1. LGBT Cultural Competency
Presented By JoAnna Michaels and Gene Silvestri

2. Disclosure Statement
The contents contained are intended for informational and learning purposes. The presenters are not responsible for any liabilities, damages, reference to, or reliance on any of the information that is presented.

3. Speaker Introductions JoAnna Michaels
U.S. Air Force Veteran
Viet Nam Era Survival Instructor
Program and Administrative Assistant, Volunteers of America
Member, Northern California LGBT Advocacy Group
CA LGBT Veterans Leadership Forum, Committee Member
Public Speaker

4. Speaker Introductions Gene Silvestri
U.S. Army Disabled Veteran Post 9/11 Era
Vice President, TAVA
Veterans Affairs Coordinator, AMPA
Member, Northern California LGBT Advocacy Group
Member, Veteran and Family Advisory Committee (VFAC) at Mather VHA
CA LGBT Veterans Leadership Forum, Committee Member

5. Focus Areas Examine cultural competency and its importance.
Discuss LGBT concepts, terms, and definitions.
Review differences between sex, gender, and sexual orientation.
Review difference between gender identity and gender expression.
Highlight common misconceptions and review grammar usage.
Ally tips.
LGBT veteran demographics, population and community.
Highlight LGBT progress made within VHA and Cal Vet.
Examine remaining challenges for LGBT veterans.
Q&A

6. What Is Cultural Competence?
“Culture Umbrella. “ Winters, Mary-Frances. Adapted from The Inclusion Solution,

7. Cultural Competence…..
Refers to a mix of knowledge, skills and awareness pertaining to cultural differences and interpretations across groups. Examines our will and actions to build an understanding between people in order to help them. Incorporates the ability to interact respectfully with people from across various groups. Includes the awareness of and respect for differences, without making assumptions.
Definitions adapted from ”What does it mean to be culturally competent?”  Livingstone, Rhonda. 10 July and Openhouse LGBT Curriculum,

8. Why Is Cultural Competency Necessary?
Encompasses the principles of trust, respect for diversity, equity, fairness, and social justice.
Highlights the growing diversity that exists within our modern culture.
Reinforces that not everyone holds the same beliefs, values and practices we do.
Fosters mutual respectful with people from across various cultures and backgrounds.
Promotes active listening, open communication, and formal communication.
Definitions adapted from ”What does it mean to be culturally competent?”  Livingstone, Rhonda. 10 July Adapted from Openhouse LGBT Curriculum,

9. LGBT Cultural Competence

10. LGBT Defined Letters stand for Lesbian, Gay, Bisexual and Transgender.
Umbrella terminology encompassing diverse communities of people (race, background, ages, careers, religious beliefs, and economics).
Emphasizes diversity of sexuality and gender identity-based cultures.
The alphabet continues to grow – LGBTQ*.
People may or may not identify themselves with one, more than one, or none of the terms.
Identity is fluid – can change over time.
Definitions adapted from The Gender Equity Resource Center at UC Berkeley
“LGBT” Page. Researched Feb Wikipedia

11. Population Comparison
U.S. Population (as of 13 Feb 2017)
≈ 324,535,106 1
U.S. LGB Population (as of 2011)
≈ more than 8 million (3.5%) 2
U.S. Transgender Population (as of 2016)
≈ 1.4 million 3
1 U.S. Census Bureau and U.S. World Population Clock. Reference 13 Feb Gates, Gary J How many people are lesbian, gay, bisexual, and transgender? The Williams Institute . April
3 Flores, Herman, Gates, Brown. How Many Adults Identify as Transgender in the United States?

13. Gender, Sex, and Sexual Orientation
Gender (Culture): Gender is not a simple case of “either/or.” Comprises gender expression, roles, and identity. Exhibited by clothing, hairstyles, body language, speech, etc.
Sex: A medical term designating a mix of chromosomes, genitals, hormones and hormonal balances, reproductive organs, and secondary- sex characteristics.
Sexual Orientation (Sexual Identity): Refers to person’s innate sense of sexual attraction toward others. Can evolve over time. Some examples include Asexual, gay, pansexual, two spirit, heterosexual, bisexual, lesbian, pansexual.
Adapted from The Gender Equity Resource Center at UC Berkeley –

14. Gender Identity and Gender Expression
Gender Identity refers to one’s innate sense of self and how someone identifies their own gender. This may or may not correspond to their assigned birth sex. Gender identity is internal and isn’t necessarily outwardly visible.
Gender Expression refers to how a person represents or expresses their gender identity to others.
Feminine/Masculine Behavior
Posture
Man
Clothing Styles
Woman
Mannerisms
Cisgender (non transgender person)
Speech Patterns
Hairstyles
Transgender
Activities
Gender Queer
Agender (person who does not identify themselves as having a particular gender.)
Adapted from Openhouse LGBT Curriculum,

16. Common Misconceptions
It’s a phase or a choice. You can tell someone is LGBT by looking at them. Gender identity determines your sexual orientation. LGBT people have been abused. LGBT people are sexually promiscuous. Sexuality is fixed and can’t change over the course of one’s lifetime. LGBT people all share a particular value system. LGBT people are mentally-ill and/or confused. All transgender people are gay. All transgender people have surgeries and take hormones. Transgender is the same as transvestite or intersex, or cross-dresser.

