What in the World Is LGBT Cultural Competence, Anyway?

Lack of provider education is only a small piece of the problem that keeps our community from seeking health care and receiving high quality treatment.
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I applaud the recent news out of D.C.; their City Council unanimously approved a bill requiring that all continuing education programs for licensed health care professionals include LGBT-related "cultural competency" training.

Before we rush to train health care providers, I recommend we slow down and ask the big questions. What do we mean by LGBT cultural competence? (We are not all employing a clear or identical definition.) What are our training goals and how can we know if we achieved them? (A huge roar of applause is not an evaluation method.) What, (if anything) is it reasonable to expect to achieve in a two-hour training? Is "learning about LGBT people" going to make any difference in the multiple health disparities in our community?

In most cases, participants walk out of the trainings they attend understanding the difference between sexual orientation and gender identity. Maybe they also learned that LGBT people use tobacco at rates that are 68% higher than the general population. They may now know that LGBT seniors are twice as likely to live alone. But does that constitute LGBT cultural competence? I don't think so. Does knowing facts improve the health of my community? Not at all.

Lack of provider education is only a small piece of the problem that keeps our community from seeking health care and receiving high quality treatment. And yet, the people who attend these trainings may leave with the erroneous misconception that they are now "LGBT culturally competent". They have ticked off the attendance-box and earned their CEU credits, but they may go back to doing their jobs exactly as they did before.

With a generous grant from the NYS Department of Health, my staff and I at the National LGBT Cancer Network spent over a year asking the big questions and researching the latest studies before beginning the creation of our new curriculum. (In the process, I also learned how to make a movie, design slides with no more than 6 words on them, and the four levels of the Kirpatrick Triangle.)

Our aims include increased knowledge about LGBT people (and the diversity within the community), but go well beyond that. We are also seeking to alter the participants' attitudes, especially their less-conscious implicit biases against LGBT people, and ultimately, our curriculum is intended to create behavior change. Our overarching goal in training is to transform the way providers interact with the LGBT people they work with. This is clearly harder to achieve and more expensive to measure than an increase in knowledge, but it is the only difference that will improve my community's willingness to engage with mainstream healthcare systems.

We ground our LGBT cultural competence training in a theory of change and the unique challenges of teaching adults. Most healthcare providers have created their professional selves with great care and they are proud of the choices they have made. They believe they are welcoming and respectful of all people because they try to be. Their hearts are in the right place. We have to help them change without eliciting the resistance that shaming causes.

The final say about the success of all this research, rethinking and recreating is in the evaluations of our trainings. My organization is in the process of collecting our data now and we will publish the results when we have them. But, we must all find ways to measure our work and learn from the results how to improve our skills and curricula.

We encourage all of you who offer LGBT cultural competence training to reach higher and share your own lessons on how to make healthcare systems and social service organizations safer for LGBT people. Together, we can do it.

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