1. An Introduction to Reducing Disparities for LGBTQ Communities
First, Do No Harm:
An Introduction to Reducing Disparities for LGBTQ Communities
Poshi Mikalson, MSW
Project Director
LGBTQ Reducing Disparities Project
Introduction to Workshop
Is everyone in the right place? Pass around sign-in.

2. How it all started Passed in 2004
Increased funding for mental health services
Is anyone not familiar with Prop. 63?
This is funded thru PEI
Provided funding for prevention and early intervention programs

3. CA Reducing Disparities Project
In response to the call to reduce mental health disparities and seek solutions for historically underserved communities in California, the Department of Mental Health (DMH), has called for a key statewide policy initiative as a means to improve access, quality of care, and increase positive outcomes for racial, ethnic and cultural communities.
In 2009, DMH launched this two-year statewide Prevention and Early Intervention project focusing on 5 population groups that have been underserved, and underrepresented by the public mental health system. (READ LIST ON SCREEN)
Each of the five groups was awarded a contract to develop population specific reports which will be combined into a statewide comprehensive plan to identify new approaches towards reducing disparities.

4. Strategic Planning Workgroup
This was the first statewide project to include LGBTQ communities and has been an exciting opportunity for us to make our voices heard about the specific needs of our communities.
Explain collaboration with EQCAI

5. Advisory Groups
Explain Ags
About 100 members

6. Advisory Groups African American/Black/African Ancestry Older Adults
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
14 advisory groups—why this was necessary

7. Community-Based Research
List of community based research
Community Gatherings
Surveys
Subject-Matter Experts
Advisory Groups

8. Community Gatherings Palm Springs Riverside Sacramento San Francisco
Visalia
YES! Conference
Chico
Eureka
Long Beach
Los Angeles
Oakland
Orange County
Explain Community Gatherings
Over 450 attendees
YES conference – Youth Empowerment Summit

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

10. Subject Matter Experts
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
Explain Subject Matter Experts

11. The Report
This is the cover…blah blah ;)

12. First, Do No Harm
First and foremost…prevention should be the operative term when discussing LGBTQ disparities…
&
Explain why it is titled first do no harm
Read p 18 & 19 to audience
POSHI – these are fly-ins
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.
Poshi these are Fly ins
Look at p 18 & 19 “they represent invisible… also work with “The need for culturally competent…”
Explain why it is titled first do no harm
Read p 18 & 19 to audience

14. Findings
Explain what they will see in the following slides

15. Sexual Orientation

16. Queer
Queer? Who fell under that identity? Talk about the decision of why we (the community) changed to queer; when someone says they are queer this is where they really fall.
Questioning – very few responded with questioning

17. Gender Identity

18. Experienced Emotional Difficulties
Due to sexual orientation

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
Poshi – these are all fly-ins so you will have to click to make each one appear

20. Social Supports: Rejection
Childhood religion
Racial/ethnic community
Family of origin
Extended family
Current religion
Other students at my school
Top 6 rejecting social supports
Poshi – these are all fly-ins so you will have to click to make each one appear
Religion was listed as the top most rejecting for almost all subgroups
Black and AANHPI listed their communities as most rejecting

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
Poshi – this is for your interactive portion. This is the list they can choose from. Answers are on the next slide.

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

23. Most rejecting providers of Sexual Orientation?
Psychiatrist
Nurse/Nurse Practitioner
Adoption
Gynecologist
Primary Care Doctor
School Counselor
Specialist
Dentist
Poshi – this is for your interactive portion. This is the list they can choose from. Answers are on the next slide.

24. Most rejecting providers
Primary Care Physician
Nurse/Nurse Practitioner
Gynecologist
Specialist
Adoption Agency
Dentist
Poshi – these are all fly-ins so you will have to click to make each one appear

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
Poshi these are fly-ins

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
(no fly ins)

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
What were the barriers to providing services? (LGBTQ provider slide is next)

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
Top 7 Barriers listed with regards to providing services

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
Top 7 Barriers listed with regards to providing services

34. Comfort matters
of non-LGBTQ providers reported being very comfortable working with LGBTQ clients
A providers comfort level is one indicator of cultural competence and affirmative care.
As comfort level increases, positive beliefs regarding LGBTQ people significantly increases, as well.
of LGBTQ providers reported being very comfortable with working with LGBTQ clients

35. Gay Affirmative Practice(GAP) Scale
Explain the Gay Affirmative Practice Scale (Catherine Crisp)

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
Fly ins

37. for each training they attended their GAP score went up 3pts
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
fly ins
Training affects beliefs

38. Recommendations
Explain what they will see in the following slides

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?
What are the barriers to implementing recommendations

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.
Fly ins
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?
What are the barriers to implementing recommendations

45. Promising Practices?
If you don’t know who you’re serving, how will you know what promising practices to put into place?
Also, suggestion regarding partnering with community members to do the actual work.

46. LGBTQ Reducing Disparities Project
Final Thoughts
Contact Information
Poshi Mikalson, MSW
Project Director,
LGBTQ Reducing Disparities Project
Cell phone:
Any final thoughts, questions, comments?