Community Standards of Practice for the Provision of Quality Health Care Services to Lesbian, Gay, Bisexual, and Transgender Clients
Introduction
The Gay, Lesbian, Bisexual and Transgender Health Access Project is a collaborative, community-based program funded by the Massachusetts Department of Public Health (MDPH). The Project's mission is to foster the development and implementation of comprehensive, culturally appropriate, quality health promotion policies and health care services for gay, lesbian, bisexual and transgendered (GLBT) people and their families.
Research has indicated that fear of discrimination and stigma cause many GLBT individuals to postpone or decline seeking medical care. Others, once in care, sometimes withhold from their providers personal information which may be critical to their well-being. Working closely with consumers and clinicians across the state, the GLBT Health Access Project works to confront the insensitivity and ignorance that many GLBT people have experienced in accessing health care and related services. Additionally, the Project seeks to support GLBT individuals in understanding and acquiring the quality care they need. The Community Standards of Practice contained here provide a benchmark for both providers and consumers in the development of and search for welcoming, culturally competent and responsive care. The need for Community Standards emerged from several sources, including a statewide provider survey and a 1997 GLBT Health Access Project report, Health Concerns of the Gay, Lesbian, Bisexual and Transgender Community. Among other things these reports detailed a serious lack of GLBT awareness and understanding among health care providers in Massachusetts. Some believed they had no GLBT clients or staff in their facilities; many were unsure about what their role should be in identifying and addressing GLBT issues; few had policies in place to guide personnel or consumers. To address these concerns, the GLBT Health Access Project convened a community Working Group of over 60 consumers, providers, public and private agency administrators and staff. Over the course of a year, the group worked to develop a framework to improve GLBT access to quality care and to assist clinicians and their facilities in creating responsive environments. The working group's efforts were guided by four principles: (1) the elimination of discrimination on the basis of sexual orientation and gender identity; (2) the promotion and provision of full and equal access to services; (3) the elimination of stigmatization of GLBT people and their families; and (4) the creation of health service environments where it is safe for people to be "out" to their providers. The resulting community standards of practice and quality indicators outlined in this document will guide and assist providers in achieving these goals. The standards address both agency administrative practices and service delivery components, including the following areas: I. Personnel II. Client's Rights III. Intake and Assessment IV. Service Planning and Delivery V. Confidentiality VI. Community Outreach and Health Promotion
GLBT people live in and seek health care and prevention services in every community in Massachusetts. Eliminating barriers to care requires both an educated and empowered consumer base and a skilled, culturally competent, sensitive and welcoming provider community that is openly supportive of gay, lesbian, bisexual and transgendered people and their families. These standards are one tool for achieving greater health care for all. Return to top of page
STANDARDS AND INDICATORS
I. Personnel Standard 1. The agency shall establish, promote and effectively communicate an inclusive, non-discriminatory work place environment for gay, lesbian, bisexual and transgendered employees.
INDICATOR: Written policies, including but not limited to non-discrimination, diversity and non-harassment policies that explicitly include gay, lesbian, bisexual and transgendered employees.
INDICATOR: Inclusion of policies in all new employee orientation programs and materials; inclusion of policies in employee handbook.
INDICATOR: Written sign-off on policies by all employees.
INDICATOR: Discussion of polices with job applicants during interviewing process.
INDICATOR: Posting of polices in all of agency's facilities.
INDICATOR: Annual review of all policies, and opportunities for ongoing employee input and training.
Standard 2. The agency shall support and encourage visibility of gay, lesbian, bisexual and transgendered employees.
INDICATOR: Active employment recruitment of gay, lesbian, bisexual and transgendered employees, including outreach to GLBT organizations, and advertising in GLBT media.
INDICATOR: Development and implementation or revision of existing policies to ensure effective procedures for dealing with employee complaints of discrimination or harassment based on sexual orientation or gender identity.
INDICATOR: Written notice to all employees that discrimination or harassment of other employees on the basis of sexual orientation or gender identification is grounds for appropriate levels of discipline, up to and including dismissal.
Standard 3. The agency shall work towards ensuring that gay, lesbian, bisexual and transgendered employees of all ages are subject to the same terms and conditions of employment, including the same benefits and compensation, as all other employees.
