Jason D. Coleman, PhD, MSPH University of Nebraska at Omaha Ryan C. Wilson, MEd

1. Gay? Fine by Me: Creating a Friendly Space for LGBT Youth Jason D. Coleman, PhD, MSPH University of Nebraska at Omaha Ryan C. Wilson, MEd South Carolina Campaign to Prevent Teen Pregnancy

2. Objectives • Apply theory to the creation of inclusive spaces for LGBT youth • Examine needs of LGBT youth in clinical and community settings • Identify best practices for creating an environment friendly to LGBT youth • Create strategies for LGBT inclusiveness University of Pennsylvania, School of Medicine Photo credit: http://www.med.upenn.edu/lgbt/

3. Worldview Making Sense of the World

4. What words, issues, or ideas come to mind when you hear… • Lesbian • Gay • Bisexual • Transgender • Queer • Questioning • Intersex • Ally

5. Our Beliefs • What have you heard about LGBTQ persons?

6. Exercise • Heterosexual Questionnaire • Read through each question • How would you feel if you were asked these questions?

7. Influences on our Beliefs: Media

8. Influences on our Beliefs: Media Need More Media Photos

9. Influences on our Beliefs: Religion

10. Influences on our Beliefs: Policy

11. Influences on our Beliefs • Family • LGBTQ family members • Friends • Social Networks • Colleagues • Co-workers and associates • Who else?

12. Theoretical Approaches Risk and Protective Factors Theory Developmental Assets Approach

13. Risk and Protective Factors Theory • Risk factors increase the likelihood of problem behaviors • Protective factors counter risk factors • Heart Disease • Risk factors: eating fatty foods, smoking • Protective factors: eating a low-fat diet, getting adequate exercise • The same principle applies to problem behaviors Protective Factors Risk Factors Example borrowed from Hogan, Gabrielsen, Luna & Grothaus, Substance Abuse Prevention: The Intersection of Science and Practice. Allyn & Bacon: New York. 2003.

14. Risk Factors

15. Risk Factors

16. Risk Factors

17. Risk Factors Based on Hogan, Gabrielsen, Luna & Grothaus, Substance Abuse Prevention: The Intersection of Science and Practice. Allyn & Bacon: New York. 2003.

18. Protective Factors • Individual Characteristics • Gender • Resilient temperament • Positive social orientation • Intelligence • Bonding • Opportunities • Skills • Recognition • Healthy Beliefs and Clear Standards

19. Protective Factors • Individual Characteristics • Gender • Resilient temperament • Positive social orientation • Intelligence • Bonding • Opportunities • Skills • Recognition • Healthy Beliefs and Clear Standards

20. Developmental Assets • Defines 40 assets that decrease the incidence of high risk behaviors • Assets are categorized into 2 levels: • External Assets • Internal Assets • As student services professionals and health care providers, we have the opportunity to increase assets in youth Developed by the Search Institute; Revised by Project Cornerstone

21. External Assets • Support • Family support • Positive family communication • Adult relationships (other than family) • Caring neighborhood • Caring school climate • Parental involvement in schooling • Empowerment • Community values youth • Youth as resources • Service to others • Safety • Boundaries and Expectations • Family boundaries • School boundaries • Neighborhood boundaries • Adult role models • Positive peer influence • High expectations • Constructive Use of Time • Creative activities • Youth programs • Religious community • Time at home

22. External Assets • Support • Family support • Positive family communication • Adult relationships (other than family) • Caring neighborhood • Caring school climate • Parental involvement in schooling • Empowerment • Community values youth • Youth as resources • Service to others • Safety • Boundaries and Expectations • Family boundaries • School boundaries • Neighborhood boundaries • Adult role models • Positive peer influence • High expectations • Constructive Use of Time • Creative activities • Youth programs • Religious community • Time at home

23. Internal Assets • Commitment to Learning • Achievement motivation • School engagement • Homework • Bonding to school • Reading for pleasure • Positive Values • Caring • Equality and social justice • Integrity • Honesty • Responsibility • Restraint • Social Competencies • Planning and decision making • Interpersonal competence • Cultural competence • Resistance skills • Peaceful conflict resolution • Positive Identity • Personal power • Self-esteem • Sense of purpose • Positive view of personal future • Positive cultural identity

24. Internal Assets • Commitment to Learning • Achievement motivation • School engagement • Homework • Bonding to school • Reading for pleasure • Positive Values • Caring • Equality and social justice • Integrity • Honesty • Responsibility • Restraint • Social Competencies • Planning and decision making • Interpersonal competence • Cultural competence • Resistance skills • Peaceful conflict resolution • Positive Identity • Personal power • Self-esteem • Sense of purpose • Positive view of personal future • Positive cultural identity

25. Youth services professionals and health care providers must create an environment conducive to the positive development of all youth.

26. LGBT Health Specifics National Trends South Carolina Survey Results

27. Behavior vs. Identity • Identity: Refers to the words people use to describe themselves, such as heterosexual, gay, lesbian, or bisexual. • Behavior: Refers to what people actually do, sexually or otherwise, that puts them at risk for STIs or other health concerns. The Fenway Institute – www.fenwayhealth.org

28. Health Issues: Gay Men • Safer Sex (HIV/AIDS, STDs, Anal Papilloma) • Substance Use, Alcohol, & Tobacco • Mental Health (Depression/Anxiety) • Cancer (Prostate, Testicular, & Colon) • Fitness (Diet, Exercise, & Body Image) Gay & Lesbian Medical Association – www.glma.org

