cultural competence in behavioral health care 1 a free sample background from © 2004 by default!...

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Improving Service Provision to Lesbian, Gay, Bisexual,

Transgender, Queer, and Questioning Clients and Staff

Cultural Competence in Behavioral Health Care


Overview

State, Local, and Organizational Initiatives

ADHS/DBHS LGBTQ Advisory Committee

LGBTQ Behavioral Health Coalition of Southern Arizona

La Frontera Center LGBTQ Client Initiative



Purpose: To make recommendations to DBHS on policies and procedures in addressing the behavioral health needs of the LGBT community

Composition: State agencies, provider organizations, educational institutions, advocacy groups/organizations



Activities and Accomplishments

Assessed capacity of behavioral health organizations to provide culturally appropriate care to LGBTQ individuals using Workplace Environment Survey– Employment/Human Resources Policies and

Procedures– Staff Training– Service to Clients– Service to Client Who Are Minors



Activities and Accomplishments (Cont’d)

Identified needs and developed 20-part training for health care practitioners working with LGBTQ individuals– Terminology– Coming Out and Disclosure– The Bisexual Experience– Health Disparities– Mental Health



Activities and Accomplishments (Cont’d)

Revised DUG form to collect data on sexual orientation and gender identity

Developed mandatory training for behavioral health staff regarding terms and how to ask clients for information


LGBTQ Behavioral Health Coalition of Southern Arizona

Purpose: To address the mental health and substance use needs of the LGBTQ community in Southern Arizona

Mission: To advocate for culturally appropriate services for lesbian, gay, bisexual, transgender, and questioning individuals and their families and work to eliminate the stigma of LGBTQ stereotypes within the behavioral health community.


LGBTQ BHC of Southern ArizonaActivities and Accomplishments

Convened community forum of LGBTQ individuals regarding behavioral health services and how to improve overall treatment outcomes; reported findings to local and state providers and funders– Training– Customer Service– System Advocacy


LGBTQ BHC of Southern ArizonaActivities and Accomplishments (Cont’d)

Developed three training modules to educate behavioral health professionals regarding service provision for LGBTQ individuals with funding from the Community Foundation for Southern Arizona (A fourth module has since been developed)



– LGBTQ 101: Out of the Closet and Into the Clinic

– LGBQ 201: Somewhere over the Rainbow: Therapeutic Assessment and Intervention

– Trans 101: The Brave New World of Gender: A Media Exploration of Gender Variance

– Trans 202: Pathways to Understanding



Developed self-assessment checklist for service providers to assess their level of cultural competence in serving LGBTQ individuals– Physical Environment, Materials, and

Resources– Communication Styles– Values and Attitudes



Present workshops at conferences– Cesar Chavez Conference– Arizona Summer Institute– Southwestern School for Behavioral Health

Studies– Recovery and Wellness Family Conference



Provide informational materials at community events, such as the NAMI Walk and the Recovery and Wellness Family Conference

Developed and maintain web site and Facebook page with links to events, resources, etc. (www.lgbtqmentalhealthaz.org)

Planning an LGBTQ Behavioral Health Conference in Tucson for Spring 2012

http://www.lgbtqmentalhealthaz.org/


La Frontera LGBTQ Client Initiative

Purpose: To ensure the provision of culturally competent care for LGBTQ individuals with regard to organizational environment, human resources, public relations, and clinical services

Composition: Staff from clinical and administrative departments, including members of the LGBTQ population


La Frontera LGBTQ Client InitiativeActivities and Accomplishments

Placed LGBTQ-themed artwork and literature in client lobbies (flags, pictures, wind chimes)

Developed list of staff qualified to provide services to LGBTQ individuals

Provided on-site training for clinical staff on topics pertinent to LGBTQ individuals

Participated in and/or sponsored community events targeting the LGBTQ population


La Frontera LGBTQ Client InitiativeActivities and Accomplishments

Identified and provided signage for single-stall unisex bathrooms

Identified point person at every site for provision of information related to resources for LGBTQ individuals

Offered peer support group for LGBTQ youth and adults

Held staff LGBTQ Meet Yourself event and Diversity Film Series


La Frontera LGBTQ Client InitiativeActivities and Accomplishments (Cont’d)