INDICATOR: Written policies explicitly stating that the agency does not discriminate on the basis of sexual orientation or gender identity in providing compensation and benefits, including but not limited to family and medical leave, bereavement leave, and such other benefits as the agency offers its employees.
INDICATOR: Written policies explicitly extending the same benefits to all families, including the families of gay, lesbian, bisexual and transgendered employees. Such policies may allow employees to designate who shall be considered their "family" members. If the agency offers health, life, disability insurance and pension benefits to its employees, the agency shall work towards including full and equal coverage for its gay, lesbian, bisexual and transgendered employees and their families.
INDICATOR: Comprehensive ongoing training of all human resource and other appropriate personnel in sexual orientation and gender identity issues with regard to employee benefits.
INDICATOR: Mechanisms to appropriately convey GLBT-related policies and make relevant training accessible to all employees at all levels, including those with disabilities, and those for whom English is not their primary language.
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II. Client's RightsStandard 4. The agency shall assure that comprehensive policies are implemented to prohibit discrimination in the delivery of services to gay, lesbian, bisexual and transgendered clients and their families. The agency shall ensure that all staff use, and all written forms and policies employ, culturally appropriate language when dealing with gay, lesbian, bisexual or transgendered clients and their families. For the purpose of these standards the terms "family" and "families" shall be broadly construed, and shall include but not be limited to relatives by blood, adoption, marriage or declaration of domestic partnership.
INDICATOR: Written polices that explicitly state that the agency does not discriminate on the basis of sexual orientation or gender identity in the provision of services. Such policies shall specifically include families of all clients.
INDICATOR: Conspicuous posting of non-discrimination policies in all languages appropriate to the populations served by the agency, and inclusion of policies in agency brochures, informational and promotional materials.INDICATOR: Mechanisms to ensure that non-discrimination policies and procedures are appropriately conveyed to all clients, including those with disabilities and those for whom English is not their primary language.
INDICATOR: Explicit sign-off on policy by all employees.
Standard 5. The agency shall ensure that it has comprehensive and easily accessible procedures in place for clients to file and resolve complaints alleging violations of these policies.
INDICATOR: Written complaint procedures.
INDICATOR: Designation of one or more persons responsible for ensuring agency compliance.
INDICATOR: Written notice to all employees that discrimination in the delivery of services based on sexual orientation or gender identity violates standards of good care, and is subject to appropriate discipline.
INDICATOR: Conspicuous posting of complaint procedures, inclusion of procedures in informational materials given to agency clients and their families.
INDICATOR: Translation of procedures into and provision of information in all languages appropriate to populations the agency serves.
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III. Intake and AssessmentStandard 6. The agency shall develop and implement or revise existing intake and assessment procedures to ensure that they meet the needs of gay, lesbian, bisexual and transgendered clients of all ages and their families.
INDICATOR: All reception, intake and assessment staff are trained to use culturally appropriate language.
INDICATOR: Development and implementation of intake and assessment forms which provide for optional self-identification in all categories of gender identity, sexual orientation, marital, partnership and family status, and provide clients with the option and opportunity for further written explanation.
INDICATOR: Develop mechanisms to ensure that all reception, intake and assessment staff are familiar with providers within the agency with expertise in and sensitivity to gay, lesbian, bisexual and transgender issues, and appropriately convey this information to clients.
INDICATOR: Development and implementation of training for all intake and assessment staff to assure medically and culturally appropriate referrals for gay, lesbian, bisexual and transgendered clients and their families to providers within and outside of the agency.
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IV. Service Planning and DeliveryStandard 7. All agency staff shall have a basic familiarity with gay, lesbian, bisexual and transgender issues as they pertain to services provided by the agency.
INDICATOR: Development and implementation or revision of agency training and programs on diversity, harassment, and anti-discrimination to assure explicit inclusion of gay, lesbian, bisexual and transgender issues.
INDICATOR: Development and implementation of training for all intake, assessment, supervisory, human resource, case management and direct care staff on basic gay, lesbian, bisexual and transgender issues.
Standard 8. All direct care staff shall routinely provide general care to gay, lesbian, bisexual and transgendered clients. All direct care staff shall be competent to identify and address, within the scope of their field of expertise, specific health problems and treatment issues for gay, lesbian, bisexual and transgendered clients and their families, to provide treatment accordingly, and to provide appropriate referrals when necessary.
