1. Geomapping Initiative to Reduce Health Disparities among LGBTQ Youth Laura DelloStritto Boston University School of Public Health Social/Behavioral Sciences & Maternal/Child Health

2. Site Information MA Commission on LGBTQ Youth The Massachusetts Commission on LGBT Youth is established by law as an independent agency of the Commonwealth to recommend and advocate to all branches of state government effective policies, programs, and resources for LGBT youth to thrive. The Commission was established in 2006, succeeding the Governor's Commission on Gay and Lesbian youth that was created in 1992 by Governor William F. Weld in response to an epidemic of suicide among gay and lesbian youth.

3. Site Information The Fenway Institute The Fenway Institute (TFI) is an interdisciplinary center for research, training, education, and policy development. TFI works to ensure access to quality, culturally competent medical and mental health care for traditionally underserved communities, including lesbian, gay, bisexual and transgender (LGBT) people by conducting innovative research and developing education and advocacy programs.

4. Project Background The “Geomapping Initiative” originated from recommendations from the Commission to the Executive Office of Health & Human Services and the Department of Children and Families (DCF) to expand its network of safe homes for LGBTQ youth. In response, DCF determined that the resources available to LGBTQ youth across the state should be broadly inventoried. In addition, data should be validated to ensure competency to care for these populations.

5. When compared to heterosexual youth, sexual minority youth report: –4x greater rate of dating violence 1 –Increased alcohol use 2 –Increased smoking 2 –Increased suicidal ideation 3 –4x greater rate of attempted suicide 3 –Disproportionate homelessness 4 –Report from 2011 “alarming rates of behavioral and social problems [but] service use among these youth is disproportionately low” 5 Project Background

6. Objectives The overall goal of this initiative is to reduce various health disparities that affect the LGBTQ community by creating a web-based tool of providers that facilitates service accessibility for LGBTQ youth, families, and allies. Validate information from list of providers serving LGBTQ youth (location, contact information, services offered, mission statement, etc.) Develop tools to conduct initial and follow-up LGBTQ competency evaluations Expand existing list of providers serving LGBTQ youth

7. Activities To ensure referrals to safe and competent services: Create LGBTQ competency assessment Develop assessment evaluation criteria Distribute assessment to existing list of providers (identified though LGBTQ resource guides and referrals from other LGBTQ providers) Determine list inclusion/exclusion based on results Notify participants with positively framed personalized recommendations and free LGBTQ competency resources

8. Methods Literature Review to develop 10 question assessment 6-11 Outcome measure = percentage of competency questions ≥ 77% answered satisfactorily, with requirement that these questions answered satisfactorily –Would staff be comfortable if an LGBTQ Youth came out to them? –What is the bathroom access policy for transgender/gender nonconforming youth? (trans* inclusive) Sent to 171 organizations from LGBTQ resource guides over 3 month period –Various categories: Faith Based Organization, Community & Social Support, Physical Health, Mental Health, Training & Advocacy, Legal, Employment & Housing Administered survey electronically (63), via phone (4), and via email (1) 15-20 minutes to complete

9. Preliminary Results 171 Organizations Contacted Response rate: 83/171 = 48.5% Completion rate: 68/171 = 39.7% n=68 LGB-inclusive rate: 63 59/68 = 92.6% Trans*-inclusive rate: 53/68 = 77.9%

10. All Organizations 91% of organizations surveyed report working with self-identified LGBTQ youth However, only 46% report requiring competency training that explicitly discusses sexual orientation, gender identity and expression (“inclusive competency training”)

11. All Organizations 38% of organizations receive state funding Of 27 organizations that use intake forms, many do not collect important identify information that can affect quality of care and inform future interventions

12. State Funded Organizations Only 58% of state funded organizations require inclusive competency training Of 20 organizations that use intake forms, many do not collect important identify information that can affect quality of care and inform future interventions

13. Independently Funded Organizations Only 39% of independently funded organizations require inclusive competency training Of 7 organizations that use intake forms, many do not collect important identify information that can affect quality of care and inform future interventions

14. Discussion Interpretation: Training extremely limited Intake forms insufficient for best care, data collection 13 Bathroom access policies, nondiscrimination policies also limited (data not shown) Limitations: Organizational diversity affected interpretation of questions Limited staff (1) Timing (summer/no time) (2) No longer existing (4 closed/merged) Incorrect contact info (16 emails bounced) Did not think survey applicable (no LGBTQ/youth-specific services) (2)

