Chat with us, powered by LiveChat Care of the LGBTQ Community After review of the sources provided under the week 6 content tab and the assigned readings, watch the following video and answer the following questions. LGBT He | EssayAbode

Care of the LGBTQ Community After review of the sources provided under the week 6 content tab and the assigned readings, watch the following video and answer the following questions. LGBT He

 

OPTION 1: Care of the LGBTQ Community

After review of the sources provided under the week 6 content tab and the assigned readings, watch the following video and answer the following questions.

LGBT Healthcare Training Video: "To Treat Me, You Have to Know Who I Am"

https://www.youtube.com/watch?v=NUhvJgxgAac&feature=youtu.be 

Think back to your nursing school experience and reflect on the new hire orientation program in your employer organization.

 - Was the care of special populations like the LGBTQ community addressed in your nursing education or orientation? If so, how? If not, what was missing?

-Based on the readings and video, what do you propose could be done to strengthen the orientation program at your organization or in your basic nursing education in regards to caring for special populations like the LBGTQ community?

-What changes will you make to your own personal nursing practice as a result of what you are learning this week?

-Must be in APA 

-Must use journal articles attached as references and youtube video provided in link 

QUAL WOM

The580

LGBTQ E

ITY EN Me

Journa

ducation: Earn Your “A”

The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community is estimated to represent 3.5% of the adult popu- lation in the United States, roughly 9 million people.1 A substantial proportion of that number are people who identify as female. This group suffers significant health disparities linked to a long-standing history of discrimination, stigmatization, and the denial of many civil rights.2 LGBTQ populations experience high rates of substance abuse, suicide, mental health

CARE FOR ’S HEALTH gan Spiekermeier,

DNP, WHNP

disorders, homelessness, obesity, sexually transmitted infections (STIs), and violence.1-4

LGBTQ persons are less likely to seek preven- tive services due to lack of insurance coverage or fear of stigmatization and discrimination.1

Women already face significant health disparities based on sexism; intersecting forms of discrim- ination (homophobia, transphobia, stigmatiza- tion, or even ambivalence) can compound the negative effects on women’s physical and mental health and overall well-being.5 Results from the Lambda Legal Health Care Fairness Survey revealed that respondents who identified as female within the LGBTQ population surveyed were more likely than their nonfemale coun- terparts to experience barriers to health care services, discrimination, and incompetent care.5

In the survey, female respondents were most affected by the denial of infertility services and taxation of same-sex partner benefits.5 There were greater percentages of female respondents

l for Nurse Practitioners – JNP

that reported being treated differently than other people at health care appointments and who felt that health care providers were unaware of LGBTQ-specific needs.5 Many female respondents cited barriers to care including: insufficient numbers of health care professionals trained to care for LGBTQ people; the possibility of being refused care based on gender identity or sexual orientation; and the fear of mistreatment.5 These barriers can lead to reluctance to seek care, and thus, poorer health outcomes for LGBTQ individuals and families.

Healthy People 2020 established a goal to “improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender individu- als.”2(p1) Although increased societal acceptance and legal nondiscrimination policies have improved access to health care and insurance for the LGBTQ community, policies do not guar- antee provider competence or freedom from discrimination.1 Despite recommendations from several expert panels for LGBTQ cultural competency training for health care profes- sionals, traditional medical and nursing education curricula provide limited to no content on LGBTQ issues.3 As a result, there is a shortage of clinicians who are knowledgeable and culturally competent in LGBTQ health.

Nurses comprise the largest portion of direct patient care providers and are often the first health care provider a patient encounters. Yet, nurses report that they do not feel comfortable or prepared to care for LGBTQ patients and desire additional education.4 As leaders in the nursing profession, advanced practice registered nurses could address the needs of the LGBTQ community. Proper training and education on gender and sexual minorities could foster trusting patient- provider relationships, increase identification of gender and sexual minority patients, and in- crease provider competency in assessment and diagnosis of health care problems impacting LGBTQ persons. By decreasing barriers to

Volume 13, Issue 8, September 2017

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care, more LGBTQ persons may seek pre- ventive health services, have more confidence in the health care system, and live healthier and longer lives. Addressing gaps in education may benefit the LGBTQ population and the com- munity at large in the form of increased quality and quantity of life, reduction in disease transmission and progression, and decreased health care costs.2 For these reasons, it is imperative that the nursing profession take action within education institutions, health policy, and within communities to insure inclusive and culturally competent care for the LGBTQ population. The National LGBT Education Center of the Fenway Institute offers many online training, education, and resources for healthcare institutions to integrate into their programs.6 To aid in the integration of LGBTQ education into nursing curricula, national nursing standards and competencies should reflect stronger language or mandates for the inclusion of LGBTQ cultural competency training. Together these recommendations will likely improve nursing competencies in LGBTQ care and create a competent nursing workforce across all health care settings.

