/received diagnosis
LGBTQ Research Collaboratory & Transgender Caucus • Faculty-led efforts for systemic change • Cross-departmental collaboration • Multi-level and department buy-in
Diversity and Inclusion Initiative • Comprised of C-Suite leaders, quality director, general counsel and HR representatives • Objectives – Create a culture of inclusion – Participate in HRC Healthcare Equality Index – Prepare medical, nursing and public health students to be LGBTQI-sensitive and affirming
Development of National Trainings for Health Care Providers
TEAM Training The Together-Equitable-Accessible-Meaningful (TEAM) education program will engage a cohort of multidisciplinary health care professionals from 25 health systems across the country in a multi-phase training program in Fall 2017 and Winter 2018. The goal of the training program is to help individual health care organizations implement quality improvements regarding patient-provider communication, cultural sensitivity, health literacy and shared decision-making. Components of the training include: • A self-paced, online course • A two-day workshop in Washington, D.C. • Assistance in creating and implementing an institutional action plan
To learn more, visit bit.ly/AboutTEAMProject
Assessing and Addressing Oncology Social Worker Needs for LGBTQ-Affirming Cancer Care • Project is funded through a grant from AOSW • Research will inform the development of educational materials for health care team members and GBT prostate cancer survivors • For providers a 90 minute training, with experts in the field, will be offered live via webinar (with no-cost CE)
Ways you can help
Create a Welcoming Environment • Check your assumptions, attitudes and biases • Ask patients about their SOGI and pronouns & include these on forms • Ask permission before storing in the EHR • Take confidentiality seriously – it could be the difference between life and death • Ask about “current sex partners,” “current relationship status” and “current living situation” • Be respectful, professional and supportive • Do not ask questions to satisfy your own curiosity • Use the same terminology the patient uses (don’t presume marriage or heterosexual partnership) (Margolies, McDavid, & Joo, 2014)
Show You Have a Safe Environment • • • • • • • • •
Nondiscrimination policies Rainbows Brochures Posters Liaison for LGBT – particularly T – concerns “Out List” HRC Healthcare Equality Index Staff training Resources
Asking Clients About Sexual Orientation and Gender Identity Best Practices for Asking About Sexual Orientation and Gender Identity 1. 2. 3. 4. 5. 6. 7. 8. 9.
10.
Ask the question in an open and non-judgmental manner. Explain that all staff at your agency routinely ask these questions of all patients/clients. Ask the questions with a clear voice and display open body language. Follow the client’s lead with regard to maintaining eye contact or not. Be aware that LGBT clients may be observing you closely for signs or acceptance or nonacceptance and this may influence their level of openness and disclosure. Look up from the computer screen when asking these and other questions. Explain that the reason for asking these questions is to promote health and well-being of all your clients. Be patient in allowing the person to respond. Make efforts to ensure that the surroundings indicate that your organization is a safe place for LGBTQ clients/patients. For example, display posters, brochures, etc. that are LGBTQ friendly. Demonstrate genuine interest in the individual’s response. (New York State Department of Health, 2015)
Forms If you can’t change the form, CHANGE YOUR USE OF IT.
(Margolies, McDavid, & Joo, 2014)
When You Meet a Transgender Patient or Client • Ask what name they use and use that name • Ask about their pronouns and names for body parts • Avoid invasive and unnecessary questions
What is your name?
Do you call that your chest?
I wonder if he had “the surgery”
What pronouns do you use?
(Margolies, McDavid, & Joo, 2014)
Look Out for Elders
http://gensilent.com/
It’s Ok to Make Mistakes Stepping on toes is the unintentional pain caused by a NEWFOUND WILLINGNESS to be close with people who are different.
References Centers for Medicare and Medicaid Service. (2011). https://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/downloads/R75SOMA.pdf Gates, G. J. (2014). LGBT Americans report lower well-being. Retrieved from http://www.gallup.com/poll/175418/lgbt-americans-report-lower.aspx Gates G. (2011). How many people are lesbian, gay, bisexual and transgender? The Williams Institute. HHS.gov. (2017). Section 1557 of the Patient Protection and Affordable Care Act. Retrieved from https://www.hhs.gov/civil-rights/for-individuals/section-1557/ Human Rights Campaign. (2017). Healthcare Equality Index. Retrieved from http://www.hrc.org/hei Joint Commission. (2011). LGBT Field Guide. Retrieved from http://www.jointcommission.org/assets/1/18/LGBTFieldGuide.pdf Margolies, L., McDavid, J., Joo, R. (2014). LGBT cultural competence: Improving care to the LGBT community [PowerPoint slides]. Retrieved from http://www.lgbtcultcomp.org/how-to New York State Department of Health. (2015). Best Practices for Asking About Sexual Orientation and Gender Identity. Retrieved from http://www.airsny.org/How2Documents/Guide%20for%20Completing%20AIRS%20LGBT%2 0Fields.pdf
Thank you! Jennifer Bires
[email protected]
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