17. Grammar Usage
Infographics adapted from

18. Grammar Usage
Infographics adapted from

19. Grammar Usage
Infographics adapted from

20. How Can I Be An Ally ? As easy as providing support and acceptance.
Listen with an open mind. 
Willing to engage in open communication.
Be an ally among your allies – help to educate others.
“Come out” as an LGBT Ally.
Connect with your local LGBT community.
Admit you don't know something versus making assumptions.
Believe in treating others with dignity and respect.
Adapted from Glaad Be An Ally & A Friend

21. LGBT Etiquette
Treat each person with respect, as you would expect for yourself.
Avoid backhanded compliments or "helpful" tips.
Don’t make assumptions or generalizations.
Avoid using stereotypes or slang phrases.
Please do not laugh at someone, especially in their presence.
Check preconceived thoughts and opinions at the door.
Be inclusive.
Remain mindful of your words, tone and actions.
Always use a person’s preferred name, pronoun, gender, or avoid using specific references.
If you don’t know…ask politely!
Don’t continue to use the incorrect pronoun.
If you “slip up,” don’t make a big deal about it.
Apologize, correct yourself, and move on.
Seek permission from the individual before asking specific questions.
Adapted from Steven Petrow's Complete Gay & Lesbian Manners: The Definitive Guide to LGBT Life (Workman, 2011)

22. LGBT Military & Veteran Demographics

23. Current Population U.S. Service Members ≈ 1,301,000 Active1
≈ 811,000 Reserve1
U.S. LGB Service Members
≈ 71,000 (2.8%) identify as LGB 2
U.S. Transgender Service Members
≈ 150,000 have served or are serving3
U.S. Military Veterans
≈ 22 million4
U.S. LGB Veterans
≈ over 1 million5
U.S. Transgender Veterans
≈ over 134,000 Veterans / Retired Guard and Reserves6
1Department of Defense (DoD) Release “Fiscal Year 2017 President’s Budget Proposal”. 9 February Retrieved 13 February 2017.
2Goldbach, J.T. & Castro, C.A.“Lesbian, Gay, Bisexual, and Transgender (LGBT) Service Members: Life After Don’t Ask, Don’t Tell.” Current Psychiatry Rep (2016) 18: 56. doi: /s Gates, GJ and Herman, JL Transgender Military Service in the United States. Williams Institute, UCLA School of Law.
4 Department of Veterans Affairs (VA). The Veteran Population Projection Model 2014 (VetPop2014).
5 VA LGBT Program LGBT Veteran Health Care Fact Sheets. Referenced 13 Feb
6 Gates, GJ and Herman, JL Transgender Military Service in the United States. Williams Institute, UCLA School of Law.

24. Quick Facts
DADT Repeal and Open Transgender Service do not heal old wounds.
Experience higher rates of suicidal ideation and attempts than heterosexual veterans. * **
Experience higher rates of military sexual trauma (MST), harassment, and abuse.**
Suffer from a host of service-connected mental health and physical ailments.*
Continue to endure discrimination and struggle with reintegration processes.*
Continue to experience higher rates of unemployment.*
Experience higher rates of homelessness.*
*Stalsburg, Brittany L. “After Repeal: LGBT Service Members and Veterans The Facts.” September Referenced 13 Feb
**Lonero, Gabriel Angelo. Ramirez, Maria Heliana. “Living out Loud, Laughing out Loud: Best Practices of an LGBT Veteran Support Group.” 13 January

25. VHA and LGBT Veterans
The U.S. Veterans Health Administration (VHA) is likely the largest provider of LGBT healthcare in the world. 1
1 Kauth Michael R. and Shipherd Jillian C.. LGBT Health. Transforming a System: Improving Patient-Centered Care for Sexual and Gender Minority Veterans. May 2016, 3(3):  

26. Progress Made Within the VHA
More welcoming and inclusive environment on campuses nationwide (groups, signage, events).
June 2011 – creation of Transgender and Intersex Health Care Directive (updated in 2013).
As of 2013, more than 250,000 LGB veteran patients were receiving VHA care services.*
In 2013, VHA treated 2,567 veterans with transgender specific care.*
As of 2017, VHA is treating over 5,000 patients who identify as transgender.**
Currently there are more than 500 LGBT- inclusive initiatives underway across VHA facilities nationwide.*
Each facility now has an LGBT Veteran Care Coordinator.
Pre and post operative care; hormonal therapies covered.
Capability to change one’s name and gender marker on VA medical records.
*Information adapted from VHA Patient Pop - The VA By the Numbers: How Big Is It and Who Uses It?
by Monica Alba, NBC News 09 May
VHA LGB Patient Pop - Kauth, M. R., & Shipherd, J. C. (2016). Transforming a System: Improving Patient-Centered Care for Sexual and Gender Minority Veterans. LGBT Health.
**“Transgender Vets, the VA, and Respect”– Jan

