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Providing inclusive care for LGBTQ patients at SBHCs
The document outlines the challenges and health disparities faced by LGBTQ patients, particularly youth, highlighting issues such as lower access to healthcare, increased risks for mental health issues, and higher rates of STDs and HIV. It also discusses initiatives by SBHCs to implement inclusive care practices, including staff training on LGBTQ-related terminology and health disparities. The importance of understanding and documenting sexual orientation and gender identity in healthcare settings is emphasized to improve patient care and outcomes.
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Providing inclusive care for LGBTQ patients at SBHCs
- 1. Providing Inclusive Care forLGBTQ Patients at SBHCs May 17, 2018 Sarah Roush, MSPH, CHES Senior Sexual + Reproductive Health Program Manager
- 2. Essential Access Health Champions and promotes quality sexual + reproductive health care for all Partners with the CA STD Control Branch and LA County Division of HIV/STD Programs Implements best practices in STD prevention and case management statewide.
- 3. Overview Health disparitiesimpacting LGBTQ youth Assessment of LAUSD SBHC services Tools + best practices related to inclusive care Resources
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- 5. LGBTQ Demographics Demographics: United States: 3.5% Los Angeles County: 4.1% Teenagers & Young Adults (15-21) 13.4% females self-identify as lesbian, bisexual or other 7.1% males self-identify as gay, bisexual or other Williams Institute. (2013). http://williamsinstitute.law.ucla.edu/research/census-lgbt-demographics-studies/gallup-lgbt-pop-feb-2013/ Brewster, McCabe & Tillman. (2011). Patterns and Correlates of Same-Sex Sexual Activity Among U.S. Teenagers and Young Adults.
- 6. Health Disparities LGBTQindividuals are less likely to have health insurance or access to health services Many LGBTQ people aren’t comfortable disclosing their sexual/gender identity with providers
- 7. Health Disparities Heart Disease:major risk factors include alcohol and tobacco use; obesity also more prevalent among WSW Cancers: increased risk for cancers including breast, cervical, prostate, testicular, colon, and anal cancers Substance Abuse: studies suggest LGBTQ individuals are more likely than the general population to use alcohol and drugs Sexual Health: high rates of STD and HIV infection, particularly among MSM and transgender women Injury & Violence: violence based on sexual minority status, as well as higher levels of intimate partner violence Mental Health: higher rates of depression, anxiety, suicidal ideation
- 8. Health Disparities: Youth CDC: LGBTQ & questioning students are on average 63-76% more at risk for violence, attempted suicide, tobacco use, alcohol use, drug use, and risky sexual behaviors as compared with heterosexual peers. CDC. (2011). Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors among students in grade 9-12: Youth Risk Behavior Survey. U.S. Department of Health and Human Services.
- 9. Health Disparities: Youth 85% of LGBT youth report having been verbally harassed in the past year; 35% were physically harassed; and 16% were physically assaulted because of their sexual orientation.
- 10. LAUSD Youth Risk BehaviorSurvey Data Health Risk Behavior Heterosexual- Identified Gay, Lesbian or Bisexual Ever had sexual intercourse1 29.4% 49.4% Did not use a condom at last sex2 36.2% 42.8% Did not use any method to prevent pregnancy at last sex2 13.8% 32.7% Never tested for HIV1 89.8% 84.3% Have experienced sexual dating violence (including rape)1 3.4% 16.7% 1 2017 YRBS data 2 2015 YRBS data
- 11. Health Disparities: HIV 26% of new HIV infections annually are among youth aged 13- 24; the greatest % increase in infection rates has been among YMSM A majority (60%) of youth aged 13-24 are unaware that they are HIV-positive 60% HIV-positive YMSM considered themselves to be at “low risk” prior to learning their status. MacKellar, et al. (2005) Acquired Immune Deficiency Syndrome, 38(5), 603-612.
- 13. Health Disparities: STDs YMSM: disproportionate risk YWSW: often overlooked, but also have prevention, screening & treatment needs Perceived risk for STIs is low among LGBTQ youth; particularly among WSW
- 14. Trends in TeenPregnancy Rates
- 15. Health Disparities: Unplanned Pregnancy Recentstudy of NYC YRBS Data: 23% of lesbian and bisexual female students had experienced a pregnancy, compared with 13% of heterosexual female students. 29% of gay or bisexual male students and 38% of male students reporting both male and female partners reported causing a pregnancy, compared with only 10% of heterosexual male students. Lindley & Walsemann. 2015. American Journal of Public Health.
