LGBT Health Volume 1, Number 1, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/lgbt.2013.0020
MEETING REPORT
First Annual LGBT Health Workforce Conference: Empowering Our Health Workforce to Better Serve LGBT Communities Nelson F. Sa´nchez, MD,1 John Paul Sa´nchez, MD, MPH,2 Mitchell R. Lunn, MD,3 Baligh R. Yehia, MD, MPP, MSHP,4 and Edward J. Callahan, PhD 5
Abstract
The Institute of Medicine has identified significant health disparities and barriers to health care experienced by lesbian, gay, bisexual, and transgender (LGBT) populations. By lowering financial barriers to care, recent legislation and judicial decisions have created a remarkable opportunity for reducing disparities by making health care available to those who previously lacked access. However, the current health-care workforce lacks sufficient training on LGBT-specific health-care issues and delivery of culturally competent care to sexual orientation and gender identity minorities. The LGBT Healthcare Workforce Conference was developed to provide a yearly forum to address these deficiencies through the sharing of best practices in LGBT health-care delivery, creating LGBTinclusive institutional environments, supporting LGBT personal and professional development, and peerto-peer mentoring, with an emphasis on students and early career professionals in the health-care fields. This report summarizes the findings of the first annual LGBT Health Workforce Conference. Key words: access to care, LGBT, public policy and advocacy, sexual orientation.
sources for the identification, measurement, tracking, and reduction of LGBT health disparities.1 In 2011, the Institute of Medicine (IOM) released a report assessing the state of scientific knowledge related to the health of LGBT people.2 This report called for more research on the health needs of LGBT people and for improved efforts to identify LGBT individuals accessing the U.S. health-care system. The Liaison Committee on Medical Education (LCME), which accredits allopathic medical schools, and The Joint Commission (TJC), which accredits hospitals across the country, have adopted national standards that preclude discrimination on the basis of sexual orientation and gender identity.3,4 LCME standards IS-16 and MS-8 require institutions to develop policies and practices that promote diversity among students, faculty, and staff.3 As part of the more comprehensive patient–provider communications standards for accreditation, TJC has suggested numerous strategies to optimize effective communication and cultural competence in the care of LGBT people.4
Introduction
T
he marked health and health-care disparities found among lesbian, gay, bisexual, and transgender (LGBT) populations argue for a need to enhance the capability of the U.S. health workforce to provide access to quality care. These tasks have become more feasible through a recent series of significant judicial, legislative, and policy changes. The U.S. Supreme Court’s overturn of the Defense of Marriage Act on June 26, 2013, is the latest in a series of national milestones on the road to LGBT equality, a path that may lead to future health equity. Training a health workforce to care for sexual orientation and gender minority individuals is critical to eliminating health disparities and optimizing the care of LGBT people. Over the past decade, federal, local, and private initiatives have highlighted the unique health-care needs of LGBT individuals. For the first time, Healthy People 2020 designated LGBT health as a new health objective for the U.S. healthcare system, providing greater national support and re1
Weill-Cornell Medical College and Memorial Sloan-Kettering Cancer Center, New York, New York. Building the Next Generation of Academic Physicians Initiative, Hispanic Center of Excellence; Einstein LGBT Steering Committee, Albert Einstein College of Medicine; and Center for Lesbian and Gay Studies, City University of New York, New York, New York. 3 Division of Nephrology, Department of Medicine, University of California–San Francisco, and Stanford LGBT Medical Education Research Group, Stanford University School of Medicine, San Francisco, California. 4 University of Pennsylvania Perelman School of Medicine and Penn Medicine Program for LGBT Health, Philadelphia, Pennsylvania. 5 School of Medicine, University of California–Davis, Sacramento, California. 2
62
LGBT HEALTH WORKFORCE CONFERENCE The identification and professional development of health professionals committed to providing quality care to LGBT people is necessary to ensuring health equality for this often overlooked population. Over the years, a number of national organizations and societies have developed initiatives to improve LGBT health care as well as the cultural sensitivity and competency of providers in all health-care settings.5–8 To foster professional development, staff retention, and patient satisfaction, hospitals and academic health centers (AHCs) have also developed institutional climate policies and programs to create a welcoming and nurturing environment for students, faculty, staff, and patients (www.einstein.yu.edu/education/studentaffairs/safe-zone/; weill.cornell.edu/diversity/communities/ lgbt-communities/; www.ucdmc.ucdavis.edu/diversity/lgbt2 .html; All accessed August 20, 2013). In June 2013, LGBT health-care providers, educators, researchers, and policy makers convened in New York to share and discuss current best