I was standing in front of a room of nurses, physician assistants, support staff and doctors. My heart was pounding. I give LGBT cultural competency trainings to healthcare providers all the time, but each time I feel a rush of nervousness before I begin. The day I lose that is the day I should put down the slide-advancing clicker for good.
Most health professionals get very little exposure to LGBT health issues and culturally competent care during their years of formal education. They haven't learned how discrimination has lead to health problems in many LGBT people. Despite all their best intentions, members of our community often enter their offices wary, scarred from experiences of discrimination and harassment in the offices of other providers. Yet nearly all the professionals I have met have their heart in the right place: they want to offer safe and respectful care to their LGBT patients/clients but are unaware of how their current practices may be sending a message of unwelcome instead. They want to get it right and mistakenly think they've covered all the bases if they "treat everyone the same." So they enter my training room feeling vulnerable, afraid of being called out on unconscious homophobia and/or transphobia.
Cultural competence training is not a showdown; at best it is a profound meeting of diverse human beings who all want to offer the highest quality care. They are being asked to examine their attitudes, expose areas of ignorance and, despite years of professional practice, be willing to learn new skills. This applies to me, the trainer, too, as there is always more for me to learn about myself, LGBT health concerns and how to give the highest quality trainings.
I am far from alone in offering these trainings. Universities, hospitals and social service agencies are hungry for high quality cultural competency trainings and many passionate individuals are offering presentations across the country. With the passage of California's Assembly Bill 496 requiring that existing cultural competency training for health care providers include discussion of LGBT issues, we expect the demand for such trainings will dramatically increase. How can we make sure that the demand is met with consistently high-level trainings?
Ask any trainer and they can tell you how the field of LGBT cultural competency training is still young. Great trainings exist, but the field is also chaotic; there are no accepted standards for cultural competency trainings, no accepted measures for evaluating them, and no roadmaps for how to develop a good one. For years, this meant I spent a lot of time on the phone giving new trainers tips from my many years of experience. When the New York City municipal hospital system asked my organization to develop a mandatory training for their employees, I was able to convert my experience into a curriculum that could be used wholesale by others. This year, with funding from the New York State Department of Health, we've moved one step further: we're ushering in a new level of guidance for those who develop and give cultural competency trainings nationwide.
My staff and I at the National LGBT Cancer Network spent a year researching and studying the field of LGBT cultural competency. We compared dozens of existing curricula, delved into the latest adult learning theories, conferred with expert trainers across the country and honed our evaluation skills.
The work culminated in the creation of a Best Practices Manual for creating and delivering LGBT cultural competence trainings to health and human service organizations. It is free and downloadable. The manual provides a clear roadmap for designing a wide range of trainings, from short to long ones, for large groups and small ones. It includes guidelines for selecting the best training methods (when to use lectures, activities, media and handouts). The manual also provides a clear evidence-based foundation for developing evaluation tools. Most importantly it offers a simple set up adaptable building blocks to design a top notch LGBT cultural competency training, all based on measurable goals of changing knowledge, attitudes and behavior in human service providers.
Let's tame the Wild West and work to deliver consistently high-level LGBT cultural competency trainings. Our guide is yours for the taking.