promoting LGBT Health Equity: - PowerPoint Presentation

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promoting LGBT Health Equity: - PPT Presentation

Challenges and Solutions 2018 Tim Vincent MS Deborah WyattONeal RN MSN CNS Shavar Johnson MSSA 2018 Note to the Reviewer Promoting LGBT Health Equity is a training we custom developed for healthcare providers in Los Angeles seeking to better understand and engage LGBTid ID: 791412

health lgbt www gender lgbt health gender www amp transgender sexual identity sex individuals people https knowledge orientation building

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Slide1

promoting LGBT Health Equity:Challenges and Solutions

2018

Tim Vincent, MS

Deborah Wyatt-O’Neal, RN, MSN, CNS

Shavar Johnson, MSSA

2018

Slide2

Note to the Reviewer

Promoting LGBT Health Equity is a training we custom developed for healthcare providers in Los Angeles seeking to better understand and engage LGBT-identifying patients experiencing health disparities. The training is designed to increase knowledge of key cultural barriers experienced by LGBT individuals in the healthcare setting. Cultural Humility, Implicit Bias, Sex Positivity, and SOGI are key components of the course to guide participants towards identifying areas of organizational change. Through this training, participants were given the opportunity to develop inclusive strategies for LGBT staff and patients, serving as a frame to develop post-training structural interventions.

Slide3

jec

ives

the end of the training, participants will be able to:Increase knowledge of key cultural barriers experienced by LGBT individuals in the healthcare setting. Increase skill to assess existing services specific to the needs of LGBT individuals. Identify at least 3 strategies to promote a culture of sensitivity and inclusivity for the LGBT individuals, both staff and patients. Increase knowledge on screening individuals for concerns related to sexual orientation and gender identity.3

Slide4

Introductions

& OverviewExamining Bias and the Impact of Culture

Reviewing Terminology

Health Disparities among LGBT Communities

Why History Matters

Collecting SOGI dataBuilding Inclusive Environments

Assessing the Services and Building Leadership Today44

Slide5

Housekeeping

Emergency

Exit

Restrooms

Phone

CallsBreaks/LunchParking Lot5

Slide6

Group Agreements

Respect

Opinions

Active Listening

ConfidentialityParticipate

Slide7

Unconscious Bias and Cultural Humility

Module

Slide8

Introduction & Discussion

Challenges

Slide9

What you know

Write one thing you know, you learned, or you heard about the populations listed on the assigned sheets

Slide10

Unconscious Bias

Slide11

Unconscious Bias

(Wilkie, 2014 – adapted)

Slide12

Unconscious Bias

https://youtu.be/dlwkvB0Diz4

Slide13

Unconscious Bias: Enacted Stigma

https://www.youtube.com/watch?v=F8JKUCvGJ7I

Slide14

Addressing BiasReflectConfrontEngage

CommitMaintainDiscuss14

Slide15

WHY IS This Important?

Slide16

local

Slide17

Culture decides what skills, strengths, & activities are appreciated

Slide18

A Critical Definition Of Culture

Cultural Empathy

Slide19

Gender

Physical-Mental

Ability

Syphilis/HIV

Race

Sexual Identity

Immigration Status

Class

Religion/Spirituality

Geography

Ethnicity

Age

Class

Slide20

Cultural

Slide21

Cultural Humility

Slide22

Cultural Humility Principles

Slide23

Review of Terminology - LGBTQ+

Module

Slide24

Review of TermsBiological SexA person’s combination of genitals, chromosomes and hormones, usually categorized as “male” or “female” based on visual inspection of genitals via ultrasound or at birth

Gender IdentityA person’s deep-seated, internal sense of who they are as a gendered being—specifically, the gender with which they identify themselves

Green, E.R. & Maurer, L.M. (2015). The Teaching Transgender Toolkit: A Facilitator’s Guide to Increasing Knowledge, Decreasing Prejudice, & Building Skills. Ithaca, NY: Planned Parenthood of the Southern Finger Lakes: Out for Health. ISBN: 978-0-9966783-0-8. www.teachingtransgender.com.

