Presented By JoAnna Michaels and Gene Silvestri Disclosure Statement The contents contained are intended for informational and learning purposes The presenters are not responsible for any liabilities damages reference to or reliance on any of the information that is presented ID: 715601
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LGBT Cultural Competency Presented By JoAnna Michaels and Gene Silvestri Slide2
Disclosure StatementThe contents contained are intended for informational and learning purposes. The presenters are not responsible for any liabilities, damages, reference to, or reliance on any of the information that is presented.Slide3
Speaker Introductions JoAnna Michaels
U.S
. Air Force
Veteran
Viet
Nam Era Survival Instructor
Program and Administrative Assistant, Volunteers of America
Member, Northern California LGBT Advocacy
Group
CA LGBT Veterans Leadership Forum, Committee Member Public Speaker
Slide4
Speaker Introductions Gene Silvestri
U.S. Army Disabled Veteran - Post 9/11 Era
Vice President, TAVA
Veterans Affairs Coordinator, AMPA
Member, Northern California LGBT Advocacy Group
Member, Veteran and Family Advisory Committee (VFAC) at Mather VHA
CA LGBT Veterans Leadership Forum, Committee Member
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Focus AreasExamine cultural competency and its importance.Discuss LGBT concepts, terms, and definitions.Review differences between sex, gender, and sexual orientation.Review difference between gender identity and gender expression.Highlight common misconceptions and review grammar usage.Ally tips.LGBT veteran demographics, population and community.
Highlight LGBT progress made within VHA and Cal Vet. Examine remaining challenges for LGBT veterans.
Q&ASlide6
What Is Cultural Competence?“Culture Umbrella. “ Winters, Mary-Frances. Adapted from The Inclusion Solution, 2013. http://www.theinclusionsolution.me/what-is-diversity-part-6-its-all-about-culture/Slide7
Cultural Competence…..Refers to a mix of knowledge, skills and awareness pertaining to cultural differences and interpretations across groups. Examines our will and actions to build an understanding between people in order to help them. Incorporates the ability to interact respectfully with people from across various groups.Includes the awareness of and respect for differences, without making assumptions.
Definitions adapted from ”What does it mean to be culturally competent?” Livingstone, Rhonda. 10 July 2014. https://wehearyou.acecqa.gov.au/2014/07/10/what-does-it-mean-to-be-culturally-competent/ and Openhouse LGBT Curriculum, http://openhouse-sf.org/Slide8
Why Is Cultural Competency Necessary?Encompasses the principles of trust, respect for diversity, equity, fairness, and social justice.Highlights the growing diversity that exists within our modern culture.Reinforces that not everyone holds the same beliefs, values and practices we do.
Fosters mutual respectful with people from across various cultures and backgrounds.
Promotes active listening, open communication, and
formal communication.
Definitions
adapted from ”What does it mean to be culturally competent?” Livingstone, Rhonda. 10 July 2014. https://wehearyou.acecqa.gov.au/2014/07/10/what-does-it-mean-to-be-culturally-competent/
Adapted from Openhouse LGBT Curriculum, http://openhouse-sf.org/Slide9
LGBT Cultural CompetenceSlide10
LGBT DefinedLetters stand for Lesbian, Gay, Bisexual and Transgender.Umbrella terminology encompassing diverse communities of people (race, background, ages, careers, religious beliefs, and economics).
Emphasizes diversity of sexuality and gender identity-based cultures.
The alphabet continues to grow –
LGBTQ*.
People may or may not identify themselves with one, more than one, or none of the terms.
Identity is fluid – can change over time.
Definitions adapted from The Gender Equity Resource Center at UC Berkeley http://geneq.berkeley.edu/lgbt_resources_definition_of_terms
“LGBT” Page. Researched Feb 2017. Wikipedia https://en.wikipedia.org/wiki/LGBTSlide11
Population ComparisonU.S. Population (as of 13 Feb 2017)
≈ 324,535,106
1
U.S. LGB Population (as of 2011)
≈ more than 8 million (3.5%)
2
U.S. Transgender Population (as of 2016)
≈
1.4 million
3
1 U.S. Census Bureau and U.S. World Population Clock. Reference 13 Feb 2017.
2 Gates, Gary J How many people are lesbian, gay, bisexual, and transgender? The Williams Institute . April 2011. http://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf
3 Flores, Herman, Gates, Brown. How Many Adults Identify as Transgender in the United States? http://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf Slide12
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Gender, Sex, and Sexual OrientationAdapted from The Gender Equity Resource Center at UC Berkeley – http://geneq.berkeley.edu/lgbt_resources_definition_of_termsSex: A medical term designating a mix of chromosomes, genitals, hormones and hormonal balances, reproductive organs, and secondary- sex characteristics
.
