WHAT DOE S I T RE AL L Y ACCOMPL I SH? Ja c k Burkha lte r, - - PowerPoint PPT Presentation
L GBT CUL T URAL COMPE T E NCE T RAINING: WHAT DOE S I T RE AL L Y ACCOMPL I SH? Ja c k Burkha lte r, PhD liz ma rg o lie s, L CSW Da nie l Brune r, J.D., M.P.P. GL MA s 35th Annua l Co nfe re nc e o n L GBT He a lth
Ja c k Burkha lte r, PhD liz ma rg o lie s, L CSW Da nie l Brune r, J.D., M.P.P.
GL MA’ s 35th Annua l Co nfe re nc e o n L GBT He a lth Phila de lphia , Pe nnsylva nia |Se pte mb e r 14, 2017
Danie l Br une r , Se nior Dir e c tor
Whitman- Walke r He alth
e de ra lly Qua lifie d He a lth Ce nte r in Wa shing to n, DC, with a spe c ia l missio n to the L GBT Q c o mmunity a nd to pe o ple living with HI V.
se rvic e s.
me dic a l stude nts, re side nts, me nta l he a lth a nd sub sta nc e a b use tre a tme nt pro fe ssio na ls, so c ia l se rvic e pro vide rs, e lde r a nd yo uth se rvic e pro vide rs a nd la wye rs.
Mo st in the pa st de c a de .
T ra ine e s inc lude d: me dic a l, nursing a nd c o unse ling stude nts (9); me dic a l re side nts (3); he a lth c a re a nd so c ia l se rvic e pro vide rs (9); he a lth c a re pro vide rs a nd o the r sta ff o f a c o rre c tio na l syste m (1).
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GBT (6); le sb ia n, g a y a nd b ise xua l pe rso ns (6); tra nsg e nde r a nd g e nde r no nc o nfo rming pe rso ns (5); L GBT e lde rs (4).
Wide ra ng e o f tra ining fo rma ts:
* L ist o f studie s a va ila b le o n re q ue st.
Pre -tra ining a nd po st-tra ining q ue stio nna ire o nly – usua lly a 5-
po int L ike rt Sc a le (9).
Pre -tra ining a nd po st-tra ining q ue stio nna ire + na rra tive q ue stio ns
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(4).
Atte mpts to a sse ss impa c ts o n pa tie nts (tra nsg e nde r inma te s in a
c o rre c tio na l syste m) (1).
Co mpa riso n o f impa c ts o f diffe re nt tra ining fo rma ts (1-2 ho urs vs.
6-ho urs) (1).
Mo de st, sig nific a nt impro ve me nts in kno wle dg e , a ttitude s a nd se lf-re po rte d c o mfo rt le ve l/ se lf-e ffic a c y.
One study: 6-ho ur tra ining s yie lde d g re a te r c o mfo rt with L GBT pa tie nts tha n 1-ho ur a nd 2- ho ur tra ining s.
Pa rtic ipa nts a lso te nd e d to b e c o me mo re a wa re o f he a lth-re la te d le g a l/ so c ia l/ institutio na l b a rrie rs fa c e d b y L GBT pe o ple – e .g ., insura nc e d isc rimina tio n a g a inst tra nsg e nd e r pe rso ns; le g a l c ha lle ng e s fa c e d b y L GBT fa milie s.
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a no the r sho we d re g re ssio n to b a se line le ve ls; a third ha d insuffic ie nt pa rtic ipa tio n to dra w c o nc lusio ns.
One surve y o f re side nts a t Bo sto n-a re a ho spita ls: c urric ula r ho urs ha d le ss impa c t
GBT pa tie nts.
Only o ne study a tte mpte d to a sse ss impa c ts o n pa tie nts:
No te tha t the tra ining s we re o nly o ne c o mpo ne nt o f a
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mpo rta nc e o f inc o rpo ra ting ra c ia l/ e thnic dive rsity, issue s o f inte rse c tio na lity, a nd a wide r ra ng e o f g e nde r ide ntitie s.
Pa rtic ipa nts ma y no t b e a wa re o f ra c ia l a nd o the r inte rse c tio na l c ha lle ng e s if tra ining s d o no t e xplic itly hig hlig ht the m.