Slide25

Review of TermsTransgenderAdjective used to describe a person whose gender identity does not “match” the biological sex they were assigned at birth

“Transgender” serves an umbrella term to refer to the full range and diversity of identities within transgender communitiesCurrently the most widely used and recognized term

Slide26

Slide27

Review of TermsGender Non-ConformingA person whose gender expression is perceived as being inconsistent with cultural norms expected for that gender

Specifically, boys/men are not masculine enough or are feminine, while girls/women are not feminine enough or are masculine27

Slide28

Review of TermsGender Non-ConformingNot all transgender people are gender non-conforming, and not all gender non-conforming people identify as transgender

Cisgender people may also be gender non-conformingGender non-conformity is often inaccurately confused with sexual orientation

www.teachingtransgender.com

.Photo Credit: https://www.glsen.org/author/all?page=4

Slide29

Review of TermsSexual Orientation

Sexual orientation is about attraction to other people (external), while gender identity is a deep-seated sense of self (internal)All people have a sexual orientation that is separate from their biological sex, gender identity and gender expression

Slide30

Instead

of saying this:

Say this:

FTM, used to be a woman, born a female

Transgender man, or, Transman

MTF, used to be a man, born a maleTransgender woman, or, TranswomanSex Change, The Surgery, Transgendering, pre-operative, post-operativeMedical TransitionHermaphroditeIntersex person or Person who is intersexSexual preference, homosexualSexual orientationAffirming Terminology30

Slide31

Instead

of saying this:

Say this:

Affirming Terminology

“Real” sex, “real” gender, genital sexSex assigned at birthA transgenderTransgender person, or, person who is transgenderTransgendersTransgender people, or, people who are transgenderTransgenderedTransgender

Slide32

Affirming Name & Pronouns

A note on affirming vs. preferred name or pronouns.

Best practice is to acknowledge that individuals have the agency to decide this for themselves…

How to Ask:

“What is your chosen name?”

“What are your pronouns?”

Slide33

Coming Out

The process of internally identifying one’s gender or sexual identity and then socially disclosing (voluntarily telling people).

“Coming out is an ongoing, iterative process, because social identity is negotiated daily in the context of other relationships and experiences. Depending on a persons’ circumstances – geographic location, age, race, religion, class, and other factors – each individual’s coming out process is unique and involves different

risks

.”

(Lindhurst, et al., 2010)

It a complex, difficult and life-long series of events. 33

Slide34

Outing

Having one’s sexual orientation or gender identity disclosed against one’s will or without one’s consent.

LGBTQ individuals are ALWAYS assessing the cost/benefit of coming out, as well as

where

and

who

it is safe to come out to.Because of the very real risks that outing can pose to a person’s physical and emotional safety, it is essential that we maintain confidentiality and make every effort to not unintentionally out the person. 34

Slide35

Notes on Language

Language and words that communities use to define themselves vary temporally, geographically, and culturally.

Because many oppressed communities have had their right to self-identify taken away, using respectful language is the first important step toward creating a safer space for LGBTQ individuals.

Slide36

LGBTQ Identities: Key Points

Different terms are used in different communities.

Terms are

always changing

Sexual orientation and gender identity

are not the same thing.LGBTQ individuals are incredibly diverse.Always allow individuals to self-identify.Respect how people identify, however that may be.Maintain confidentiality and take care not to intentionally or unintentionally “out” a person.36

Slide37

LBGT Health Disparities – Making the Connection

Module

Slide38

Identity and Culture Identity:The manner in which we define

ourselves.Culture:Shared experiences or commonalities that have developed and continue to evolve in relation to changing social and political contexts.

Race

Ethnicity/National Origin

Language

SexGender IdentitySexual OrientationReligion/Spiritual BeliefsAge

Class

Ability/Disability Status

Immigration Status

Education

Geographic Location/Space

Rural/Urban

Time

Social/Political Context

…and more!

Slide39

Inequities are never the result of single, distinct factors. Rather, they are the outcome of intersections of different social locations, power relations, and experiences.

Olena Hankivsky, PhD

Slide40

homo/Bi/Transphobia

Slide41

LGBT Health Disparities

Lesbians are less likely to get preventive services for cancer.Lesbians and bisexual females are more likely to be overweight or obese.Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals.

Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.

LGBT populations have the highest rates of tobacco, alcohol, and other drug use.

US Department of Health and Human Services. Healthy People 2020. [Internet]. Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

Slide42

LGBT Health Disparities

LGBT health requires specific attention from health care and public health professionals to address a number of disparities, including:LGBT youth are 2 to 3 times more likely to attempt suicide.LGBT youth are more likely to be homeless. Studies indicate that between 25% and 50% of homeless LGBT youth are on the streets because of their sexual orientation or gender identity.

Gay men are at higher risk of HIV and other STDs, especially among communities of color.

US Department of Health and Human Services. Healthy People 2020. [Internet]. Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

Slide43

LGBT Health Disparities

https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

Slide44

History Matters- LGBT Timeline

Module

Slide45

History Matters:

Slide46

Viewing the Timeline

Place a pink sticker of something you feel is significant in understanding experience of LGBT

Place

a lavender

sticker on something that is meaningful to you in your work…

Slide47

Collecting SOGI data and Taking a Sex Positive Approach

Module

Slide48

Do you ask about Sex?