INDICATOR: Comprehensive ongoing training provided for direct care staff to identify and address basic health issues within their field of expertise that may particularly or uniquely affect gay, lesbian, bisexual and transgendered clients.
INDICATOR: Creation and implementation of mechanism for identification of staff with special expertise in and sensitivity to gay, lesbian, bisexual and transgender issues.
INDICATOR: Provision of training for direct care staff on how, when and where to make appropriate referrals for gay, lesbian, bisexual and transgendered clients and their families.
INDICATOR: Development of a comprehensive resource list for appropriate referrals for special gay, lesbian, bisexual and transgender health concerns.
INDICATOR: Outreach to and development of relationships with other agencies and providers with expertise in gay, lesbian, bisexual and transgender health issues.
INDICATOR: Evidence of agreements or other appropriate mechanisms to ensure cooperation with other agencies and providers to whom gay, lesbian, bisexual and transgendered clients and their families may be referred for specialized care and treatment.
Standard 9. All case management and treatment plans shall include and address sexual orientation and gender identity where it is a necessary and appropriate issue in client care.
INDICATOR: Provision of training for all case management and direct care staff on gay, lesbian, bisexual and transgender health, treatment and cultural issues.
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V. ConfidentialityStandard 10. The agency shall ensure the confidentiality of client data, including information about sexual orientation and gender identity issues. Gay, lesbian, bisexual and transgendered clients shall be informed about data collection that includes references to sexual orientation and/or gender identity, including in what circumstances such information may be disclosed, whether it may be disclosed as aggregate or individual information whether personal identifiers may be disclosed, and how and by whom such information may be used.
INDICATOR: Written confidentiality policies which explicitly include sexual orientation and gender identity, indicating that such information is to be considered highly sensitive and treated accordingly.
INDICATOR: Designation of sexual orientation and gender identity is at client's option on forms and records.
INDICATOR: Comprehensive training for appropriate staff on data collection and reporting issues as they relate to confidentiality.
INDICATOR: Written disclosure to clients explaining when information may or must be disclosed to third parties for payment or other reasons, and in what circumstances such disclosures may include information regarding sexual orientation and gender identity.
Standard 11. The agency shall provide appropriate, safe and confidential treatment to gay, lesbian, bisexual and transgendered minors, unless the agency's services are inappropriate for all minors. All clients who are minors shall be informed of their legal rights, and advised of the possibility and possible consequences of any statutory or otherwise mandated reporting.
INDICATOR: Staff training regarding the legal rights of minors.
INDICATOR: Development and implementation of procedures for intake, assessment and treatment of minors that is sensitive to gender identity and sexual orientation.
INDICATOR: Written and oral notice to minors of various mandated reporting laws and their implications, and of the minor's rights regarding confidentiality and treatment without parental consent.
INDICATOR: Reception staff trained to be sensitive to issues of gay, lesbian, bisexual and transgendered youth.
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VI. Community Relations and Health PromotionStandard 12. The agency shall include gay lesbian, bisexual and transgendered people and their families in outreach and health promotion efforts.
INDICATOR: Agency advertising and promotional materials clearly indicate nondiscrimination policies regarding sexual orientation and gender identification.
INDICATOR: Agency outreach efforts to social service, medical and other providers promote services to gay lesbian, bisexual and transgendered clients and their families.
INDICATOR: Agency outreach and promotional efforts accurately reflect the level and quality of services available to gay lesbian, bisexual and transgendered clients and their families.
Standard 13. The composition of the agency Board of Directors and other institutional bodies shall encourage representation from GLBT communities.
INDICATOR: The process for electing or appointing members of the Board of Directors and other institutional bodies includes outreach to and inclusion of gay, lesbian, bisexual and transgendered candidates.
Standard 14. Agency community benefits programs shall include gay, lesbian, bisexual and transgendered people in the communities the agency serves.
INDICATOR: Development of criteria for community benefits programs that provide for inclusion and promotion of issues of concern to gay lesbian, bisexual and transgendered people and their families.
