L.G.B.T. HEALTH:WITHOUT EQUALITY,

THERE IS NO QUALITY Presented by:Josh Hyatt DHSc, MHL, CPHRM

SPEAKER

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.

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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 GENDERSex

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 2020The 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 abusePrevalence 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 MODELSexual 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 CAREContributing 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, CPHRMHyatt.josh@yahoo.com