- 16. Why Do LGBTQYouth Experience SRH Disparities? Identity ≠ behaviors Stresses related to discrimination & harassment Lack of access to health services Lack of inclusive, affirming SRH education Risk perceptions Higher levels of STDs/HIV in sexual networks Power dynamics in dating older people Higher rates of sexual victimization
- 17. Background: Assessment of LAUSDWellness Center Services
- 18. Project Background LAUSD serves~650,000 students Student population is largely urban + low income 2007: 14 Wellness Centers created in areas of highest need Wellness Centers serve students + community members
- 19. Project Background: ClinicAssessment 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% LGBTQ-inclusive materials SOGI in Nondiscrimination Policy Intake forms have inclusive gender options LGBTQ screening recommendations EMR documents gender identity EMR documents sexual orientation Sexual histories documented Sexual histories conducted Provision of LGBTQ-Inclusive Services at Wellness Center SBHCs
- 20. Project Activities 2015:Development of resource toolkit, “Providing Inclusive Care for LGBTQ Patients” 2016: Accompanying trainings for Wellness Center clinic staff
- 25. Implementation of ClinicTrainings
- 26. Clinic Training Objectives 1.Define current, culturally sensitive terminology related to LGBTQ patients. 2. Describe major health disparities impacting LGBTQ populations. 3. Implement recommended sexual & reproductive screening & counseling recommendations for LGBTQ patients. 4. Utilize EHR systems to document screening and counseling activities for LGBTQ patients.
- 27. Training Content: Terminology SexGender Identity Sexual Orientation Male Transgender Gay Female Cisgender Lesbian Intersex Gender Non-conforming Bisexual Genderqueer Pansexual Queer Assigned sex Affirmed gender Questioning Asexual
- 28. Terminology Example: Jazz Pansexual
- 29. Sample Intake FormQuestions
- 32. Training Content: ClinicalRecommendations Extragenital STD Screening Patton, et al, Clinical Infectious Diseases, 2014 Extragenital Gonorrhea and Chlamydia Testing and Infection Among Men Who Have Sex With Men – STD Surveillance Network, United States, 2010-2012
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- 35. Evaluation of ClinicTrainings
- 36. Evaluation Methods 6clinics targeted for training Priority: clinics located in South Los Angeles; areas with high STD rates; low-resource settings Data collection methods: Sign-in sheets; Pre/Post-tests; Evaluation surveys Questions assessed knowledge, attitudes and self-efficacy related to the provision of LGBTQ-inclusive clinical services Analysis completed in STATA14. Consisted primarily of descriptive statistics. Descriptive statistics were reported for quantitative assessment, calculating frequency of responses on Likert scales
- 37. Evaluation Results: TrainingParticipants Date FQHC Clinical Personnel Non-Clinical Personnel Total Participants 4/29/16 Watts Health Corporation 5 4 9 5/31/16 St. John’s Well Child and Family Center 4 1 5 6/6/16 South Bay Family Health Care 2 3 5 6/22/16 To Help Everyone (THE) 1 7 8 6/30/16 South Central Family Health Center1 30 13 43 7/21/16 South Central Family Health Center2 21 6 27 TOTAL 63 34 97
- 38. Evaluation Results Pre/PostSelf Assessment: “Knowing a patient’s sexual orientation and/or gender identity is important for providing effective healthcare.” 26% increase in those who “strongly agree” 60 21 7 12 86 5 3 6 0 10 20 30 40 50 60 70 80 90 100 Strongly Agree Agree Disagree Strongly Disagree PercentageofParticipants Pre-test Post-test
- 39. Evaluation Results Pre/PostSelf Assessment: “I feel confident using LGBTQ terminology in conversations with patients.” 23% increase among those who report feeling “very confident” 29 48 21 2 52 44 3 2 0 10 20 30 40 50 60 70 80 90 100 Very confident Mostly confident Notveryconfident Notat all confident PercentageofParticipants Pre-test Post-test
- 40. Evaluation Results Pre/PostSelf Assessment: “I am comfortable asking a patient about their sexual orientation and/or the sex of their partners.” 23% increase among those who report feeling “very confident” 29 48 21 2 52 44 3 2 0 10 20 30 40 50 60 70 80 90 100 Very confident Mostly confident Notveryconfident Notat all confident PercentageofParticipants Pre-test Post-test
- 41. Evaluation Results Documentingsexual orientation and gender identity (SOGI) data At pre-test, only 50% of participants indicated that they regularly document SOGI in patient charts Reasons for not documenting SOGI included: Confidentiality concerns EHR system does not capture SOGI Forgetting to document
- 42. Key Takeaways 1. Trainingapplies to all staff: encompass diverse knowledge + comfort levels 2. Basic terminology (definitions + practice) is a critical starting point 3. Use data + stories to underscore importance of issues like inclusive clinic environments to staff 4. Providers appreciate clinical updates + data on LGBTQ topics 5. Emphasize that language/information is constantly evolving – don’t be afraid to make a mistake; use it as a learning opportunity 6. Data shows: offering training on this topic is effective!