Gender (Culture):
Gender is not a simple case of “either/or.” Comprises gender expression, roles, and identity. Exhibited by clothing, hairstyles, body language, speech, etc.
Sexual Orientation (Sexual Identity):
Refers to person’s innate sense of sexual attraction toward others. Can evolve over time. Some examples include
Asexual, gay, pansexual, two spirit, heterosexual, bisexual, lesbian, pansexual.Slide14
Gender Identity and Gender Expression Gender Identity refers to one’s innate sense of self and how someone identifies their own gender. This may or may not correspond to their assigned birth sex. Gender identity is internal and isn’t necessarily outwardly visible.
ManWoman
Cisgender (non transgender person)
Transgender
Gender Queer
Agender (person who does not identify themselves as having a particular gender.)
Gender Expression
refers to how a person represents or expresses their gender identity to others.
Feminine/Masculine Behavior
PostureClothing Styles MannerismsSpeech PatternsHairstylesActivities
Adapted from Openhouse LGBT Curriculum, http://openhouse-sf.org/Slide15Slide16
Common MisconceptionsIt’s a phase or a choice.You can tell someone is LGBT by looking at them.Gender identity determines your sexual orientation. LGBT people have been abused.LGBT people are sexually promiscuous.Sexuality is fixed and can’t change over the course of one’s lifetime.LGBT people all share a particular value system.LGBT people are mentally-ill and/or confused. All transgender people are gay.All transgender people have surgeries and take hormones.
Transgender is the same as transvestite or intersex, or cross-dresser.Slide17
Infographics adapted from http://grammarly.com/grammar-checkGrammar UsageSlide18
Grammar UsageInfographics adapted from http://grammarly.com/grammar-check.Slide19
Grammar UsageInfographics adapted from http://www.glaad.org/reference/transgender.Slide20
How Can I Be An Ally ?As easy as providing support and acceptance.Listen with an open mind. Willing to engage in open communication.Be an ally among your allies – help to educate others.“Come out” as an LGBT Ally.Connect with your local LGBT community.Admit you don't know something versus making assumptions.Believe in treating others with dignity and respect.
Adapted from Glaad Be An Ally & A Friend http://www.glaad.org/resources/allySlide21
LGBT EtiquetteTreat each person with respect, as you would expect for yourself.Avoid backhanded compliments or "helpful" tips.Don’t make assumptions or generalizations.Avoid using stereotypes or slang phrases.Please do not laugh at someone, especially in their presence.Check preconceived thoughts and opinions at the door. Be inclusive.
Remain mindful of your words, tone and actions.Always use a person’s preferred name, pronoun, gender, or avoid using specific references.If you don’t know…ask politely!
Don’t continue to use the incorrect pronoun.
If you “slip up,” don’t make a big deal about it.
Apologize, correct yourself, and move on.
Seek permission from the individual before asking specific questions.
Adapted from Steven
Petrow's
Complete Gay & Lesbian Manners: The Definitive Guide to LGBT Life (Workman, 2011)Slide22
LGBT Military & Veteran DemographicsSlide23
Current Population U.S. Service Members
≈ 1,301,000 Active
1
≈ 811,000 Reserve
1
U.S. LGB
Service Members
≈ 71,000 (2.8%) identify as LGB
2
U.S. Transgender
Service Members
≈ 150,000 have served or are serving
3
U.S. Military Veterans
≈ 22 million
4
U.S. LGB Vetera
ns
≈ over 1 million
5
U.S. Transgender Veterans
≈ over 134,000 Veterans / Retired Guard and Reserves
6
1Department of Defense (DoD) Release “Fiscal Year 2017 President’s Budget Proposal”. 9 February 2016. Retrieved 13 February 2017.
2Goldbach, J.T. & Castro, C.A.“Lesbian, Gay, Bisexual, and Transgender (LGBT) Service Members: Life After Don’t Ask, Don’t Tell.” Current Psychiatry Rep (2016) 18: 56. doi:10.1007/s11920-016-0695-0.
3Gates, GJ and Herman, JL. 2014. Transgender Military Service in the United States. Williams Institute, UCLA School of Law.
