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Public Comments Bree Collaborative LGBTQ Health Care Public Comment Q1 What sector do you represent? (Choose the option that is the best fit.) Answered: 19 Skipped: 0 Person Who Identifies a... Primary Care Provider Other Clinician Hospital/Clinic Administration Government/Publ ic Purchaser Researcher Employer Health Plan 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ANSWER CHOICES RESPONSES Person Who Identifies as LGBTQ 21.05% 4 Primary Care Provider 10.53% 2 Other Clinician 26.32% 5 Hospital/Clinic Administration 15.79% 3 Government/Public Purchaser 10.53% 2 Researcher 10.53% 2 Employer 0.00% 0 Health Plan 5.26% 1 TOTAL 19 # OTHER (PLEASE SPECIFY) DATE 1 Community-based HIV service organizatoin 8/22/2018 10:37 AM 2 LGBTQ person who provides HR support to Healthcare Employees 8/17/2018 3:48 PM 3 Psychiatric Nurse Practitioner 8/12/2018 10:34 AM 4 psychiatric nurse practitioner 8/8/2018 8:50 PM 5 Washington State Psychological Association 8/7/2018 10:16 AM 6 Quality Improvement Organization 8/4/2018 9:11 PM 1 / 2 Bree Collaborative LGBTQ Health Care Public Comment 7 HIV and primary care/LGBT care physician 8/1/2018 8:26 AM 2 / 2 Bree Collaborative LGBTQ Health Care Public Comment Q2 Do you have any comments on the purpose statement (pg 3)? Answered: 15 Skipped: 4 # RESPONSES DATE 1 We support the purpose statement of aligned care delivery for LGPTQ people and improved health 8/24/2018 4:22 PM equity. 2 Thank you for your work on these recommendations. Planned Parenthood Votes Northwest and 8/23/2018 11:13 PM Hawaii (PPVNH) shares the Bree Collaborative’s commitment to creating a health care system that works for everybody and that addresses the unique health care needs and disparities of LGBTQ individuals. 3 On page 5, persons who identify as LGBTQ are the first stakeholder group listed under the 8/22/2018 10:37 AM "Specific Stakeholder Actions and Quality Improvement Strategies" section. This signals greater responsibility and onus for taking action on the group that has been targeted and marginalized by medical systems. We like the section overall and think it should be included but LGBTQ people should not be called out on the list first. On pages 5 and 19, the resource lists are very Seattle- centric. We suggest adding more resources that are located outside of Seattle (beyond just the Rainbow Center in Tacoma) and include HIV service providers (such as Cascade AIDS Project, Lifelong and PCAF), and other queer youth programs (such as OASIS in Tacoma and GLOBE in Everett). 4 No 8/17/2018 3:48 PM 5 seems very specific and clear 8/15/2018 2:54 PM 6 I found the purpose statement to be very thorough and well written. 8/12/2018 10:34 AM 7 no 8/8/2018 8:50 PM 8 This is well-written and appropriate 8/7/2018 2:03 PM 9 no 8/7/2018 10:16 AM 10 I think the first paragraph adequately states the purpose (goal). The rest is (appropriate) 8/4/2018 9:11 PM background. 11 . 8/3/2018 8:31 AM 12 fghbxfb 8/1/2018 10:37 AM 13 good 8/1/2018 8:26 AM 14 I think that this statement accurately portrays our current state in Washington. 7/30/2018 3:25 PM 15 "Approximately 3.5% of Americans identify as lesbian, gay, or bisexual and 0.3% of American 7/30/2018 11:21 AM adults are transgender although many people have had same sex sexual experiences" = delete everything after "although" because it currently reads as equating being bi and trans with having same sex experiences, which is not always the case. Furthermore, this guideline is targeted to to people who identify as LGBTQ - not straight people who have has same sex experiences, as evidenced by the immediate following sentences, "Lesbian, gay, bisexual, transgender, and questioning or queer (LGBTQ) people share common challenges and have health care needs distinct from those who do not identify as LGBTQ. While all people share baseline health care needs, the LGBTQ population is also at a higher risk for specific medical problems." - these are great - keep them. You have no information on the specific health risks that bisexual people face. Why? There are stats for the other letters in LGBT. This is an example of something called "bi erasure". Please google it before you proceed with any edits to this document, as it will come up in my comments frequently. Same comment re: specific health risks for trans people, especially Black trans women. They are the most marginalized group within the LGBTQ community and yet there are no statistics in this section about the disparities and oppression they face. 1 / 1 Bree Collaborative LGBTQ Health Care Public Comment Q3 Do you have any comments on focus area one: Communication, Language, and Inclusive Environments? Answered: 19 Skipped: 0 # RESPONSES DATE 1 In addition to noted specific areas of improvement, recommend inclusion of HR components such 8/24/2018 4:22 PM as training and tools to support inclusive communication. 