Are Multicultural Courses Addressing Disparities? Exploring Multicultural and Affirmative Lesbian, Gay, and Bisexual Competencies of Counseling and Psychology Students

Assessment of Transgender/Gender-Expansive Accessibility in Inpatient Pediatric Mental Health Facilities

Purpose

This study surveyed a national sample of inpatient pediatric behavioral health facilities on policies related to care for transgender and gender-expansive (TGE) youth to assess adherence to best practices.

Methods

Staff/providers at youth inpatient psychiatric facilities were recruited by phone or email. Participants completed an electronic survey on facilities' training policies, staff comfort related to gender diversity, and other policies related to caring for TGE youth.

Results

Of 479 potential participating facilities, 124 surveys were initiated and 59 were completed. Measures to ensure accessibility to TGE patients are present in many facilities surveyed, with most reporting that their facility had nondiscrimination policies in place (86.2%) and required training on working with TGE patients (52.5%). A minority of participants (12.1%) reported that their facility roomed TGE youth based on sex assigned at birth, although only a small portion roomed based on gender identity alone (19.0%). Slightly more than two-thirds stated that their facility had individual restrooms available. Most participants (74.6%) stated that facility staff were comfortable discussing gender diversity in general, although this was less common for other topics related to TGE patient care.

Conclusion

Our survey highlights efforts made by inpatient behavioral health facilities to ensure accessibility of services to TGE youth, although our results showed notable differences across facilities. Given inconsistent federal protections for TGE patients, there remains a need for efforts to ensure that TGE youth are receiving all possible support in these treatment settings, such as accessible restrooms and bedroom assignments, as well as the opportunity to room with peers.

Neuropsychological assessment with lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals: Practice, education, and training survey

Objective: We sought to describe the LGBTQ + related education, training, and clinical practice of independently licensed neuropsychologists in the United States and to identify factors that predict affirmative neuropsychological practices. We hypothesized that LGBTQ + identity, female gender, more recent training, and extent of LGBTQ + education/training would predict use of LGBTQ + practice guidelines. Method: A workgroup of clinical psychologists with experience in LGBTQ + psychology and neuropsychology developed a survey to identify personal and professional factors that predict affirmative neuropsychological testing practices. The survey was distributed through professional organizations and listservs between August and September 2021 with 118 responses meeting inclusionary criteria. Results: The majority of participants identified as heterosexual (70.3%) and cisgender (97.5%), and most (48-63%) received LGBTQ + training post-licensure. Between 19% and 32% of participants reported never completing LGBTQ + specific education. Consistent with our hypotheses, factors predicting affirmative clinical practice behaviors were LGBTQ + education/training, and personal background (sexual minority status, female/feminine gender, and years since degree). Other significant factors included prior experience with LGBTQ + patients and primary patient population (child vs. adult). Qualitative responses indicated varying values, attitudes, and knowledge regarding collection of LGBTQ + information and modification of clinical practice. Conclusions: Neuropsychologists underutilize affirming practices as evidenced by low rates of querying pronouns, knowing whether LGBTQ + health information is available at their institutions, and adjusting evaluation and feedback approaches. We provide specific training and education recommendations to increase knowledge and skills and to address beliefs about LGBTQ + health that can serve to promote affirmative neuropsychological practice.

Trends in mental health service utilization among LGB+ college students

OBJECTIVES

1) Compare service utilization among LGB+ and straight-identified students. 2) Assess rates of mental health concerns among LGB+ students only. Participants: Undergraduates (N = 675) reported on their sexual orientation, mental health conditions, and past service providers. Methods: Logistic regression was used for aim 1 and descriptive statistics for aim 2. Results: LGB+ students were more likely than straight-identified students to seek services for anxiety (odds ratio [OR] = 2.051; p < .01) or depression (OR = 3.058; p < .001) and from a counselor/therapist/psychologist (OR = 2.937; p < .001) or their university's counseling/health services (OR = 1.933; p < .01). Bisexual students utilized the most services. Conclusions: Colleges must ensure that programing, outreach, and overall support for the mental health needs of their LGB+ students are being met so that this vulnerable population continues to seek services.

Transphobia Among Students Majoring in the Helping Professions

The study was designed to further the understanding of transphobia among students majoring in the helping professions including social work, occupational therapy, and nursing. The study's hypotheses examined the effects of transgender content in education (e.g., textbooks and lectures), religiosity, contact with transgender people, and several sociodemographic variables with transphobia. Differences in transphobia levels between social work students and those in aligned professions were also explored. The sample consisted of 600 students of a public, urban university in New York City who participated in an online survey. Measures included transphobia and transgender content scales. Students reported (75%) a deficient amount of transgender content in education, and almost one half of the sample reported moderate to high levels of transphobia. Other findings showed that transgender content in education was positively correlated with transphobia, and 1-way ANOVA showed that transphobia differed significantly across the majors. The author suggestions included increasing transgender content in textbooks, lectures, and class discussions as well as developing field sites that provide students with opportunities to serve this population.

Contextualizing Competence: Language and LGBT-Based Competency in Health Care

Changes in the language and terminology used to refer to individuals identifying as lesbian, gay, bisexual, and transgender (LGBT), as well as how best to discuss issues of sexual and gender identity, can prove challenging for health care providers due to (1) lack of training; (2) interdisciplinary issues; and (3) prejudices on personal and institutional levels. Given the importance of language in the relationship between health care provider and patient as well as the myriad ways in which language can reflect knowledge, skills, and attitudes, we contend that language is both a facilitator and inhibitor of competence. In this article, we discuss language as a means of exhibiting cultural competence as well as the barriers to facilitating this degree of competence. Communicative competence, a concept traditionally used in linguistics, is discussed as a framework for contextualizing LGBT-specific cultural competence in health care. Ideally, a professional will be considered competent once they (1) acquire a foundation in issues associated with LGBT individuals, as well as a basic understanding of appropriate vocabulary' (2) reconcile personal beliefs with their professional role; (3) create an inclusive healthcare environment such that the influence of personal biases does not negatively impact care; and (4) use identifiers suggested by the patient.

Educational Program to Improve Provider Knowledge, Attitudes, and Behavior in Lesbian, Gay, Bisexual, and Transgender Self-Disclosure

Lesbian, gay, bisexual, and transgender (LGBT) individuals have long been subject to discrimination. This has led to the fear of victimization and the overall avoidance of health care services and increasing health disparities in this group. Health care providers, including nurses who have limited knowledge, poor attitudes, and behavior, have been shown to significantly dilute the patient-provider relationship. This reduces self-disclosure and increases likelihood of poor outcomes of the LGBT individual. An educational program was developed to focus on health care providers (n = 8) knowledge, attitudes, and behavior in LGBT self-disclosure. A pretest, posttest methodology was used to assess the aforementioned concepts using a 29-item sexual orientation counselor competency scale. All measured concepts showed clinical significance with highest being self disclosure, which revealed both clinical and statistical significance from (SD) 1.0 to 1.63, a 63% increase. The implications of these findings on the current and future practice of health care providers and nurses support cultural competency training for both practicing health care professionals and students in educational curriculums.