The following suggested actions are a starting point towards LGBTI inclusive practice for health and community services.
To build comprehensively inclusive services for people who are LGBTI, service providers are encouraged to further information, training, professional development and accreditation opportunities.
In implementing gender-sensitive practice, services should consider the needs of individuals who do not identify as either female or male, or who do not identify as heterosexual. LGBTI people are as diverse as the rest of the community and make up 10 to 15 per cent of the overall population. Those identifying as LGBTI may share some experiences, such as the experience of exclusion and discrimination, but are likely to have a range of different needs depending on the individual. For example, someone questioning their gender identity is likely to have different needs to someone questioning their sexuality. LGBTI people are generally exposed to greater rates of marginalisation and discrimination. Same-sex attracted young people and young people questioning their sexuality may be particularly vulnerable to discrimination and homophobic abuse.
Service responses should demonstrate sensitivity, thoughtfulness and responsiveness about the particular support needs that LGBTI individuals may have. Part of ensuring the gender sensitivity of the service for LGBTI people involves communicating openness and acceptance of people’s gender, sexual identity and lifestyle. Any type of homophobic or transphobic discrimination can have a detrimental impact on a person’s mental health and wellbeing.
Guidance for practitioners working with LGBTI people practitioners need to:
- recognise the diverse needs of LGBTI people
- understand the issues people of diverse gender identity and sexual preference
- face and be responsive to individual needs
- provide an accessible service and referral to appropriate services/support
- where necessary
- be sensitive and receptive in talking about and responding to LGBTI people
- as people share personal information in a range of different ways
- convey openness and a non-judgemental attitude about LGBTI issues
- address transgender people by their preferred gender
- ensure sensitive enquiry occurs about the preferred contact person/partner and
- make adjustments on intake/assessment forms as appropriate.
Below are some possible questions that practitioners might use in ascertaining people’s needs in relation to their gender identity and sexuality. Questions should be asked sensitively and not sequentially. It can be helpful to introduce questions regarding sexual orientation by explaining why you are asking these questions, for example:
- To determine the best service for each person’s needs, I ask all people entering the service about their living arrangements.
- Transgender people do not identify with the gender of their upbringing.
- Intersex people are people who are born with reproductive organs or sex chromosomes that are not exclusively male or female.
- As part of our assessment processes we need to understand how you like to live your life. Can you tell me about your home life, who you live with, who your support people are…?
Other demographic questions about partners and living arrangements might include:
- Do you have a partner? (rather than ‘Are you married?’)
- What is your partner’s name?
- Is your partner female or male? (if the answer to the previous question is unclear)
- Do you live with anyone?
- Who do you regard as your close family?
- Do you have any children?
- Are you co-parenting children with anyone?
The following questions can be useful if the person does not have a partner, in order to understand preferred social networks or to explore health issues related to discrimination:
- How would you describe your sexual orientation (or gender identity)?
- Have you had any negative experiences relating to your sexual orientation/gender identity/intersex status?
- Ensure policies, including privacy, marketing, staff training and patient-centred care policies, make overt references to people who are LGBTI.
- Develop an affirmative action policy that supports the appointment of a diverse range of staff, including staff who are LGBTI.
- Develop and display an anti-discrimination policy that directly refers to people who are LGBTI and specifies that discrimination on the basis of sexual orientation, gender identity or intersex status is not tolerated from staff, patients or carers.
- Add inclusive service clauses to all policy documentation, including position descriptions, service agreements, staff interview questions, and support worker and team leader manuals.
- Seek advice from representatives from LGBTI communities regarding services.
- Seek LGBTI representatives for consumer and service advisory committees and forums.
- Consult and partner with LGBTI stakeholders to ensure that all work is led by evidence and informed by LGBTI stakeholders and communities.
- Display LGBTI symbols and health materials in public areas to indicate an inclusive approach.
- Conduct and/or participate in activities, such as public campaigns and community events, that raise awareness of LGBTI communities and issues.
- Provide LGBTI-specific support and access, such as phone, web chat and email support, information resources, supporting volunteers and speakers.
- Train staff to use language that is inclusive of the diverse range of LGBTI people and their relationships, while being careful to protect confidentiality.
- Develop a referral network of services and providers that are known to be LGBTI inclusive.
- Disseminate LGBTI information factsheets and resources.
Health and personal information
- Train staff in skills of respectful facilitation of disclosure and sensitive sexual history taking, as well as in evidence-based LGBTI specific health information.
- Ensure staff carefully and respectfully document LGBTI identity in the patient files and referral letters with the permission of each patient.
- Ensure LGBTI partners are readily recognised as next of kin without needing to produce documentary evidence.
- Support research projects focused on LGBTI communities.