l.g.b.t. health:without equality, there is no quality

A personal membershipgroup of

L.G.B.T. Health:Without Equality, There is No Quality

Presented by:Josh Hyatt DHSc, MHL, CPHRM


Speaker

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Dr. Josh Hyatt, DHSc, MHL, CPHRMSenior Risk Management SpecialistMajor Medical Professional Liability Insurance Carrier.Adjunct Professor: Health Law, Medical Ethics, Health Leadership, Health Communication and Education.


Disclaimers

• Discussions of sexuality and gender can be controversial in nature

• There is no intent to change the participants core values or moral convictions

• The focus of this presentation is to start a dialogue with health care providers on the health care disparities and barriers to care that the LGBT community faces everyday


ObjectivesFollowing this session participants should be able to:• Identify and evaluate some health disparities in the LGBT community and their impact on public health overall.

• Analytically evaluate the legal and ethical risks that health care institutions face related to LGBT health care issues.

• Develop plans that work towards reducing health disparities in the LGBT community and improve overall quality of care.


LGBT Terms

LGBT

Ally

Sexual Orientation Gender

Identity

Trans

Coming Out

Cisgender

What other terms can you think of that you want to

discuss?


Self-Awareness

• What are your personal attitudes towards LGBT issues?

• What has shaped them?• Is sexual orientation a biological determinate?

• Is gender a biological determinate?

• Does it really matter?

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WORDS

A. GaydarB. Queen C. DykeD. Sexual PreferenceE. FaggotF. Butch / FemmeG. Breeder

H. Fag Hag / Fag StagI. TrannyJ. TransvestiteK. Drag Queen/KingL. QueerM. FruitN. Nancy Boy

Identify the word(s) you have negative associations with:


Words have power.


Exercise

• EXERCISE:– Write 5 words or phrases that you associate with LGBT individuals

– Write 5 words or phrases that you associate with LGBT rights

– Write 5 words or phrases that you associate with LGBT health care

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Census Data

3.4% of the US Population- LGBT

10.8 million individuals


Sex and Gender

Sex• Biological Differences• Chromosomes• Hormones• Internal/External

Genitalia• Biological Male or

Female

Gender• A category to which an

individual is assigned by self or others, on the basis of sex.

• Expression of Gender Identity• Social and Cultural Norms• Stereotypical notions of

masculinity or femininity• Behaviors, roles,

expectations, and activities in society

Neither sex nor gender refers to orientation


Discrimination facing the LGBT

community• Homophobia

• Transphobia

• Reparative Therapy

• Religious and Social Ostracism

• Victimization, Bullying, and Abuse


Health Disparities in the LGBT Community

• HIV/AIDS• Cancer• Mental Health• Smoking• Eating Disorders/Obesity • Poverty• Access to Care• Violence (Bullying, Community, Family, Domestic)


LGBT Disparities

The primary cause(s) of health disparities in the LGBT community include:

A.Perceived and actual discrimination B.Social stigmatizationC.Unfair marketing of productsD.Lack of positive role-models in the

mediaE.Patchwork of state laws


Healthy People 2020

The reasons for this goal included:– Health disparities linked to social stigma and discrimination

– Impact of non-acceptance of sexual orientation or gender identification on adolescents and young adults

– Lack of health insurance coverage for same-sex – Increased rates of psychiatric and substance abuse– Prevalence of attempted and actual suicide – Increased amount of violence and bullying experienced by the community


Heteronormativity

• A belief that:

– Favors opposite-sex relationships

– Encourages distinct gender roles

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Heteronormativity

• Institutional Systems:

– Rules/Policies: Visitation Rights– Forms/Documents– Website Information– Training That Ignores LGBT Health Issues

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Questions

• What institutional heteronormality practices can you identify in your facility?

• How many of you have cultural competency programs in your facility?

• How many of you include LGBT in that training?

• How many market to the LGBT community or have specific programs?

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Micro-Messaging

• Subtle messages that devalue, discourage, or impugn others

• Double-blind Effect:– Lack of options result in a sense of penalty, censure, or deprivation

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Micro-Messaging

• Examples:– Eye contact– Tone of voice– Body language– Hetero-normal terms on forms– Gender pronoun issues

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Questions

• What are some micro-messaging you see in your home?

• What are some micro-messaging you see in the general population?

• What are some micro-messaging you see in your workplace?

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Minority Stress Model

Sexual minority health disparities are linked to stressors induced by a hostile and homophobic culture, which results in the

• Harassment,• Maltreatment• Discrimination• Victimization


Self-Identity and Coming Out

• Self-identity • Coming Out

• Outing

Acceptance or denial of an individual’s

sexual orientation can be a defining aspect of their life as it

can directly influence the risk of negative,

self-destructive behaviors.


Coming Out- Provider’s Role

• Provider-patient relationship

• Positive, non-judgmental experience will often lead to a more positive self-image

• Confidentiality laws are inconsistent in federal and state laws


Barriers to Care

• Perception that LGBT couples are less committed

• Fear of social rejection and isolation• Lack of understanding of LGBT issues• Fear of disclosure• Stigmatization


Barriers to Care

Contributing Factors:• Lack of awareness and LGBT training in medical and nursing school,

• Presumption of a heterosexual orientation by care givers,

• Discomfort when asking about or discussing sexual orientation, and

• Lack of LGBT presence in health care settings and leadership roles


Barriers to Training

• Cultural and Institutional bias• Fear of Backlash• Lack of Qualified Speakers• Addressing Micro-messages• Very Difficult to Change Culture

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Risk Management Issues in LGBT Care

• Access to Care• Marriage/Civil Union/ Domestic Partnership• End-Of-Life • Decision Making• Visitation Rights• Spousal Insurance Rights


Recommendations- Communication

• Don’t conflate sex and gender in the trans community or overemphasize sexual orientation in the LGB community.

• Procedural changes (forms, posters, etc.)

• Scripts to structure patient encounters

• Language on marketing and websites

• Identify services that could be controversial

• Integrated and open culture


Recommendations- Educational

• Establish LGBT cultural competency programs

• Narratives should focus on characteristics, not behaviors. Focus on the ethical care and services

• Micro-messaging• Avoid “victim” and “oppressor” dynamics• Avoid the “Black and White” discussion of sexual orientation and gender identity


Recommendations- Individual

• Identify moral distress components• Identify own biases, attitudes, and assumptions

• Differentiate between “couch” issues and “institutional” issues

• Identify when personal judgments may be creating micro-messaging


Thank You

Questions and Answers

Josh Hyatt DHSc, MHL, [email protected]