Lesbian, Gay, Bisexual and Trans (LGBT)

Ontarians and Primary Health Care

Anna Travers, MSW

Director, Rainbow Health Ontario

Agenda

Introduction to Rainbow Health Ontario

Lesbian, Gay, Bisexual and Trans Ontarians as

Primary Health Care Clients

Building Capacity to Serve LGBT Ontarians

Progress and Leadership

Challenges

Questions and Discussion

About Rainbow Health Ontario

RHO is a Knowledge Transfer and Exchange Program

funded by the Ontario Ministry of Health and Long-term

Care.

RHO is a program of Sherbourne Health Centre,

Toronto, which provides a broad range of primary health

programs and services to several thousand LGBT

clients, as well as homeless and newcomer populations.

About Rainbow Health Ontario

RHO’s goal is to improve access to services and

promote the health of Ontario’s LGBT communities.

We work with health and social service providers,

researchers, policy makers and LGBT community

members in three main areas:

Information and Outreach

Education and Training

Research and Policy

LGBT Ontarians

as Primary Health

Care Clients

Adult health promotion

Cathy, a new client is 52

years old. During her

initial appointment with

the nurse practitioner, she

says “By the way, I’m a

lesbian so you won’t need

to worry about a pap test”.

How should the NP

respond?

Seniors Peter and Ken have been a couple

for over 30 years. They have been

leaders in the local gay community.

Recently Ken had a stroke and has

lost much of his mobility and ability

to care for himself.

The health centre has a Seniors’

Program that offers exercise, social

activities and a nutritious lunch.

Will it be a welcoming place for Ken?

How will staff deal with homophobic

remarks by other clients?

Youth, Newcomer Kumar, aged 15 and his family

have lived in Canada for 3 years.

His mother has brought him in

because of severe headaches. He

is also spending a lot of time in his

room and says he is being teased

at school.

Alone, Kumar tells you that “the

kids always call me fag”.

How would you explore what is

going on with this boy?

Transgender Margaret is a trans woman. After years

of unemployment and lack of contact

with her adult children, things are finally

improving. She has moved here to take

a new job and reconnect with her son.

Margaret requires ongoing hormone

treatment, and appropriate screenings

and health education.

Will the providers be able to meet

Margaret’s health needs?

Will staff use appropriate pronouns?

Bisexual, Refugee

Paul, a refugee claimant from

Mexico, has been referred by his

lawyer. He was beaten and set on

fire for being bisexual.

Paul needs medical documentation

of his injuries for his hearing. He

also needs counselling for trauma

and referrals to places where he

can find support as a bisexual man.

How comfortable is the team in

dealing with these issues?

Two Spirited Kim,17 identifies as Two Spirited and

has left home due to conflict with her

family. She is living on the streets,

using crack cocaine and doing sex

work.

Kim is now pregnant and wants to

“get clean and get settled”. She has

many needs including a wish to know

others who identify as two spirited.

How will the team approach Kim’s

complex needs?

Colleagues

Grace, one of the medical

secretaries, is pregnant. She has

never talked about her private

life, but the staff are aware that

she has a same-sex partner.

There is much conversation behind

the scenes. Some staff want to hold

a baby shower for Grace as they

do for other colleagues. Others find

the idea inappropriate.

How should this be handled?

Building Capacity

to Serve LGBT

Ontarians

Foster research, disseminate evidence and

best practices Better population based statistics and inclusion in

population level surveys, e.g. Canadian Health

Survey.

In Canada, more robust research on health status

and specific concerns of LGBT people in many

areas, not only HIV/AIDS.

Professional schools need to include education on

health disparities of LGBT people, how to work

respectfully with clients.

Promote understanding of historical and

social factors

Understand how historical institutional and personal

discrimination have affected LGBT communities.

Be aware of ongoing effects of homophobia and

transphobia on health and wellness of LGBT people.

Learn differences between sexual orientation and

gender identity and use appropriate language and

vocabulary.

Organizational Change Health service planners:

Community engagement, need assessments

Use of evidence, inclusion in strategies and funding

decisions.

Health service providers:

Policies to ensure safety of clients, staff, volunteers

Training in cultural and clinical competence

Recruitment of LGBT people to board, staff, volunteers

Environment which reflects community, is respectful and

affirming.