practices in mobilizing the nation’s health care workforce to provide quality care to LGBT people. Special emphasis was placed on the personal and professional development of students and early career professionals in order to influence this field over the long-term. Conference Planning The idea for the LGBT Health Workforce Conference was developed through a collaboration between members of the Building the Next Generation of Academic Physicians (BNGAP) initiative and the Center for Lesbian and Gay Studies, City University of New York (CLAGS).9,10 BNGAP was created in 2009 to increase diverse medical students’ and residents’ interest in academic careers. To address its mission of demographically diversifying the academic workforce, BNGAP decided to investigate and cultivate the LGBT presence at AHCs. Simultaneously, CLAGS committed to expanding its academic portfolio to include health disciplines. CLAGS was founded in 1991, as the first university-based research center in the United States dedicated to the study of historical, cultural, and political concerns vital to LGBT individuals and communities. By sponsoring public programs and conferences, offering fellowships to individual scholars, and functioning as a conduit of reliable information, CLAGS serves as a national center for the promotion of LGBT scholarship and academic development that fosters social change. CLAGS’s interdisciplinary approach to LGBT health education made it an ideal conference partner. Additional collaborators included LGBT leaders from AHCs across the country, national organizations, and liaisons from federal agencies, including the Centers for Disease Control and Prevention and the National Institutes of Health (NIH). The First Annual LGBT Health Workforce Conference took place on June 5–6, 2013, at Hunter College of the City University of New York with the mission of presenting up-to-date practices on institutional climate enhancement and educational development to prepare the health-care workforce to address the health needs of LGBT people. The health workforce was defined as current and future facilitators of quality LGBT health care, including healthcare providers (e.g., physicians, nurses, physician assistants, social workers, psychologists), health educators, administrators, health policy experts, and trainees.
63 Presentation topics included LGBT-specific professional leadership development, research funding opportunities, health policy updates, clinical content, student advising/ mentorship, and assessing institutional climate for LGBTidentified persons. LGBT e-mail distribution lists of national organizations (e.g., Association of American Medical Colleges, American Medical Association) and AHCs (e.g., Einstein LGBT Steering Committee, Albert Einstein College of Medicine) were used to publicize the conference. Scholarships were offered through private sponsorship. Continuing medical education credit for the conference was obtained from the Office of Continuing Medical Education at Morehouse School of Medicine. Conference Participants Two hundred fifty individuals registered for the conference. Seventy-five percent of registrants received scholarships and attended the conference without charge. Fifty-five percent of registrants self-identified as female, and 60% self-identified as LGBT. Professionally, 15% of registrants were high school/college students, 40% graduate students, and 45% health-care professionals. Thirty-five percent of the registrants were from outside New York, Connecticut, and New Jersey. When completing the registration form, participants were asked how attendance at the conference would benefit their personal or professional development. Comments explaining their interest in the conference were grouped into 11 themes: professional development (reported by 30 registrants), best clinical practices (23 registrants), best educational practices (21 registrants), networking (17 registrants), institutional climate (13 registrants), personal development (11 registrants), leadership development (10 registrants), resources (6 registrants), research opportunities (6 registrants), mentoring (3 registrants), and faculty development (3 registrants). Conference Program The conference program comprised four major educational activities: 1. Working Group Meeting: a meeting among national AHC leaders described current initiatives and developed strategic plans to build a more supportive climate for LGBT staff, students, and patients at AHCs. Over 20 institutions participated, including Albert Einstein College of Medicine, Harvard Medical School, the Perelman School of Medicine at the University of Pennsylvania, and UC Davis School of Medicine. 2. Plenary Sessions: session topics included LGBT health leadership, federal efforts to empower the health workforce to serve LGBT communities, and transforming the nation’s hospitals to better serve LGBT individuals. 3. Concurrent Sessions: presentation topics included the role of professional organizations in transforming LGBT health, building supportive institutional climates, nursing leadership, innovations in advising across the workforce ‘‘pipeline,’’ advances in LGBT health education, best practices in transgender care, and best practices in mental health and substance abuse. 4. Networking Event: the networking event provided an opportunity for conference attendees to meet role models, leaders, and potential mentors in the field of LGBT health.
