Informed, Affirming and Focused: Client Perspectives on the Importance of Specialist LGBTIQ + Family Violence and Other Health Services

Lim G., Lusby S., Carman M., Bourne A.

Lusby S., Lim G., Carman M., Bourne A.

Abstract Purpose There are inadequate resources available to support lesbian, gay, bi + , trans and gender diverse, intersex and queer (LGBTIQ) people experiencing family violence in Australia. Government funding agencies and mainstream family violence service providers regularly state that there is insufficient evidence to justify investment in more inclusive services. This article explores practitioner perceptions of such claims. Method 21 practitioners from mainstream and specialist LGBTIQ family violence services were interviewed about structural challenges associated with implementing LGBTIQ-inclusive family violence services. Participants’ accounts highlight the political tensions and material repercussions of epistemic definitions of ‘evidence’ as they pertain to LGBTIQ individuals’ experiences of violence within policy environments. Utilizing Carol Bacchi’s feminist policy analysis framework, we ask ‘what is the problem represented to be?’, examining participant perceptions about how evidence is currently positioned in policy and resourcing decisions pertaining to LGBTIQ family violence, and discuss its implications. Results Participants overwhelmingly called for more investment in research and data gathering about family violence against LGBTIQ people and provision of effective supports. Even allowing for this, participants indicated that there is also already enough existing knowledge to justify urgent expansion of LGBTIQ-inclusive services. Conclusions Expanded provision of services and generating a more robust evidence base about LGBTIQ family violence service needs are critically important and intertwined issues. However, the way that they are currently sequenced in policy and broader sector conversations, where ‘enough’ evidence is required in order to justify increased services, is inhibiting progress on both.

Yu H., Flores D.D., Bonett S., Bauermeister J.A.

Abstract Background Health disparities experienced by LGBTQ + individuals have been partially attributed to health professionals’ lack of cultural competence to work with them. Cultural competence, the intricate integration of knowledge, skills, attitudes, and behaviors that improve cross-cultural communication and interpersonal relationships, has been used as a training framework to enhance interactions between LGBTQ + patients and health professionals. Despite multiple published LGBTQ + cultural competency trainings, there has been no quantitative appraisal and synthesis of them. This systematic review assessed articles evaluating the design and effectiveness of these trainings and examined the magnitude of their effect on cultural competence outcomes. Methods Included studies quantitatively examined the effectiveness of LGBTQ + cultural competency trainings for health professionals across all disciplines in various healthcare settings. 2,069 citations were retrieved from five electronic databases with 44 articles meeting inclusion criteria. The risk of bias in the included studies was assessed by two authors utilizing the Joanna Briggs Institute critical appraisal checklists. Data extracted included study design, country/region, sample characteristic, training setting, theoretical framework, training topic, modality, duration, trainer, training target, measurement instrument, effect size and key findings. This review followed the PRISMA statement and checklist to ensure proper reporting. Results 75% of the studies were published between 2017 and 2023. Four study designs were used: randomized controlled trial (n = 1), quasi-experimental pretest–posttest without control (n = 39), posttest only with control (n = 1) and posttest only without control (n = 3). Training modalities were multiple modalities with (n = 9) and without simulation (n = 25); single modality with simulation (n = 1); and with didactic lectures (n = 9). Trainings averaged 3.2 h. Ten studies employed LGBTQ + trainers. The training sessions resulted in statistically significant improvements in the following cultural competence constructs: (1) knowledge of LGBTQ + culture and health (n = 28, effect size range = 0.28 – 1.49), (2) skills to work with LGBTQ + clients (n = 8, effect size range = 0.12 – 1.12), (3) attitudes toward LGBTQ + individuals (n = 14, effect size range = 0.19 – 1.03), and (4) behaviors toward LGBTQ + affirming practices (n = 7, effect size range = 0.51 – 1.11). Conclusions The findings of this review highlight the potential of LGBTQ + cultural competency training to enhance cultural competence constructs, including (1) knowledge of LGBTQ + culture and health, (2) skills to work with LGBTQ + clients, (3) attitudes toward LGBTQ + individuals, and (4) behaviors toward LGBTQ + affirming practices, through an interdisciplinary and multi-modal approach. Despite the promising results of LGBTQ + cultural competency training in improving health professionals’ cultural competence, there are limitations in study designs, sample sizes, theoretical framing, and the absence of longitudinal assessments and patient-reported outcomes, which call for more rigorous research. Moreover, the increasing number of state and federal policies that restrict LGBTQ + health services highlight the urgency of equipping health professionals with culturally responsive training. Organizations and health systems must prioritize organizational-level changes that support LGBTQ + inclusive practices to provide access to safe and affirming healthcare services for LGBTQ + individuals.

Amos N., Hill A.O., Parsons M., Lusby S., Lyons A., Carman M., Bourne A.