15. Next Steps Continue website development and pilot test with youth and providers Develop protocol to re-assess competency annually Policy advocacy: require competency benchmarks (inclusive competency training, intake forms, bathroom policies, nondiscrimination policies) to receive state funding Population mapping to allocate funding based on need

16. Website Development Community partner = Code for Boston Current features: –Display services offered, contact info, mission –Toggle by population served, category –Directions Future features: –Easily print info/directions –User feedback –Color code categories –Improved accessibility info –Add service button

17. Screenshot of current pilot website

18. References 1.Massachusetts Department of Public Health. (2012). [2011 Youth health survey, data analysis by sexual orientation]. Unpublished data. 2.Massachusetts Department of Public Health. (2012). [2011 Massachusetts youth risk behavior survey and youth health survey combined data, LGB analysis]. Unpublished data; Gonsalves, D., McKenna, M., Hawk, H., & Tinsley, 3.Goodenow, C. (2011). Prevention needs of sexual minority youth, MYRBS 1995-2009. 4.Corliss et al., High burden of homelessness. 5.Acevedo-Polakovich, I.D., Bell, B. Gamache, P., & Christian, A.S. (2011). Service accessibility for lesbian, gay, bisexual, transgender, and questioning youth. Youth and Society, 1-23. 6.Shaughnessy, A. (2014). MISSOURI CASE STUDY 6: SPARKING MISSOURI HOSPITALS INTO REVIEWING THEIR LGBT WELCOMING POLICIES – ATTEMPT #1. LGBT HealthLink. Retrieved from http://MISSOURI CASE STUDY 6: SPARKING MISSOURI HOSPITALS INTO REVIEWING THEIR LGBT WELCOMING POLICIES – ATTEMPT #1 7.Shaughnessy, A. (2014). MISSOURI CASE STUDY 7: SPARKING MISSOURI HOSPITALS INTO REVIEWING THEIR LGBT WELCOMING POLICIES – ATTEMPT #2. LGBT HealthLink. Retrieved from http://blog.lgbthealthequity.org/2014/06/26/missouri- case-study-7-sparking-missouri-hospitals-into-reviewing-their-lgbt-welcoming-policies-attempt-2/ 8.Shaughnessy, A. (2014). MISSOURI CASE STUDY 8 – MAXIMIZING OUR MISSOURI HOSPITAL OUTREACH. LGBT HealthLink. Retrieved from http://blog.lgbthealthequity.org/2014/07/03/missouri-case-study-8-maximizing-our-missouri-hospital- outreach/ 9.East Bay Pride,. (2014). Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex & 2-Spirited (LGBTQQI2S) Resources for the East Bay (Contra Costa & Alameda Counties) and the San Francisco Bay Area. Eastbaypride.com. Retrieved 23 August 2014, from http://www.eastbaypride.com/policy%20a.html 10.Gay and Lesbian Health Victoria,. (2014). sexual diversity health services audit (1st ed.). Retrieved from http://www.eastbaypride.com/sexual%20diversity%20health%20services%20audit.pdf 11.Health Imperatives,. (2014). Agency Safety Assessment Tool (1st ed.). Health Imperatives. Retrieved from http://hcsm.org/sites/default/files/spiritweb/GLYS/Agency%20safety%20assessment%20tool.pdf 12.Health Imperatives,. (2014). OutHealth! Hospital Safety Assessment Tool (1st ed.). Retrieved from http://www.healthimperatives.org/sites/default/files/spiritweb/GLYS/Hospital%20Safety%20Assessment%20Tool%20formatted.pdf 13.Herukhuti,. (2014). TAKING A BREATH: FIRST NIGHT AT THE CONFERENCE ON LGBTI HEALTH RESEARCH. LGBT HealthLink. Retrieved from http://blog.lgbthealthequity.org/2014/08/08/taking-a-breath-first-night-at-the-conference-on-lgbti-health- research/ 14.Human Rights Campaign,. (2014). All Children - All Families: Benchmarks of LGBT Cultural Competency. Human Rights Campaign. Retrieved 23 August 2014, from http://www.hrc.org/resources/entry/benchmarks-of-lgbt-cultural-competency