Creating an inclusive culture at your pediatric practice does more than support a diverse group of physicians, staff, and families. LGBTQ+ youths are more likely to be homeless, more at risk for bullying, relationship violence, and mental health problems, issues that can lead to lifelong health outcomes. Patients who feel safe at their pediatrician’s office can be open about their choices and health, allowing physicians to create the solid relationships that great healthcare is based on.
Basics of LGBTQ+
In this post, we’ll cover the needs of kids and teens of minority sexual orientations and gender identities and ways your practice can support their wellbeing and create a safe, inclusive environment, both for them and for all patients under your care. This post will not cover the definitions of common language associated with LGBTQ culture, such as the process of coming out or what it means to be “ace”.
If you, a parent, or a patient has questions about the definitions of LGBTQ identity or wants to know how teens can explore their identities further, there are many great resources to explore, such as Planned Parenthood, The Trevor Project, and the Centers for Disease Control.
Healthcare Risks for LGBTQ Youth
Why is it important for pediatricians to consciously promote inclusion, provide resources for LGBTQ support, and practice gender-affirmative care? First and foremost, it is because inclusion can help promote honesty and transparency in LGBTQ youth in regards to their choices and lifestyles, which leads to better healthcare.
Secondly, pediatricians can help protect and support patients in these gender and sexual orientation minorities, who are more at risk of more social inequities and discrimination than their heterosexual peers. These inequalities can lead to a myriad of risks such as poorer mental health outcomes, substance abuse, intimate partner or domestic violence, or unsafe sexual health practices. When these issues affect young patients, the associated risks can quickly begin to jeopardize their overall health, as well as negatively affect school performance.
While some LGBTQ youth talk about their gender or sexual orientation openly and evolve their views as they grow older, the nature of “coming out” for some patients can be more sudden. Whether they have a supportive network or not, this shift in perspective can leave families struggling to cope mentally and emotionally, making conversations with a trusted pediatrician important to ensure the safety and wellbeing of patients, as well as helping families learn how to support their child’s identity at home and in school.
Supporting LGBTQ Patients in Your Practice
While creating a safe space is relatively simple, the comfort and security it offers your patients is priceless. It may also give patients the reassurance they need to be open about their health needs and lifestyles, giving pediatricians the opportunity to provide the best possible care.
You can begin by listing your practice in the GLMA Provider Directory to help families and patients find your practice. According to the American Medical Association, “The Gay and Lesbian Medical Association (GLMA) is the national leader in LGBTQ health issues, and their GLMA Provider Directory is a free-to-the-public listing of LGBTQ-friendly practices in the United States.” You can also sign up to be listed in the The Healthcare Equality Index, which measures equity and inclusion in healthcare settings.
In-take forms, questionnaires, forms, and even your EHR can be customized to record sexual orientation, relationship status, and gender identities. It helps patients and families feel accepted to find that not only that questions are asked respectfully and without judgement, but that their LGBTQ identity is validated by inclusion.
By simply stating that your practice values all patients regardless of sex, gender identity, or orientation, you’re off to a great start in creating an inclusive practice culture. What’s important to remember is that this value should extend to every part of your culture, from hiring new employees to how you word your emails.
There are many ways to be inclusive, from small gestures to larger ones. You could go as far as decorating your office for Pride Month and cultivating conversations about LGBTQ healthcare on your practice’s social media or website. You could also start as simply as hanging a sign that welcomes all patients. When hiring or promoting employees, you can frame questions such as, “How comfortable are you providing care to a patient that self-identifies as LGBTQ?” to measure how your employees’ values pair with your office culture. Even gestures such as rainbow lanyards, pins, or stickers can help signal to patients that their identity will be treated with compassion and respect.
You may also wish to guide staff through sensitivity training and study appropriate language to use. The Gay and Lesbian Medical Association has created a useful guide for physicians for these topics and many more.
In many cases, LGBTQ patients have similar healthcare needs as their classmates and peers. There are however some important points to consider to ensure patients are healthy and safe:
- As with all patients, LGBTQ patients should be given access to information about safe sex practices, STDs, birth control, and more when age-appropriate. Resources are many, including I Wanna Know and Planned Parenthood.
- When seeing a new patient who identifies as transgender, it may be important to discuss history of hormone use or the desire to use hormones in the future. According to the AAP, further research on the psycho-social effects of hormone use in youths is needed.
- For patients experiencing gender dysphoria, care and compassion are needed to assess the best ways to frame their healthcare experience -- for example, using the anatomical terms and pronouns they are comfortable with, as well as preparing them for the gender-specific care (such as PAP smears) they need to be healthy.
- During exams and counseling, use the language the patient and their family uses when referring to their gender, partner, or identity. In absence of these indications, you can choose non-gendered, inclusive language such as “they” pronouns, “partner” or “significant other”.
- Ask if the patient has experienced any form of bullying, violence, or homophobia, and provide resources that provide support. This might be a local LGBT community center, parents, schools, counselors, or formal mental health services where appropriate.
- If a patient is “out” (or open about their LGBTQ identity) to their pediatrician, it is important not to assume the patient is “out” with their family, friends, and community. You will be better able to understand the patient’s support system and any emotional or mental health stresses they may be experiencing by asking who they feel safe sharing with, and how secure they feel in exploring their identity. It is generally accepted that only the patient should reveal their identity, and only do so in safe circumstances.
- A patient that discloses their identity to their pediatrician but not their family or friends may need additional resources to ensure they are safe and supported by trusted adults outside the home. Even patients who do not disclose this information can find support from local LGBTQ community centers, online resources, or school counseling resources, provided during their visit or via posters and printed materials in the office.
- LGBT individuals face many social challenges that can pose dangers to their emotional, physical, and mental health. For example, according to the Williams Institute, 40% of the homeless youth served by their agencies identify as LGBT. Exploring age-appropriate topics like housing safety, mental health, and substance use with LGBT patients can help pediatricians provide support and resources when they are needed.
- All LGBT patients will be different, so nuance and understanding are necessary in order to conduct successful visits with patients of varying identities, ages, races, ethnicities, and socioeconomic backgrounds. For example, you might discuss feelings about bullying differently with a younger patient or with a patient who might also experience racism. The Trevor Project offers a guide to these kinds of intersectional conversations.
While each conversation, exam, and interaction with LGBTQ patients and their families will be a little different, entering into each with empathy, compassion, and an open mind is the foundation for a trusting relationship and a positive healthcare experience for every child. For more information about treating LGBTQ patients, be sure to visit the AAP’s resource page and healthychildren.org for insights on how you might approach conversations with patients and parents.
Supporting LGBT youth is just one value of many for a modern pediatric practice, and for many trans patients, it can be hard to find specific resources. Find trans-specific resources for families and your practice below to learn more -- many of these resources will also be useful to LGBTQ+ families.