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Providing LGBT Competent Care

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This information was compiled by the Duke Doctor of Physical Therapy Gay-Straight Alliance in 2014, after recognizing that the LGBT community can often times go under-represented in clinical …

This information was compiled by the Duke Doctor of Physical Therapy Gay-Straight Alliance in 2014, after recognizing that the LGBT community can often times go under-represented in clinical education. As a result we wanted to create a brief introduction into the importance of understanding who your patient is, and preparing future clinicians for competent interactions with individuals from this community.

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  • It’s important to never assume that your patients or coworkers identify with a particular sexual orientation. A patient interview, conversation, or casual dialogue with coworkers and peers can become uncomfortable or even inappropriate when this oversight is made.
  • Transcript

    • 1. This Presentation brought to you by: Updated For Factual Relevance: 5/25/2014
    • 2. •Sex – Classification of people as male or female •Gender Identity – One’s personal sense of being a man or woman •Gender Expression – External manifestation of gender identity •Sexual Orientation – Describes a person’s physical and emotional attraction to another person •Transgender – People whose gender identity/expression differs from the sex they were assigned at birth (Transsexual, GID) •Transitioning – Complex process of altering one’s birth sex •Intersex – A person whose biologic sex is ambiguous www.glaad.org
    • 3. •Lesbian – A woman attracted to other women •Gay – A man attracted to other men (sometimes an umbrella term) •Bisexual – A person who is attracted to the two genders, not necessarily equally or simultaneously •Asexual – A person who does not have sexual attraction •Questioning – A person who is exploring their sexual identity or orientation •Ally – A person who advocates for/supports the LGBT community •Queer – Traditionally a pejorative term, queer has been appropriated by some LGBT people to describe themselves or straight allies that support them •Homophobia – The irrational fear/intolerance of LGBT people •Heterosexism – Assuming everyone is heterosexual www.glaad.org
    • 4. Provision of Excellent Healthcare for All Patients *It’s Your Professional Responsibility*
    • 5. Within the field of physical therapy we recognize and accept the professional obligations of all physical therapists to: • Treat each patient with dignity and respect • Respond effectively, compassionately and professionally to the needs of all types of patients for excellent, comprehensive health care • Facilitate greater health, wellness, independence and enhanced quality of life in each of our patients
    • 6. Principle #1: Physical therapists shall respect the inherent dignity and rights of all individuals. (Core Values: Compassion, Integrity) 1A. Physical therapists shall act in a respectful manner toward each person regardless of age, gender, race, nationality, religion, ethnicity, social or economic status, sexual orientation, health condition, or disability. 1B. Physical therapists shall recognize their personal biases and shall not discriminate against others in physical therapist practice, consultation, education, research, and administration. http://www.apta.org/uploadedFiles/APTAorg/About_US/Policies/HOD/Ethics/Codeofethics.pdf
    • 7. Principle # 2, 3, 6, 8 state that we also commit to • Act in the best interests of patients • Provide compassionate care that incorporates the individual and cultural differences of patients • Adhere to evidence-based practice • Take responsibility for professional development based on critical self- assessment and reflection • Advocate to reduce health disparities and health care inequalities • Improve access to health care services • Address the health, wellness and preventive health needs of all people http://www.apta.org/uploadedFiles/APTAorg/About_US/Policies/HOD/Ethics/Codeofethics.pdf
    • 8. • In the 2012 Healthcare Equality Index, Duke University Hospital was identified as one of 234 facilities in the United States that: • protect LGBT patients and employees from discrimination • ensure equal visitation access for LGBT people through explicitly inclusive policies • provide staff training in LGBT patient-centered care • Duke is the only hospital system in all of North Carolina to meet this standard. • As a Duke DPT student, you are now part of our institution's commitment to providing high-quality care to LGBT patients. http://www.hrc.org/hei/hei-leaders#.UcR1r_nCaSo
    • 9. • Furthermore, as part of the oath we take in the annual White Coat Ceremony, we pledge to: • Uphold the standards of excellence set forth by the institution of Duke University. • Practice with integrity, compassion, humility, and purpose. • Uphold my sense of social responsibility and promote health, while lending my hands and knowledge to those in need.
    • 10. As a healthcare provider why is knowledge about LGBT issues necessary for competent care?
