LGBT Health Listening Session Notes

On Oct. 26, Equality Virginia hosted the U.S. Department of Health & Human Services for an LGBT Health Listening Session at Virginia Commonwealth University. Facilitators were Joanne Grossi, Region III HHS Regional Director and AJ Pearlman, HHS Office of Intergovernmental and External Affairs. Aryanna Abouzari, HHS Region III Executive Officer, transcribed the following notes.  For privacy, audience members are identified only by organization as appropriate in context. Joanne provided an introduction about HHS Region III and an overview of LGBT Public Listening Sessions. AJ introduced herself and gave a brief overview of HHS’s work on the following LGBT health-related topics: the ACA; new CMS rules on hospital visitation; HHS Coordinating Committee and the 2011 Recommendations ; IOM report on gaps in health disparities; anti-bullying website and initiatives; LGBT foster care guidance to states; improving data collection on sexual orientation and gender identity; grants that LGBT organizations have received (SAGE; Los Angeles Gay and Lesbian Center; HRSA grant to Fenway Institute; ACF grant to Hartland Alliance).

Listening Session Feedback

Audience Member 1 -- Department of Biological Complexity, VCU (Geriatrician) Recently conducted a study on people that trans-identify in 22 countries There is a need to improve health care services for the elderly trans population o There is a fear among elderly trans population to even go near health care providers o Would like to see some mechanism created to enact a “trans-friendly” environment NHIS questions: Audience Member's team proposed questions and the response they received was negative. They were basically told that gender-identity was not an issue. Who is reviewing these proposals? HHS should consider that the people reviewing proposals may not be trans-friendly. VCU is creating the first transgender database. Would be happy to share this data with HHS. Audience Member 2, Member, Society for Participatory Medicine Big question: in ICD-10, is trans-gender going to be removed from the mental disorder list? What is being done to address teen suicide rates in LGBT teens? Audience Member 3  As a transgender person, she is thankful to Obama Administration for his appointment to head of the Veterans Administration. However, even with insurance coverage, she finds it difficult to find primary care doctors who treat transgender people. This is likely a problem nationwide. o There is a local VA clinic that she can use for treatment, but finding a doctor is generally difficult for transgender people. Sometimes it seems like doctors don’t want to treat LGBT/transpeople Audience Member 4 Echoes comments that access to health care in trans community is rough. Limited ability to find physicians that will treat transgender people, especially when you have insurance and have to identify a primary care doctor. She can’t find an endocrinologist within the Newport News area, so will have to drive to Richmond. Other people travel hours to find access to doctors to assist them. Some friends have had to resort to getting hormones through unregulated means. This is not by choice, but by necessity. AJ: If HHS would provide funding for LGBT clinics, would that be helpful? Yes. Audience Member 1 Has applied for NIH funding for past 20 years for data research and has never received it. Transgender status is not a sexual orientation. It goes against the question that is likely to be asked in January. These are multi-dimensional constructs, can’t always put things in a box. AJ: yes, we are aware of the difference between identity and sexual orientation and understand that current labels are not always adequate. Audience Member 5, Virginia probably won’t expand Medicaid through ACA. In addition to culturally competent doctors, we need culturally competent navigators who are also sensitive to LGBT needs. A focus on outcomes-based measures is critical; HRSA has started to do this and it is helpful. CDC is also beginning this, but HHS needs to do it more often. We need more opportunities like the recent demonstration on HIV care and treatment for transgender women of color LGBT community will continue to become part of the health care system; data collection must be collected consistently at the national level. Need more guidance to states to help make that process more consistent. o Is the data patient-identified or provider-identified? Need guidance on these types of issues. Audience Member 6 What resources are available for people working with LGBT youth in foster care? VA law prevents them from doing work their work directly, so they have figured out ways to work around the restrictions so that they can work with families interested in LGBT youth. What can HHS do to assist them? AJ: In 2010, the Los Angeles Gay and Lesbian Center received money to develop best practices for LGBT youth in foster care and to examine barriers to adoption. We will share this data once we receive it. Audience Member 7, Virginia Association of School Nurses The VA Association’s position is unified with the National Association of School