4 Department of Veterans Affairs (VA). The Veteran Population Projection Model 2014 (VetPop2014). https://www.va.gov/vetdata/veteran_population.asp
5 VA LGBT Program LGBT Veteran Health Care Fact Sheets. Referenced 13 Feb 2017. http://www.patientcare.va.gov/LGBT/VA_LGBT_Outreach.asp
6 Gates, GJ and Herman, JL. 2014. Transgender Military Service in the United States. Williams Institute, UCLA School of Law.Slide24
Quick FactsDADT Repeal and Open Transgender Service do not heal old wounds.Experience higher rates of suicidal ideation and attempts than heterosexual veterans. * **Experience higher rates of military sexual trauma (MST), harassment, and abuse.**Suffer from a host of service-connected mental health and physical ailments.*Continue to endure discrimination and struggle with reintegration processes.*Continue to experience higher rates of unemployment.*Experience higher rates of homelessness.*
*
Stalsburg
, Brittany L. “After Repeal: LGBT Service Members and Veterans The Facts.” September 2011. Referenced 13 Feb 2017. https://www.pritzkermilitary.org/files/5214/4120/4269/LGBT-Fact-Sheet-091411.pdf
**
Lonero
, Gabriel Angelo. Ramirez, Maria
Heliana
. “Living out Loud, Laughing out Loud: Best Practices of an LGBT Veteran Support Group.” 13 January 2017. http://sswr.confex.com/sswr/2017/webprogram/Paper30148.htmlSlide25
VHA and LGBT Veterans 1
Kauth Michael R. and Shipherd Jillian C.. LGBT Health. Transforming a System: Improving Patient-Centered Care for Sexual and Gender Minority Veterans. May 2016, 3(3): 177-179.
The U.S. Veterans Health Administration (VHA) is likely the largest provider of LGBT healthcare in the world.
1Slide26
Progress Made Within the VHAMore welcoming and inclusive environment on campuses nationwide (groups, signage, events).June 2011 – creation of Transgender and Intersex Health Care Directive (updated in 2013).As of 2013, more than 250,000 LGB veteran patients were receiving VHA care services.*In 2013, VHA treated 2,567 veterans with transgender specific care.*As of 2017, VHA is treating over 5,000 patients who identify as transgender.**Currently there are more than 500 LGBT-inclusive initiatives underway across VHA facilities nationwide.*Each facility now has an LGBT Veteran Care Coordinator.
Pre and post operative care; hormonal therapies covered.Capability to change one’s name and gender marker on VA medical records.
*Information adapted from VHA Patient Pop - The VA By the Numbers: How Big Is It and Who Uses It?
by Monica Alba, NBC News 09 May 2014. http://www.nbcnews.com/storyline/va-hospital-scandal/va-numbers-how-big-it-who-uses-it-n101771
VHA LGB Patient Pop - Kauth, M. R., & Shipherd, J. C. (2016). Transforming a System: Improving Patient-Centered Care for Sexual and Gender Minority Veterans. LGBT Health.
**“Transgender Vets, the VA, and Respect”
– Jan 2017. https://www.va.gov/health/NewsFeatures/2017/January/Transgender-Vets-the-VA-and-Respect.aspSlide27
Progress Made Within the VHAPatients’ right to be treated according to their gender identity for purposes of pronouns, restroom access, and room placements.LGBT-specific VA Disability Claim Assistance Services.VHA facilities are recognized as leaders in LGBT Health Care Equality by the Humans Rights Campaign’s (HRC) Healthcare Equality Index (HEI).VA LGBT-specific webpage on the VA website, share points, care sheets and other resources.Development of the Speech-Language Pathology program.
Information adapted from VHA Patient Pop - The VA By the Numbers: How Big Is It and Who Uses It?
by Monica Alba, NBC News 09 May 2014. http://www.nbcnews.com/storyline/va-hospital-scandal/va-numbers-how-big-it-who-uses-it-n101771
VHA LGB Patient Pop - Kauth, M. R., & Shipherd, J. C. (2016). Transforming a System: Improving Patient-Centered Care for Sexual and Gender Minority Veterans. LGBT Health.