Introduction
The Gay, Lesbian, Bisexual and Transgender Health Access Project is a collaborative, community-based program funded by the Massachusetts Department of Public Health (MDPH). The Project's mission is to foster the development and implementation of comprehensive, culturally appropriate, quality health promotion policies and health care services for gay, lesbian, bisexual and transgendered (GLBT) people and their families.
Research has indicated that fear of discrimination and stigma cause many GLBT individuals to postpone or decline seeking medical care. Others, once in care, sometimes withhold from their providers personal information which may be critical to their well-being. Working closely with consumers and clinicians across the state, the GLBT Health Access Project works to confront the insensitivity and ignorance that many GLBT people have experienced in accessing health care and related services. Additionally, the Project seeks to support GLBT individuals in understanding and acquiring the quality care they need. The Community Standards of Practice contained here provide a benchmark for both providers and consumers in the development of and search for welcoming, culturally competent and responsive care. The need for Community Standards emerged from several sources, including a statewide provider survey and a 1997 GLBT Health Access Project report, Health Concerns of the Gay, Lesbian, Bisexual and Transgender Community. Among other things these reports detailed a serious lack of GLBT awareness and understanding among health care providers in Massachusetts. Some believed they had no GLBT clients or staff in their facilities; many were unsure about what their role should be in identifying and addressing GLBT issues; few had policies in place to guide personnel or consumers. To address these concerns, the GLBT Health Access Project convened a community Working Group of over 60 consumers, providers, public and private agency administrators and staff. Over the course of a year, the group worked to develop a framework to improve GLBT access to quality care and to assist clinicians and their facilities in creating responsive environments. The working group's efforts were guided by four principles: (1) the elimination of discrimination on the basis of sexual orientation and gender identity; (2) the promotion and provision of full and equal access to services; (3) the elimination of stigmatization of GLBT people and their families; and (4) the creation of health service environments where it is safe for people to be "out" to their providers. The resulting community standards of practice and quality indicators outlined in this document will guide and assist providers in achieving these goals. The standards address both agency administrative practices and service delivery components, including the following areas: I. Personnel II. Client's Rights III. Intake and Assessment IV. Service Planning and Delivery V. Confidentiality VI. Community Outreach and Health Promotion
GLBT people live in and seek health care and prevention services in every community in Massachusetts. Eliminating barriers to care requires both an educated and empowered consumer base and a skilled, culturally competent, sensitive and welcoming provider community that is openly supportive of gay, lesbian, bisexual and transgendered people and their families. These standards are one tool for achieving greater health care for all. Return to top of page
STANDARDS AND INDICATORS
I. Personnel Standard 1. The agency shall establish, promote and effectively communicate an inclusive, non-discriminatory work place environment for gay, lesbian, bisexual and transgendered employees.
INDICATOR: Written policies, including but not limited to non-discrimination, diversity and non-harassment policies that explicitly include gay, lesbian, bisexual and transgendered employees.
INDICATOR: Inclusion of policies in all new employee orientation programs and materials; inclusion of policies in employee handbook.
INDICATOR: Written sign-off on policies by all employees.
INDICATOR: Discussion of polices with job applicants during interviewing process.
INDICATOR: Posting of polices in all of agency's facilities.
INDICATOR: Annual review of all policies, and opportunities for ongoing employee input and training.
Standard 2. The agency shall support and encourage visibility of gay, lesbian, bisexual and transgendered employees.
INDICATOR: Active employment recruitment of gay, lesbian, bisexual and transgendered employees, including outreach to GLBT organizations, and advertising in GLBT media.
INDICATOR: Development and implementation or revision of existing policies to ensure effective procedures for dealing with employee complaints of discrimination or harassment based on sexual orientation or gender identity.
INDICATOR: Written notice to all employees that discrimination or harassment of other employees on the basis of sexual orientation or gender identification is grounds for appropriate levels of discipline, up to and including dismissal.
Standard 3. The agency shall work towards ensuring that gay, lesbian, bisexual and transgendered employees of all ages are subject to the same terms and conditions of employment, including the same benefits and compensation, as all other employees.
INDICATOR: Written policies explicitly stating that the agency does not discriminate on the basis of sexual orientation or gender identity in providing compensation and benefits, including but not limited to family and medical leave, bereavement leave, and such other benefits as the agency offers its employees.