29. Health Issues: Lesbians • Cancer (Breast & Gynecological) • Mental Health (Depression/Anxiety) • Cardiovascular Health/Fitness • Substance Use, Alcohol, & Tobacco • Domestic Violence • Osteoporosis Gay & Lesbian Medical Association – www.glma.org

30. Health Issues: Transgender Persons • Access to Health Care/Health History • Hormones • Cardiovascular Health • Cancer • STDs & Safer Sex • Substance Use, Alcohol, & Tobacco • Mental Health (Depression/Anxiety) • Injectable Silicone • Fitness (Diet & Exercise) Gay & Lesbian Medical Association – www.glma.org

31. Health Issues: Bisexual Persons • Substance Use, Alcohol, & Tobacco • Safer Sex (HIV/AIDS & STDs) • Cancer (Prostate, Testicular, & Colon) • Fitness (Diet & Exercise) • Heart Health • Mental Health (Depression/Anxiety) • Social support, quality of life • Self harm and suicide attempts National Gay & Lesbian Taskforce – www.thetaskforce.org

32. LGBT Needs Assessment: South Carolina • Survey conducted with LGBT persons in South Carolina, 2009 (Coleman, Lindley, Wilson, Thompson) • Total of 837 completed surveys submitted • Data extracted for LGBT students enrolled in two-year colleges, four-year colleges and universities, and graduate/professional schools (n=115)

33. Demographics • Age range: 18-25 years • Gender • Male: 54% • Female: 45.1% • Transgender (FTM): 0.9% • Race • White: 77% • Bi-racial/Multi-racial: 6.2% • Black/African American: 13.3% • Asian/Pacific Islander: 2.7% • Ethnicity • Hispanic/Latino: 5.4% • Sexual Identity • Gay: 47% • Lesbian: 33% • Bisexual: 15.7% • Questioning: 2.6% • Queer: 1.7% • Enrollment • Four-year college or university: 56.5% • Two-year or community college: 28.7% • Graduate or professional school: 14.8%

34. Demographics • Relationship Status • Single: 41.7% • Dating one person: 35.7% • Partnered or married: 20% • Dating multiple people: 2.6% • Health Insurance • Health insurance: 79.6% • No health insurance: 16.8% • Not sure: 3.5% • Source • Parents: 75.9% • Job: 14.9% • Student health insurance: 4.6% • Self-insured: 3.4% • Government program: 1.1% • Primary Health Care Provider • Private provider: 66.4% • Urgent care: 8.4% • Hospital Emergency Room: 7.5% • Student Health Center: 6.5% • Health Department: 2.8% • Community Clinic: 1.9% • Work Clinic: 1.9% • Other: 4.6% • Sexual Orientation Disclosure to Care Provider • Never: 37.8% • Some of the time: 22.5% • Most of the time: 12.6% • Always: 27%

35. Results: Community Factors • 45% reported being the victim of a hate crime or bias in their lifetime • 88.3% reported feeling “safe” or “very safe” in their community • 36.6% reported “never” or “rarely” trusting law enforcement to protect their best interests

36. Results: Health Concerns Reported as percentages

37. Results: Health Concerns Reported as percentages

38. Guide to LGBT-Friendly Practice Recommendations for Inclusion

39. Activity • Describe the events of your last weekend without using any names or pronouns that would identify the gender of the person/persons with whom you spent the weekend. • For an LGBT individual, the decision to disclose their sexual orientation and/or the gender of their partner is a sometimes daily undertaking. This decision to disclose often extends to their health care provider.

40. Guidelines for Care of LGBT Patients • Creating LGBT-Sensitive Intake Forms • Emphasizing Confidentiality • Using Inclusive Language • Understand Unique Health Risks Gay & Lesbian Medical Association – www.glma.org

41. Creating a Welcoming Clinical Environment • Post rainbow flag, pink triangle, unisex bathroom signs, or other LGBT-friendly symbols or stickers • Exhibit posters showing racially and ethnically diverse same-sex couples or transgender people including posters from non-profit LGBT or HIV/AIDS organizations • Display brochures (multilingual when possible and appropriate) about LGBT health concerns Gay & Lesbian Medical Association – www.glma.org

42. Creating a Welcoming Clinical Environment • Disseminate or visibly post a non-discrimination statement stating that equal care will be provided to all patients, regardless of age, race, ethnicity, physical ability or attributes, religion, sexual orientation or gender identity/expression. • Acknowledge relevant days of observance in your practice such as World AIDS Day, LGBT Pride Day, and National Transgender Day of Remembrance Gay & Lesbian Medical Association – www.glma.org

43. Creating a Welcoming Clinical Environment • Display LGBT-specific media, including local or national magazines or newsletters about and for LGBT and HIV-positive individuals. • Require Staff Sensitivity Trainings • Ensure your facility offers Gender Neutral Restrooms on-site Gay & Lesbian Medical Association – www.glma.org

44. More Ideas • Find examples of breaking gender stereotypes • Did you know that many professional football players take ballet? • Consider how you talk about LGBT issues • Are they discussed as “controversial topics”? • Avoid “all” or “none” language • “All gay people do xyz” • We are individuals, not sexualities or genders!

45. Building on Assets: Strategies for Inclusivity

46. Recommended Readings • Healthy People 2010: Companion Document for Lesbian, Gay, Bisexual, and Transgender (LGBT) Health. (2001) – www.glma.org • Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients. (2006) – www.glma.org

47. Jason D. Coleman, PhD, MSPHAssistant ProfessorSchool of Health, Physical Education, and RecreationUniversity of Nebraska--Omahajdcoleman@unomaha.edu Ryan C. Wilson, MEd Training Coordinator SC Campaign to Prevent Teen Pregnancy Columbia, SC rwilson@teenpregnancysc.org