LGBTQ Capacity Building in Health Care Systems: A Social Work Imperative

Abstract

Working within a diverse array of health care settings, social workers encounter a variety of client populations, many of whom we are well prepared to serve. We have specialties in working with children, adolescents, and older adults with mental illnesses, substance use issues, or particular health care concerns such as HIV. As a profession, we have begun to pay attention to racial and ethnic health disparities that may cut across each of these groups and have actively engaged in efforts of cultural competence. However, we have not, until recently, paid attention to the health disparities and particular health care needs of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) population. Estimates of the size of the LGBTQ population in the United Sates vary, with Kinsey's (1948) 10 percent estimate holding almost mythical status. However, a recent estimate generated by Gary Gates at the Williams Institute, who cross-compared a number of different population surveys, put the number of LGB individuals at approximately 3.5 percent of the population and transgender individuals at 0.3 percent (Gates, 2011). Gates noted that this amounts to 9 million LGBT Americans, a figure roughly equivalent to the population of New Jersey (p. 1). Given this prevalence, it is likely that all social workers will encounter LGBTQ clients on their caseload whether or not they overtly identify their orientation or gender identity. Throughout history the dominance of a heteronormative paradigm has resulted in LGBTQ individuals experiencing stigmatization and discrimination. This discrimination may manifest as verbal or physical assaults (Kosciw, Greytak, Diaz, & Bartkiewicz, 2010) or as policies that render these individuals' relationships invisible (such as not being eligible for a life-partner's social security benefits). Having been socialized in a cultural environment that is at best heteronormative and at worst homophobic, health care providers frequently make assumptions of heterosexuality in the questions they ask their patients. In turn, patients anticipate that disclosure of sexual orientation will negatively affect the care they receive (James & Platzer, 1999). The impact of stigmatization of and discrimination against LGBTQ individuals is the potential for uneven care when accessed, or avoidance of care altogether, resulting in disparities emerging within health issues because many unaddressed social, contextual, psychological, developmental, interpersonal, and environmental factors can produce deleterious outcomes (Mayer et al., 2008)). The extent of these disparities is sufficient cause for concern that the U.S. Department of Health and Human Services has elevated sexual orientation from a noted disparity in their Health People 2010 (U.S. Department of Health and Human Services, 2000) objectives to a target group for concern and improvement in Healthy People 2020 (see http://www.healthypeople.gov/2020/ topicsobjectives2020/det:ault.aspx). Social workers have an important role to play in helping to address this charge. Social work's values, as articulated by the NASW Code of Ethics (NASW, 2008), call on us not only to honor the dignity and worth of all persons and to promote social justice, but also to more actively challenge social injustice, noting that social workers should pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people (p. 5). Social workers, therefore, have an ethical imperative to increase their capacity to provide culturally competent services to clients of all sexual orientations and gender identities, shedding assumptions of heterosexuality and creating more inclusive practices. They should also actively engage in the LGBTQ competency training for all health professionals. INEQUALITIES, SOCIAL JUSTICE, AND NEGATIVE HEALTH INDICATORS Recently, the Joint Commission for the Accreditation of Health Care Organizations set for a road map detailing requirements for the inclusion of LGBTQ loci within health care settings (Joint Commission, 2010). …