Measures of Health Care Providers' Knowledge, Clinical Skills, or Prejudice Toward Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Sexual and Gender Minority Populations: A Scoping Review

Purpose: Assessing health care providers' knowledge, clinical skills, and prejudice toward lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority populations (LGBTQIA+) can help identify areas for improvement in health care provider training. The aim of this study was to map the range of studies that report measures of health care providers' knowledge, clinical skills, or prejudice toward LGBTQIA+ populations. Methods: A scoping review adopting the Joanna Briggs Institute methodology was conducted. Electronic database searches were conducted in CINAHL via EBSCO Host, Epistemonikos, LILACS via Virtual Health Library Regional Portal, PubMed, Scopus, and Web of Sciences. The samples of other reviews were screened. Studies that validated, translated, and/or cross-culturally adapted measures of the knowledge, clinical skills, and prejudice of health care providers and students toward LGBTQIA+ individuals were selected. Scholars were consulted to ensure that no relevant studies were missing. Data were extracted by two independent reviewers and presented in tabular form along with narrative summaries. Results: This scoping review identified 27 measures that have been validated, translated, and/or adapted with health care providers or students as the target population, distributed across 33 studies. Conclusions: Psychometric studies involving LGBTQIA+ patients and health care professionals have increased in recent years, with North American countries being the most frequent location. However, a growing number of studies are being conducted in Latin American countries such as Brazil and Colombia.

Assessing the Implementation of an LGBTQ+ Mental Health Services Training Program to Determine Feasibility and Acceptability During the COVID-19 Pandemic

Despite significant social and legal progress, LGBTQ+ (lesbian, gay, bisexual, transgender, and other sexual and gender minority) populations continue to experience higher rates of mental health and substance use disorders than their heterosexual and cisgender counterparts. Effective LGBTQ+ affirmative mental health care is essential for addressing these disparities but is often limited and difficult to access. The shortage of LGBTQ+ affirmative mental health care providers results from the absence of required and accessible LGBTQ+-focused training and technical assistance opportunities for mental health care professionals. This study evaluates the implementation of our COVID-19 adapted, completely virtual, organization- and therapist-focused training program to improve the mental health workforce's cultural competence in working with the LGBTQ+ community: the Sexual and Gender Diversity Learning Community (SGDLC). Guided by an expanded RE-AIM model, we used administrator and therapist feedback to assess SGDLC implementation factors to understand how it may be best translated for scaled-up promotion and widespread adoption. Assessment of the initial reach, adoption, and implementation of the SGDLC indicated that it had strong feasibility; reports on satisfaction and relevance support the SGDLC's acceptability. Maintenance could not be fully assessed from the short study follow-up period. Still, administrators and therapists expressed an intent to continue their newfound practices, a desire for continued training and technical assistance in this area, but also concerns about finding additional opportunities for this education.

Sexual orientation knowledge and attitudes and its association with therapy satisfaction among lesbian, gay, and bisexual + Hispanic Puerto Ricans

This study aimed to examine the difference in therapy satisfaction between lesbian, gay, and bisexual + (LGB +) individuals and heterosexual individuals, and to identify the association between therapy satisfaction and the perception of knowledge and attitudes of their last therapist among the LGB + participants. Through an exploratory design with a comparative group, 125 LGB + and 75 heterosexual participants were recruited online by availability. Results indicate that the participants' sexual orientation has no significant relation on therapy satisfaction. However, there was a significant positive association between satisfaction with therapy and the LGB + participants' perception that their therapist demonstrated knowledge and positive attitudes. This research highlights the importance for continuous education and curriculum efforts on LGB + issues.

Affirmative Stances in Training Programs Toward Sexual and Gender Minority Clients: Views From Clinical and Counseling Psychology Graduate Students

Despite training recommendations to address mental health disparities among sexual and gender minority (SGM) individuals, the current state of SGM affirmative training in clinical and counseling doctoral psychology programs remains unclear. The present study surveyed 147 clinical and counseling psychology graduate students in the United States. Participants completed surveys on affirmative training stances in their graduate program for sexual minority clients, gender minority clients, and self-reported perceptions of their attitudes, knowledge, and skills related to SGM clients. Results revealed that current graduate students reported more affirmative stances for sexual minority clients compared to gender minority clients. SGM graduate students reported fewer affirmative stances in their programs for both sexual and gender minority clients compared to their heterosexual cisgender peers. Lastly, SGM identity was a significant predictor of perceived SGM clinical competency beyond years of training, program model, or type of graduate program. Implications for training and future research are discussed.