In conclusion, nursing has long been the most trusted profession that places the utmost importance on the role of patient advocate, yet, we have failed in our ethical responsibility to address the needs of our LGBTQ patients and families. As criteria for defining sexual orientation, gender identity and expression continue to evolve, letters are

ww.npjournal.org

being added to the acronym. The letter “A” has begun to appear to stand for “ally” to acknowledge those that stand ready to support the LGBTQ community. By advo- cating for strong LGBTQ content in health profession curricula, advanced practice regis- tered nurses could enable more clinicians to be prepared to apply evidence-based best practice for this vulnerable population and earn their “A.”

References

1. Kates J, Ranji U, Beamesderfer A, et al. Health and access to care and

coverage for lesbian, gay, bisexual, and transgender individuals in the

U.S. The Henry J. Kaiser Family Foundation. November 11, 2016.

http://kff.org/disparitiespolicy/issue-brief/health-and-access-to-care

-and-coverage-for-lesbian-gay-bisexual-and-transgender-individuals

-in-the-u-s/. Accessed May 23, 2017.

2. Healthy People 2020. Lesbian, gay, bisexual, and transgender health.

https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian

-gay-bisexual-and-transgender-health/. Accessed May 23, 2017.

3. Lim FA, Brown DV, Kim SM. Addressing health care disparities in the

lesbian, gay, bisexual, and transgender population: a review of best

practices. Am J Nurs. 2014;114(6):24-34. 4. Carabez R, Pellegrini M, Mankovitz A, et al. “Never in all my years.”:

nurses’ education about LGBT health. J Prof Nurs. 2015;31(4): 323-329.

5. Lambda Legal. When health care isn’t caring: LGBT women. 2010.

http://www.lambdalegal.org/sites/default/files/publications/

downloads/whcic-insert_lgbt-women.pdf/. Accessed May 23, 2017.

6. National LGBT Education Center: Fenway Institute. What we offer.

https://www.lgbthealtheducation.org/about-us/lgbt-health-education/.

Accessed May 23, 2017.

Megan Spiekermeier, DNP, WHNP, is a recent graduate of the ASU Women’s Health NP program. She can be reached at [email protected] Department Editor Denise G. Link, PhD, WHNP, FAAN, FAANP, who would like to hear your ideas for future columns, can be reached at [email protected]

1555-4155/17/$ see front matter

© 2017 Elsevier Inc. All rights reserved.

http://dx.doi.org/10.1016/j.nurpra.2017.05.091

The Journal for Nurse Practitioners – JNP 581

Reproduced with permission of copyright owner. Further reproduction prohibited without

permission.

  • LGBTQ Education: Earn Your “A”
    • References

,

Development and Evaluation of Training for Rural LGBTQ Mental Health Peer Advocates

Tania Israel University of California, Santa Barbara

Cathleen E. Willging Pacific Institute for Research and Evaluation,

Albuquerque, New Mexico

David Ley New Mexico Solutions, Albuquerque, New Mexico

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people in rural areas experience negative mental health consequences of minority stress, and encounter multiple barriers to accessing mental health and substance use treatment services. As part of a larger intervention study, we developed and piloted a unique training program to prepare peer advocates for roles as paraprofessionals who assist rural LGBTQ people with mental health needs. Thirty-seven people in New Mexico took part in either the initial training or a second revised training to improve their knowledge and skills to address LGBTQ mental health needs. Evaluation of this training consisted of self- administered structured assessments, focus groups, and open-ended interviews. Results for the initial training showed no significant increases from pre- and posttest scores on knowledge about LGBTQ people and their mental health issues, whereas significant increases were detected for the revised training. There also were significant increases in self-efficacy to perform tasks associated with the peer advocate role for all but a subset of tasks for the revised training. Qualitative data reveal that participants appreciated the opportunity to increase information and skills, especially concerning bisexual and transgender persons, and the opportunity to connect with others in the community who want to support LGBTQ people.

