August 2022

Article by Tori Ellis, PTA, BS

Healthy People 2020 defines a health disparity as, “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage” and notes that disparities, “adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.” The focus of this article is on the disparities affecting our LGBTQIA+ community.

Frequently, patients who identify as LGBTQ meet resistance in response to their lifestyle and suffer consequences. According to the National Alliance on Mental Illness, “LGB adults are more than twice as likely as heterosexual adults to experience a mental health condition” (NAMI, 2022). Additionally, their findings show transgender patients are nearly four times as likely to experience a mental health condition. A study titled “Mental Health Disparities Within the LGBT Population: A Comparison Between Transgender and Nontransgender Individuals” showed that Nebraskans over the age of 19 who identified as trans report discrimination and higher levels of depression and suicidal attempts/ideation (Su D, 2016). As healthcare providers, we cannot stand by and allow these disparities to persist.

The good news is that we can make a difference by making small changes to our simple, day-to-day routines. The study by Su et. Al referenced above shows that members of the LGBTQ community who had come to terms with their identity reported substantially lower reports of depressive symptoms. This is amazing news! This tells us that validating gender identity and providing all-around inclusive care allows patients to live happier lives and experience better outcomes. Below are some examples of ways that we may validate gender identity for our patients:

• Share your pronouns! (Nametags, buttons, verbal identification, etc)

• Gender inclusive paperwork/intake forms

• Utilizing preferred patient pronouns

• Seek company-wide training on LGBTQIA+ education (Safe Space Nebraska is a good resource for this)

• Avoid gender binary specific language when able i.e. “humankind vs. mankind” and” “hey everyone vs hey guys”

• Try not to make assumptions

• If you don’t know, just ask!

Overall, it is important to remember this:

happy patients = more buy in = better care = improved outcomes

It’s that easy.

Disparities. Disparities | Healthy People 2020. (n.d.). Retrieved July 28, 2022, from https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities

NAMI. "LGBTQI." National Alliance on Mental Illness, NAMI, 2022,

www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/LGBTQI

Su, D., Irwin, J. A., Fisher, C., Ramos, A., Kelley, M., Mendoza, D. A. R., & Coleman, J. D. (2016). Mental health disparities within the LGBT population: A comparison between transgender and nontransgender individuals. Transgender health, 1(1), 12-20.

March 2022

Article by Claudia Cortes Reyes

It's time to revitalize our subjective exam and plan to address our patient's needs in the intra-personal, interpersonal, institutional, community, and policy realms. The feature article published in APTA Magazine's March 2022 issue, "Using Fundamental Interventions To Address Social Determinants of Health," is a must-read for all health care providers. It is imperative that PTs/PTAs explore a marginalized patient lens. To read more, follow the link to the APTA Magazine or look at a perspective article published in October 2021 in PTJ by Dana McCarty, PT, DPT, and Meghan Shanahan, Ph.D., MPH.

1. https://www.apta.org/apta-magazine/2022/03/01/interventions-to-address-social-determinants-health

2. Dana McCarty, PT, DPT, Meghan Shanahan, PhD, MPH, Theory-Informed Clinical Practice: How Physical Therapists Can Use Fundamental Interventions to Address Social Determinants of Health, Physical Therapy, Volume 101, Issue 10, October 2021, pzab158, https://doi.org/10.1093/ptj/pzab158

December 2021

Article by Sara Bills

Artwork by Claudia Cortes Reyes

The DEI Committee hosted their first Lunch and Learn on November 30, 2021. Amber Koch, a Speech Therapist at Nebraska Medicine’s Transgender Clinic, presented “Gender Affirmative Care in a Therapy Setting.” Ms. Koch began by discussing common microaggressions perpetrated in the clinical setting such as deadnaming (use of birth or former name without consent), misgendering (saying ‘he’ instead of ‘she’ or ‘they’), avoidant behavior (such as not making eye contact or moving away) and intrusive questioning about intimate details. When describing the cumulative effect of microaggressions, she utilized the metaphor of mosquito bites. Watch a similar metaphor video here. Ms. Koch provided the group with culturally responsive practices and resources to better support our patients who are transgender and non-binary. Examples are listed below.

1. Ask your patient for their preferred pronouns: “My name is _____ and I am your PT/PTA today. My pronouns are _(he/his, she/her, they/their)__. What are yours?”

2. Practice your patient’s pronouns and name.

3. If you misgender a patient, apologize and quickly carry on with your session. You do not want to make the patient uncomfortable while you explain away your mistake. After the interaction, reflect on how you can do better next session (see number 2).

4. If someone else in your clinic commits a microaggression, apologize and assure the patient that you will address it.

5. Consider training for clinical and non-clinical staff in LGBTQ+ cultural competencies.

6. See resources here: CDC and WPATH (World Professional Association for Transgender Health)

7. A Field Guide to Gender-Neutral Language: For business, families and allies. Available on Amazon.

8. Offer gender-neutral bathrooms or encourage individuals to use the bathroom that aligns with their gender identity. See signage options here.

9. Review your intake/registration documents for gender-neutral and inclusive language. www.transplaining.info offers this service.

The DEI Committee expressed our appreciation of Ms. Koch’s presentation. If you are interested in learning more about this topic or other DEI matters, please reach out to us!