Professional Expectations of Provider LGBTQ Competence: Where We Are and Where We Need to Go

Introduction

Mental and behavioral health professional organizations use their governing documents to set expectations of provider competence in working with LGBTQ+ clients.

Method

The codes of ethics and training program accreditation guidelines of nine mental and behavioral health disciplines (n=16) were analyzed using template analysis.

Results

Coding resulted in fives themes: mission and values, direct practice, clinician education, culturally competent professional development, and advocacy. Expectations for provider competency vary greatly across disciplines.

Conclusion

Having a mental and behavioral health workforce that is uniformly competent in meeting the unique needs of LGBTQ populations is key for supporting the mental and behavioral health of LGBTQ persons.

Professional Expectations of Provider LGBTQ Competence: Where We Are and Where We Need to Go

INTRODUCTION

Mental and behavioral health professional organizations use their governing documents to set expectations of provider competence in working with LGBTQ+ clients.

METHOD

The codes of ethics and training program accreditation guidelines of nine mental and behavioral health disciplines (n=16) were analyzed using template analysis.

RESULTS

Coding resulted in fives themes: mission and values, direct practice, clinician education, culturally competent professional development, and advocacy. Expectations for provider competency vary greatly across disciplines.

CONCLUSION

Having a mental and behavioral health workforce that is uniformly competent in meeting the unique needs of LGBTQ populations is key for supporting the mental and behavioral health of LGBTQ persons.

"You say you're inclusive, but can you show us?" The importance of cultural competence when working with sexual minorities in a mental health setting

OBJECTIVES

Sexual minorities experience higher rates of psychological distress than heterosexual people, likely due to minority stress. While rates of help-seeking by sexual minorities are high, sexual minorities report greater dissatisfaction with mental health service providers. This dissatisfaction may result from poor cultural competence practices. Our study sought to determine the importance of service provider cultural competence practices to a community sample of sexual minority people.

METHODS

Participants (n = 274) were sexual minority Australians recruited from affirming Facebook groups, organizations, and research-based organizations. To measure the importance of cultural competence practices, participants completed a modified online version of the Gay Affirming Practices Scale (GAP) and responded to open-ended questions.

RESULTS

Between 80% and 99% of participants endorsed each item on the GAP, indicating the importance of service providers demonstrating an array of culturally affirming practices. No significant associations were found between overall GAP score and age or sexual orientation, though further analyses revealed individual items on the GAP showed associations with age. A structured tabular thematic analysis, of open-ended participant responses, found positive attitudes, knowledge, and affirming practices were the three most important characteristics for service providers seeking to demonstrate culturally competent practices, mirroring the tripartite model (attitudes, knowledge, and skills) of cultural competence.

CONCLUSION

Recommendations for service providers to demonstrate cultural competence include: utilizing affirming practices such as inclusive language, increasing knowledge about sexual minorities, and utilizing education resources such as cultural competence workshops, lived experience stories, and seeking mentorship from service providers with expertise in working with sexual minorities.

A Moderation Analysis of Perfectionism, Cultural Sensitivity, and Counselors-In-Training Attitudes Toward Non-Dominant Sexual Identities

The purpose of this study was to explore the moderating effect of maladaptive perfectionism on the relationship between cultural sensitivity and counselors-in-training attitudes toward non-dominant sexual identities. A total of 209 counseling graduate students participated in the study. Results showed that cultural sensitivity predicted attitudes toward individuals who identify with a non-dominant sexual identity after controlling for age. Also, a regression analysis demonstrated that maladaptive perfectionism is a moderator in the relationship between cultural sensitivity and attitudes toward individuals who identify with a non-dominant sexual identity among counselors-in-trainings. Implications in the counseling and education field and suggestions for future research are discussed.

A systematic review to determine how service provider practises impact effective service provision to lesbian, gay and bisexual consumers in a mental health setting

Lesbian, gay and bisexual (LGB) consumers utilize mental health services at a similar rate to their heterosexual counterparts yet report greater dissatisfaction with service quality. This dissatisfaction may be explained by service provider's microaggressions, stemming from a lack of cultural competence in working with LGB consumers. This systematic review examines how the practises of mental health service providers impacted effective service provision to LGB people in a clinical practice. Five health databases (Scopus, MEDLINE, PsycINFO, Web of Science and CINAHL) were examined to determine relevant studies for this review. Twenty four qualitative and quantitative studies between 2000 and 2020 examining data related to how service provider practises impacted effective service provision to LGB people were included in the final review. A narrative synthesis, thematic summary approach was employed to account for the multi-method nature of the data. Themes developed in our analysis are organized under the three components of cultural competence, service provider attitudes, knowledge and skills. Provider attitudes ranged from positive to negative towards LGB people and heterosexism were present in several services. Poor service provider knowledge about the issues impacting LGB consumers leads to a weakened therapeutic alliance and service providers often lacked a comprehensive understanding of the issues impacting LGB people. Service providers were seen as more skilful if they were LGB, created a safe space and had completed cultural competence training. Trends within the characteristics (explorative nature, mixed service provider samples, potential for bias) of the 24 studies included in the review are discussed. Based on the results, recommendations are included to ensure services demonstrate cultural competence in working with LGB consumers.

