[Research Spotlight] LGBTQIA+ Affirmative Care: Upholding Professional Responsibilities
I recently read an AJOT study that I couldn’t wait to share with you all as it shows the power of continuing education.
A study conducted last year by Bolding et al. (2022) examined the knowledge, clinical preparedness, and attitudinal awareness of occupational therapy practitioners, in regards to the LGBTQIA+ folks. This self-report study was broken down by category and found that on a scale of 1-7, respondents scored a mean of 4.7 in their Knowledge about queer populations, 4.4 in Clinical Preparedness, and 5.6 in Attitudinal Awareness.
There were a number of factors that contributed to respondents scoring significantly higher in all three sub-scales, including a graduate degree in OT, past or present experience in mental health settings, or respondents with a close friend or family member who identifies as SGM (sexual gender minorities e.g., agender, bisexual, gay, lesbian, gay, gender non-conforming, transgender). Academic preparedness and continuing education specific to SGM populations were also indicators of higher scores in all three subscales.
It should be noted that continuing education courses about general cultural awareness have not been proven to impact clinical preparedness and attitudes about working with SGM individuals. That said, respondents who had completed continuing education courses relevant to LGBTQIA+ communities scored higher in the Knowledge and Clinical Preparedness categories.
Scores in Attitudinal Awareness - defined in the study as explicit bias and prejudice - were less likely to be affected by continuing education courses. The article suggests that attitudes about queer people stem from beliefs that are more deeply held and require a greater degree of introspection, in order to correct the dissonance between the values of one’s personal life and adherence to their Professional Code of Ethics. Specifically, respondents who identified religion as an important part of their lives typically scored lower in Attitudinal Awareness and Knowledge than those to whom religion is less important. Occupational therapy practitioners have to reconcile the need to practice ethically in accordance with the AOTA core professional values of altruism, equality, freedom, justice, dignity, truth, and prudence with the teachings of their religion, particularly if those teachings condemn SGM individuals (American Occupational Therapy Association [AOTA], 2020).
The existence of health disparities for SGM populations has been well documented, and these disparities can at least partly be attributed to healthcare providers’ inadequate overall training and continuing education about queer individuals. It’s not an overstatement to say this lack of knowledge can be life or death for SGM populations. SGM individuals are more likely to experience mental health disorders, suicidal ideation, substance abuse, trauma, chronic health conditions, and homelessness because of the stigma they experience. Not only are SGM individuals more likely to face discrimination from healthcare workers, but the fact that this is true has served as a powerful deterrent for LGBTQIA+ people to delay or avoid treatment altogether, which in turn exacerbates the likelihood of adverse health outcomes.
In terms of occupational therapy services, ignorance and bias among OT practitioners can lead to occupational injustice for SGM populations and reinforce the stigma and danger for SGM. The solution for this problem is twofold:
In general, a standardization of SGM training and continuing education is needed to increase knowledge and clinical preparedness for OT practitioners.
Moreover, OT practitioners whose attitudes, beliefs, and religious practices contribute to their bias about queer populations must engage in self-reflection and continuing education on how they can uphold their professional responsibilities regardless of their personal beliefs to be in compliance with the AOTA Code of Ethics.
More research is needed to identify ways in which the latter can be effectively addressed, as that may require more of an institutional and societal change in attitudes. Additionally, OT practitioners can be advocates and allies at their clinics to encourage clinic-wide LGBTQIA+ continuing education.
If you’re interested in taking or advocating for a clinic wide training opportunity, The Institute for Sex, Intimacy & Occupational Therapy offers a 2 hour CEU course “OT & LGBTQIA+ Inclusive Practice”.
Additionally, we recommend reaching out to LGBTQIA+ clinics and programs in your local community to partner with for ongoing training opportunities.