Slide49

Gender Identity Sample QuestionsTwo Question Approach - Part 1

Sex were you assigned at birth: What sex was listed on your birth certificate?MaleFemaleNote: In rare cases, a person may be listed as intersex on their birth certificate, but this is not one of the categories reported to the Health Resources and Services Administration.

Other is not reported back to HRSA

http://www.lgbthealtheducation.org/wp-content/uploads/2016/09/Fotolia_4177714_Subscription_XL-940x300.jpg data.pnghttp

://www.trainingtoserve.org/sites/default/files/images/Sensitive%20History.pdf

Slide50

Gender Identity Sample Questions

Two Question Approach- Part 2Gender Identity: Do you identify as male; female; transgender male/ female-to-male; transgender female/ male-to-female; other; choose not to disclose?MaleFemaleTransgender Male/ Female-to-Male

Transgender Female/Male-to-FemaleOtherChoose not to disclose

Slide51

Gender Identity Sample Questions

Sexual Orientation: What is your sexual orientation? (Possible prompt: who are you attracted to?)Lesbian or GayStraight (not lesbian or gay)Bisexual

Something elseDon’t know

Choose not to disclose

http://www.trainingtoserve.org/sites/default/files/images/Sensitive%20History.pdf

Slide52

Why it is important to ask…..

35% of MSM do not share their sexual orientation with their medical providers

25% of HIV-infected patients report that they discussed transmission with their providers

6% of HIV-infected patients report discussing sexual practices with their primary care providers

Slide53

SOGI Data ImportanceIf you are not counted, you are discounted

Data collection allows us to tell the LGBT storyCreates safe spaces and affirms the LGBT Community Identifies disparitiesSecures fundingInforms public policies and laws

Evaluation Ethical Responsibility and Legal Compliance

Slide54

SOGI Data Collection Registration Staff

54https://vimeo.com/260306345

Slide55

SOGI Data Collection Clinical Staff

https://vimeo.com/260311623

Slide56

Let’s Practice! - SOGI

Slide57

SOGI Edition

Slide58

Defining Sex Positivity

Sex positivity

is "an attitude towards human sexuality that regards all

consensual sexual activities

as fundamentally

healthy and pleasurable, and encourages sexual pleasure and experimentation. The sex-positive movement is a social and philosophical movement that advocates these attitudes. The sex-positive movement advocates sex education and safer sex as part of its campaign.Gabosch, Allena (2008-02-26). "A Sex Positive Renaissance". Retrieved 2014-09-12.58

Slide59

A Sex Positive Health Professional

Checks their own assumptions and biases

Embrace our clients as assets & as experts on their experience

Centers the client’s priorities in communication and decision making

Practices self reflection, humility, & empathy

Seeks ongoing training and development

Responsive, relevant, respectfulRemembers that pleasure is an important part of sexual health59

Slide60

Building an Inclusive Environment

Module

Slide61

Being LGBT at Work

Millions of Americans fear losing job due to sexual and gender identityMore than 40% of Lesbian, Gay and Bisexual people and almost 90% of Transgender people experienced workplace discrimination and mistreatmentNo current Federal protection under the law

Challenge for business and employee

Krejcova

, M. (2015, March 10). The value of LGBT equality in the workplace. Retrieved July 9, 2018, from https://www.glaad.org/blog/value-lgbt-equality-workplace

Slide62

Being LGBT at Work

LGBT employees who spend considerable time and effort hiding their identity in the workplace experience higher levels of stress and anxiety resulting in health problems and work-related complaints

Krejcova, M. (2015, March 10). The value of LGBT equality in the workplace. Retrieved July 9, 2018, from https://www.glaad.org/blog/value-lgbt-equality-workplace

Slide63

Benefits of an inclusive work Environment

Employer benefitsLower legal costs related to discrimination lawsuits Lower health insurance cost due to improved health of employeesLGBT employee retentionLess money spent on recruitment and onboardingIncreased creativity, innovation, new ideas

Krejcova, M. (2015, March 10). The value of LGBT equality in the workplace. Retrieved July 9, 2018, from https://www.glaad.org/blog/value-lgbt-equality-workplace

Slide64

Benefits of an inclusive work EnvironmentMore LGBT clients/patients seeking services.

LGBT individuals support organizations that support them.

Slide65

Institute for Inclusion in the Legal Profession. (2011). The Business Case for Diversity: Reality or Wishful Thinking?

Slide66

Assessing the Services and Building Leadership

Module

Slide67

To Treat Me, You Have To Know Who I am

https://youtu.be/NUhvJgxgAac

Slide68