Nurses, which holds that all students – regardless of their sexual orientation or the sexual orientation of their family members -- are entitled to a safe school environment and equal opportunities for academic achievement and school participation. o Over 80 percent of LGBT youth are verbally harassed; 40 percent physically harassed; over 18 percent are physically assaulted in school. o LGBT youth encounter higher rates of anxiety, depression, and physical risks o Health issues include abuse, obesity, alcoholism, and drug abuse o Students of same-sex parents may also be subject to bullying Given these facts, registered school nurses are in a unique position to: o Recognize health risks that are disproportionately high for LGBT youth o Provide health services that are safe, in a private setting, and confidential o Make referrals for evidence-based care o Support and encourage policies in schools that promote physical, psychological, and social safety of LGBY youth and respect for diversity As HHS moves forward, the health of LGBT students must be a priority in all initiatives. Joanne: the Affordable Care Act created new funding opportunities for school-based health centers. Aryanna, Joanne’s chief-of-staff, will send Amy information about school based health center funding. Audience Member 8, Virginia Sexual and Domestic Violence Action Alliance Represents an organization that works on behalf of all victims of sexual and domestic violence Received half a million dollars from HHS More awareness needed for sexual and domestic violence within the LGBT community As HHS considers issues related to LGBT health, they encourage us to take the following steps: o ensure LGBT specific sexual and domestic violence funding opportunities are available o requirements for funding should include prohibiting discrimination based on sexual orientation o HHS should not look at transgender issues as second to other issues in the LGBT spectrum. This is a separate issue from sexuality and should be included right from the start o We should strengthen the prohibition of discrimination in employment o We should expand projects and demonstrations to study civil rights of LGBT people (e.g., the impact of restricting LGBT couples from collecting Social Security benefits) ACA: finding an insurance company that extended domestic partner benefits was difficult. She only found one insurance company that would cover her partner. She received a MLR rebate, though! AJ: Data from the National Intimate Partner and Sexual Violence Survey will be released soon, giving us a better idea of DV rates among lesbian, gay, and bisexual people. Audience Member 9 Partner is a school-teacher. They are looking for health care and want to retire in a place that will recognize their marriage and will provide them with health care benefits, but costs are prohibitive. Gay and Lesbian couples are looking at what happens to DOMA. They want to be able to move and find health care like everyone else. Would appreciate information on how to find health care in other states. Joanne: explained the health care navigator tool that is available at to help people explore their healthcare options in every state. AJ: DOMA may be headed to the Supreme Court. Stay tuned. tool permits you to search for insurers that extend benefits to domestic partners. Wyatt Albertson, student at VCU Covered through his parents insurance. Certain companies will pay for gender counseling but not testosterone shots, and vice versa. Wants surgery, but it is expensive. Why isn’t surgery covered? AJ: a lot of companies have exclusions for trans-specific care. There are advocacy groups at the state level working to remove those exclusions. Some of this may be tied to the process called Essential Health Benefits, but HHS hasn’t finalized the EHBs yet. Audience Member 10, lesbian Building trust with the government is hard. Anything we can do to put some teeth in changing the things causing the stress on the LGBT community would be helpful. What can the community do to take issues to the Legislature? She would like to talk to the government, but she needs the right tools to do so. Joanne: understands that it is hard to build trust, but encourages the community to speak up about issues that concern them. Funding decisions are often made based on the information available about a specific community. If the information is not shared with the government (e.g., City of Philadelphia was reluctant to share HIV data with the state), a community can lose out on funding. Audience Member 11, Richmond Chapter of Gay, Lesbian, Straight Education Network (GLSEN) Was going to discuss the recently released 2011 National School Climate Survey data, but it was already mentioned. Would like to see HHS and the Department of Education focus on improving health outcomes for LGBT youth in schools, after-school programs, and social service agencies. Possible focus areas: o Certain schools have non-discrimination and anti-bullying policies, but others do not. HHS and Department of Education should work to ensure policies become widespread. o State AG has indicated that schools can’t exceed what