Addressing LGBTQ+ Health Sensitivity Training Priorities

Hudson Pride Center (HPC) is an organization that seeks to be an inclusive home and voice for the diverse LGBTQ+ community in Jersey City – home to the largest Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning population in New Jersey. Over the past 25 years, HPC has delivered a wide array of services, programs, and events to address the evolving health and social support needs of LGBTQ+ individuals, peer circles, and families.  

Health disparities affecting LGBTQ+ individuals in America most often arise from access-to-care barriers, such as a lack of financial/insurance resources, institutional discrimination, provider lack of knowledge about LGBTQ health needs, and perceived fears of how they might be treated by providers.

Determined to address unmet LGBTQ+ health concerns, HPC prioritized constituent reluctance to access healthcare and related social services due to the insensitivity, dismissal, and discrimination they often experienced when interacting with medical and social service providers. HPC proposed a training program designed to enhance the ability of health care professionals to deliver LGBTQ+ affirming care.

The program entitled “Training for Health and Service Providers and Non-Profits” was structured to address specific shortcomings in the delivery of LGBTQ+ health services.

• LGBTQ-Affirming Care
  Focus on aspects of service delivery that typically were “less than adequately” handled by health and social service providers dealing with LGBTQ+ individuals. Most providers lack a general understanding of LGBTQ+ health and related social issues, needs, and concerns.

• Transgender-Specific Needs
  Across the LGBTQ+ spectrum, transgender individuals often feel the most isolated and disconnected in healthcare settings due to misgendering and other transphobic actions.

• PrEP and other HIV Prevention Interventions
  Based on LGBTQ+ feedback, few primary care providers are even aware of PrEP or PEP as HIV prevention strategies. This leaves many Jersey City residents needlessly at risk for HIV when a simple referral or written prescription would alleviate HIV concerns.

• Lack of HIV Management Knowledge
  In NJ, social service providers are not required to take courses on HIV/AIDS to achieve either college or graduate degrees. As a result, they are usually unprepared for working with those at risk for HIV or who have HIV – a common LGBTQ+ community issue. 

Alignment of LGBTQ+ Sensitivity Training with HealthierJC Goals

Estimated at 1,870:1, Hudson County has the highest ratio of residents to primary care providers in the state of New Jersey.  Given those metrics, it is unlikely that Jersey City residents routinely access healthcare when sick, nor schedule annual wellness visits. And when rates of routine healthcare visits decline in a population, rates of chronic illnesses and behavior (mental illness, addiction, HIV/STI, intimate partner violence, etc.) will inversely rise. This behavior is even more pervasive amongst LGBTQ+ individuals at the greatest risk of under-treatment for serious health issues within Jersey City African diaspora and Latinx communities.

The HPC training program to improve the relationship and trust between primary care and social service providers and their LGBTQ+ patients, increases the likelihood that this often marginalized segment will seek out and receive the care they need.  The program clearly aligns with HealthierJC goals to work with community partners with a shared vision to positively impact bio-psycho-social health outcomes for all Jersey City residents. 

Building the Program

The ultimate intent of the “Training for Health and Service Providers and Non-Profits” program is to establish a professional continuing education curriculum that will enhance LGBTQ+ sensitivity, increase understanding of LGBTQ+ health issues, and equip healthcare providers with the insight needed to deliver culturally humble and LGBTQ+ affirming health services.  

In addition, the program would provide healthcare workers with a practical way to get the Continuing Education (CE) credits required to maintain their licenses while expanding their skillsets to better serve the community. 

To build the program, HPC leveraged their proven experience in training course development and instruction, and created the following series of 4 workshops of 1-2 hour(s) in duration.

1. LGBTQ+ Affirming Health and Social Service Delivery
2. Meeting Transgender Health and Social Service Care Needs
3. PrEP and Other HIV Prevention Strategies For Health and Social Service Providers
4. HIV Management Issues for Social Service Providers

After three months of development, HPC scheduled 10 workshops for social service/healthcare providers in Jersey City located in communities either at high risk for HIV and/or with a large LGBTQ presence.

• 7 workshops for health and social service providers at multidisciplinary primary care, clinic-based, and/or hospital-based practice.
• 3 workshops for social workers at social service/mental health agencies.