Conducted focus groups with staff– Most diverse and accepting place at which

staff had worked– Need training regarding the transition

process– Sites are very respectful with regard to this

issue– Need to develop HIV competency– Members of LGBTQ community report very

positive experiences working with LFC– Add section to NEO re LGBTQ and

community resources


Developing a Work Plan

Conduct assessment to identify what the organization has already accomplished and next steps to be taken

Incorporate next steps into a work plan that identifies objectives, action items, persons responsible, and due dates

Meet on a regular basis to review progress and revise plan as needed


Treatment Experiences of

LGBTQQ Persons with Co-occurring

Conditions:

A Focus Group

Patricia Penn, PhD, Denali Brooke, MSW,

Margrit McIntosh, PhD, Audrey Brooks, PhD

Sandra Gallagher, PhD


Background

LGBTQQ (lesbian, gay, bisexual, transgendered, queer, questioning) persons represent a significant portion of the treatment population.

The literature includes examinations of LGBTQQ persons with serious mental illness or substance abuse issues, but not co-occurring conditions (CC).

This population is not well-studied and often is not recognized in treatment.

Treatment experiences of LGBTQQ persons with CC are rarely reported.


Purpose

Present the results from a focus group for persons:

– With co-occurring substance abuse and mental illness

– Who are LGBTQQ

– Who receive services from three behavioral health agencies in Tucson


Sample

N = 10

Ages 20-51, ave. = 40

50% female (self-identified)

Ethnicity (self-identified):

50% White

20% Hispanic

20% Native American

10% Black


Sample (Cont’d)

Ave age self-identified as LGBTQQ: 11

30% gay

20% lesbian

20% bisexual

10% bisexual/transgendered

10% lesbian/bisexual

10% gay/bisexual


Sample (Cont’d)

Average age first sought mental health treatment: 17

Average age first sought substance abuse treatment: 24

Average length of sobriety: 13 mos.

How long taking medication: 8 years


Sample (Cont’d)

Who are you

out to? None Some All NA +

Orig. Family 10% 90% *

All Family 50% 40% 10%

Friends 30% 60% 10%

Tx Provider 30% 60% 10%

Co-Workers 30% 40% 30%

Neighbors 30% 10% 30% 30%

+ Missing data

* Except "not dad" for one


Focus Group Questions

Who has come out in treatment and who has not? Why or why not?

Has any treatment provider done a good job integrating all issues, mental health, substance abuse and LGBTQQ? What was that like and how, was your experience good, did they prioritize your needs?



Was there a difference coming out in one or the other settings (strictly mental health or substance abuse)?

Over your entire lifetime, how do you think being LGBTQQ has affected your substance abuse and/or mental health?



How did you prioritize your mental health, substance abuse and LGBTQQ issues while in treatment?

What treatment improvements do you think can be made to help LGBTQQ persons with co-occurring mental health and substance abuse issues?


Data Analysis

Conducted with NVivo software

Coded passages by primary content areas, and secondary themes

Coded by second author

Eight primary content areas were verified by a 2nd rater and reviewed by first author


Primary Content Areas

Positive experiences 37

Silence about sexual identity 34

Experienced prejudice 31

Perceptions on interrelatedness

of issues 20

Client tx suggestions 17

Negative tx consequences for

coming out 16

Transgender experiences 11

Feels misunderstood by others 5

# of Passages


Experienced Prejudice

In treatment: – More prejudice in SA Tx vs. MH Tx?

• Prejudice for LGBT in MH or SA Tx• Easier to come out in MH Tx

In the community: – Prejudice for being LGBTQQ– Prejudice for MH Dx– Prejudice for SA Dx

Equal prejudice for being LGBTQQ and

a person with CC

Other prejudice

Feels unsafe


Silence about Sexual Identity

Chose not to talk about it

Client hides sexuality

Family and friends don‟t talk

Tx staff don‟t talk about it

Told to NOT talk about LGBTQQ in Tx

Counselors are not “hip” about it

No one asked

Never thought about it until now


Negative Tx Consequences for Coming Out

Coming out has negative effect with treatment staff

Feels isolated in treatment setting

Segregated in treatment

Offered therapy to convert to heterosexuality

Denied treatment


Client Quote

“ Friends and family [say], “Not only does he have a mental illness, he‟s a drug addict and he‟s gay too”…then I don‟t even want to get married and have kids and lead a normal life, so it‟s like they didn‟t see anything they wanted. There were no bright spots.”


