Several recent Community Access to Child Health (CATCH) grants have focused on bridging barriers between health care providers and lesbian, gay, bisexual, transgender (LGBT) and gender variant youths.
Grantees have conducted needs assessments and focus groups to learn about LGBT youths’ health care experiences and priorities.
“We have heard experiences both positive and negative, and have learned that youth are eager to share their stories and suggestions for improvement,” said Gayathri Chelvakumar, M.D., FAAP, from Nationwide Children’s in Columbus, Ohio. “Consistent themes that are brought up by youth through all of our sessions are the need for health care providers to be educated about the care of LGBT populations, the need for youth to feel heard and respected.”
Vincent Devlin, D.O., a pediatric resident at Louisiana State University Health Sciences Center, has learned that youths who are gender variant or who identify as LGBT “are willing to work with health care providers but need them to be more open and willing to assess their needs as different from the general population.”
LGBT youths are at higher risk for substance abuse, homelessness, depression, sexually transmitted infections, intimate partner violence and self-harm. The grantees stress the importance of holistic assessments, histories and anticipatory guidance, as well as the need for culturally appropriate and readily available resources.
Equally important is providing a safe place. Dr. Chelvakumar recommends using signs around the office or clinic to show that youths of all backgrounds are welcome.
“It can be as subtle as putting a rainbow sticker on your badge or having a Pride sign in the registration area or clinic rooms,” she said.
In an effort to establish a safe place for LGBT youths, Stephanie Kwon, D.O., and Carly Schuetz, M.D., pediatric residents at the University of Louisville School of Medicine, are working to provide Q Cards from the Q Card Project in their continuity clinics. Q card is a communication tool that allows LGBTQ youth to fill in their sexual orientation, gender identity, preferred gender pronouns and specific concerns. The cards empower LGBTQ youth and help to initiate open communication with their health care providers, Drs. Kwon and Schuetz said.
Away from the clinic, Dr. Devlin reaches out to community organizations that provide resources for LGBT youths.
Overall, the CATCH grantees have similar recommendations for those working with LGBT and gender variant youths.
“Be respectful and honest about what you do know and don’t know,” Dr. Chelvakumar suggested. “Avoid any assumptions about gender identity, sexual attraction, sexual practices and sexual orientation. Ask and listen.”
Drs. Kwon and Schuetz advised using non-judgmental tone and body language, and avoiding common assumptions, e.g., sexual orientation is based on appearance and presuming heterosexuality. They also noted that the terminology used to describe sexual and gender identity is vast and growing, so health care providers should not be afraid to ask for clarification of unfamiliar terminology.
Dr. Devlin added: “Start the conversation by letting these individuals know they are in a safe space and allowing them to express themselves. If they (providers) have any questions about the individual’s gender identity, it's always best to ask over assuming.”
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