Poshi Mikalson , MSW Project Director LGBTQ Reducing Disparities Project

1. First, Do No Harm: An Introduction to Reducing Disparities for LGBTQ Communities PoshiMikalson, MSW Project Director LGBTQ Reducing Disparities Project

2. Passed in 2004 How it all started Increased funding for mental health services Provided funding for prevention and early interventionprograms

3. CA Reducing Disparities Project

4. Strategic Planning Workgroup

5. Advisory Groups

6. Advisory Groups • African American/Black/African Ancestry • Asian American, Native Hawaiian, & Pacific Islander • Bisexual • Consumer, Clients, Survivors, & Family Members • County Staff • Latino • Native American • Older Adults • Research & Data • Rural • School-Based Issues • Transgender • Women’s Issues • Youth

7. Community Gatherings Advisory Groups Surveys Subject-Matter Experts Community-BasedResearch

8. Community Gatherings Palm Springs Riverside Sacramento San Francisco Visalia YES! Conference Chico Eureka Long Beach Los Angeles Oakland Orange County

9. Surveys Community Survey N=3023 Provider Survey N=1247 LGBTQ Identified Providers n= >350

10. African-American • Anti-LGBTQ Initiatives • Asian-Pacific Islander & Native Hawaiian • Bisexual • Domestic Violence • HIV and AIDS • Native American • Older Adults • Parents, Children, & Families • Transgender • Youth Subject Matter Experts

11. The Report

12. First, Do No Harm First and foremost…preventionshould be the operative term when discussing LGBTQ disparities… & First, do no harm should be the credo

13. First, Do No Harm LGBTQ individuals are being harmed…daily, weekly, monthly, yearly, & sometimes lifetime basis due to stigma, discrimination, prejudice, rejection & legal inequality. The need for culturally competent mental health services is great, but greater still is the need to eliminate the multiple harms that contribute to negative mental health throughout LGBTQ communities.

14. Findings

15. Sexual Orientation

16. Queer

17. Gender Identity

18. Experienced Emotional Difficulties

19. Social Supports I am not out about my sexual orientation to: • Extended family • Childhood Religion • Coworkers • Family of origin • Racial/ethnic community • Other students at my school

20. Social Supports: Rejection • Childhood religion • Racial/ethnic community • Family of origin • Extended family • Current religion • Other students at my school

21. Providers I am not out to about my sexual orientation ? • Gynecologist • Specialist • Mental Health Provider • Nurse/Nurse Practitioner • Primary Care Doctor • Dentist • Pediatrician • School Counselor

22. Providers I am not out to about sexual orientation Dentist Primary Care Nurse/Nurse Practitioner Specialist Gynecologist Pediatrician

23. Most rejecting providers of Sexual Orientation? • Psychiatrist • Nurse/Nurse Practitioner • Adoption • Gynecologist • Primary Care Doctor • School Counselor • Specialist • Dentist

24. Most rejecting providers • Primary Care Physician • Nurse/Nurse Practitioner • Gynecologist • Specialist • Adoption Agency • Dentist

25. LGBTQ-Specific Barriers to service • Don’t know how to find an LGBTQ competent provider • Cannot find a provider who I am comfortable with who is also LGBTQ knowledgeable • Concerned my provider will be unsupportive of my LGBTQ identity • No LGBTQ specific services in my area • SO/GI confidentiality concerns • LGBTQ competent providers are in the same social circle

26. Problems with Mental Health Providers • Did not know how to help with my sexual orientation concerns • Did not know how to help with my gender identity/expression concerns • (Trans Spectrum – 5X more likely) • My SO/GI became the focus of my treatment, but was not why I sought services

27. Problems with Mental Health Providers • Made negative comments about my sexual orientation • Made negative comments about my gender identity/expression • (Trans Spectrum - 4x as likely) • Did not know how to help same-sex couples • Did not know how to help mixed-orientation couples

28. Why a Provider Survey?

29. Barriers to providing services

30. Experiences of LGBTQ Providers BECAUSE of sexual orientation or gender identity /expression • Sought after as an expert on LGBTQ issues • Treated differently by colleagues • Verbally harassed • Assigned to LGBTQ clients/patients • Socially excluded by colleagues • Instructed to keep sexual orientation or gender identity hidden

31. What are your barriers to providing services?

32. Top 7 Barriers Lack of training on the concerns and needs of Transgender people Lack of training on the concerns and needs of LGBTQ parents Lack of training on the coming out process Lack of training on the concerns and needs of LGB people

33. Top 7 Barriers No access to supervision/consultation with providers who have expertise in LGBTQ concerns and needs Not able to provide services in client’s/patient’s native language Personal religious beliefs

34. Comfort matters of non-LGBTQ providers reported being very comfortable working with LGBTQ clients of LGBTQ providers reported being very comfortablewith working with LGBTQ clients

35. Gay Affirmative Practice(GAP) Scale

36. Training matters • 75% reported attending at least one LGBTQ specific training in the past 5 years • 67% reported attending at least one LGBTQ specific training in the past year • LGBTQ providers reported completing significantly MORE LGBTQ workshops and trainings than non-LGBTQ colleagues in the past 12 months

37. Why training matters The more trainings someone reported attending the higher their GAP scale… for each training they attended their GAP score went up 3pts

38. Recommendations

39. Counting LGBTQ people Demographic information should be collected for LGBTQ people across the lifespan, & across all demographic variations (race, ethnicity, age, geography) at the state and county levels.

40. Possible barriers to counting LGBTQ People What are the possible barriers to implementing this recommendation?

41. Asking the Question • Only 29% of Mental/Behavioral/Medical Health providers ask about sexual orientation • Only 26% ask about gender identity More trainings = asking about sexual orientation or gender identity/expression!

42. Training Statewide workforce training & technical assistance should be required in order to increase culturally competent mental, behavioral, and physical health services, including outreach and engagement, for all LGBTQ populations across the lifespan, racial & ethnic diversity, & geographic locations. Training of service providers in public mental/behavioral & physical health systems should focus on the distinctiveness of each sector—lesbians, gay men, bisexual, transgender, queer & questioning—with an overarching approach to mental health throughout the lifespan for the racial, ethnic, & cultural diversity of LGBTQ communities.

43. Training Cultural competency training,[…] cannot only be a general training on LGBTQ as a whole but also needs to include separate subgroup-specific training sessions.

44. Possible barriers to more LGBTQ Trainings What are the possible barriers to implementing this recommendation?

45. Promising Practices?

46. Final Thoughts Contact Information PoshiMikalson, MSW Project Director, LGBTQ Reducing Disparities Project Email: LGBTQMentalhealth@att.net Cell phone: 530-908-9755