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Qcare: Improving Healthcare for Lgbtq Youth

Friday, October 19, 2012
Room R06-R09 (Morial Convention Center)
Lynn Hunt, MD, FAAP, Pediatrics, University of California, Irvine, Santa Ana, CA, Tim Muldoon, MS1, School of Medicine, Program in Medical Education for the Latino Community (PRIME-LC), University of California, Irvine, Irvine, CA, Maryjane Vennat, MS1, School of Medicine, University of California, Irvine, Irvine, CA, Ryan Serrano, MS3, University of California, Irvine School of Medicine, Long Beach, CA, Aliyah Khan, MS3, School of Medicine, University of California Irvine, Long Beach, CA and Laura Kanter, MSW, The Center Orange County, Santa Ana, CA

Case Report:

We present our ongoing process to develop culturally competent and supportive care to address the needs of LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Questioning/Queer) youth. This project has grown out of a robust collaboration between pediatricians and other partners, and is informed in an ongoing fashion by the youth themselves.

The Problem

LGBTQ youth, especially those facing bias or family rejection, are at increased risk for a number of adverse health outcomes including higher rates of suicide attempts, substance use, depression and sexual health risks. Medical homes are important for all teens, but prevention and primary care take on heightened importance for high-risk patients. 

The Process

With the support of a CATCH grant, we organized a community coalition, held focus groups and key informant interviews, and conducted an online youth survey. 

Key Outcomes

Our Partners:
  • LGBT services center
  • LGBTQ youth
  • Medical school gay-straight alliance
  • Community health center
  • High school gay-straight alliances
  • AAP chapter
  • Department of Education
  • Latino health advocates
  • Homeless advocates
  • County department of health and social service agency

Focus Groups:

Youth Views on Provider & Staff Qualities:

Positive

  • Supportive
  • Knowledgeable
  • Show interest in youth
  • Professional, Non-judgmental

Negative

  • Uncertainty or hesitation 
  • Lack of confidentiality
  • Judgmental/Generalize
  • Staff uncomfortable touching patient

Issues for Younger Teens:

  • Inexperience choosing a provider
  • Confidentiality issues with parents
  • Unsure about patient/provider rights and responsibilities
  • Difficult transition when visiting their long-term pediatrician
  • Intergenerational differences with parents, provider

Issues for Latino Youth:

  • Stigma discussing sexuality at all
  • Religion vs. “alternative lifestyle”
  • Cultural differences: generational + societal + LGBTQ + accepted gender role
  • Difficulty maintaining confidentiality – “chismes”
  • Lower income 

Online Youth Survey:

Only 16% of respondents say they have a healthcare provider they can talk to about LGBTQ issues.

  • Best way to choose a doctor: providers who are known to be LGBTQ friendly or going to own doctor with LGBTQ specific training.
  • Second best: Referral from a trusted friend

Pediatricians:

Few pediatricians are willing to participate in explicit outreach for LGBTQ youth, site inadequate preparation. 

Adolescent specialists only group expressing competence.

Discussion:

In order to increase access to culturally competent medical homes:

  • We have strengthened partnerships to encourage the development of a new LGBTQ outreach clinic housed at a neighborhood health center.
  • Medical students are a driving force for the project overall, and provide mentorship to youth to further ensure ongoing youth input.
  • Pediatrician training has begun for both residents and community pediatricians.
  • Department of Education, the LGBT center, and the AAP chapter are working to provide anti-bullying education.