Improving affirming care for sexual and gender minority veterans.

Abstract

Lesbian, gay, bisexual, and transgender (LGBT) populations face a range of health disparities that all health care systems must address. In response to known health disparities, the LGBT Health Program of the Veterans Health Administration (VHA) developed policies supporting the provision of affirming care to LGBT veterans. To support policy implementation, the program launched the LGBT Veteran Care Coordinator (LGBT VCC) Program in 2016, requiring every VHA facility to appoint at least one clinical staff member to serve as an LGBT VCC. This quality improvement project reports on LGBT VCCs' perspectives on the state of affirming care at their facilities in the first year of the program. LGBT VCCs (n=79) completed a brief online survey, including qualitative questions on barriers and facilitators to implementation, and general recommendations for the program. The Consolidated Framework for Implementation Research (CFIR) guided directed content analysis of reported facilitators and barriers. The highest proportion of facilitators and barriers reported by the LGBT VCCs were coded under leadership

Variation in Sexual Orientation Documentation in a National Electronic Health Record System

“…We observed the majority of documentation after the repeal of DADT, which corroborates prior findings that SM Veterans reported less need for confidentiality and more willingness to disclose sexual orientation to VHA providers. 24 In 2014, VHA issued its first directive about providing affirming care to Veterans with SM identities, 27 and since 2016 every VHA facility is required to have a LGBT Veteran Care Coordinator on staff 33 who provides education and clinical consultation to VHA providers regarding LGBT policies and directives. Similarly, efforts are underway to improve medical curricula surrounding sexual orientation and gender identity (SOGI), 34 and newer clinicians are being increasingly trained in understanding the health disparities experienced by sexual and gender minority (SGM) individuals.…”

The Role of Implementation Science in Reducing Sexual and Gender Minority Mental Health Disparities

“…9 Within routine clinical care, the majority of health care systems also do not collect sexual orientation and gender identity data, 10 even within health care systems that have prioritized the care of SGM individuals (e.g., the Veterans Health Administration). 11 Thus, the reach and effectiveness of routine mental health care for SGM populations are also not well established. These issues suggest that, beyond mental health interventions needing to be efficacious for SGM populations, they must also be able to reach these populations in the real world, be integrated into routine care, and be sustainable to have a reliable positive impact on SGM mental health disparities.…”

Transitioning from the Battlefield: A Theoretical Model for the Development of Posttraumatic Stress Disorder (PTSD) in Gender Diverse Veterans

“…Stigmatization can also occur during probing questions regarding the veteran's transition process that are unrelated to the veteran's referral question (Lutwak et al, 2014). An environment of this nature has been shown to have detrimental impacts on the therapeutic alliance and health outcomes (Kauth et al, 2019).…”

“…Over the past 10 years the prevalence of veterans diagnosed with Gender Identify Disorder nearly doubled among veterans enrolled in VA services (Blosnich et al, 2013). Given the increasing numbers of transgender veterans accessing VA services, it is vital that we develop culturally responsive treatments to meet the needs of this marginalized population (Kauth et al, 2019). In recent years, the VA has been attempting to adapt a more inclusive policy in order to serve the increasing numbers of veterans within this marginalized population (Sharpe & Uchendu, 2014).…”

“…In recent years, the VA has been attempting to adapt a more inclusive policy in order to serve the increasing numbers of veterans within this marginalized population (Sharpe & Uchendu, 2014). This has been done by developing programs such as therapeutic support services (i.e., individual and group-based psychotherapy) as well as offering hormone replacement therapy (Valentine et al, 2019).…”