Keywords: LGBTQ, mental health, peer, rural, training

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people in the United States experience tremendous mental health and substance use disparities (Institute of Medicine, 2011). High rates of depression, anx- iety, and suicidality within the LGBTQ popula- tion may originate in “minority stress,” which comprises chronic stigma, discrimination, and

violence (Meyer, 2003). Minority stress oper- ates within cultural institutions and social struc- tures, including health care systems (Meyer, 2003; Meyer, Schwartz, & Frost, 2008), and may disproportionately affect gender noncon- forming individuals, people of color, and rural LGBTQ persons (Díaz, Bein, & Ayala, 2006; McLaughlin, Hatzenbuehler, & Keyes, 2010; Pinhey & Millman, 2004; Williams, Bowen, & Horvath, 2005).

With regard to rural communities, LGBTQ people may face social pressure to adhere to tra- ditional gender roles and norms (Barefoot, Rick- ard, Smalley, & Warren, 2015), as well as nega- tive attitudes related to lack of contact with sexual and gender minorities (Barefoot et al., 2015; El- dridge, Mack, & Swank, 2006; Herek, 2002; Sniv- ely, Kreuger, Stretch, Watt, & Chadha, 2004). Victimization—verbal harassment, property dam- age, and physical assault—is commonly reported by rural LGBTQ people (Barefoot et al., 2015;

Tania Israel, Department of Counseling, Clinical, and School Psychology, University of California, Santa Bar- bara; Cathleen E. Willging, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico; David Ley, New Mexico Solutions, Albuquerque, New Mexico.

The project described in this article was supported by NIMH R34MH095238.

Correspondence concerning this article should be ad- dressed to Tania Israel, Department of Counseling, Clinical, and School Psychology, Gevirtz School, University of Cal- ifornia, Santa Barbara, CA 93106-9490. E-mail: [email protected] education.ucsb.edu

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Journal of Rural Mental Health © 2016 American Psychological Association 2016, Vol. 40, No. 1, 40–62 1935-942X/16/$12.00 http://dx.doi.org/10.1037/rmh0000046

40

Boulden, 2001; Cody & Welch, 1997; Leedy & Connolly, 2008; Oswald, Gebbie, & Culton, 2003). Some LGBTQ people migrate from rural to urban areas in search of robust LGBTQ com- munity, leaving those who remain in rural areas further lacking in social support. Geographic iso- lation, insufficient opportunity to socialize with other LGBTQ people, and the perceived need to conceal gender or sexual identities can contribute to mental distress, erode social support, and result in fewer visible LGBTQ role models in rural areas (Barefoot et al., 2015; Leedy & Connolly, 2008; Mathy, Carol, & Schillace, 2004; McCarthy, 2000; Oswald & Culton, 2003).

Rural residents in general, but especially those who self-identify as LGBTQ, report hard- ship accessing high quality mental health care, often because services are in short supply (Wil- liams, Williams, Pellegrino, & Warren, 2012). The quality of support LGBTQ people can ex- pect from available mental health and substance use treatment providers varies. Clinical provid- ers often lack culturally appropriate training and fail to recognize how minority stress affects LGBTQ people, while the broader setting where services are rendered may lack safeguards to ensure that neither individual nor institutional bias influences care (Eliason & Hughes, 2004; Israel, Ketz, Detrie, Burke, & Shulman, 2003; Israel, Walther, Gortcheva, & Perry, 2011; Mahdi, Jevertson, Schrader, Nelson, & Ramos, 2014; Walinsky & Whitcomb, 2010; Willging, Salvador, & Kano, 2006a; Willging, Salvador, & Kano, 2006b).

One means of addressing such deficits within systems of mental health and substance abuse treatment is to employ people who are members of the target community to bridge the gap in culturally competent care. Peer-based ap- proaches draw upon established community health worker models and represent a growing practice in mental health treatment (Getrich, Heying, Willging, & Waitzkin, 2007; Waitzkin et al., 2011; Weeks et al., 2009a; Weeks et al., 2009b). Peer helpers have been employed for a range of populations and medical concerns, in- cluding diabetes management (Tang, Funnell, Gillard, Nwankwo, & Heisler, 2011), serious mental illness among veterans (Chinman, Sal- zer, & O’Brien-Mazza, 2012), maternal/child health, and general health promotion (O’Brien, Squires, Bixby, & Larson, 2009). Consistent with such models, we recruited and trained

community health workers, called “peer advo- cates,” to enhance social support and access to professional services for LGBTQ residents of rural areas (Willging & Israel, 2012). These peer advocates were lay people who were mem- bers of, or strongly connected to, LGBTQ com- munities and who were willing to develop knowledge and skills to address LGBTQ mental health issues. Peer advocates were expected to undertake a wide range of complex tasks, in- cluding needs assessment, goal setting, referral, assistance navigating behavioral health systems, and community outreach, and to enhance knowl- edge about, and social support for, LGBTQ peo- ple in rural communities. These peer advocates were employed as paid, part-time community health workers who received regular coaching and support from the project staff.