    • 11. “A recent literature review found that self-identified LGB individuals are more likely than heterosexuals to rate their health as poor, have more chronic conditions, and have higher prevalence and earlier onset of disabilities.” (http://kaiserfamilyfoundation.files.wordpress.com/2014/01/8539-health-and-access-to-careand-coveragefor-lesbian-gay- bisexual-and-transgender-individuals-in-the-u-s.pdf) Medical education does not routinely encompass LGBT health issues. More than half of medical schools and public health school curricula lack instruction about the health concerns of LGBT people.
    • 12. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662085/) (http://data.lambdalegal.org/pdf/158.pdf) (http://www.nea.org/assets/docs/HE/glbtstatus09.pdf ) http://nwnetwork.org/wp-content/uploads/2012/08/2006-NCLR-LGBTQ-Youth-in-the-Foster-Care-System1.pdf )
    • 13. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662085/ • As a physical therapist you will be closer to your patient than much of the medical community. It is important to know your patient and understand possible risks such as depression, and mental health when implementing treatment.
    • 14. (http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25) • Screening and interventions can be life saving aspects of your career. LGBT individuals tend to have lower rates of health insurance due to issues of coverage resulting from unmarried partners. Additionally, Fear of discrimination and negative experiences with healthcare providers result in decreased screening in lesbian and bisexual women despite an increased risk for developing illnesses such as breast cancer, asthma, UTI’s, and cardiovascular disease. (http://kaiserfamilyfoundation.files.wordpress.com/2014/01/8539-health-and-access-to-careand-coveragefor-lesbian-gay-bisexual-and- transgender-individuals-in-the-u-s.pdf)
    • 15. (http://www.socialworkers.org/agingConference/documents/presentations/Needs%20of%20LGBT%20Seniors-Thurston.pdf) • Being aware of your patients living situation is crucial to treatment and discharge planning. 90% of LGBT elders do not have children and nearly 20% report having “no one to call in a time of crisis”, a statistic that is 10 times higher than the general senior population.
    • 16. • What are the health risks specific to a population that can not always be readily identified? In order to treat your patients with complete competence you need to know who they are. Gay and Lesbian Medical Association. “Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender patients”
    • 17. (http://www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf) • Don’t be an uninformed provider. Know your patient, understand your patient, and be able to provide competent, comprehensive, and compassionate treatment.
    • 18. (http://www.glma.org/_data/n_0001/resources/live/GLMA%20guidelines%202006%20FINAL.pdf#__utma=149406063.1503028756.1372082685.1372099408.13721 02112.3&__utmb=149406063.1.10.1372102112&__utmc=149406063&__utmx=- &__utmz=149406063.1372102112.3.2.utmcsr=google|utmccn=(organic)|utmcmd=organic|utmctr=lgbt%20friendly%20intake%20form&__utmv=- &__utmk=230978207) • Heart Health • HIV/AIDS • Hypertension • Intimate Partner Violence/Domestic Violence Decreased access to: • Mammograms • Papanicolaou “Pap” Screening • STD Screening • Avoidance, denial, or Underutilization of medical care • Lack of health insurance • Youth homelessness / abandonment • Overweight or obesity • Smoking and substance abuse • Lower rates of pregnancy • Colon cancer • Depression • Mental health • Diabetes • Fertility and pregnancy
    • 19. It is essential to understand that these risk factors do not identify an inherent flaw within the LGBT community. These factors represent the compounding effects of: social stigmatization, harassment, discrimination, denial of civil and human rights, community and family abandonment, use of alcohol or illicit drugs as coping mechanisms, and failure of the medical community to reach out with effective intervention or prevention education. (http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25)
    • 20. How can I take an LGBT- sensitive social history?