Pa rtic ipa nts ma y a ssume tha t a ll tra nsg e nd e r pe o ple a re like the pa rtic ula r ind ivid ua l(s) the y sa w d uring the tra ining .
T
ra ine e s re po rt tha t the y a ppre c ia te inte ra c tive se ssio ns.
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b ut sho rt CME se ssio ns a re the no rm, e spe c ia lly fo r physic ia ns.
So me stud ie s o f ra c ia l/ e thnic c ultura l c o mpe te nc y inte rve ntio ns sug g e st tha t inte rve ntio ns fo c use d o n nurse s a re like ly to yie ld the mo st po sitive re sults.
Re q uire me nts in me dic a l sc ho o ls, nursing sc ho o ls, o the r
e duc a tio na l pro g ra ms.
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e g a l ma nda te s fo r CME fo r lic e nse s/ c e rtific a tio ns.
Give n the dive rsity o f se xua l o rie nta tio ns a nd g e nde r ide ntitie s,
a nd ra c ia l a nd e thnic dive rsity within tho se c o mmunitie s, fo c using o n a b a sic se t o f c o nc e pts a nd pra c tic e g uide line s ha s limita tio ns a nd ma y misle a d pra c titio ne rs.
Ma y b e mo re pro duc tive to fo c us o n skills (liste ning ,
c o mmunic a tio n).
“Cultura l humility” vs. “c ultura l c o mpe te nc e .” So me studie s o f tra ining s to impro ve physic ia n liste ning a nd
c o mmunic a tio n skills ha ve sho wn impro ve me nts in pa tie nt sa tisfa c tio n, e ng a g e me nt in c a re , a nd he a lth indic a to rs.
T
But c ultura l c o mpe te nc y/ humility tra ining s fo r pro vide rs
Da nie l Brune r, J.D., M.P.P liz ma rg o lie s, L CSW Ja c k Burkha lte r, PhD .
F unde d b y the NY Sta te De pa rtme nt o f He a lth, AI DS I nstitute ,, Co ntra c t # CO28649
Unit 1- Intr
Se ts the sta g e fo r the g ro up to b e a b le to wo rk, sa fe ty
Unit 2- T he Basic s
De fine s the te rms a nd de fine s WHY it’ s impo rta nt to ide ntify whic h c lie nts/ pa tie nts a re L GBT .
Unit 3- Inte r se c tionality
Pla c e s L GBT ide ntitie s into a b ro a de r c o nte xt a nd a sks pa rtic ipa nts to lo o k a t the pub lic / priva te , privile g e d/ o ppre sse d pa rts
Unit 4- L GBT He alth Dispar itie s
T e a c he s fa c ts a b o ut L GBT he a lth a nd, c umula tive ly, b ring s a b o ut c ha ng e s in a ttitude , o nc e pa rtic ipa nts se e the diffic ultie s L GBT pe o ple fa c e
Unit 5- Cr e ating a We lc oming E nvir
Addre sse s b e ha vio r a nd syste mic c ha ng e s tha t he a lth a nd
Ja c k Burkha lte r, PhD, Me mo ria l Slo a n K e tte ring Ca nc e r Ce nte r, Ne w Yo rk City liz ma rg o lie s, L CSW, Na tio na l L GBT Ca nc e r Ne two rk, Ne w Yo rk City Imra n Muja wa r, MBBS, MS, Wa shing to n, D.C. Re j Jo o , MPH
F unde d b y the NY Sta te De pa rtme nt o f He a lth, AI DS I nstitute , Co ntra c t # CO28649 Ja c k Burkha lte r, Ph.D. a lso suppo rte d b y NI H/ NCI Ca nc e r Ce nte r Suppo rt Gra nt P30 CA008748
Pr e - and post- tr aining se lf- r e por t me asur e s of KASI Knowle dge o f L GBT he a lth c o nc e rns a nd dispa ritie s. Positive Attitude s to wa rds wo rking with L GBT c lie nt/ pa tie nts. Se lf- e ffic ac y (c o nfide nc e ) in c o mmunic a ting with a nd he lping L GBT c lie nts/ pa tie nts Inte ntions to a pply c ultura l c o mpe te nc e kno wle dg e a nd skills in inte ra c tio ns with L GBT c lie nts o r pa tie nts.