64 Synopsis of Plenary Sessions Leadership and LGBT health This session highlighted examples of leadership in promoting a stronger LGBT health workforce. Speakers discussed the benefits of fostering collaborations between AHCs and university-based centers of lesbian and gay studies in order to explore how ‘‘the theoretical and political grounding’’ of AHCs contributes to the continued health inequities faced by LGBT individuals.10 Representatives from the New York City Health and Hospitals Corporation (HHC), the largest municipal health-care organization in the country, presented their efforts to create a culture to better serve their LGBT patients. In 2011, the HHC mandated that all staff complete a video-based LGBT cultural competency module.11 The module introduces viewers to LGBT identities, the challenges LGBT individuals face in obtaining care, and simple steps to make services accessible. Beyond ensuring that their entire workforce completes this video module, the HHC is also working toward full implementation of the new TJC requirements, enforcing nondiscrimination policies, conducting research on LGBT disparities, and establishing partnerships with LGBT organizations.12 Federal efforts to empower the health workforce to serve the LGBT communities Representatives from the NIH presented current initiatives to improve LGBT health research activities and to develop an LGBT-inclusive health workforce. In 2009, the IOM report, The Health of Lesbian, Gay, Bisexual and Transgender People, highlighted the dearth of national-level data on LGBT health and called on the scientific community to implement a research agenda and funding initiatives to advance understanding of LGBT health concerns.2 In response to the IOM report, the NIH has formed an LGBT Research Coordinating Committee to develop and coordinate potential research and training activities, assess relevant programs across the NIH, and develop recommendations for new initiatives focused on research and training. To improve national health data collection on specific LGBT population groups, the NIH currently supports the collection of data on sexual orientation and gender identity in electronic health records and national health surveys (e.g., National Health Interview Survey, National Survey of Family Growth). There is a need for enhanced communication between the NIH and LGBT researchers and advocates to foster the development of innovative and timely LGBT health research initiatives. On June 27, 2013, the NIH posted a ‘‘Request for Information,’’ inviting comments and suggestions on the health and health research needs of LGBT populations (http://grants.nih.gov/grants/guide/notice-files/NOT-OD-13-076.html). Responses will be collected until October 28, 2013, and the information gathered will inform the NIH’s strategic plan in addressing the health needs of LGBT populations. The NIH has also spearheaded efforts to address LGBT workforce issues. These include developing equal employment opportunities and inclusion training for employees (e.g., safe zone, Trans 101 trainings), pride observance activities (e.g., Transgender Day of Remembrance, Bisexuality Day), efforts to increase data on LGBT employees in the
SANCHEZ ET AL. NIH workforce (e.g., focus groups, institutional climate surveys), and recruitment and retention initiatives in collaboration with the Office of Human Resources and the Office of Intramural Training and Education.13 Transforming our hospitals to better serve LGBT communities Representatives from Continuum Health Partners (CHP), a New York City–based nonprofit hospital system, presented the successful strategies that have transformed their hospitals to better serve LGBT patients. The Human Rights Campaign Healthcare Equality Index has recognized three hospitals within the CHP network as leaders in providing LGBT-inclusive care: Beth Israel Medical Center, St. Luke’s Hospital, and Roosevelt Hospital.14 The Human Rights Campaign Healthcare Equality Index serves as a guide for hospitals seeking to provide equitable and inclusive care to LGBT patients. This annual assessment evaluates adherence to over 40 recommended policies and practices for LGBT care. Health-care facilities receive leader status if they meet criteria within the following four core domains: patient nondiscrimination, equal visitation, employment nondiscrimination, and staff training in LGBT-centered care.14 Since 2000, staff at CHP have developed a coordinated approach to training, outreach, and care delivery models specifically targeted to the LGBT community. LGBT committees were formed at individual hospitals to inform, educate, and encourage awareness of LGBT needs among hospital staff by offering sensitivity trainings, providing resources and literature, and amending hospital policies to be more inclusive. Staff engaged senior hospital leadership throughout the process to ensure support. In 2012, these efforts culminated in the formation of The LGBT Health Services Program at Beth Israel Medical Center. The program has four main focuses, which align with the Health Equality Index and TJC LGBT guidelines: 1. Needs Assessments and Community Relations Meet with local LGBT stakeholders (e.g., LGBT community boards, organizations, consumers). Offer local health screenings and health education. Sponsor LGBT events and activities (e.g., pride parade). Participate on LGBT community advisory boards and committees. 2. Build System Capacity Conduct provider education and training in LGBT competent care. Develop and sustain web-based resources and referral guides. Address specialty needs (e.g., anal pap smears, transgender care, LGBT families with children). 3. Monitor and Improve Quality of Care to LGBT Patients Document and monitor delivery of services. Assess patient satisfaction and outcomes. Insure implementation of system policies and practices. 4. Promotion of LGBT Services Dedicated hospital LGBT web site Print and web banner ads Television and radio commercials