- 43. Project Next Steps December 2016: partnered with LA LGBT Center to present “Leveraging EHRs to Collect Sexual Orientation + Gender Identity Data” January 2017: released online version of the clinic training August 2017: released brief series of videos on Terminology + Communication, Inclusive Sexual History-Taking, and SOGI Data Collection. Each video is 5-9 minutes long and can be used in staff trainings/in-services.
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- 48. Thank you! Sarah Roush,MSPH, CHES Sr. Sexual + Reproductive Health Program Manager [email protected] 213-386-5614 x4516
Editor's Notes
- #6 These statistics are from the Williams Institute at UCLA, looking at individuals who self-identify as LGBTQ. Overall, you can see that about 1 in 25 individuals in our community identifies as LGBTQ, meaning you are serving LGBTQ patients, whether you realize it or not! Additionally, because these statistics look at personal identity, rather than behavior, it doesn’t capture individuals who don’t personally identify as LGBTQ but may engage in sexual activity with partners of the same sex, which is relevant information particularly for sexual health and STD/HIV prevention. This data comes from 2002 National Survey of Family Growth, and looked at data from more than 2600 young people. Data from the 2013 LAUSD YRBS is similar, with about 10% of high school aged female students and 4% of male students identifying themselves as gay, lesbian or bisexual (averages are higher among older students) Based off of 2013 Williams Institute Data: Data for individuals who self identify as LGBTQ. Reported numbers will vary from state to state as individuals who live in states with more LGBTQ social acceptance, will be more likely to feel comfortable openly identifying. Difficult number to assess, as many individuals may choose not to report, and others may engage in same sex behavior but do not identify as LGBTQ.
- #7 LGBTQ individuals are historically less likely to have health insurance or access to health services (access to health services including culturally competent, inclusive services – an individual may be able to access services in their community, have the ability to pay for services, but if they feel that they will be discriminated against, they may not seek care, or may not disclose critical information about their sexual or gender identity, resulting in them not receiving the care and services that they need.) Non-disclosure of sexual orientation to healthcare providers is high among some LGBTQ people (study in NYC ranged from 10% (lesbians), 13% (gay men) to 33% among bisexual women and 39% among bisexual men) Related to internalized homophobia, poor psychological wellbeing; more prevalent among younger individuals, individuals with lower education, racial/ethnic minorities and individuals born outside the US In a 2002 national study, 6% of physicians reported discomfort caring for LGBT patients Health disparities are related to experiences of stigma, discrimination and related life stresses (when discussing population level disparities – while individual behaviors impact health, root causes of homophobia, family and social rejection, discrimination, harassment and violence contribute to substance use, risky behaviors, and create barriers to health seeking behaviors such as cancer or STD/HIV screening) Kaiser Family Foundation. (2002). National survey of physicians part I: doctors on disparities in medical care. Durso & Meyer. (2012). Patterns and Predictors of Disclosure of Sexual Orientation to Healthcare Providers among Lesbians, Gay Men, and Bisexuals.