Networking, mentorship and ongoing learning

To retain and build knowledge, confidence and skills, health service organizations and individual practitioners need:

Networks in which they can share information, make referrals, and build local integrated systems.

Ongoing sources of learning and mentorship – webinars, fact-sheets, mentorship, newsletters, conferences.

Evaluation and measurement of progress of organization and individuals.

Progress and

Leadership in

Ontario

General LGBT Training (2009 – 2013)

Some CHC’s have been actively providing services

to LGB clients for years, e.g. Centretown.

Over the past 5 years, many CHC’s, mental health

agencies, shelters, and others have accessed RHO

and other trainings.

RHO’s LGBT general training ranges from 2 hours to

a full day. 32 centres have received some training.

Examples of general training workshops

LGBT cultural competence, history, language, etc.

Mental and emotional health issues

Health disparities and clinical concerns

Working with racialized and newcomer LGBT people

Seniors health, long-term care, palliative, etc.

Issues for LGBT youth,

Serving LGBT families, family planning and support.

References and Resources Brotman S, Ryan B, Meyer E. (2006). The Health and Social Service

needs of gay and lesbian seniors and their families in Canada. McGill School of Social Work. Montreal. http://www.mcgill.ca/files/interaction/Executive_Summary.pdf

Part III - Barriers and Specific Population Groups. Access to Care: Exploring the Health and Well-Being of Gay, Lesbian, Bisexual and Two-Spirit People in Canada. McGill Centre for Applied Family Studies, Health Canada.(2000) http://www.hc-sc.gc.ca/hcs-sss/pubs/acces/2001-certain-equit-acces/part3-doc1-eng.php

The Health of LGBT People. (2011) Institute of Medicine. National Academies Press. Washington, DC.www.nap.edu

Fredriksen-Goldsen, K. et al (2013) Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population. The Gerontologist, doi:13.1093/geront/gnt021

RHO website resources – www.rainbowhealthontario.ca/resources

Trans Health Connection

Special RHO project started in 2011 to provide

intensive training to primary health and social

service providers.

Four full days of training on providing

comprehensive primary care to trans clients:

introductory session – history, trans identities, language

hormone assessment and management

preparation for surgery and aftercare of clients

providing social and psychological support, group work

Trans Health Connection

Training and Education across

Ontario, 2011 - 13 Toronto Cambridge

St. Catharines

Thunder Bay

Windsor

Ottawa

Ajax / Oshawa

Peterborough

Trans Health Connection trainees by profession MODULE Introduction Primary Care Surgery Counselling

Physicians 31 36 25 5

Nurses 56 65 43 9

Social Work 50 8 7 24

Mental Health 45 11 8 28

Managers 11 3 4 9

Youth Workers 24 14 7 24

Community 14 8 5 8

Community

Health 81 29 2 42

Students 15 6 9 11

Specialists 5 11 1 3

Other 33 38 6 31

TOTAL 365 229 117 194

Examples of Leadership in LGBT care in Ontario

Primary Care Centretown, Ottawa,

Norwest, Thunder Bay

Quest, St Catharines

Windsor FHT

E. Mississauga (LAMP)

Lang’s Farm, Cambridge

Sherbourne, Planned

Parenthood,

Access Alliance, Parkdale,

WHWH (all in Toronto)

Hospitals and Long-Term Care Mount Sinai Hospital

Children’s Hospital of Eastern Ontario

Fudger House and True Davidson Acres

Sick Children’s Hospital

North Ontario School of Medicine

Other Organizations Children’s Aid Society, Toronto

Children’s Services, Thunder Bay

Family Services Ottawa

CMHA Peterborough

Many AIDS service organizations

Many university student organizations

Challenges

in providing

LGBT Care

Challenges

LGBT people are still invisible to many organizations although estimated to be 1 – 1.25 million in Ontario.

Often not seen as part of all our diverse communities

Not always regarded as population group with diverse and legitimate needs.

Organizations have many competing priorities and are required to balance many needs.

Majority of health care providers still have no formal education or training in LGBT health.

Gaps in research and policy make it harder to develop comprehensive strategies.

Questions and Discussion

Do you have questions or information to add?

Do you have suggestions on how the primary health

care sector should move forward?

Is there a role for the AOHC and the Board?

atravers@RainbowHealthOntario.ca

www.RainbowHealthOntario.ca