“Transgender Vets, the VA, and Respect”– Jan 2017. https://www.va.gov/health/NewsFeatures/2017/January/Transgender-Vets-the-VA-and-Respect.aspSlide28
California Population and LGBT VeteransCA Population (as of 2014)
≈ 38.8 million
1
CA LGBT Population (as of 2012)
≈ 1,338,164
2
CA Veteran Population (as of 2013)
≈ 2 million
3 *
CA Gay and Lesbian Veterans (as of 2004)
≈ 136,000
3
*
1“Welcome to QuickFacts – California.” Referred to 13 Feb 2017. http://www.census.gov/quickfacts/table/PST045215/06
2"Decennial Census Data on Same Sex Couples". Same Sex Couples. U.S. Census Bureau. Retrieved 30 June 2013.
3 “California has nation's highest number of veterans .” July 13, 2012. http://
latimesblogs.latimes.com/lanow/2012/07/california-has-nations-highest-number-of-veterans.html
*California Research Bureau White Paper “Better Serving Those Who Serve: California’s LGBT Veterans Speak Out.” Kellie Jean Hogue, Ph.D. and Tonya D. Lindsey, Ph.D., Senior Policy Analysts. 2015 June. http://www.library.ca.gov/crb/CRBReports.htmlSlide29
CalVet and LGBT VeteransAdapted from CalVet’s Minority Veterans Division website page - https://www.calvet.ca.gov/MinorityVets/Pages/LGBT.aspx Slide30
CalVet and LGBT VeteransCalVet is committed to ensuring all veterans have access to and receive the benefits they have earned. LGBT veteran issues are housed under CalVet’s Minority and Underrepresented Veterans Division.The Minority Veterans Division promotes the use of VA benefits, programs, and services by minority and LGBT Veterans. Supports and initiates activities that educate and sensitize the public to the unique needs of minority and LGBT veterans.Advocates by identifying gaps in services and makes recommendations for improvements.CalVet LGBT Veterans information webpage - https://www.calvet.ca.gov/MinorityVets/Pages/LGBT.aspx
Adapted from CalVet’s Minority Veterans Division website page - https://www.calvet.ca.gov/MinorityVets/Pages/LGBT.aspx Slide31
California LGBT Veterans Leadership ForumWhen - Held over a two-day period in (September 26-27, 2014) at Sacramento State.Background - CalVet, along with a planning committee, and the CRB support, convened the first statewide forum on LGBT veterans. to ensure that LGBT veterans were receiving the benefits they have earned. Purpose - to help identify, explore and discuss the needs of the LGBT veteran community. Key Areas Covered - Housing, Employment, Healthcare, Education and Legal.
Outcome - The forum identitified needs, gaps, and exclusions in service; provided legal and programmatic remedies; local programs that can serve as a model initiaitives. White Paper
-
released in June 2015. Discussed numerous state, local and federal policy recommendations for each forum key area covered. Some have already been achieved. Slide32
Challenges Remain(Photo Credit: AP)Slide33
Some Remaining ChallengesMany LGBT veterans are fearful of outing themselves in order to access earned benefits.Issues persist with updating discharge code and name on DD-214 Form.Experiencing higher rates of suicidal ideation.Need for stronger wraparound services for LGBT veterans.Lack of access t0 viable local and state current resources. Inconsistent enforcement and knowledge of VHA LGBT healthcare policies and directives at facilities nationwide.Issues in coordinating care across VHA services, especially in rural areas.Access to safe-space LGBT community housing.Embarrassing, insensitive, and hostile appointment experiences.
Long delays in getting access to care and needing to travel to get care. Current VHA ban on transgender-related surgeries.Slide34
ResourcesAmerican Legion Alexander Hamilton Post 448 – www.post448.orgAmerican Military Partner Association (AMPA) – militarypartners.orgAmerican Veterans for Equal Rights(AVER) – aver.usCalVet LGBT Veterans https://www.calvet.ca.gov/MinorityVets/Pages/LGBT.aspxCenterLink: The Community of LGBT Centers - http://www.lgbtcenters.orgServicemembers Legal Defense Network (SLDN) -
https://www.outserve-sldn.org/Swords to Plowshares - https://www.swords-to-plowshares.org/
The Gender Equity Resource Center at UC Berkeley –
http://geneq.berkeley.edu/lgbt_resources_definition_of_terms
Transgender American Veterans Association (TAVA) -
transveteran.org
Transgender Law Center -
https://transgenderlawcenter.org/
VA LGBT Veteran Care -
http://www.patientcare.va.gov/LGBT/VHA Transgender & Intersex Veterans Directive -http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863Slide35
Questions?