- #8 Toolkit: SAMHSA “Top Health Issues for LGBT Populations Information & Resources Kit” contains a comprehensive introduction to health disparities impacting LGBTQ populations. For LGBTQ individuals and particularly youth, an abusive relationship can be extremely isolating and difficult to receive help for due to: Closeted relationships Stigma around outing Hesitance to report abuse (historical mistreatment from law enforcement results in a underreporting of violent crime and IPV against LGBTQ individuals) Lack of knowledge or discussion around abuse in LGBTQ relationships
- #9 Why is this important? We know that LGBTQ individuals experience serious health disparities- Note: these are all issues that can be screened for and addressed in clinical settings. LGBTQ Youth Higher risk for STDs: YMSM are one of the highest risk groups for HIV, and worryingly an estimated 60% of young positives are unaware of their status Higher risk for unplanned pregnancy: LB youth experience twice the risk of unintended pregnancy compared with their heterosexual peers More likely to be homeless: 25-35% of homeless youth identify as LGBTQ; more than 1 in 5 youth in the Los Angeles County foster system are LGBTQ, and they are more likely to be in group home (due to being rejected by their families as well as foster families) 2-3 times more likely to attempt suicide As a result of fear of stigma, these youth may be less likely to seek preventive health services or to come out to their provider. Conron KJ, Mimiaga MJ, Landers SJ. A population-based study of sexual orientation identity and gender differences in adult health. Am J Public Health. 2010 Oct;100(10):1953-60. Garofalo R, Wolf RC, Wissow LS, et al. Sexual orientation and risk of suicide attempts among a representative sample of youth. Arch Pediatr Adolesc Med. 1999;153(5):487-93. Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health
- #10 Data from 2015 School Climate Survey (GLSEN). And as surveys have shown: Students who experienced higher levels of victimization because of their sexual orientation were 3x as likely to have missed school in the past month. Students who experience higher levels of victimization based on sexual orientation or gender expression have higher levels of depression.
- #11 Looking specifically at the experiences of LGB students in LAUSD: In all of these measures, LGB youth are (statistically significantly) more vulnerable and engaging in practices or having experiences that put them at greater risk than their heterosexual peers. Although this data set didn’t find that GLB youth are more likely to begin having sex at younger ages, on average, than their heterosexual peers, many national studies have found a statistically significant trend toward earlier sex for GLBT youth, which is associated with negative sexual & reproductive health outcomes. Substance use, lack of prevention/protection, and sexual assault and abuse are all also associated with negative outcomes. These are extremely serious issues that the young people you see in your work settings may be experiencing.
- #12 CDC: http://www.cdc.gov/media/releases/2012/p1127_young_HIV.html -among adolescent males, more than 90% of new infections were the result of sexual transmission with a male partner. -black YMSM experience the most disproportionate rates of HIV; additionally, transgender women, particularly transgender women of color experience disproportionate rates of hiv infection.
- #13 Black MSM, and YMSM in particular, are at disproportionate risk. Why do black YMSM have disproportionate risk for HIV infection? Studies have suggested that despite no significant differences in personal risk practices, black MSM have a 3x disproportionate risk of infection. The InvolveMENt study (Emory) looked at 399 black MSM and 310 white MSM, aged 18-39 in Atlanta. The study found baseline HIV prevalence of 42% among black MSM and 14% among white MSM, with annual incidence of 6.4% bMSM and 1% wMSM. wMSM in the study were more likely to report more male sexual partners in the previous 12 months, and more unprotected anal intercourse. wMSM were also more likely to be aware of their infection (82% vs 66%) bMSM were more likely to have viral loads high enough to be at risk of transmitting the virus (>400) 25% vs 8% Significant differences: awareness of HIV infection, undetectable viral loads even a relatively low number of UAI partners (~3) leads to a >50% chance of being exposed to a partner with the risk of transmitting HIV. Issues: bMSM tend to date other bMSM, = small relatively closed sexual networks with high probabilities of exposure; less likely to know their status, be engaged or retained in care, or have undetectable viral loads, meaning that a sexual partner with HIV is more likely to be at risk of transmitting the virus. bMSM are also more likely to have STDs like syphilis which increase the risk of transmission.
- #14 YMSM: disproportionate risk for STDs, including syphilis, also increases the risk of HIV infection. YWSW: are a diverse population that is often overlooked, but studies have demonstrated that many STDs are transmissible between female partners, and many WSW also have male partners. Their needs are the same as women who only have opposite-sex partners – STD screening, cervical cancers screening, and recommended vaccinations.