    • 21. Intake form utilized from: (http://www.kingcounty.gov/healthservices/health/personal/glbt/IntakeForm.aspx#__utma=149406063.1503028756.1372082685.1372099408.1372102112.3&__ utmb=149406063.1.10.1372102112&__utmc=149406063&__utmx=- &__utmz=149406063.1372102112.3.2.utmcsr=google|utmccn=(organic)|utmcmd=organic|utmctr=lgbt%20friendly%20intake%20form&__utmv=-
    • 22. Questions to consider when taking your social history “Do you have a partner or significant other?” “What name would you prefer to be called?” “What kind of support structure do you have?” “Do you currently, or have you ever, used hormones?” Gay and Lesbian Medical Association. “Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender patients”
    • 23. Tips to consider when conducting your interview: -Ask your patient to clarify any terms or behaviors you may be unfamiliar with. -Address each interview showing empathy, open mindedness and reservation of judgment. -Stress the confidential patient-provider interaction “Gay and Lesbian Medical Association. “Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender patients”
    • 24. Coming out is a risky decision... - Physical Threats - Risk of Being Stereotyped - Troubling Discrimination In Health Care - Loss of Social Support - Risk of Losing Employment
    • 25. According to 2012 FBI published reports, Sexual orientation ranks as the second- highest motivator for hate crime incidents (19.6% of reported cases) (htp://www.fbi.gov/news/stories/2013/november/annual-hate-crime-statistics-show-slight-decease/annual-hate-crime-statistics-show- slight-decrease) • Understand how social aspects affect your patients health and life decisions. • Coming out to a healthcare provider is often difficult and may be perceived as exposing oneself to potential threat. It is essential that you create a safe environment for your patients.
    • 26. There are many misconceptions about the health status of the gay community from long standing (often incorrect) stereotypes. Gay people Gay Men Gay Women - not religious - non-monogomous - sexually promiscuous - estranged from family - pedophiles/predators - weak - clearly identifiable - are all effeminate - all engage in risky sexual behavior - are generally HIV+ - HIV is a gay male disease or gay disease - masculine - sexually abused as children - negative opinion of men Due to longstanding stereotypes, misinformation, and inappropriate beliefs, members of the LGBT community are still legally prohibited from donating blood despite health officials admitting that "it is a persons behavior, not their sexual orientation, that puts them at risk" for acquiring HIV and then transmitting the virus via the blood donation process. (http://www.cnn.com/2012/07/06/health/gay-men-blood-ban)
    • 27. -Lambda Legal Health Care Report (2010) 4,916 LGBT patients were asked if they had experienced discrimination from health care services in the following ways *Being refused needed care -LGB 8% -Transgender: 27% *Professionals refusing to touch them or using extreme precautions -LGB: 10.6% -Transgender: 15.4% *Professionals using harsh or abusive language -LGB: 10.7% -Transgender: 20.9% *Being blamed for their health status -LGB: 12.2% -Transgender: 20.3% *Professionals being physically rough or abusive -LGB: 4.1% -Transgender: 8% -An overall look reveals: >56% of LGB patients having at least one of these experiences >70% of transgender patients having at least one of these experiences >8% LGB denied health care outright
    • 28. -LGBT youth are most often dependent on family for emotional, financial, and healthcare support. Disclosure of one's sexual orientation may often result in catastrophic loss of these support systems.
    • 29. -Relationships in a work or health care environment may be affected if an individual chooses to come out. Individuals can legally be fired for being gay In 29 states, and in 34 states for being transgender. Consider how this may affect your patients, your colleagues, your coworkers...... (http://www.upworthy.com/29-states-can-fire-you-for-being-gay-is-your-state-one-of-them)
    • 30. Being an Ally: For Your Patients & For Your Community
    • 31. You! • A person who is a member of the dominant group who works to end oppression and discrimination of an oppressed population. • A person who supports and advocates for a group other than her/his own in both her/his private and professional life.
    • 32. (http://straightupthanks.tumblr.com/)
    • 33. • Use inclusive language in conversation and paperwork • Post “Safe Zone” or other signals of your acceptance • Educate yourself: • Familiarize yourself with resources available to LGBTQ individuals and communities • Take time to learn about LGBTQ issues • Don't make assumptions • Don't be afraid to ask questions!
    • 34. • Make it known that your clinic, office, home, desk, or personal bubble is a safe space. • Stand up to homophobic, intolerant, or ignorant language and actions when you see them. • Challenge stereotypes (your own and those of others). • Do not make jokes about LGBTQ individuals, and let others know that their jokes are hurtful and inappropriate.
    • 35. For more information please contact: Justin.Stambaugh@dm.duke.edu Keenan.Whitesides@dm.duke.edu Christine.ulses@dm.duke.edu Or visit our website at: http://dukegsa.wix.com/duke-health-gsa Or check us out on facebook at: https://www.facebook.com/groups/426601734085179/ Thank You For Watching!
    • 36. If you’re interested in the Duke Doctor of Physical Therapy Gay-Straight Alliance please join us for an Ally Discussion group at: 5:00 on Wednesday, June 4th in Conference Room A.