Client Quote

“They love to shoot you and beat you up. I‟ve gotten shot six months ago so then I have problems with sleeping and stuff…so I don‟t know much about myself, but as far as society goes or them, I have to run from them.”


Client Quote

“You are first of all dealing with your…mental situation plus being gay and the majority of your life you have had people ridicule you or basically be prejudiced against you. So you are trying to help yourself out, but you still have that in the back of your mind, like „I can‟t really do this or that, because they are going to…ridicule me.‟ So that‟s a barrier to you actually getting well.”


Client Quote

“Like the girls were expected to do things like iron and mend clothes and sew and do other bullshit things to earn money. And I am like the guys who go on work crews and do laboring or painting….I want to do [the guys‟ work] and not [the girls‟] and all of a sudden my sexuality and everything else is brought out on the table in front of all the staff, all the people, everyone there.”


Perceptions on the Interrelatedness of Issues

Found LGBTQQ, MH and SA issues to be interrelated

Being LGBTQQ interrelated with SA issues

MH issues interrelated with SA issues

Found no interrelatedness/chose not to talk about it


Client Quote

“I think my sexuality is an important part of me. And when things are not going well with my love life, whether there is one or isn‟t, I have learned that I need to love and care for myself, exactly who I am…I think it is all correlated. I think the more my counselors know about me, the better they can help.”


Client Quotes

“I guess I didn‟t relate it (being LGBTQQ) to being part of my problem or it being even necessary to even mention it.”

“So I never thought about connecting my sexuality with my treatment.”


Transgender Experiences

Feels isolated, segregated

Looks different

Needs additional financial help

Difficult to accommodate in residential settings

Feels unsafe


Client Quote

“ … everyone thinks I am mental just in meeting me…they think I have a mental condition [and] that is why I am like I am. So just about everyone I meet thinks immediately that there is something mentally wrong with me.”


Client Quote

“ There is no hiding who I am. I have been segregated the whole way. So it‟s like you are still alone.”


Positive Experiences

Feel accepted by treatment staff

Had positive interaction with staff

Experienced a shift in perspective since treatment

Feel accepted by ministers, doctors, friends and family

Thinks LGBTQQ treatment is improving

Have coping strategies for dealing with prejudice


Client Quote

“Coming out at La Frontera has been an extremely welcome change in my life. It was not met with any kind of opposition…. Nothing was said when I said I was gay and that is a welcome change for me.”


Client Quote

“I think the biggest thing is the people who believed in me and thought I was worth it…and I‟m starting to…believe in me more….”


Client Suggestions

These participants want:

LGBTQQ treatment staff

“Out” treatment staff

Staff who are genuine re: LGBTQQ

More classes teaching “tolerance”

Holistic (integrated) approach to Tx

LGBTQQ-specific services


Client Suggestions

These participants want:

More LGBTQQ needs assessments

LGBTQQ questions included in the intake documents

A safe environment for all

LGBTQQ photos and artwork displayed at agencies


We are moms… and dads…


We are interracial…


We are lifetime partners…


We are funny…


We want acceptance…


Davin Franklin-Hicks, BHT

Transitioning on the Job


• Human Resources-Supportive from the start-Assurance for the individual

• Identified culturally competent liaison within the company-Explored options for notifying co-workers

-Developed trainings to increase knowledge of co-workers

Recommendations


• Management-Ensure the manager is comfortable supporting the individual

-Identify potential barriers in clinical relationships

Recommendations

(Cont’d)


Contact Us

Karen Chatfield, M.A., Director of Cultural and Community Affairs, (520) 838-3923, [email protected]

Patricia E. Penn, Ph.D., Director of Research and Evaluation, (520) 838-5520, [email protected]

Davin Franklin-Hicks, BHT, Supervisor of Residential Services, (520) 792-5736, [email protected]

mailto:[email protected]






Thank you!

cultural competence in behavioral health care 1 a free sample background from © 2004 by default!...

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