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 Phila de lphia , Pe nnsylva nia |Se pte mb e r 14, 2017

Impa c ts of L GBT Cultura l Compe te nc y T ra ining of He a lth Ca re a nd Soc ia l Se rvic e Profe ssiona ls: Studie s to Da te Danie l Br une r , Se nior Dir e c tor of Polic y Whitman- Walke r He alth

Whitman- Walke r He alth F 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. Outpa tie nt me dic a l, b e ha vio ra l he a lth, le g a l a nd c o mmunity he a lth • se rvic e s. Mo re tha n 16,000 pa tie nts in 2016. • Whitma n-Wa lke r sta ff a nd vo lunte e rs c o nduc t nume ro us tra ining s fo r • 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.

Surve y a nd Ana lysis of 21 Re porte d Studie s of L GBT Cultura l Compe te nc y T ra ining s*  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).  F o c us o f tra ining s: g e ne ra l L 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: Brie f se ssio ns – o ne ho ur o r le ss (2).  One -time se ssio n o f 2-3 ho urs (7).  5 ho urs to a full da y (3).  Multiple se ssio ns o ve r a se me ste r o r o the r pe rio d o f time (3).  No t spe c ifie d (2).  * L ist o f studie s a va ila b le o n re q ue st.

Study T ype s  E va lua tio ns o f spe c ific tra ining pro g ra ms (17).  Surve ys o f stude nts o r pra c titio ne rs, c o rre la ting ho urs o f tra ining with se lf-re po rte d kno wle dg e , a ttitude s a nd skills (3).  I mpa c ts o f a tra ining pro g ra m a s o ne e le me nt o f c o mpre he nsive institutio na l re fo rm o f the NYC c o rre c tio na l syste m’ s tre a tme nt o f tra nsg e nde r inma te s (1).

E valuation Me thodologie s  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 o r in-pe rso n inte rvie ws with a sa mple o f pa rtic ipa nts (3).  F o llo w-up q ue stio ns to pa rtic ipa nts se ve ra l we e ks to 90 da ys la te r (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).

Re sults  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 ini ng 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.  L o ng e r-te rm o utc o me s le ss c le a r: 1 study sho we d c o ntinue d impro ve me nts; 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 o n c o mfo rt le ve ls tha n c linic a l e xpo sure to L GBT pa tie nts.

Re sults  Only o ne study a tte mpte d to a sse ss impa c ts o n pa tie nts: the NYC c o rre c tio na l syste m fo und a 50% dro p in c o mpla ints 3 mo nths a fte r sta ff tra ining , a nd c o mpla ints dro ppe d to ze ro within 6 mo nths.  No te tha t the tra ining s we re o nly o ne c o mpo ne nt o f a multi-fa c e te d e ffo rt a t institutio na l re fo rm.

Some Implic ations F r om Re sponse s of Par tic ipants  I 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.  L o ng e r tra ining s ma y b e mo re e ffe c tive tha n ve ry sho rt tra ining s, 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.

Some Implic ations F r om Re sponse s of Par tic ipants  Ma ny study a utho rs wo rry a b o ut se le c tio n b ia s.  Se le c tio n b ia s ma y b e diffic ult to e limina te in the a b se nc e o f ma nda te s.  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.  L e g a l ma nda te s fo r CME fo r lic e nse s/ c e rtific a tio ns.

Some Implic ations F r om Re sponse s of Par tic ipants  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.

Some Implic ations F r om Re sponse s of Par tic ipants  T ra ining s to impro ve the kno wle dg e , a ttitude s a nd skills o f individua l pro vide rs will ha ve limite d impa c ts o n he a lth ine q uitie s in the a b se nc e o f institutio na l re fo rm.  But c ultura l c o mpe te nc y/ humility tra ining s fo r pro vide rs c a n inc re a se pro vide r a wa re ne ss o f le g a l a nd institutio na l b a rrie rs (e .g ., disc rimina tio n fa c e d b y tra nsg e nde r pa tie nts) a nd mo tiva te the m to a dvo c a te fo r institutio na l a nd le g a l c ha ng e .

Evaluating the Effectiveness of LGBT Cultural Competence Trainings 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

2013- 2018

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Our g oa ls: K nowle dge A ttitude B e havior Our me a sure s of suc c e ss: E va lua tions

FIRST, A MANUAL www.c anc e r - ne twor k.or g

FIRST, A MANUAL www.c anc r - ne twor k.or g

THE FIVE UNITS IN THE TRAINING Unit 1- Intr oduc tion 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 o f the ir o wn ide ntitie s. 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 onme nt Addre sse s b e ha vio r a nd syste mic c ha ng e s tha t he a lth a nd

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Evaluating the Effectiveness of LGBT Cultural Competence Trainings 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