Creating Inclusive and Culturally Competent Healthcare for the LGBTQ+ Community: a Curriculum
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University of North Dakota UND Scholarly Commons Occupational Therapy Capstones Department of Occupational Therapy 2020 Creating Inclusive and Culturally Competent Healthcare for the LGBTQ+ Community: A Curriculum Caelin Hansen Jordyn Himley Follow this and additional works at: https://commons.und.edu/ot-grad Recommended Citation Hansen, Caelin and Himley, Jordyn, "Creating Inclusive and Culturally Competent Healthcare for the LGBTQ+ Community: A Curriculum" (2020). Occupational Therapy Capstones. 447. https://commons.und.edu/ot-grad/447 This Scholarly Project is brought to you for free and open access by the Department of Occupational Therapy at UND Scholarly Commons. It has been accepted for inclusion in Occupational Therapy Capstones by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. Creating Inclusive and Culturally Competent Healthcare for the LGBTQ+ Community: A Curriculum by Caelin Hansen, MOTS Jordyn Himley, MOTS Advisor: Jessa Hulteng, MOT, OTR/L A Scholarly Project Submitted to the Occupational Therapy Department of the University of North Dakota in partial fulfillment of the requirements for the degree of Master of Occupational Therapy Grand Forks, North Dakota May 2020 i Approval Page This Scholarly Project Paper, submitted by Caelin Hansen and Jordyn Himley in partial fulfillment of the requirement for the Degree of Master of Occupational Therapy from the University of North Dakota, has been read by the Faculty Advisor under whom the work has been done and is hereby approved. ________________________________ Faculty Advisor 4/13/2020 Date ii PERMISSION Title: Creating Inclusive and Culturally Competent Healthcare for the LGBTQ+ Community: A Curriculum Department: Occupational Therapy Degree: Master of Occupational Therapy In presenting this Scholarly Project in partial fulfillment of the requirements for a graduate degree from the University of North Dakota, we agree that the Department of Occupational Therapy shall make it freely available for inspection. We further agree that permission for extensive copying for scholarly purposes may be granted by the professor who supervised our work or, in her absence, by the Chairperson of the Department. It is understood that any copying or publication or other use of this Scholarly Project or part thereof for financial gain shall not be allowed without our written permission. It is also understood that due recognition shall be given to us and the University of North Dakota in any scholarly use which may be made of any material in our Scholarly Project Report. Signature ___________________ Date 4/13/2020 Signature ___________________ Date 4/13/2020 iii TABLE OF CONTENTS ACKNOWLEDGEMENTS ……………………………………… v ABSTRACT ……………………………………… vi CHAPTER I. INTRODUCTION ……………………………………… 1 II. REVIEW OF LITERATURE ……………………………………… 9 III. METHODOLOGY ……………………………………… 42 IV. PRODUCT ……………………………………… 46 V. SUMMARY ……………………………………… 123 REFERENCES ……………………………………… 126 iv ACKNOWLEDGMENTS We wish to thank all the people whose assistance was a milestone in the completion of this scholarly project, as we could not have done it without them. First, we would like to recognize our project advisor, Jessa Hulteng, for her continued contribution through proofreading, editing, and guidance throughout the entire process. Secondly, we would like to recognize the director of the Pride Center at the University of North Dakota, as he was an amazing resource throughout the development of content and activities found in this guide. Third, we would like to thank LaVonne Fox for her guidance of theoretical frameworks and the love and support she has given us throughout the entirety of the occupational therapy program. Lastly, we would like to recognize our friends and family, for all their love and support as they were our number one cheerleader throughout this scholarly project. v ABSTRACT The lesbian, gay, bisexual, transgender, queer, etc. (LGBTQ+) population is growing in America and in recent years has shown an increase in equal rights and societal acceptance (Newport, 2018). However, despite the positive changes that have been made, the LGBTQ population is still underserved in healthcare and faces health disparities (Dean, Victor, & Grimes, 2016; Institute of Medicine, 2011). This may be due to the fact that medical professionals receive little to no education regarding LGBTQ care, which can result in misconceptions, discomfort, and use of microaggressions towards the population. (Beagan, Chiasson, Fiske, Forseth, Hosein, Myers, & Stang, 2013; Utamsingh, Kenya, Lebron, & Carrasquillo, 2017). The research and education that is presented for healthcare professionals on the LGBTQ population is