How well does your clinical setting or private practice serve LGBTQIA patients and clients? Is there more you could be doing? In ILCA’s recently released webinar, Care of the Same Sex Family, Diane DiTomasso, PhD, RN, shares strategies for effectively supporting LGBTQIA families.
Here are ten highlights for providing culturally appropriate care from her webinar. Answer the following questions to see how your practice measures up—and where you can improve.
Have you checked your implicit biases?
The first step, according to DiTomasso, is scrutinizing your own attitudes—especially subtle ones, which often come from early learning. “Take a minute and think about the earliest messages you ever received about people in this population and the source of those messages,” she advises. “Who taught you what and how to feel about people in the LGBTQIA community?”
If parents or other influences communicated negative attitudes, your early programming may still be influencing your behavior in ways you don’t realize—even if your beliefs as an adult don’t align with those messages. “Consider your verbal and nonverbal communications, and the intentional or unintentional signals you may be sending based on those messages you received,” DiTomasso says.
Are you fluent in LGBTQIA concepts and terms?
Knowing the right words to use reflects a commitment to respectful care. Some basic terms to know: Sexual orientation refers to how a person characterizes their sexual and emotional attraction to others. Gender identity is the internal sense of being male, female, both, or neither. When a person’s gender identity conforms to the gender they were assigned at birth, they are cisgender. Gender fluid means gender identity is not fixed—a gender fluid person may identify as male or female at different times. Someone who is transgender has a gender identity that does not correspond with the gender they were assigned at birth. Those who were assigned male sex at birth but who identify as female may refer to themselves as transgender women, trans women, or male-to-female persons. People who were assigned female at birth but identify as male may refer to themselves as transgender men, trans men, or male-to-female persons.
Another note on language: Pronouns are extremely important. “When we address people by the pronouns they use, that is central in … building rapport,” DiTomasso says. “Match the person’s language. Use the pronouns they use and use the names they use. This is so important.”
For a more comprehensive list of terms, the United States’ National LGBTQ Educational offers an updated and comprehensive list of terms here.
What messages do your workspace and paperwork convey?
These elements send powerful signals. Avoid clinic or practice names and signs that seem welcoming to only one gender. Include literature relevant to LGBTQIA people in your waiting areas, and establish gender-neutral bathrooms, DiTomasso suggests. Revise your forms and documents to reflect the diversity of sexual orientations, gender identities, and family structures. For example, instead of asking for “male or female” on a form, ask, “What is your gender identity?” Then offer these options: male, female, neither, both, transgender, other. “All of these things could be done in an afternoon,” DiTomasso says. “It doesn’t take a lot of time to go online and find a gender-neutral bathroom sign and tape it up, or to revise your forms and documents.”
However, “[Signs and forms] are meaningless if the care received and the treatment don’t match them,” DiTomasso cautions. “What matters is the way you are treated by the people—it’s so much more powerful than any of these other things.”
Are you open and trustworthy?
Do you encourage your clients to share sensitive information, by being a good listener? LGBTQIA clients may be reluctant to disclose personal information for fear of discrimination and compromised quality of care. “The consequences of nondisclosure can include development of mistrust, missed opportunities for health education, and ill-informed clients and health care workers,” DiTomasso says. How do you help someone feel safe to share information? “Open the door for disclosure. Recognize how difficult it is to come out, over and over,” she urges. “Ask open-ended questions with attention to tone of voice and body language. Encourage conversations. If you don’t know what to say, simply say, ‘Tell me about it.’ Let people talk. The key is using clear, nonjudgmental communication.”
Do you make assumptions during client contacts?
Assuming heterosexuality and assuming gender identity are “common and widely accepted,” according to DiTomasso, but this can lead to unintentional blunders—for example, asking a married female client about her husband, when in fact, she is married to a woman. “It takes a lot of emotional energy to correct someone,” DiTomasso says. “It’s like when someone calls you by the wrong first name. It becomes all you can think about in the interaction. You are embarrassed, because you don’t want to embarrass them.” If such a mistake happens? “Simply apologize and move on,” she suggests. Don’t allow embarrassment to cause you to overcompensate, making your client even more uncomfortable. “And then work on trying not to make assumptions, because that avoids the whole problem to begin with!”
The best way to avoid assumptions? Use inclusive rather than exclusive language. Examples of inclusive questions: Do you have a partner or significant other? How do you refer to your partner? Can you tell me about your family?
Are you aware of unique clinical concerns?
Certain issues like anxiety, depression, and substance use are higher among LGBTQIA populations. Other issues are as well, such as intimate partner violence and sexual abuse. Excellence in care means being aware of these statistics.
Does your workplace address invisibility?
Making sure LGBTQIA people are part of your community is another important step. “[We need to] recruit, support, and retrain ‘out’ LGBTQ-identified people to work in health care facilities,” DiTomasso says. You can also establish a visible LGBTQIA presence through posters, photos, other materials in your setting. “They make a difference,” she says.
Do you support research efforts?
More studies are needed to examine the impact of prejudice and discrimination on the wellbeing of LGBTQIA people and their families and to focus on the unique health needs and concerns of people in LGBTQIA groups.
Are you an ally?
“You may not be a member of this group, but you sure can be an ally,” DiTomasso says. What does that over-used word actually mean? “It means you stand up for and support the rights of minority people,” she says. “You respond to anti-LGBTQIA behavior, and you let people know you do not tolerate homophobia or transphobia. This sends a strong message.”
Want to learn more?
ILCA members, take advantage of your free webinars! Access the entire webinar here. Not a member yet? Learn more about how you can access this and other continuing education at ILCA here.
I have people very close to me with some of these issues and I have had a heart change in my attitude. But besides treating people with sensitivity and compassion I feel that someone should be asking what is causing so much gender and sexual confusion and brokeness in the first place. And looking for solutions and healing. Rather than pretending that it’s all healthy and normal. The rate of depression, anxiety and suicide indicates something is broken. 😢😢😢
I urge you to please watch this webinar in which I discuss the history of how LGBTQIA people have been treated in the United States and within the health care system. In the webinar I explain how and why this treatment has contributed to mental health issues and suicide rates among this population. I also encourage you to please do some reading about, “minority stress”; this term was first used to describe the stressors experienced by people from ethnic minorities but I believe it is also very applicable to gender minorities. Finally, I urge you to reflect upon your own beliefs and biases. While there are health concerns for this population, I am quite certain that the majority of LGBTQIA people do not consider themselves to be either, “confused” or “broken”.
ILCA, thank you for this blog which I have shared on my own social media. It is excellent.
Sharon^^^, I encourage you to open your heart even more. Accepting and respecting that people are who they say they are — and not “confused” and “broken” (and presumbly in need of fixing) — is the “sensitivity and compassion” that is lacking in our society. My guess is that *not* finding compassion to let folks be themselves, without fear or shame, is what contributes to the abyssmal rates of mental health disease and attempted suicide for LGBTQIA+ folks.
And, of course, it is an ethical requirement for IBCLCs to provide inclusive care, under 6.3 of our IBLCE Code of Professional Conduct.