Abstract Purpose LGBTQ + people who have experienced intimate partner violence (IPV) and family of origin violence (FOV) are known to face significant barriers to reporting or seeking support for these experiences and may not always feel supported when do so. Method Data from 4,607 participants of a nationwide survey of LGBTQ + adults in Australia who indicated having ever experienced IPV or FOV was analysed. Multivariable logistic regression analyses were conducted to identify factors associated with reporting the most recent experience of IPV or FOV and with feeling supported when reporting. Results In total, 1,188 (25.9%) participants indicated that they reported their most recent experience of IPV or FOV and 1,112 (84.6%) of those felt supported. Participants’ sexual orientation, level of education, engagement with a regular general practitioner (GP), experience of homelessness and country of birth were associated with reporting their most recent experience of IPV or FOV. Of those who reported their experience, participants were most likely to feel supported if they had a regular GP and least likely to feel supported if they had ever experienced homelessness. Conclusion The findings of this study highlight inadequacies in family violence frameworks in promoting or facilitating access to services that could benefit this population. Encouraging LGBTQ + people to engage with a regular GP, establishing family violence services that cater to the specific needs of LGBTQ + people, and training family violence responders and service providers to recognise diverse relationship dynamics may improve support outcomes for LGBTQ + survivors of family violence.

Amos N., Hill A.O., Lusby S., Carman M., Parsons M., McNair R., Lyons A., Bourne A.

Abstract Purpose LGBTQ people are less likely to seek support and face significant barriers in accessing affirmative family violence support services. Efforts to improve family violence service access must be grounded in the preferences of LGBTQ people themselves. Method Data from a large nationwide Australian survey of the health and wellbeing of LGBTQ adults were analysed. 4,148 participants expressed a preference for family violence service provision. Multivariable logistic regressions were used to identify factors associated with preferences for family violence service provision, comparing mainstream services that are not known to be inclusive, mainstream services that are known to be LGBTQ-inclusive, and LGBTQ-specific services. Results In total, 8.8% (n = 363) of participants indicated a preference for mainstream services, 57.5% (n = 2,383) for mainstream services that are known to be LGBTQ-inclusive and 33.8% (n = 1,402) for LGBTQ-specific services. Trans and non-binary identified people were more likely to prefer LGBTQ-specific services than cisgender participants, while bisexual, pansexual and asexual people were more likely to prefer mainstream LGBTQ-inclusive services. Participants with a regular general practitioner were more likely to prefer LGBTQ-inclusive services. Participants who had not felt supported the most recent time they reported an experience of family violence were more likely to prefer LGBTQ-specific services. Conclusion Family violence and healthcare services require training in LGBTQ issues to provide inclusive and affirming care. The findings have implications for policy and practice in family violence care and illustrate an urgent need to reform the current narrative of family violence, which frequently excludes LGBTQ communities.

Hill A.O., Cook T., McNair R., Amos N., Carman M., Hartland E., Lyons A., Bourne A.

Couch D., Clow S.

People from LGBTIQA+ communities living in rural areas experience significant disparities across a range of health and wellbeing indicators, high levels of stigma and discrimination, and difficulty accessing inclusive health and support services. This article discusses a targeted health promotion intervention designed to build supportive health and social programs to address these problems. We describe the initial needs assessment undertaken to inform the intervention, the role and activities of the health promotion officer funded through the program, and present evaluation data on program outcomes. The article demonstrates that modest funding for health promotion can make a positive contribution to connecting and supporting individuals in a small regional community, leading to better health and wellbeing outcomes.

Bishop J., Crisp D., Scholz B.

Sechrist S.M., Laplace D.T., Smith P.H.

Intimate partner violence (IPV) is as prevalent or more so as reported by lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals compared with non-LGBTQ individuals. Yet largely due to prior harmful and nonaffirming experiences with service providers, they are reluctant to seek services from domestic violence service providers (DVSP). These factors, combined with the reality that those who do seek services may not be provided with safe, affirming, and effective responses, exacerbate the impact of IPV on LGBTQ health and recovery. The North Carolina (NC) LGBTQ Domestic Violence Response Initiative (NC Initiative) was developed to increase DVSP capacity to serve LGBTQ survivors. This article describes the first four phases of the Initiative’s development: (1) formative focus group research with DVSPs statewide, identifying agencies’ interest in improving their responses to LGBTQ survivors; (2) Initiative launch, including funding and identification of partners; (3) development of capacity assessment tools; and (4) review of baseline capacity assessment findings. The development of tools, specifically designed to assess capacity of DVSPs to serve LGBTQ survivors, is a unique contribution as no tools existed to do so. The common capacity-building needs and data-informed recommendations identified provide a starting point for agencies expanding into LGBTQ-focused work, who may not have the benefit of grant funding, tools, or evaluators to assist. Our findings, lessons learned, and tools may be used by agencies to evaluate and inform their own practices, thereby creating safer, more affirming agencies that are capable provide effective care to meet unique needs of LGBTQ survivors.

Bishop J., Crisp D.A., Scholz B.

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.

Santoniccolo F., Trombetta T., Rollè L.