INDICATOR: Written policies explicitly extending the same benefits to all families, including the families of gay, lesbian, bisexual and transgendered employees. Such policies may allow employees to designate who shall be considered their "family" members. If the agency offers health, life, disability insurance and pension benefits to its employees, the agency shall work towards including full and equal coverage for its gay, lesbian, bisexual and transgendered employees and their families.
INDICATOR: Comprehensive ongoing training of all human resource and other appropriate personnel in sexual orientation and gender identity issues with regard to employee benefits.
INDICATOR: Mechanisms to appropriately convey GLBT-related policies and make relevant training accessible to all employees at all levels, including those with disabilities, and those for whom English is not their primary language.
Return to top of page
II. Client's RightsStandard 4. The agency shall assure that comprehensive policies are implemented to prohibit discrimination in the delivery of services to gay, lesbian, bisexual and transgendered clients and their families. The agency shall ensure that all staff use, and all written forms and policies employ, culturally appropriate language when dealing with gay, lesbian, bisexual or transgendered clients and their families. For the purpose of these standards the terms "family" and "families" shall be broadly construed, and shall include but not be limited to relatives by blood, adoption, marriage or declaration of domestic partnership.
INDICATOR: Written polices that explicitly state that the agency does not discriminate on the basis of sexual orientation or gender identity in the provision of services. Such policies shall specifically include families of all clients.
INDICATOR: Conspicuous posting of non-discrimination policies in all languages appropriate to the populations served by the agency, and inclusion of policies in agency brochures, informational and promotional materials.INDICATOR: Mechanisms to ensure that non-discrimination policies and procedures are appropriately conveyed to all clients, including those with disabilities and those for whom English is not their primary language.
INDICATOR: Explicit sign-off on policy by all employees.
Standard 5. The agency shall ensure that it has comprehensive and easily accessible procedures in place for clients to file and resolve complaints alleging violations of these policies.
INDICATOR: Written complaint procedures.
INDICATOR: Designation of one or more persons responsible for ensuring agency compliance.
INDICATOR: Written notice to all employees that discrimination in the delivery of services based on sexual orientation or gender identity violates standards of good care, and is subject to appropriate discipline.
INDICATOR: Conspicuous posting of complaint procedures, inclusion of procedures in informational materials given to agency clients and their families.
INDICATOR: Translation of procedures into and provision of information in all languages appropriate to populations the agency serves.
Return to top of page
III. Intake and AssessmentStandard 6. The agency shall develop and implement or revise existing intake and assessment procedures to ensure that they meet the needs of gay, lesbian, bisexual and transgendered clients of all ages and their families.
INDICATOR: All reception, intake and assessment staff are trained to use culturally appropriate language.
INDICATOR: Development and implementation of intake and assessment forms which provide for optional self-identification in all categories of gender identity, sexual orientation, marital, partnership and family status, and provide clients with the option and opportunity for further written explanation.
INDICATOR: Develop mechanisms to ensure that all reception, intake and assessment staff are familiar with providers within the agency with expertise in and sensitivity to gay, lesbian, bisexual and transgender issues, and appropriately convey this information to clients.
INDICATOR: Development and implementation of training for all intake and assessment staff to assure medically and culturally appropriate referrals for gay, lesbian, bisexual and transgendered clients and their families to providers within and outside of the agency.
Return to top of page
IV. Service Planning and DeliveryStandard 7. All agency staff shall have a basic familiarity with gay, lesbian, bisexual and transgender issues as they pertain to services provided by the agency.
INDICATOR: Development and implementation or revision of agency training and programs on diversity, harassment, and anti-discrimination to assure explicit inclusion of gay, lesbian, bisexual and transgender issues.
INDICATOR: Development and implementation of training for all intake, assessment, supervisory, human resource, case management and direct care staff on basic gay, lesbian, bisexual and transgender issues.
Standard 8. All direct care staff shall routinely provide general care to gay, lesbian, bisexual and transgendered clients. All direct care staff shall be competent to identify and address, within the scope of their field of expertise, specific health problems and treatment issues for gay, lesbian, bisexual and transgendered clients and their families, to provide treatment accordingly, and to provide appropriate referrals when necessary.
