June is Pride Month, which honors and commemorates the history of civil rights activism and accomplishments for LGBTQ people. Pride is also a time where LGBTQ individuals can celebrate freedom in who they are. Experiencing pride is incredibly important for LGBTQ youth, says Children’s Hospital Colorado pediatric psychologist Jenna Glover, PhD, Director of Psychology Training, because it helps with developing a sense of confidence and self-respect rather than shame and fear.
Despite significant changes in acceptance of LGBTQ people over the past two decades, LGBTQ youth are still at risk for being bullied by peers and losing emotional and financial support from family members. Stigma related to heterosexism and homophobia remain pervasive in society. Ninety-two percent of LGBTQ youth report that they have heard negative messages about being LGBTQ, and research shows that they are two times as likely as peers to be physically assaulted1. Additionally, it is estimated that approximately 40% of homeless youth identify as LGBTQ2.
As a result of these significant stressors, LGBTQ youth experience higher rates of depression, substance use disorders and death by suicide compared to their non-LGBTQ counterparts. Given the challenges these youth face, says Dr. Glover, it is vital that pediatric providers work to create an environment that is inclusive of LGBTQ individuals and engage in practices that ensure the best outcomes for these youth.
Creating inclusive care environments
In 2013, the American Academy of Pediatrics introduced a policy statement outlining recommendations for effective care practices with LGBTQ youth3. Despite these guidelines, recent research has found that LGBTQ youth are reporting negative experiences during their PCP visits including poor communication, disrespect, and lack of discussion about sexual and emotional health4. It is clear more intentional work needs to be done in order to bridge the gap between care guidelines and patient experiences. One significant step providers can take is ensuring that their offices reflect a safe and inclusive space for LGBTQ youth. Below are recommendations for creating an inclusive environment for patients.
- Provide visual clues for patients that your practice is a safe place (e.g., brochures and education materials about LGBTQ health, visible nondiscrimination statements, posters from LGBTQ organizations such as the Human Rights Campaign or Trevor Project).
- Review intake forms and assessments for inclusive language. Inclusive forms include options for patients to include their legal name as well as “name used,” pronouns, gender accompanied by multiple options, sexual orientation accompanied by multiple options including choices such as “something else” or “don’t know,” and sex assigned at birth.
- List your practice in the Gay and Medical Association provider directory, which provides free access to the public of LGBTQ friendly practices.
- Include training in working with LGBTQ individuals as part of orientation for onboarding new staff and annual updated trainings in this area for all staff.
- Consider restroom options for patients. If you have single-stall restrooms that are gendered, change these to unisex.
- Use non-presumptive language. Ask a teen if they are in a romantic or sexual relationship rather than asking if they have a boyfriend or girlfriend.
Engaging in effective care practices
In addition to creating an inclusive environment, it is critical that providers also consider ways to ensure they are delivering effective care to LGBTQ youth. It is recommended that providers take a confidential psychosocial history as well as screen for depression and suicidality for all adolescents. When non-heterosexual orientation is disclosed, providers should assess to whom the patient has come out and maintain confidentiality of disclosed orientation when the patient is not out to family members.
Additionally, providers should offer the same quality of care in assessing and providing education to LGBTQ youth related to sexual behaviors and safe sex practices. Finally, providers should work on supporting parents who need help in adjusting to a child’s disclosure of LGBTQ identity, providing education that LGBTQ orientation is normative, not a choice and cannot be changed. It is recommended that providers work to balance validating parents’ concerns who are having difficulty accepting LGBTQ youth while providing education that LGBTQ youth who come out report higher rates of happiness than those who have not come out. Engaging in the above practices indicates awareness of these patients and is critical in supporting and celebrating LGBTQ youth and improving their physical and mental health outcomes.
- Growing Up LGBT in America, Human Rights Campaign
- LGBT Homelessness, National Coalition for the Homeless
- Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) Youth, American Academy of Pediatrics
- Snyder BK, Burack GD, Petrova A. LGBTQ Youth's Perceptions of Primary Care. Clin Pediatr (Phila). 2017;56(5):443‐450. doi:10.1177/0009922816673306