LGBTQ+ Inclusiveness in College
Social justice, human dignity, and respect for all remains first and foremost in the American College Health Association’s core values statement. Ensuring inclusiveness and a welcoming environment when treating students who identify as lesbian, gay, bisexual, transgender, queer, or other (LGBTQ+) is a basic tenet. This article may be used as a companion to the ACHA Guidelines Trans-Inclusive College Health Programs, which details creating an affirming and inclusive environment for delivering health services to students who identify as transgender or gender non-conforming. A plethora of resources are available on LGBTQ+ health care and inclusiveness; several are listed at the end of this article.
Mission/Vision Statement(s) and Policies for Fostering Inclusiveness
Examining your health or wellness center’s current mission/vision/values statement is a great place to start when developing or revising these statements or creating policies to foster inclusiveness. Title IX guidelines for educational institutions require that services be provided regardless of an individual’s gender identity or sexual orientation. The Affordable Care Act also emphasizes non-discrimination on the basis of gender identity and sexual orientation for the provision of health services. These two tenets should be applied when establishing or revising your mission/vision statement.
A mission and/or vision statement that prioritizes diversity, cultural competence, and inclusion proclaims the organization’s commitment to these values to all stakeholders and may include words such as “non-judgmental,” “caring,” “compassionate,” “elimination of barriers,” and “respectful.” For examples, see mission statements from the University of Maryland, the University of Georgia, and the University of New Mexico.
Engage the assistance of campus affiliates when developing or re-working your mission/vision statement(s). Departments such as the Office of Diversity and Inclusion and/or a LGBTQ+ Equity Center are knowledgeable resources and can provide valuable information about the campus LGBTQ+ community and provide guidance with language, policy development, and institutional initiatives and priorities.
Striving for a score of five using the Campus Pride Index may be helpful in examining the health center’s policies to ensure they support inclusiveness. Consider utilizing the Campus Pride Index’s assessment for the health center regardless of whether the institution participates or not. This could be an indicator as to how well the current policies reflect LGBTQ+ inclusiveness.
Policies should address practices that reflect a welcoming environment and should be consistent throughout the health and wellness center.
Examples may include:
- Asking and documenting the student’s preferred pronouns on the medical record. Pronouns cannot be assumed based on a person’s outward appearance or their gender assigned at birth. A student may elect to use he/his, she/her, they/them pronouns and/or other pronoun permutations
- Recording the student’s preferred name and appropriate gender marker. This may be accomplished in a quiet and respectful manner through the use of an LGBTQ+ sensitive intake form. Forms should include designation of “sex assigned at birth,” “gender identity,” and “preferred name.”
- Calling patients by last name when in waiting and other public areas to prevent unintentionally “outing” a transgender student.
- Working with the electronic health record (EHR) provider to ensure names and gender are transmitted as designated on the student’s insurance card to prevent denials.
- Working with the EHR provider and the university’s registrar to automatically download the student’s preferred name and gender into the medical record.
Health and wellness center staff should be knowledgeable about the LGBTQ+ community and their basic health and wellness concerns. There should be no assumptions about staff knowledge. Therefore, basic training on inclusiveness should be provided for all staff. The staff should be educated by trainers with subject matter expertise and should include terminology and the difference between sexual orientation and gender identity.
Training can be completed online or in person, depending on resources, staff availability, and access. Online training is usually accompanied by a certificate or continuing education credits. Depending on the source of in-person training, continuing education units may not be available.
Three sources for online training and resources:
In-person training can be provided by health or wellness center staff previously trained in LGBTQ+ inclusiveness, experienced colleagues from other universities with established LGBTQ+ programs and services, or campus affiliates such as the diversity and inclusion office and/or a LGBTQ+ equity center.
Establish a Welcoming Environment
Establishing policies and procedures and providing training to staff will be less effective if the health or wellness center is not welcoming to LGBTQ+ students. LGBTQ+ students should feel welcome when first entering the center and when reviewing the center’s website.
Ways to establish a welcoming environment include:
- Designating gender neutral restrooms in the center: converting as many traditional restrooms as possible and provide at least one on each floor.
- Displaying posters from LGBTQ+ non-profit organizations (like this one from the National LGBT Health Education Center)
- Placing information about LGBTQ+ health and wellness care in waiting areas, clinical spaces, and on the website. For example, the University of Georgia Health Center’s website includes both local and national resources.
- Become a recognized leader in LGBTQ+ health care by having your policies and practices evaluated using the Human Rights Campaign’s Healthcare Equality Index (HEI) benchmarking tool.
- Actively recruit LGBTQ+ identified students to participate in student health and wellness center programs like:
- Health promotion activities
- Peer education
- Student health advisory committee (SHAC)
Additional approaches to creating a welcoming environment can be found in GLMA guidelines and ACHA’s 10 Ways to Make Your Health Center More Welcoming to Diverse Students.
Clinical competency for providers should include coming-out issues, gender identity issues, sexual risk assessment, and HIV pre-exposure and post-exposure prophylaxis (PrEP/PEP) to ensure that LGBTQ+ students receive care appropriate to their individual needs as well as standard age-appropriate health care. If they are struggling with aspects of coming out or gender identity, they may also have co-existing depression, anxiety, substance misuse, or other health issues. Lesbians may have the misperception that they are not at risk for sexually transmitted infections because they are not having penile-vaginal intercourse. A woman undergoing transition may assume that she does not need to have a well women’s visit and will need education as to why this is still medically necessary. Providers need to know when and how to prescribe PrEP for all students at risk, including the LGBTQ+ population. The CDC offers a comprehensive guide to PrEP. Clinicians also should be familiar with The World Professional Association for Transgender Health’s (WPATH) Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People and the ACHA Guidelines on HIV PrEP.
Clinical competency also requires appropriate patient-provider communication, which is indicative of cultural competency. Training for cultural competency is offered by many professional organizations, including the American Medical Association, American Nurses Association, National Association of Social Workers, and the American Pharmacists Association. Most training is free to the organization’s members.
Providing Hormone Therapy
If the health center does not offer hormone therapy and local resources are scarce or inaccessible, consider adding this service. Providing hormone therapy involves a multidisciplinary approach. For example, at the University of Maryland, initiation of hormone therapy is a three-step process that aligns with the guidelines [pdf] outlined by WPATH. These steps include an initial meeting(s) with a mental health professional, then a meeting with a sexual health educator, and finally, an appointment with a medical provider.
The clinic’s decision to initiate hormonal therapy or provide continuing therapy only may be influenced by the availability of clinicians with experience in managing hormone therapy provider or interested in continuing education to provide such therapy.
For additional general information about expanding services, refer to Establishing New Services.