27. Progress Made Within the VHA
Patients’ right to be treated according to their gender identity for purposes of pronouns, restroom access, and room placements.
LGBT-specific VA Disability Claim Assistance Services.
VHA facilities are recognized as leaders in LGBT Health Care Equality by the Humans Rights Campaign’s (HRC) Healthcare Equality Index (HEI).
VA LGBT-specific webpage on the VA website, share points, care sheets and other resources.
Development of the Speech-Language Pathology program.
Information adapted from VHA Patient Pop - The VA By the Numbers: How Big Is It and Who Uses It?
by Monica Alba, NBC News 09 May
VHA LGB Patient Pop - Kauth, M. R., & Shipherd, J. C. (2016). Transforming a System: Improving Patient-Centered Care for Sexual and Gender Minority Veterans. LGBT Health.
“Transgender Vets, the VA, and Respect”– Jan

28. California Population and LGBT Veterans
CA Population (as of 2014)
≈ 38.8 million 1
CA LGBT Population (as of 2012)
≈ 1,338,164 2
CA Veteran Population (as of 2013)
≈ 2 million 3 *
CA Gay and Lesbian Veterans (as of 2004)
≈ 136,000 3 *
1“Welcome to QuickFacts – California.” Referred to 13 Feb
2"Decennial Census Data on Same Sex Couples". Same Sex Couples. U.S. Census Bureau. Retrieved 30 June 2013.
3 “California has nation's highest number of veterans .” July 13,
*California Research Bureau White Paper “Better Serving Those Who Serve: California’s LGBT Veterans Speak Out.” Kellie Jean Hogue, Ph.D. and Tonya D. Lindsey, Ph.D., Senior Policy Analysts June.

29. CalVet and LGBT Veterans
Adapted from CalVet’s Minority Veterans Division website page -

30. CalVet and LGBT Veterans
CalVet is committed to ensuring all veterans have access to and receive the benefits they have earned.
LGBT veteran issues are housed under CalVet’s Minority and Underrepresented Veterans Division.
The Minority Veterans Division promotes the use of VA benefits, programs, and services by minority and LGBT Veterans.
Supports and initiates activities that educate and sensitize the public to the unique needs of minority and LGBT veterans.
Advocates by identifying gaps in services and makes recommendations for improvements.
CalVet LGBT Veterans information webpage -
Adapted from CalVet’s Minority Veterans Division website page -

31. California LGBT Veterans Leadership Forum
When - Held over a two-day period in (September 26-27, 2014) at Sacramento State.
Background - CalVet, along with a planning committee, and the CRB support, convened the first statewide forum on LGBT veterans. to ensure that LGBT veterans were receiving the benefits they have earned.
Purpose - to help identify, explore and discuss the needs of the LGBT veteran community.
Key Areas Covered - Housing, Employment, Healthcare, Education and Legal.
Outcome - The forum identitified needs, gaps, and exclusions in service; provided legal and programmatic remedies; local programs that can serve as a model initiaitives.
White Paper - released in June Discussed numerous state, local and federal policy recommendations for each forum key area covered. Some have already been achieved.

32. Challenges Remain
(Photo Credit: AP)

33. Some Remaining Challenges
Many LGBT veterans are fearful of outing themselves in order to access earned benefits.
Issues persist with updating discharge code and name on DD-214 Form.
Experiencing higher rates of suicidal ideation.
Need for stronger wraparound services for LGBT veterans.
Lack of access t0 viable local and state current resources.
Inconsistent enforcement and knowledge of VHA LGBT healthcare policies and directives at facilities nationwide.
Issues in coordinating care across VHA services, especially in rural areas.
Access to safe-space LGBT community housing.
Embarrassing, insensitive, and hostile appointment experiences.
Long delays in getting access to care and needing to travel to get care.
Current VHA ban on transgender-related surgeries.

34. Resources
American Legion Alexander Hamilton Post 448 –
American Military Partner Association (AMPA) – militarypartners.org
American Veterans for Equal Rights(AVER) – aver.us
CalVet LGBT Veterans
CenterLink: The Community of LGBT Centers -
Servicemembers Legal Defense Network (SLDN) -
Swords to Plowshares -
The Gender Equity Resource Center at UC Berkeley –
Transgender American Veterans Association (TAVA) - transveteran.org
Transgender Law Center -
VA LGBT Veteran Care -
VHA Transgender & Intersex Veterans Directive -

35. Questions?