limited, and there are limited resources for healthcare professionals to use to increase their knowledge and cultural competence on the population. Because of these issues, an extensive literature review was conducted to address the following: 1) LGBTQ terms and definitions; 2) demographics; 3) identified healthcare disparities; 4) national initiatives and policies; and 5) occupational therapy’s role when working with LGBTQ clients. In addition, the director of the Pride Center at the University of North Dakota was consulted to gain information and resources regarding the population. The result of this scholarly project is a curriculum that can be utilized by health programs to facilitate learning opportunities for students to increase cultural competency with the LGBTQ population in a safe learning environment. It is important to address these issues at the educational level, so healthcare students feel comfortable and are educated on the population prior to entering the workforce. vi CHAPTER I INTRODUCTION Occupational Therapy is a unique profession that assists individuals of all ages participate in everyday activities in all environments, while also addressing an individual’s physical, cognitive, and psychological function (AOTA, n.d.). Due to practitioners treating individuals of all ages, socioeconomic status, race, and ability, the association saw the importance of establishing legal standards, policies, and procedures for practitioners to follow, giving every individual equal access to the quality care that they deserve. In 2014, the American Occupational Therapy Association (AOTA) updated their stance on the profession’s nondiscrimination and inclusion document to represent how the practice is committed to serve all populations no matter their culture, ethnicity, race, age, religion, gender, sexual orientation, or capacity (AOTA, 2014). The document states that every individual is “entitled to maximum opportunities to develop and use their abilities” and has “the right to achieve productive and satisfying professional and personal lives” (AOTA, 2014, p. S23). The following statement represents AOTA’s stance and commitment: We are committed to nondiscrimination and inclusion as an affirmation of our belief that the interests of all members of the profession are best served when the inherent worth of every individual is recognized and valued. We maintain that society has an obligation to provide the reasonable accommodations necessary to allow individuals access to social, educational, recreational, and vocational opportunities. By embracing the concepts of nondiscrimination and inclusion, we 1 will all benefit from the opportunities afforded in a diverse society (2014, p. S23- S24). Through this document AOTA expresses the importance of treating all people equally, valuing individual persons, and respecting different cultures, ethnicities, races, ages, religions, genders, sexual orientations, and capacities (AOTA, 2014). The World Health Organization (WHO) recognizes that sexual health is a human right and fundamental to not only social and economic development, but to the physical and emotional well-being of all persons (2010). Sexual health is “the desire of individuals and couples of all sexual orientations and any background to have fulfilling and pleasurable sexual relationships, and its concerns go beyond fertility and reproduction to encompass issues such as sexual dysfunction and disability, and violence related to sexuality” (WHO, 2010, p. iv). This topic is necessary to address as maintaining sexual health is a basic human right. In relation to occupational therapy, the subject of sexual health and activity, even though an identified Activity of Daily Living (ADL) within the Practice Framework, is often brushed over within educational and professional settings due to limited education and discomfort (Lohman, Kobrin & Chang, 2017). This discomfort expressed by practitioners, educators, and students is due to institutional sanctions, cultural beliefs, and the lack of quality and amount of education (Egledger et al., 2018; Lohman et al., 2017). However, when the subject of sexual health and activity is omitted this violates the professions holistic approach to evaluation and intervention, therefore individuals are no longer receiving complete and quality healthcare (Lohman et al., 2017). 2 An aspect of sexual health that is often omitted more frequently due to social controversy is sexual orientation. When reading AOTA’s position, stated above, on sexual health and sexual orientation, the association summarizes the importance of nondiscrimination and inclusion of the LGBTQ population. However, this population has continued to experience disparities due to the profession failing to fully support the population within education and practice