Affirmative Competence and Practices of Mental Health Professionals with LGB clients: An Ibero-American Study

There are not many studies about affirmative competence and practices among mental health professionals working with Lesbian, Gay, and/or Bisexual (LGB) clients. Thus, the objectives of this research are to assess the levels of affirmative competence and practices of professionals in Ibero-American countries. The sample consists of 630 mental health professionals from various countries whose ages range from 22 to 75 years old, with a mean age of 41.46 years. The study utilizes the following measures: a socio-demographic questionnaire, the Sexual Orientation Counselor Competency Scale, and the Affirmative Practice Questionnaire. Results show that mental health professionals who present higher levels of Affirmative Competence are those who have higher levels of education and training on LGBT topics, show left-wing political affiliations, self-identify as LGB, and have no religious affiliations. Regarding Affirmative Practices, it was found that single participants show lower practices, and more studies are needed to better understand this result. Regression models demonstrate that Affirmative Practices and Competences are predicted by the hypothesized variables, namely, religious and political beliefs, and training/education. Hence, this study indicates that mental health professionals could undergo some type of academic or professional training and/or possess experience in regard to working with LGB clients, in order to enhance their approach when working with this population.

Educational Program to Improve Provider Knowledge, Attitudes, and Behavior in Lesbian, Gay, Bisexual, and Transgender Self-Disclosure

Lesbian, gay, bisexual, and transgender (LGBT) individuals have long been subject to discrimination. This has led to the fear of victimization and the overall avoidance of health care services and increasing health disparities in this group. Health care providers, including nurses who have limited knowledge, poor attitudes, and behavior, have been shown to significantly dilute the patient-provider relationship. This reduces self-disclosure and increases likelihood of poor outcomes of the LGBT individual. An educational program was developed to focus on health care providers (n = 8) knowledge, attitudes, and behavior in LGBT self-disclosure. A pretest, posttest methodology was used to assess the aforementioned concepts using a 29-item sexual orientation counselor competency scale. All measured concepts showed clinical significance with highest being self disclosure, which revealed both clinical and statistical significance from (SD) 1.0 to 1.63, a 63% increase. The implications of these findings on the current and future practice of health care providers and nurses support cultural competency training for both practicing health care professionals and students in educational curriculums.

Attitudes of therapists and other health professionals towards their LGB patients

Lesbian, gay and bisexual people continue to suffer minority stress around the world, but particularly in Africa, the Middle East and Eastern Europe. This anti-homosexual prejudice can enter into the therapist-client relationship and seriously damage the outcome of psychotherapy, particularly in instances where therapists regard their clients' sexuality as contributing to their psychological difficulties. This paper takes an historical perspective to research on the attitudes of a range of professionals who provide talking therapies or other types of psychological support to their clients who are lesbian, gay or bisexual. The nature and origins of prejudice, its effects on LGB clients, and how it might best be addressed are considered. Challenging the ethics and evidence base for treatments that purport to change sexual orientation, as well as asking heterosexual therapists to reflect on their own heteronormative assumptions, are crucial to effecting change and ensuring LGB people are treated equally to their heterosexual counterparts.

Coaching mental health peer advocates for rural LGBTQ people

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) people are affected by mental health disparities, especially in rural communities. We trained peer advocates in rural areas in the fundamentals of mental health, outreach, education, and support for this population. The peer advocates were coached by licensed mental health professionals. We evaluated this process through iterative qualitative analysis of semi-structured interviews and written logs from coaches and advocates. The six major themes comprising the results centered on (1) coaching support, (2) peer advocate skills and preparation, (3) working with help seekers, (4) negotiating diversity, (5) logistical challenges in rural contexts, and (6) systemic challenges. We concluded that peer advocacy for LGBTQ people with mental distress offers an affirmative, community-based strategy to assist the underserved. To be successful, however, peer advocates will likely require ongoing training, coaching, and infrastructural support to negotiate contextual factors that can influence provision of community resources and support to LGBTQ people within rural communities.