state provides in terms of non-discrimination protection. Can federal government provide more protections? o Are schools that have policies and training programs to protect youth effective in doing so? If so, what kinds of policies and programs are they using? This is an important topic for research. o School nurses, custodians, and janitors also serve an important role in schools. They should also be included in anti-bullying training and appropriate interventions, because they are often more likely to have exposure to bullying and harassment than teachers. o HHS needs more resources on website. Currently there is only one teacher-training video. o Are there ways we could get word out through media (e.g., public service announcements) or celebrities? More education needs to be done and this might be an effective way to do it. AJ: will share this feedback with the Department of Ed. She thinks that the Dept. of Ed has done work around anti-bullying with MTV. Audience Member 12, Virginia Sexual and Domestic Violence Action Alliance Free sexual and domestic violence training needs to include supports for gay, bi, and trans men, not just women Sometimes a provider is the only opportunity someone will have to share their experience about domestic violence. Can’t overstate the importance of this moment with a health care provider; perhaps collecting data from providers would also be helpful. Audience Member 13, PhD student at School of Social Work at VCU; licensed social worker There is a need for more funding for LGBT youth in foster care There is a focus on supporting LGBT kids in the foster care system; however, kids in residential treatment facilities and group homes also need support. The workers overseeing kids in these facilities (ages 5-17) also need training, because some the children might never make it to a foster care setting. Most of the workers in these settings do not have graduate degrees, which is where this type of training would normally occur. AJ: is there a way to train these workers as part of their required training? Yes, this is typically done state-by-state. Audience Member 14, Professor, VCU School of Social Work There is still a need for supports for LGBT young adults in college. She would like to see a program announcement for LGBT youth support services in higher education. We also need to expand programs to support services for LGBT youth on college campuses It would be great if funding could be used to train professionals that work with LGBT students. A needs assessment of LGBT youth in higher education would also be helpful. An intervention piece would also be helpful to explore whether some interventions more helpful than others. Audience Member 15 Would be great if campuses could hire LGBT coordinators full time Daughter of lesbians. She has faced real trouble finding insurance because of her Moms. Her mom, an ob-gyn, has to do her own research on developments in LGBT health. It is tough to find community resources for LGBT supports. There is a dearth of information for medical practitioners on LGBT health. Can the government do anything to help LGBT friendly practitioners? AJ: SAMHSA has a tool-kit created for providers treating LGBT persons. Gay and Lesbian Medical Association, ACOG also have guidance on working with transpeople. Audience Member 16 ROSMY, does training for providers For people under 18, a lot of times they only get counseling from a counselor that their parents want them to see. There need to be more options for counseling: at schools and outside of homes, maybe around family planning services Housing is a critical issue: there is a tremendous lack of emergency housing for LGBT youth AJ: HHS Secretary Sebelius is the Chair of the Interagency Council on Homelessness. The Council is trying to figure out ways to reach the young LGBT homeless population. HHS is also trying to determine how best to do research on LGBT homeless youth, as they are such a hard-to-reach population. Audience Member 17, Project Coordinator, Virginia Center on Aging, VCU: Housing is needed for all ages of LGBT youth. Many residential facilities don’t recognize LGBT couples and this is a hardship for seniors. She is interested in more information about the trainings for ombudsmen. AJ: CMS has provided guidance to states saying that they can treat same sex couples the same way they treat opposite sex couples when it comes to spousal impoverishment rules. HHS is also working on what else needs to go along with an ombudsmen video. James Parrish, Equality Virginia Thanked HHS for the work that it is doing on these issues. It would be great if we could have these same conversations at the state level. Audience Member 1: Youth have problems with injecting hormones. LGBT homogenizes the needs of each specific component within “LGBT” Really scared for elders, especially those that are ethnic minorities AJ’s Closing Remarks on Next Steps for Forum: Notes from today’s session will go right to LGBT sub-committee. Feel free to contact AJ with any additional comments or questions. She also has a LGBT distribution list; people should email her if they want to be on the list.