2 Creating an inclusive environment involves a variety of factors and we encourage you to expand 8/23/2018 11:13 PM these recommendations. In addition to the existing recommendations, providers should ensure that print materials are gender inclusive in both language and imagery/graphics. For example, anatomy charts on the wall in exam room should be labeled “Reproductive Anatomy” rather than “Female Reproductive Anatomy.” 3 cc 8/23/2018 11:22 AM 4 On pages 4, 5, 6, 10, 12, 14, and 16, the sections on “Communication, Language, and Inclusive 8/22/2018 10:37 AM environments”, “Screening” and “Sexual History” (specifically the “types of sex” parts), should reference mirroring the appropriate and non-stigmatizing language the patient uses to describe their own bodies and body parts. For example, if a transman doesn’t use the word vagina, asking if he has vaginal sex can be offensive. • http://www.deanspade.net/wp- content/uploads/2011/02/Purportedly-Gendered-Body-Parts.pdf • https://lgbtihealth.org.au/sites/default/files/Alliance%20Health%20Information%20Sheet%20Inclusi ve%20Language%20Guide%20on%20Intersex%2C%20Trans%20and%20Gender%20Diversity_0 .pdf • https://www.lgbthealtheducation.org/wp-content/uploads/2017/01/Sexual-Health-among- Transgender-People.pdf On page 15, in the section on “Gender of sex partners”, it’s not clear that the first two questions (Do you have sex with men, women, or both? What is the sex of your sex partners?) really shouldn’t be used. Please make it more explicit that these are examples of ways the questions are inappropriately asked. 5 No 8/17/2018 3:48 PM 6 again, clear guidelines are present 8/15/2018 2:54 PM 7 no 8/12/2018 10:34 AM 8 no 8/8/2018 8:50 PM 9 It is comprehensive and well-written 8/7/2018 2:03 PM 10 a 8/7/2018 1:54 PM 11 inclusiveness 8/7/2018 10:16 AM 12 I understand there's a whole taxonomy of gender and sexual identity with dozens of descriptors on 8/4/2018 9:11 PM social media. Some guidance on how to deal with this might be helpful. I think the term "cis" was used without definition. 13 no 8/3/2018 12:24 PM 14 Inclusive environments require inclusive governance. It is a best practice for LGBTQ persons to be 8/3/2018 8:31 AM involved on boards of directors, patient advisory committees, planning and evaluating programs, and staff positions. The Recommendations could be strengthened by emphasizing the importance of working WITH the population. 15 No 8/1/2018 10:39 AM 16 dgg 8/1/2018 10:37 AM 17 good 8/1/2018 8:26 AM 18 I have seen many different examples of language, it seems like there would need to be agreement 7/30/2018 3:25 PM on what language for pronouns will be used rather than each person making up their own words. 1 / 2 Bree Collaborative LGBTQ Health Care Public Comment 19 "Persons Who Identify as LGBTQ • Find a primary care provider that you feel comfortable talking 7/30/2018 11:21 AM with about your health care needs. " -- is the Bree Collaborative going to do anything to facilitate this identification process? Otherwise, this is telling a group of people who are systematically denied health care coverage to go try out PCP's until they find one they like. 2 / 2 Bree Collaborative LGBTQ Health Care Public Comment Q4 Do you have any comments on focus area two: Screening and Taking a Social and Sexual History? Answered: 19 Skipped: 0 # RESPONSES DATE 1 Based on the increased frequency of depression and sexually transmitted infections agree with the 8/24/2018 4:22 PM addition of focused history. 2 -The LGBTQ community has a history of unethical treatment and probing by the medical 8/23/2018 11:13 PM community. Because of this history, verbal and/or written rationale should be provided as to why screening is taking place on each item (mental health, social history, sexual history, etc.) before beginning the screening. Additionally, information should be provided in advance of screening about what impact, if any, the patient’s answers will have on their ability to access the care they seek. -During sexual history intakes, questions about sexual history should not be gendered or use heteronormative assumptions of what sex is. Questions should address relevant risk factors based on the anatomy of the patient and their sexual partner(s), as well as sexual behaviors beyond penetrative vaginal or anal sex between two cisgender people.
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