LGBT HEALTH WORKFORCE CONFERENCE The CHP model is one strategy health-care facilities may use to integrate LGBT care into their institution. Hospitals and clinics will need to investigate their individual institutional and patient needs to develop their unique LGBT care strategic plan. Evaluation Among 56 participants who completed the conference evaluation survey, 95% were satisfied with the speakers and presenters, 98% felt that the conference sessions were appropriate and informative, 91% felt that the conference was well organized, and 93% reported that they would recommend this conference to others. Many participants were leading efforts at their home institutions or programs and expressed interest in additional resources to complement their own. Future Steps In order to further the mission of this conference, conference presentations and videos are available on the conference website (www.lgbthealthworkforce.org). Information about LGBT health professionals’ perspectives on academic careers gathered at this conference is being prepared for publication. The second LGBT Health Workforce Conference will be held in spring 2014. Persons interested in becoming involved with conference development are encouraged to contact the board members at
[email protected]. Opportunities to make the U.S. health-care system more responsive to the health needs of LGBT people are increasing. Recent health-care reform legislation and judicial actions have opened doors that previously excluded LGBT people from numerous health benefits. Organizing and educating health-care professionals and trainees to respond to this opportunity is both timely and necessary. Acknowledgments Special thanks to Jennifer Gaboury, Jeffrey Escoffier, and Christopher Adam Mitchell (Board Members, CLAGS), the conference executive and program committee members and the presenters for their help in ensuring a quality conference at Hunter College. We are additionally grateful to our plenary speakers - Barbara E. Warren, Psy.D., LMHC, Director of LGBT Health Services, Beth Israel Medical Center; Shane Snowdon, Director of Health & Aging, Human Rights Campaign Foundation; LaRay Brown, Senior Vice President, Corporate Planning, Community Health and Intergovernmental Relations Officer of the New York City Health and Hospitals Corporation (HHC); Albert E. Smith, Jr., LGBT Special Emphasis Program Manager, Office of Equal Opportunity and Diversity, National Institutes of Health (NIH); Rashada C. Alexander, Ph.D., Special Assistant to the Principal Deputy Director, Office of the Director, NIH; Richard Amiraian, M.D. Corporate Vice President, Primary Care, Continuum Health Partners of New York.
65 Author Disclosure Statement No competing financial interests exist. References 1. Lesbian, gay, bisexual, and transgender health. www.healthy people.gov/2020/topicsobjectives2020/overview.aspx?topic id = 25 (accessed July 15, 2013). 2. Institute of Medicine: The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press, 2011. 3. Liaison Committee of Medical Education: Functions and Structure of a Medical School. Standards for Accreditation of Medical Education Programs Leading to the MD Degree, 2013. http://www.lcme.org/standard.htm (accessed July 15, 2013). 4. The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide. Oak Brook, IL, 2011. LGBTFieldGuide .pdf (accessed July 15, 2013). 5. GLMA home page. http://glma.org (accessed July 15, 2013). 6. GLBT Advisory Committee. www.ama-assn.org/ama/pub/ about-ama/our-people/member-groups-sections/glbt-advi sory-committee.page (accessed July 15, 2013). 7. A Provider’s Handbook on Culturally Competent Care: Lesbian, Gay, Bisexual and Transgendered Population. http:// kphci.org/downloads/KP.PHandbook.LGBT.2nd.2004.pdf (accessed July 15, 2013). 8. Lesbian, Gay, Bisexual and Transgender Health. www .cdc.gov/lgbthealth/ (accessed July 15, 2013). 9. Sanchez JP, Castillo-Page L, Spencer DJ, et al.: Commentary: the building the next generation of academic physicians initiative: engaging medical students and residents. Acad Med 2011;86:928–931. 10. Gay and Lesbian Studies—Goals, History, Current Configurations. http://education.stateuniversity.com/pages/2003/ Gay-Lesbian-Studies.html/ (accessed July 28, 2013). 11. LGBT Healthcare Training Video: ‘‘To Treat Me, You Have to Know Who I Am.’’ NYC Health and Hospitals Corporation. www.youtube.com/watch?v = NUhvJgxgAac (accessed July 28, 2013). 12. http://www.nyc.gov/html/hhc/html/pressroom/pressrelease-20110525-lgbt-training.shtml (accessed August 21, 2013). 13. http://oeodm.od.nih.gov/sep-lgbti.htm (accessed August 21, 2013) . 14. http://www.hrc.org/hei (accessed August 21, 2013).
Address correspondence to: Nelson F. Sanchez, MD Memorial Sloan-Kettering Cancer Center 360 East 72nd Street B907 New York, NY 10021 E-mail:
[email protected]
