LGBTQ+ cultural‐competence training effectiveness: Mental health organization and therapist survey outcome results from a pilot randomized controlled trial

Abstract

Lesbian, gay, bisexual, transgender, queer/questioning and other sexual and gender diverse (LGBTQ+) persons frequently lack access to mental health service organizations (MHOs) and therapists who are competent with LGBTQ+ clients. Existing continuing education programmes to better equip therapists to work with LGBTQ+ clients are often not widely accessible or skills focused, evaluated for effectiveness and inclusive of MHO administrators who can address the organizational climate needed for therapist effectiveness. A virtual, face‐to‐face, multi‐level (administrators and therapists) and multi‐strategy (technical assistance, workshop and clinical consultations) LGBTQ+ cultural competence training—the Sexual and Gender Diversity Learning Community (SGDLC)—was tested in a pilot randomized controlled trial. Ten organizations were randomly assigned to the intervention (SGDLC plus free online videos) or control (free online videos only) group. Pretest/posttest Organization LGBTQ+ Climate Surveys (n = 10 MHOs) and pretest/posttest Therapist LGBTQ+ Competence Self‐Assessments (n = 48 therapists) were administered. Results showed that at pretest, average ratings across organization LGBTQ+ climate survey items were low; twice as many items improved on average in the intervention (10/18 items) than control (5/18 items) group organizations. At pretest, therapist average scores (range 0–1) were highest for knowledge (0.88), followed by affirmative attitudes (0.81), practice self‐efficacy (0.81), affirmative practices (0.75) and commitment to continued learning (0.69). Pretest/posttest change scores were higher for the intervention relative to the control group regarding therapist self‐reported affirmative attitudes (cumulative ordinal ratio [OR] = 3.29; 95% confidence interval [CI] = 1.73, 6.26), practice self‐efficacy (OR = 5.28, 95% CI = 2.00, 13.93) and affirmative practices (OR = 3.12, 95% CI = 1.18, 8.25). Average therapist and administrator satisfaction scores were high for the SGDLC. These findings suggest the SGDLC training can affect organizational‐ and therapist‐level changes that may benefit LGBTQ+ clients.

Preliminary Psychometric Evaluation of Novel Measures of Therapist Practice Related to LGBTQ+ Clients

“…Based on a literature review of existing measures and using the competencies as a guide, the research team and CAB drafted a survey across four domains: knowledge, attitudes, self-efficacy, and practice related to affirming care of LGBTQ+ clients, and then conducted multiple rounds of review and revision. Based on this exhaustive process, we identified knowledge, attitudes, self-efficacy, and LGBTQ+-affirming care as key criterion domains; these criterion domains are described in more detail in the parent study [ 26 ]. The final Therapist LGBTQ+ Competence Self-Assessment was administered to therapists through the Qualtrics online platform at study baseline before therapists were randomized to study condition and study intervention as part of the larger RCT.…”