Improving Affirming Care for Sexual and Gender Minority Veterans

• Published in: Psychological services 2021-05, Vol.18 (2), p.205-215
• Main Authors: Valentine, Sarah E., Shipherd, Jillian C., Smith, Ashley M., Kauth, Michael R.
• Format: Article
• Language: English
• Subjects: Barriers; Bisexuality; Care coordinators; Communication; Competence; Content analysis; Cultural Sensitivity; Experimentation; Female; First year; Health Care Services; Health Disparities; Health education; Human; Leadership; Lesbianism; LGBTQ; LGBTQ people; Male; Military hospitals; Military Veterans; Minority Groups; Networking; Organizational culture; Policy implementation; Policy Making; Quality management; Quality of care; Sexual Minority Groups; Sexual orientation; Test Construction; Transgender persons; Veterans
• ISSN: 1541-1559; 1939-148X
• DOI: 10.1037/ser0000378

Lesbian, gay, bisexual, and transgender (LGBT) populations face a range of health disparities that all health care systems must address. In response to known health disparities, the LGBT Health Program of the Veterans Health Administration (VHA) developed policies supporting the provision of affirming care to LGBT veterans. To support policy implementation, the program launched the LGBT Veteran Care Coordinator (LGBT VCC) Program in 2016, requiring every VHA facility to appoint at least one clinical staff member to serve as an LGBT VCC. This quality improvement project reports on LGBT VCCs' perspectives on the state of affirming care at their facilities in the first year of the program. LGBT VCCs (n = 79) completed a brief online survey, including qualitative questions on barriers and facilitators to implementation, and general recommendations for the program. The Consolidated Framework for Implementation Research (CFIR) guided directed content analysis of reported facilitators and barriers. The highest proportion of facilitators and barriers reported by the LGBT VCCs were coded under leadership engagement, available resources, other personal attributes, organizational culture, and networking and communications. LGBT VCCs requested additional support in securing adequate designated administrative time, engaging with facility leadership, improving networking and communication, tailoring programing, and providing professional advancement opportunities. Organizing findings using the CFIR enabled the LGBT Health Program to effectively promote facilitators and address barriers experienced during the startup year of the LGBT VCC Program. The VHA's efforts to reduce LGBT veteran health disparities may serve as a model for other health care systems. Impact Statement We report on barriers and facilitators to implementing national policies for providing affirming care to lesbian, gay, bisexual, and transgender (LGBT) veterans served by the Veterans Healthcare Administration (VHA). Our findings highlight the central importance of leadership engagement, resource allocation (especially protected time), and building strong organizational networks when supporting large initiatives aimed at reducing LGBT health disparities. This approach may serve as a model for other health care systems.