We can promote equity in healthcare for LGBTQ youth by providing affirmative, trauma-Informed, culturally humble and strength-based care.
The nine-year-old, assigned female at birth, sat in the doctor's office, parents nearby. Recently preferring conventionally male clothing, the child was there to discuss issues of gender identity. The parents were supportive of their child's expression and choices, curious to learn more about what they could do.
The doctor, Veenod Chulani, MD, MSEd, professor of pediatrics at the University of Arizona and chief of adolescent medicine at Phoenix Children's Hospital, checked his own bias with this family. He expected the child to be in distress, to feel stigmatized. Yet being raised in such a supportive and accepting family, there was little conflict. The family was open to whatever developed â€” whether the child was transgender, cisgender, homosexual or heterosexual.
What if all children, particularly LGBTQ youth, could feel so accepted?
In his talk "Promoting Health Equity for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth," now available for CME credit through AudioDigest, Dr. Chulani shares his insights from more than two decades of working with LGBTQ youth. He advocates for an affirmative, strength-based and trauma-informed clinical approach, one that promotes equity in healthcare for these historically marginalized groups.
Identity development and LGBTQ youth
Identity development is a core process of adolescence, and LGBTQ youth often experience it differently from cisgender or heterosexual youth. Gender-diverse and nonheterosexual youth may experience initial confusion as they recognize that their gender or sexuality is different from others'. They may feel the effects of a heteronormative environment while seeking their own community. They then must integrate their gender and sexuality identities into the rest of their developing identity. This process doesn't happen in a void; LGBTQ youth are developing in a society still full of stigma and disparities.
LGBTQ youth are more likely to experience hate crimes, discrimination and bullying. They have a higher risk of anxiety, depression and substance use. They're often economically insecure with unstable housing, lack of employment protections and sporadic healthcare coverage â€” especially in light of recent moves to reverse health protections for LGBTQ patients. Such adverse childhood experiences impact their future health outcomes.
Yet focusing on such negative aspects is an incomplete approach. Though as healthcare providers we must consider stigma, risks and exposures, we must also consider resilience, assets and strengths. Dr. Chulani emphasizes that we have a unique opportunity to help our LGBTQ adolescent patients address and explore their self-concept, lived experiences and life trajectory. In this way, we have a chance to promote equity in healthcare.
Promoting equity for LGBTQ youth in healthcare
Dr. Chulani advises that the care of LGBTQ youth requires four characteristics.
1. Affirmative care
We can affirm that being LGBTQ is an equally positive outcome in identity development as being heterosexual or cisgender. We can hire LGBTQ providers and staff. We can ask our LGBTQ youth to serve on advisory boards and inform clinical care and programming. We can connect our LGBTQ patients to community resources for further affirming care and support. We can partner with others who advocate for LGBTQ youth in schools, courtrooms and boardrooms to increase equity and reduce discrimination.
2. Trauma-Informed Care
LGBTQ youth can experience trauma due to stigma, discrimination and violence. We must acknowledge this reality and examine our service delivery to identify triggers of trauma and opportunities for support. Our healthcare systems can work to minimize retraumatization and support resilience. We must ensure safe clinical spaces and inclusive health materials. We can add questions about gender identity and sexual orientation to our patient records. We can ensure that our organizations have antidiscrimination policies inclusive of LGBTQ people.
3. Culturally humble care
We bring medical knowledge to our patients, but Dr. Chulani reminds us that "patients are experts on their lives, on their symptoms and on their strengths." We can continue our own lifelong education and self-reflection by learning from our LGBTQ patients' lived experiences and particular cultures.
4. Strength-based care
So much of the narrative around LGBTQ patients is framed in negatives â€” hardships, disparities and poor outcomes. We need to look equally at interventions that promote resilience and strength. We can promote the development of positive self-concepts in LGBTQ youth and develop language to help young people explore their own strengths.