Personal and Professional Discord: Examining Religious Conservatism and Lesbian-, Gay-, and Bisexual-Affirmative Counselor Competence

Working With Lesbian, Gay, Bisexual, and Transgender Clients: Occupational Therapy Practitioners' Knowledge, Skills, and Attitudes

IMPORTANCE

A lack of health care provider knowledge and training has been identified as one factor that contributes to health disparities for sexual and gender minority (SGM) populations.

OBJECTIVE

To explore occupational therapy practitioners' self-reported knowledge about, clinical preparedness for, and attitudes toward working with lesbian, gay, bisexual, and transgender (LGBT) clients.

DESIGN

Online survey of occupational therapy practitioners.

PARTICIPANTS AND SETTING

Respondents were recruited by means of snowball sampling through social media groups, state occupational therapy association websites, and emails. Surveys were posted to electronic occupational therapy social media sites.

MEASURES

Knowledge, clinical preparedness, and attitudes were measured using the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS). Information about demographic characteristics, education, and workplace was also collected.

RESULTS

Five hundred eighty-nine occupational therapy practitioners responded to the survey. Degree level (master's vs. bachelor's or less), continuing education (minimum 1-2 hr of LGBT-specific training), practice setting (mental health), minority sexual orientation, and having a close friend or family member who identifies as SGM were associated with higher mean scores on the LGBT-DOCSS. Higher religiosity and frequency of religious practice were associated with lower scores on knowledge and attitudinal awareness.

CONCLUSIONS AND RELEVANCE

Occupational therapy practitioners often care for clients from backgrounds and cultures that differ from their own. Identifying gaps in education and opportunities for fostering LGBT-positive attitudes can facilitate the development of programs to improve practice with LGBT clients and help measure the effectiveness of such programs. What This Article Adds: This study provides evidence that a basic level of continuing education can improve occupational therapy practitioners' knowledge of and skills for working with LGBT populations and highlights the need to examine and change structural biases.

Personal Faith and Professional Ethics: Best Practice with the Families of Sexual and Gender Minority Youths

Religious mental health practitioners who hold traditional views of gender and sexuality may face moral and ethical dilemmas when working with sexual and gender minority (SGM) clients. Typical responses to this dilemma include selective positioning, values-based referrals, and attempted objectivity. Grounded in social work ethics and values, this article examines the evidence base, viability, and repercussions of these approaches. This article demonstrates the importance of cultural competence and affirmative therapeutic practices for religious mental health practitioners, whether or not they expect to work with gender and sexual minority clients or their families. In addition, the author tackles the difficult issue of providing ethical, evidence-based therapeutic services for religiously conservative parents of SGM children and adolescents. SGM people exist in every community, in every faith, and in every kind of family. The ethical treatment of SGM clients is relevant to all mental health practitioners, regardless of personal values or the type of practice they maintain.

The Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS): Establishing a New Interdisciplinary Self-Assessment for Health Providers

These three studies provide initial evidence for the development, factor structure, reliability, and validity of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS), a new interdisciplinary LGBT clinical self-assessment for health and mental health providers. Research participants were voluntarily recruited in the United States and United Kingdom and included trainees, clinicians, and educators from applied psychology, counseling, psychotherapy, and primary care medicine. Study 1 (N = 602) used exploratory and confirmatory factor analytic techniques, revealing an 18-item three-factor structure (Clinical Preparedness, Attitudinal Awareness, and Basic Knowledge). Study 2 established internal consistency for the overall LGBT-DOCSS (α = .86) and for each of the three subscales (Clinical Preparedness = .88, Attitudinal Awareness = .80, and Basic Knowledge = .83) and 2-week test-retest reliability (.87). In study 3 (N = 564), participant criteria (sexual orientation and education level) and four established scales that measured LGBT prejudice, assessment skills, and social desirability were used to support initial content and discriminant validity. Psychometric properties, limitations, and recommendations are discussed.

An Interdisciplinary Approach to Lesbian, Gay, Bisexual, and Transgender Clinical Competence, Professional Training, and Ethical Care: Introduction to the Special Issue

There are exigent reasons to foster lesbian, gay, bisexual, and transgender (LGBT) competence, training, and ethical care for health professionals within an interdisciplinary paradigm. LGBT individuals experience serious health and psychosocial disparities; moreover, these inequalities can be amplified when other aspects of diversity such as race, ethnicity, age, gender, religion, disability, and socioeconomic status intersect with sexual orientation and gender identity (Institute of Medicine [IOM], 2011). While the origins of LGBT health and psychosocial disparities are manifold, deficiencies in professional training, ethical care, and clinical competence are underlying contributors (IOM, 2011). In addition, LGBT clinical competency advancements are often siloed within the various health care disciplines-thus advances by one group of health professionals often have limited impact for those practicing in different health and human service fields. This special issue explores LGBT clinical competence, professional training, and ethical care within an interdisciplinary context and, to our knowledge, represents the first attempt to address LGBT clinical competence from a multidisciplinary health care perspective.

Social Justice Identity

This exploratory, phenomenological qualitative study was designed to investigate the phenomenon of social justice identity by understanding respondents’ lived experiences with social justice efforts. Data analysis yielded four themes describing the lived experiences of respondents’ social justice identity. Implications for training, supervision, and research are included.