Preparation of peer advocates to perform these complex roles is essential (Ruiz et al., 2012). Training can increase the ability of para- professionals, such as peer advocates, to use basic helping skills (Aladağ & Tezer, 2009; D’Augelli & Levy, 1978) and to provide effec- tive support to people seeking mental health services (Lenihan & Kirk, 1990), although ex- tant research does not offer insight into the effectiveness of training to prepare peer advo- cates to perform complex tasks beyond individ- ual helping relationships, such as organizing events or building support networks. Although training can increase mental health profession- als’ knowledge and skills in working with gen- der and sexual minorities (Carlson, McGeorge, & Toomey, 2013; Israel & Hackett, 2004), and LGB-affirmative supervision can enhance LGB counselors’ work with LGB clients (Burkard, Knox, Hess, & Schultz, 2009), prior research has not addressed training that is designed spe- cifically for lay members of LGBTQ communi- ties to assist other sexual and gender minorities with mental health concerns. Although mem- bers of LGBTQ communities may have some LGBTQ-specific knowledge based on their lived experiences, distinctions among subpopu- lations (Fassinger & Arseneau, 2007) necessi- tates training on LGBTQ issues even for mem- bers of these communities.

We report here on our effort to train LGBTQ community members to function as peer advo- cates. This study was part of a larger project to design, implement, and assess the acceptability, feasibility, and preliminary outcomes of the

41TRAINING RURAL LGBTQ PEER ADVOCATES

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overall LGBTQ peer advocate intervention model. To obtain the knowledge and skills needed to implement this model, peer advocates took part in a 4-day series of didactic and in- teractive training exercises that were evaluated and subsequently refined based on feedback from training participants. Because they were based physically in dispersed rural communi- ties, peer advocates were to participate in indi- vidual and group coaching sessions conducted remotely rather than receive onsite supervision. Thus, it was important for peer advocates to be able to deliver interpersonal and community interventions fairly independently. Research on the effectiveness of training initiatives that pre- pare paraprofessionals for such roles is an im- portant component of developing evidence- based interventions (O’Brien et al., 2009; Ruiz et al., 2012; Tang et al., 2011).

The aim of the present study was to use a two-step process to develop, implement, evalu- ate, and revise the LGBTQ peer advocate train- ing. Evaluation involved quantitative measures of knowledge, self-efficacy, and participant re- sponses to specific aspects of the training, as well as qualitative analysis of focus group and

individual semistructured interview data. This study offers new insights by (a) focusing on training rural residents, (b) training members of LGBTQ communities to work within these communities, (c) assessing helpers’ skills be- yond those used in a one-on-one helping rela- tionship, and (d) employing a mixed-method evaluation approach to capture short- and long- term impacts of the training.

Method

Description of Training

Development and initial training. The training was developed and administered by the authors, an academic psychologist/educator, a medical anthropologist, and a practicing psy- chologist/service agency administrator who col- lectively have expertise in three areas pertinent to this study: (a) LGBTQ mental health, (b) engaging LGBTQ people in rural New Mexico for research or clinical purposes, and (c) curricu- lum development. As shown in Table 1, the initial training was organized into 12 modules, with de- scription, purpose, and learning objectives articu-

Table 1 Content of Initial and Revised Training

Initial training Revised training

Part 1

Introductions, icebreaker, communication Introductions, icebreaker, communication Key information about LGBTQ populations LGBTQ people and communities; helping skills Understanding LGBTQ populations in rural New

Mexico Mental health and substance use among LGBTQ people LGBTQ people and suicide Diversity within LGBTQ communities and cultural inquiry Mental health and substance use treatment services for

LGBTQ populations

Mental health and substance abuse among LGBTQ people

Mental health and substance use services for LGBTQ populations

Helping skills Suicide risk, crisis intervention, and other

emergencies

Part 2

Empowerment protocol Overview of Peer Advocate role Ethics and boundaries Communication with service providers and others Conducting outreach and cultivating social

support resources Challenging situations, closure

Working individually with LGBTQ community members (solution-focused approach, needs assessment, collaborative planning)

Working with service providers and others Ethics and boundaries Self-care Outreach, advocacy, presentations, social support Self-assessment of helping and leadership for LGBTQ

community (including privilege)

42 ISRAEL, WILLGING, AND LEY

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