Ex: If a man identifies as straight and has sex with another man, then he is gay or bisexual. (T or F)
Ex: I would be comfortable if I became known among my peers as someone who supports LGBTQ clients/patients, and/or colleagues.
Ex: When meeting a new patient, how confident are you in your ability to ask gender identity questions that are appropriate to your job?
Ex: How likely are you to intervene in a homophobic interaction at your workplace?
Knowle dge Attitude s Se lf- e ffic ac y Be havior al Inte ntions Be havior
Asse sse d in the C3 training No t Asse sse d in the C3 training
Cha r a c te r istic N (% ) Ge nde r ID Cis- F e ma le 190 (77.6% ) Cis- Ma le 46 (18.8% ) T r a nsg e nde r:inc luding : g e nde r que e r / non-g e nde r / que stioning / T wo- spir it 51 (18.6% ) Se xua l or ie nta tion He te r
199 (76.2% ) L GB 25 (10% ) Ase xua l/ pa nse xua l/ Que e r Que stioning / T wo-spir it 37 (14% ) Cha r a c te r istic N (% ) Ag e : 17- 30 105 (38.5% ) 31- 50 117 (42.9% ) >51 51 (18.6% ) E duc a tion <Hig h sc hool 37 (13.6% ) Assoc ia te s (2 yr .) CASAC/ T e c hnic a l tr a ining 52 (19.1% ) Ba c he lor s (4 yr .) 69 (25.3% ) Ma ste r s 103 (37.7% ) Doc tor a te / JD 12 (4.4% ) R a c e : Afr ic a n Ame r ic a n/ Bla c k 77 (28.6% ) Asia n/ S. Asia n/ PI 13 (4.8% ) Ca uc a sia n (non- Hispa nic ) 120 (44.6% ) L a tino/ Hispa nic 51 (19.0% ) Multi- r a c ial 14 (5.2% )
Re sults: K
no wle dg e impro ve d sig nific a ntly pre - to po st-te st. (Wilc o xo n sig ne d ra nks te st, p<.001)
Note : Sc o re ra ng e fro m 0 to 7 c o rre c t re spo nse s o n kno wle dg e ite ms.
Re sults: a ttitude s we re g e ne ra lly po sitive to b e g in with, b ut the y impro ve d sig nific a ntly
fro m pre - to po st-te st. (Wilc o xo n sig ne d ra nks te st, P = .001)
Note : sc o re ra ng e fro m 0 to 15 o n a ttitude ite ms.
Re sults: se lf-e ffic a c y wa s g e ne ra lly hig h to b e g in with, b ut it impro ve d sig nific a ntly
fro m pre - to po st-te st. (Wilc o xo n sig ne d ra nks te st, p<.001)
Note : sc o re ra ng e fro m 0 to 8 o n se lf-e ffic a c y ite ms.
Re sults: b e ha vio ra l inte ntio ns we re g e ne ra lly hig h to b e g in with, b ut the y impro ve d
sig nific a ntly fro m pre - to po st-te st. (Wilc o xo n sig ne d ra nks te st, P<.001)
Note : sc o re ra ng e fro m 0 to 8 o n se lf-e ffic a c y ite ms.
with cisgender men less likely to show pre-post attitude improvement compared to cisgender women (p < 0.0001), but were more likely to have higher scores overall, indicating a ceiling effect.
year college vs. more), and cisgender women (vs. cisgender men) (all p’s < .0001) were significantly and positively associated with a pre-post improvement in self-efficacy. Interpret with caution as findings could be attributed to a ceiling effect for the self-efficacy variable.
Knowle dge Attitude s Se lf- e ffic ac y Be havior al Inte ntions Re sults: se lf-e ffic a c y inc re a se a lo ne
wa s sig nific a ntly a sso c ia te d with pre - po st impro ve me nt in inte ntio n
[Odds r atio 1.49 (1.25, 1.79); p < 0.0001].
post-training supports a positive short-term impact on critical behavior change variables
trainees, is difficult and costly to assess
attitudes and self-efficacy, e.g., cisgender showed less improvement compared to cisgender women, although there were ceiling effects in these measures that suggest caution in interpreting the associations
refinement to capture the range of pre-test responses as well as be sensitive to training impact