 

Delivering the Program

While 10 workshops were planned, HPC over-delivered and conducted a total of 15 (11 live, 4 via Zoom) LGBTQ+ “Training for Health and Service Providers and Non-Profits” workshops for a broad Jersey City audience: medical case managers, public schools, university health centers, public safety, libraries, welfare staff, homeless shelters, mental health counselors, youth centers, Latinx social justice agencies, and HIV policymakers.   

 

A breakdown of workshops conducted across Jersey City by Ward is as follows: Ward A= 2, Ward B= 1, Ward C= 5, Ward D= 2, Ward E= 2, and Ward F= 3.  And a breakdown of the number of healthcare professionals participating in, and thus directly benefiting from program workshops include:

• 6 LGBTQ+ Affirming workshops were attended by 89 social service-based providers and 14 clinic-based providers.
• 2 Transgender Health workshops were attended by 23 HIV social workers.
• 2 PrEP workshops were attended by 42 social services/academic-based providers.
• 5 HIV Management workshops were attended by 66 social service providers, including 23 HIV social workers, and 22 Hudson County shelter system workers.
• 1 LGBTQ+ Affirming workshop + 1 HIV Management workshop were held at CarePoint-Christ Hospital, and attended by 14 HIV medical case managers and nurses.
• 1 PrEP workshop + 1 HIV workshop were held for 19 members of NJCU counseling/service/academic staff.
• 1 HIV workshop + 1 Trans Health workshop were attended by 9 HIV medical case managers and nurses from the Center for Comprehensive Care at Jersey City Medical Center.

In addition, customized instructional content was developed for:  

• 6 social service agencies
• 1 educational facility
• 2 other LGBTQ-serving entities
• 2 clinic-based agencies

 

Making a Difference in Jersey City…

In workshops conducted at the Center for Comprehensive Care at Jersey City Medical Center, nurses and medical case managers sought to better understand LGBTQ+ psycho-social barriers to HIV care. They were concerned that patients frequently did not adhere to HIV treatment plans, ranging from missing medication doses to dropping out of care entirely.

Many were surprised that simple issues like not having a gender neutral bathroom available on site can cause some transgender clients to stop coming to clinic.  When asked to give urine samples or dealing with a medication-induced bowel condition, LGBQT+ patients would find it embarrassing to always ask which bathroom to use. And they became weary of combatting abrasive “stare downs” from other patients unsettled by their use of the perceived “wrong” bathroom.

Following the workshop, the staff immediately took corrective action by designating a gender neutral bathroom.  This practical accommodation removed an unintentional cultural and psychological barrier for LGBTQ+ patients who interpreted bathroom gender politics as intentional malfeasance by transphobic staff.   

This is just one real life example of how the “Training for Health and Service Providers and Non-Profits” program has improved the delivery of LGBTQ+ healthcare services in Jersey City.  And with a workshop for NJCU’s health center staff scheduled for September 2020, HPC continues to partner with HealthierJC to help Jersey City healthcare providers gain a deeper understanding and empathy for their patients across the Lesbian, Gay, Bisexual, Transgender and Queer/Questioning spectrum.

 

Next Steps

In 2021, the four workshops developed for the “Training for Health and Service Providers and Non-Profits” program and conducted during the HealthierJC mini-grant period will be submitted for Continuing Education (CE) accreditation to the NJ Chapter of the National Association of Social Workers. Workshop accreditation will make the program eligible for acceptance by the licensing boards for all LSW/LCSWs, LPCs, LCADCs, LMFTs RNs, PAs, and MDs in the NJ Hudson region.  

These Next Steps would result in a powerful “win/win/win” scenario, which would: 

• Enable HPC to exponentially expand the reach of their LGBTQ+ affirming care training.
• Provide healthcare and health-related social service organizations with a means for their staff to:
• acquire CE credits required to maintain professional licenses, and
• acquire skills that will improve the quality of care delivered to a historically marginalized and medically underserved LGBTQ+ patient community.

For more information on this HealthierJC grantee, please visit the Hudson Pride Center website at www.hudsonpride.org/.