INDICATOR: Comprehensive ongoing training provided for direct care staff to identify and address basic health issues within their field of expertise that may particularly or uniquely affect gay, lesbian, bisexual and transgendered clients.
INDICATOR: Creation and implementation of mechanism for identification of staff with special expertise in and sensitivity to gay, lesbian, bisexual and transgender issues.
INDICATOR: Provision of training for direct care staff on how, when and where to make appropriate referrals for gay, lesbian, bisexual and transgendered clients and their families.
INDICATOR: Development of a comprehensive resource list for appropriate referrals for special gay, lesbian, bisexual and transgender health concerns.
INDICATOR: Outreach to and development of relationships with other agencies and providers with expertise in gay, lesbian, bisexual and transgender health issues.
INDICATOR: Evidence of agreements or other appropriate mechanisms to ensure cooperation with other agencies and providers to whom gay, lesbian, bisexual and transgendered clients and their families may be referred for specialized care and treatment.
Standard 9. All case management and treatment plans shall include and address sexual orientation and gender identity where it is a necessary and appropriate issue in client care.
INDICATOR: Provision of training for all case management and direct care staff on gay, lesbian, bisexual and transgender health, treatment and cultural issues.
Return to top of page
V. ConfidentialityStandard 10. The agency shall ensure the confidentiality of client data, including information about sexual orientation and gender identity issues. Gay, lesbian, bisexual and transgendered clients shall be informed about data collection that includes references to sexual orientation and/or gender identity, including in what circumstances such information may be disclosed, whether it may be disclosed as aggregate or individual information whether personal identifiers may be disclosed, and how and by whom such information may be used.
INDICATOR: Written confidentiality policies which explicitly include sexual orientation and gender identity, indicating that such information is to be considered highly sensitive and treated accordingly.
INDICATOR: Designation of sexual orientation and gender identity is at client's option on forms and records.
INDICATOR: Comprehensive training for appropriate staff on data collection and reporting issues as they relate to confidentiality.
INDICATOR: Written disclosure to clients explaining when information may or must be disclosed to third parties for payment or other reasons, and in what circumstances such disclosures may include information regarding sexual orientation and gender identity.
Standard 11. The agency shall provide appropriate, safe and confidential treatment to gay, lesbian, bisexual and transgendered minors, unless the agency's services are inappropriate for all minors. All clients who are minors shall be informed of their legal rights, and advised of the possibility and possible consequences of any statutory or otherwise mandated reporting.
INDICATOR: Staff training regarding the legal rights of minors.
INDICATOR: Development and implementation of procedures for intake, assessment and treatment of minors that is sensitive to gender identity and sexual orientation.
INDICATOR: Written and oral notice to minors of various mandated reporting laws and their implications, and of the minor's rights regarding confidentiality and treatment without parental consent.
INDICATOR: Reception staff trained to be sensitive to issues of gay, lesbian, bisexual and transgendered youth.
Return to top of page
VI. Community Relations and Health PromotionStandard 12. The agency shall include gay lesbian, bisexual and transgendered people and their families in outreach and health promotion efforts.
INDICATOR: Agency advertising and promotional materials clearly indicate nondiscrimination policies regarding sexual orientation and gender identification.
INDICATOR: Agency outreach efforts to social service, medical and other providers promote services to gay lesbian, bisexual and transgendered clients and their families.
INDICATOR: Agency outreach and promotional efforts accurately reflect the level and quality of services available to gay lesbian, bisexual and transgendered clients and their families.
Standard 13. The composition of the agency Board of Directors and other institutional bodies shall encourage representation from GLBT communities.
INDICATOR: The process for electing or appointing members of the Board of Directors and other institutional bodies includes outreach to and inclusion of gay, lesbian, bisexual and transgendered candidates.
Standard 14. Agency community benefits programs shall include gay, lesbian, bisexual and transgendered people in the communities the agency serves.
INDICATOR: Development of criteria for community benefits programs that provide for inclusion and promotion of issues of concern to gay lesbian, bisexual and transgendered people and their families.
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The GLBT Health Access Project is part of JRI Health
Address : 130 Boylston Street, Boston, MA 02116
Phone: 617.988.2605 Fax: 617-457-8133 Email: access@jri.org
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