- #15 Teen pregnancy and birth rates have declined steadily in the US for the past 20 years. However, this decrease hasn’t occurred uniformly among all groups of youth. Studies dating back to the late 80s have indicated that sexual minority youth are at increased risk for pregnancy. Previous studies had some limitations – they were conducted prior to these large declines in pregnancy rates, they were only among female youth, and primarily white youth. Source: HHS Office of Adolescent Health, 2016 (http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/teen-pregnancy/trends.html)
- #16 A recently released study of YRBS data (2005-2009) from New York City, addressed many of these limitations, and found that disparities in rates of unplanned pregnancy persist. GLB youth were found to be at increased risk for unplanned pregnancy – both experiencing a pregnancy, or causing a pregnancy in a partner. Sexual Orientation and Risk of Pregnancy Among New York City High-School Students. Another study found that while sexual minority young women are a diverse group, they have a number of reproductive health risk factors that may contribute to this disparity in pregnancy rates. Although some lesbian youth reported no male partners, those that did had had on average twice as many as the heterosexual youth in the study, and much lower usage of contraception, and a higher use of emergency contraception – meaning that for a subset of lesbian-identified young women, riskier sex with opposite-sex partners is putting them at risk for unplanned pregnancy. Bisexual-identified young women in the study had the highest average number of lifetime partners, and while their birth control use was comparable to their heterosexual-identified peers, they were more likely to have used emergency contraception (suggesting higher levels of unprotected sex), been pregnant, and terminated a pregnancy. This particular study noted that the reasons for these outcomes are understudied, as is the necessary response.
- #20 Discuss initial assessment and findings of Wellness Center staff surveys.
- #22 Review toolkit resources
- #27 The training itself was designed to take 2 hours; a shortened 1 hour version was also made available for clinics with limited availability for training. The training focused on providing a broad overview of LGBTQ-inclusiveness in the clinical setting.
- #28 Also mention behavioral terms: MSM/WSW, etc. Toolkit: LGBTQ 101, page 3, has resources from Straight for Equality (PFLAG) and GLAAD containing useful terminology and an introduction to concepts regarding sexuality and gender identity. Sex: Refers to biological, genetic, or physical characteristics that define males and females. These can include genitalia, hormone levels, genes, or secondary sex characteristics Male/Female Intersex: “Intersex” is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male. For example, a person might be born appearing to be female on the outside, but having mostly male-typical anatomy on the inside. Or a person may be born with genitals that seem to be in-between the usual male and female types—for example, a girl may be born with a noticeably large clitoris, or lacking a vaginal opening, or a boy may be born with a notably small penis, or with a scrotum that is divided so that it has formed more like labia. Or a person may be born with mosaic genetics, so that some of her cells have XX chromosomes and some of them have XY. (Intersex Society of North America) Ex: not XX/YY (est 1 in 1600 births), Klinefelter (XXY) 1 in 1000 births, Androgen insensitivity syndrome 1 in 13,000 births, etc. Assigned sex: The sex (male, female intersex) that is assigned to an infant at birth Gender: A set of social, psychological, or emotional traits, often influenced by societal expectations that classify an individual as either feminine or masculine Gender identity: One’s deeply held personal, internal sense of being male, female, some of both, or neither. One’s gender identity does not always correspond to biological sex (i.e., a person assigned female at birth identifies as male or a person assigned male a birth identifies as female). Awareness of gender identity is usually experienced in infancy and reinforced in adolescence. Transgender: A term that may be used to describe people whose gender expression does not conform to the cultural norms and/or whose gender identity is different from their sex assigned at birth. Cisgender: A term used to describe an individual whose gender identity aligns with the one typically associated with the sex assigned to them at birth. This is a term that is preferable to “non-trans,” “biological,” or “natal” man or woman Gender nonconforming: A person who views their gender identity as one of many possible genders beyond strictly female or male. This is an umbrella term that can encompass other terms such as “gender creative,” “gender expansive,” “gender variant,” “genderqueer,” “gender fluid”, “gender neutral,” “bigender,” “androgynous,” or “gender diverse.” Such people feel that they exist psychologically between genders, as on a spectrum, or beyond the notion of the male and female binary paradigm. Affirmed gender: The gender to which someone has transitioned. This term is often used to replace terms like “new gender” or “chosen gender,” which imply that the current gender was not always a person’s gender or that their gender was chosen rather than simply in existence Sexual orientation: Emotional, romantic, or sexual feelings toward other people. People who are straight experience these feelings primarily for people of the opposite sex. People who are gay or lesbian experience these feelings primarily for people of the same sex. People who are bisexual experience these feelings for people of both sexes. And people who are asexual experience no sexual attraction at all. Pansexual: attracted to all gender identities, or attracted to people regardless of gender. (GLAAD) Queer: A term currently used by some people—particularly youth— to describe themselves and/or their community. Some value the term for its defiance, some like it because it can be inclusive of the entire community, and others find it to be an appropriate term to describe their more fluid identities. Traditionally a negative or pejorative term for people who are gay, “queer” is disliked by some within the LGBT community, who find it offensive. Due to its varying meanings, this word should only be used when self-identifying or quoting someone who self-identifies as queer (i.e. “My cousin self-identifies as queer.”) Questioning: A term used to describe those who are in a process of discovery and exploration about their sexual orientation, gender identity, gender expression, or a combination thereof.
