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Collecting Sexual Orientation and Gender Identity Data - Creating Patient-Centered Space for All

Friday, June 15, 2018   (0 Comments)
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 Meg Bowen  
Meg Bowen is the Quality Director at Winding Waters CHC, and is also a member of the NE Oregon LGBTQ Advisory board. She lives in Joseph with her partner. 


In calendar year 2016, HRSA mandated that all federal grantees and lookalikes needed to capture sexual orientation and gender identity (SO/GI) data as part of Uniform Data Systems (UDS). Improving the health of the nation's underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent and quality primary care health services is a priority of the Health Center Program,  and sexual orientation and gender identify can play a significant role in determining health outcomes. Gaining a better understanding of populations served by health centers including sexual orientation and gender identity, promotes culturally competent care delivery and contributes to reducing health disparities overall. 


The challenge faced by Winding Waters CHC, one of the newest Federally Qualified Health Centers in Oregon, was how to obtain this information from patients who might be reticent to speak about this in a very small community. Our frontier clinic is located in the Northeast corner of Oregon, and the county has approximately 7,000 residents. WWCHC serves roughly 60% of the population of the County, and with our staff of 65, we make up nearly 1% of the county population.  All staff training on LGBTQ 101 - Creating Patient Centered Space for All - occurred in July 2017, and the goal was to gain an understanding of the health disparities faced by members of the LGBTQ community, and how to create a welcoming space for all members of our community. The initial exercise in the training helped staff think about the issues faced by members of the LGBTQ community on a daily basis:

Pair up with the person beside you and think of an exciting, true personal story. Share that story with the person beside you but omit the following - your partner, spouse or family, job, school or hobbies. Go! 

This is an example of the "coming out" that many in the LGBTQ community do on a daily basis, scanning the scene to see if it is a safe place to discuss their lives. During the training staff learned about the history of the LGBTQ movement, about health disparities and other challenges faced by this population. LGBTQ youth are 2-3 times more likely to commit suicide, and adults report higher rates of smoking, drinking, drug use, depression and anxiety. Lesbians are less likely to get regular preventive screenings, and elderly members of the LGBTQ community face additional barriers due to social isolation, diminished family support, and reduced availabilities of social services. Some seniors report discrimination by their peers when living in communal elderly housing. Our staff agreed universally that we need to be not only collecting data, but we needed to make additional resources and support available to LGBTQ members of our community. 

Recommended best practice regarding capturing SO/GI data is that the questions should be asked at the front desk upon check in, not unlike federal poverty level (FPL). Our staff decided that the medical assistant (MA) should ask these questions during the rooming process. Scripts were developed and MAs practiced asking the questions on each other to build confidence. Workflows were developed, and soon this became a standard part of the rooming process.  MAs shared success stories and lessons learned from difficult encounters. If patients declined to answer the questions, the provider would then ask the patients during the medical encounter. 

Because of the training, workflow development and implementation of this process, we were able to assess SO/GI 1600 times between August and December 2017. Only 19% of the patients refused to answer the questions with the medical assistants. Resources were made available to those patients who asked for more information on LGBTQ services and support in Wallowa County. The Northeast Oregon LGBTQ Advisory Board decided to hold the first public Pride in Wallowa County in 2017, and we were excited to have 125 community members attend the event, along with every provider from Winding Waters CHC. Our organization is awash with rainbows in an effort to alert the LGBTQ community that we are a safe space. Next steps in this implementation include tracking utilization and completion of preventive screenings for this population in Wallowa County. 


Summer Image

As June is historically the month when Pride celebrations take place, it is a great time to assess your policies and procedures around collecting SO/GI data. There are incredible training resources available through The Fenway Institute http://fenwayhealth.org/the-fenway-institute/. The Fenway Institute also provides resources in many languages that can be used to provide support to the LGBTQ community.





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