Same-Sex Intimate Partner Violence (SSIPV) is a complex issue that can be severely damaging. When involved in SSIPV, victims and perpetrators sometimes choose to seek help. The help-seeking process, however, can be difficult. Experiences of help-seeking seem to vary and may be positive or negative depending on several factors, some of which appear to be specific to lesbian, gay, and bisexual (LGB) people involved in a same-sex relationship. A systematic review of the literature has been conducted across four databases following the PRISMA statement guidelines. Out of 410 screened abstracts, 78 articles were selected for full-text review. Following the inclusion and exclusion criteria, 21 studies were included in the current review. Thematic analysis was conducted on these studies and results were discussed by three reviewers. Help-seekers tended to use informal sources of help, perceived to be ambivalently helpful. Formal sources tended to be utilized sparingly, except for counselors. Many formal sources were perceived to be unhelpful, and most of the studies identified several barriers to services that prevented effective help. Formal and helpful sources were perceived as knowledgeable and sensitive about LGB themes. While existing research is limited, formal services that can provide effective care for SSIPV appear scarce. Barriers to services seem widespread, limiting accessibility. Existing services would benefit from increasing their knowledge and sensitivity on SSIPV-specific themes. The development of policies, programs, and interventions that aim to provide effective help is needed, as well as more research.

Fish J.N., Salerno J., Williams N.D., Rinderknecht R.G., Drotning K.J., Sayer L., Doan L.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has accentuated long-standing population health disparities in the United States. We examined how the pandemic and its social consequences may differentially impact sexual minority adults, relative to heterosexual adults. Methods: Data are from a U.S. national sample of adults (n = 2996; 18.06%) collected from online panels from April to May 2020. We used eight indicators of well-being-mental health, physical health, quality of life, stress, loneliness, psychological distress, alcohol use, and fatigue-to assess the degree to which sexual identity subgroups (i.e., heterosexual, gay/lesbian, bisexual, and "other" sexual minority) varied in retrospective pre- and postpandemic onset indicators of well-being and whether groups varied in their rate of change from pre- and postpandemic onset. Results: The results showed consistent patterns of decline in well-being across sexual identity subgroups, although changes in mental health, physical health, quality of life, stress, and psychological distress were more robust among sexual minority adults in general, relative to heterosexual adults. Adjusted multivariate models testing differences in change in retrospective pre- and postpandemic onset found that well-being among bisexual men and women was most negatively impacted by the pandemic. Conclusion: The COVID-19 pandemic may have distinct health consequences for sexual minority adults in the United States. Our findings support and further legitimize calls for more comprehensive surveillance and cultural responsiveness in emergency preparedness as it relates to sexual minority people and the COVID-19 pandemic.

MacCarthy S., Darabidian B., Elliott M.N., Schuster M.A., Burton C., Saliba D.

Study Objective: As recent efforts to improve culturally competent clinical care (CCCC) have largely overlooked older LGB adults, we conducted a scoping review of position statements, empirical, and non-empirical research and suggest action steps. Methods: We followed PRISMA Extension for Scoping Reviews Guidelines and searched for articles 1/1/11-3/14/19 (n = 1210) and other resources (n = 52), deduplicating, dually screening abstracts (n = 1,156), reviewing full-text (n = 107), and conducted a content analysis to identify distinct and cross-cutting domains (n = 44). Main Findings: Most research was based on simple pre/post-training differences in provider knowledge. A majority of sources were non-empirical. We identified three distinct domains (education & staffing, physical environment, and inclusive language & communication) and three cross-cutting domains (subgroup differences, research, and policy). Principal Conclusions: Sparse empirical data that specify best approaches to improve CCCC exist; nevertheless, providers, in collaboration with researchers and policy makers, can initiate improved practices aimed at increasing CCCC for older LGB patients.

McEwing E.

Purpose Despite well-documented healthcare disparities in the lesbian, gay, bisexual, and transgender (LGBT) community, nursing education has lagged other health professions in promoting culturally competent care to members of this minority group. Methods Using national guidelines, the author developed an educational program for BSN students to improve competency in providing care for LGBT individuals. One hundred twenty-four students completed online modules and a simulation exercise, which explored LGBT healthcare topics. One hundred eight participants completed surveys pre-, post-, and 1 month after the intervention. Results Overall LGB competence scores improved from pre- (M = 4.42) to post-test (M = 5.20) and did not significantly decrease at one-month (M = 5.03, p  Conclusion Educational content focused on cultural competency for nurses may lead to improved health outcomes among the LGBT community.

Cannon C.

Batterer intervention programs (BIPs)Batterer intervention programs are the predominant form of treatment for perpetrators of intimate partner violence (IPV)Intimate Partner Violence (IPV) in the U.S. because these programs tend to be the go-to treatment option mandated by U.S. courts. Recent scholarship has begun to take seriously that LGBTQLGBTQ folks use violence to mediate their intimate relationships in comparable or increased rates as opposite-sex relationships. As LGBTQ people are increasingly accepted into society as equal rightsholders, and as such are increasingly arrested at similar rates to perpetrators in opposite-sex relationships, we can expect that LGBTQ people will also similarly be mandated to BIPs for treatment of IPV perpetration. But are BIPsBatterer intervention programs prepared to treat LGBTQ perpetrators of IPV? This chapter will assess current treatment programs for LGBTQLGBTQ perpetrators of IPVIntimate Partner Violence (IPV) , identify necessary modifications to treatment programs for LGBTQ populations, and discuss important avenues for future research.