- #31 Example of a space that isn’t designed to be adolescent, male, LGBTQ friendly as we discuss physical space. Ask participants: what is your general impression as you walk into this exam room? What if you were an adolescent male patient?
- #32 Example of a space that includes messages for different groups – adolescents, males, not entirely focused on women’s reproductive health and pregnancy. The addition of educational materials specific to LGBTQ patients, including materials with photos of same sex couples, etc would make this even more inclusive.
- #33 It’s also important to screen based on the sexual practices of your patient, identified through their sexual history. This is particularly important for men who have sex with men (MSM). The CDC recommends screening MSM annually for CT/GC. If they practice insertive sex, they should be screening for urogenital CT/GC; if they practice receptive oral sex, they should be screened for pharyngeal CT/GC; and if they practice receptive anal sex, they should be screened for rectal CT/GC. A 2014 study using STD Surveillance Network (SSUN) data found that “Among MSM who had tests performed at both urogenital and extragenital sites, >70% of extragenital GC infections and >85% of extragenital CT infections were associated with a negative urethral test and would not have been identified, and perhaps would have remained untreated, if only urethral screening had been performed.” While MSM are generally the focus for extragenital screening, it is important to take sexual histories into account for all patients. A 2010 study of gonorrhea among adolescent and adult women found that only testing cervical specimens missed 20-40% of adult infections, and 14-26% of adolescent infections. However, there are no current recommendations for routine extragenital screening of women. Commercially available NAATs are not FDA-cleared for rectal or pharyngeal specimens; however, results from commercially available NAATs can be used for patient management if the laboratory has established specifications for the performance characteristics according to CLIA regulations. Quest and LabCorp currently provide GC/CT NAAT for rectal/pharyngeal specimens. Source: Patton, et al. (2014). Extragenital Gonorrhea and Chlamydia Testing and Infection Among Men Who Have Sex With Men – STD Surveillance Network, United States, 2010-2012. Clinical Infectious Diseases. 1564-1570. Courtney, et al. (2010). Culture of Non-Genital Sites Increases the Detection of Gonorrhea in Women. Journal of Pediatric & Adolescent Gynecology. 23(4):246-252. Papp, et al. (2014). CDC: Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae – 2014. MMWR 63 (RR02);1-19.
- #34 Include PrEP info – what it is; point to toolkit + new resources; who is eligible candidate http://www.cdc.gov/hiv/library/infographics/index.html
- #35 This chart demonstrates the times when SO/GI data can be captured and documented in the EHR. When a patient registers onlines or fills in their intake form/survey, you can prompt them with questions about their sexual and gender identity. Data can be added to the EHR at that stage. Additionally, the provider can add information learned during the sexual history. Collecting and documenting this information is important not only for quality of care – providing necessary screenings or services based on risk factors, respecting patients by remembering to use the name and pronoun that they have indicated they prefer – but also because this information can be collected to assess the health status of LGBTQ populations, which is currently difficult with the lack of large scale, comparable data available.
- #38 Additionally, trained 98 school nurses from LA County; separate from this evaluation. 195 total
- #39 Attitude
- #40 Self-efficacy
- #41 Self-efficacy Additionally: Knowledge: 17% improvement overall from pre-test to post-test Pre-test average: 47% Post-test average 64% Highlights: 41% improvement in correct answers to questions regarding LGBTQ health disparities 28% increase in correct answer to question regarding HIV Pre-exposure Prophylaxis (PrEP)
- #43 Training applies to ALL staff – front desk to provider. Unless you’re providing targeted training, be broad enough to encompass diverse knowledge & comfort levels with the topic. Basic terminology (definitions + space to practice) is a critical starting point, particularly for helping staff feel more comfortable addressing patients + knowing what is appropriate to ask Use data + stories to underscore importance Providers appreciate clinical updates + data on LGBTQ topics – providers are hungry for information/training on this topic, and we received great feedback on further trainings to provide Emphasize Evaluation data demonstrated that training on LGBTQ-inclusive services was successful in improving provider confidence, knowledge, and self-efficacy regarding their ability to provide sensitive and inclusive care to LGBTQ patients
- #46 Review toolkit resources
- #47 RESOURCES: National Campaign guidance, Teen Source educational materials, Condom Access Project materials, ACLU health rights materials, Bedsider materials – posters and pamphlets, condoms – can they make available on site?