What CHWs can do for LGBTQ+ clients

Members of the LGBTQ+ community face health disparities caused by discrimination and social stigma. But Community Health Workers (CHWs) can play a role in addressing these community members' unique needs.

LGBTQ+ folks represent all races, religions, ethnicities, education levels, and career fields. But the discrimination they face can lead to poor job opportunities, inadequate medical care, poor sex education, etc. These factors contribute to the heightened rates of suicide, depression, anxiety, and substance use disorders that LGBTQ+ people experience. Additionally, a lack of family and community support can increase the incidence of chronic conditions, such as diabetes and heart disease.

Recently, there have been efforts to improve the cultural competence of clinical health staff, including doctors and nurses. Cultural competence in healthcare is the ability to appropriately and considerately treat patients from different walks of life. As clinical staff members build these skills, it's essential to acknowledge how CHWs can create a safe and equitable space for LGBTQ+ clients.

Use appropriate language.

Our words have meaning. When we mischaracterize someone by using incorrect or inappropriate language, we stigmatize them in many ways. Misgendering is often the biggest occurrence noted, so avoid using gender-specific terms. Instead, use folks, they/them, or avoid gender pronouns altogether unless you have been instructed of the individual’s pronouns. Always use inclusive language, even if you don't know that you're working with an LGBTQ+ client! For example, instead of asking a woman if she has a husband, ask if she has a spouse or partner. This helps clients feel more comfortable responding to questions without forcing them to "out" themselves or lie. Check out more inclusive language here.

Understand LGBTQ+ clients' unique needs.

To refer clients to the appropriate resources, you first have to understand their unique needs. For members of the LGBTQ+ community, their needs are impacted by stigma and discrimination. It is harder for them to find jobs, housing, and affirming mental health services, and they often face dismissal from medical systems and providers. Knowing this, you can help your clients find inclusive workplaces, combat housing discrimination, and complete medical coverage applications. There are likely resources in your area, and if you cannot identify them, ask others for recommendations and help finding them. Become familiar with gender-affirming and transgender-friendly providers in your area.

Connect clients to appropriate resources.

You won't always know that your client is or is not a member of the LGBTQ+ community. If a client has chosen to disclose that information, refer them to appropriate resources. For example, an anti-LGBTQ+ medical facility wouldn't be safe for your client. Many medical centers have become inclusive of LGBTQ+ people, so do the extra work to find those centers. Additionally, familiarize yourself with local LGBTQ+ centers. If you aren't a community member, you may not have all the resources your client needs. However, you can refer them to the LGBTQ+ center in your area to provide better resources and services. Additionally, many younger clients are not given the resources needed to affirm their sexual orientation and gender identity and may not have options for their needs to be met with insurance providers. Know where to find local hormone therapy providers and where clients can get LGBTQ+-specific medical needs addressed at a sliding scale fee or free of charge.

Create a community.

Many LGBTQ+ people have been forced to leave their families, friends, and communities because of discrimination. Isolation and abandonment are partly why depression, anxiety, suicide, and substance use occur more frequently in this population. When we create a sense of community for LGBTQ+ people, they have more protective factors and support. For CHWs, this might mean referring your LGBTQ+ clients to LGBTQ+ centers, facilitating a support group for clients who've been left by their families, or hosting events for LGBTQ+ people and allies. Always start by trying to connect clients with established groups, so that there is more opportunity for a strong social network.

Recognize abuse and intervene.

Members of the LGBTQ+ community are more likely to experience abuse. This abuse might be relational or on the job, and it can be physical, emotional, or sexual. Someone who is abused may not always tell you right away. Instead, you have to watch for signs of that abuse and intervene accordingly. If the client is facing abuse at home, help them create a go-bag and an escape plan. If the client is being bullied or abused at work, help them go through the appropriate HR channels to handle the situation. Abuse between same-sex couples is also prominent, but not always acknowledged. Reach out to your local domestic violence shelter and have them confirm their stance and policies on transgender and LGBTQ+ client services provided.

A safer and more inclusive world can exist for members of the LGBTQ+ community. But to achieve it, all public health professionals, including clinical staff and CHWs, must actively work to create it. The strategies in this article are not comprehensive, and we encourage all readers to seek additional information and training to better understand and care for members of the LGBTQ+ community. You can find this training from Andrea Foster, DE&I Subject Matter Expert.
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