“Navigating health care systems or Medicaid, generally, can be challenging. When you’re a young person who identifies as LGBTQ and experiencing homelessness, it’s especially scary. We’ve learned that transgender youth are being mis-gendered; they’re being gawked at in crowded waiting rooms; they’re being treated by a system that historically hasn’t been competent in serving LGBTQ identities, therefore little trust has been established between patient and provider. When there is no trust, there is little likelihood a young person will openly share the health issues they’re facing. Young people in that situation just stop seeking care – and that’s a really scary thing.”
That’s what Mark Erwin-McCormick, the development director for the Ruth Ellis Health and Wellness Center in Highland Park, MI, had to say about why they opened a health care facility specifically geared toward LGBTQ youth.
They’re not alone in recognizing the health disparities experienced by the LGBTQ population. Also in Detroit, the long-established Health Emergency Lifeline Program (HELP), which has served individuals with HIV for more than 30 years, opened the Corktown Health Center – Michigan’s first LGBTQ medical center that integrates comprehensive primary care, HIV care, behavioral health, and supportive services into a single facility. And in Chicago, Howard Brown Health Care – which annually serves more than 27,000 patients out of seven locations throughout the city – has become one of the nation’s largest LGBTQ organizations.
“LGBTQ folks experience different kinds of health issues and different kinds of barriers to care than the general population,” says Kelly Ducheny, Howard Brown Health’s Senior Director of Behavioral Health Services. “Oppression, prejudice, hate crimes, trauma, micro-aggressions – these things take a toll on mental health. Managing that kind of discrimination can increase substance abuse and suicidal ideation. Add to that managing a complex health care system that’s often not well informed on issues that affect you – it’s really tough for patients.”
In honor of Pride Month, IFF sat down with these three community-based health care providers – all IFF clients – who are working to address these challenges. They each emphasized the importance of creating spaces, systems, and services that honored the LGBTQ populations they serve.
Seeing yourself in the system
“As soon as you walk through our doors, our space feels different from other health care providers,” Ducheny says of Howard Brown Health, which has utilized $7.2 million in IFF financing, as well as IFF real estate services, since 1996. “You see pictures and images that represent you and the people in your life. You see literature about health services that serve your particular needs. You start seeing yourself and seeing a system that has been sculpted to be welcoming and radically informed.”
Both Ruth Ellis and the Corktown Health Center in Detroit echoed Ducheny’s thoughts about the importance of first impressions when patients walk in the door – something achieved primarily through art on the walls and literature on the tables. Health services that appear in that literature include offerings more typically used by the LGBTQ community – PEP/PreP (medications for preventing HIV infection), alternative insemination, gender affirmation services, and more.
But thoughtful space design choices also matter.
The things that people come to see us for can be intensely private,” Ducheny says. “They are talking about sexual wellness. They’re talking about hormones. They’re talking about identity. We have to be really intentional about designing space that is welcoming but also private so that people feel more relaxed about sharing these really intimate parts of themselves.
“Not all patients come feeling as comfortable as you’d like them to feel, so we have to give extra thought to making sure patients experience a calm, welcoming environment that blends comfortable seating arrangements, open areas, and private spaces to help assure them that their privacy is being honored absolutely,” says Anthony Williams, Executive Director of Corktown Health, which recently purchased their building with the help of a $1.425 million IFF loan.
That ‘absolute’ privacy asks providers to go beyond HIPPA when considering the unique needs of the LGBTQ community – many of whom experience feelings of shame or fear related to their sexual or gender identities.
“The things that people come to see us for can be intensely private,” Ducheny says. “They are talking about sexual wellness. They’re talking about hormones. They’re talking about identity. We have to be really intentional about designing space that is welcoming but also private so that people feel more relaxed about sharing these really intimate parts of themselves.”
Consider two relatively ‘administrative’ tasks not typically handled by a health care professional – checking in at the front desk, where patients are often asked for the purpose of their visit, and being called in from the waiting room, where patients’ names are often broadcast to the room. Corktown uses a system of tablets and pagers to circumvent these challenges, and other providers use similar strategies.
As Ducheny says: “People’s comfort is really directly tied to and anchored in their experience of the space.”
“Visible indicators – brochures and art – that it’s a safe space are important, and we do that. But it really comes to the people working in the space,” Erwin-McCormick says. “They’re trained specifically to have the cultural competency to serve LGBTQ young people. It’s an affirming space. It’s a happy space. It’s not a place of fear.”
Erwin-McCormick noted that sometimes young people hang out in the Ruth Ellis waiting room for hours prior to their appointment – because they know the space is uniquely theirs. This clinic was opened in 2017 with the help of a $850,000 construction bridge loan from IFF.
Culturally competent customs practiced across the three organizations IFF interviewed included:
- Enhancing the privacy of the check-in and waiting room areas
- Offering and advertising health services specific to the LGBTQ community
- Asking patients for their preferred gender pronouns and preferred names
- Honoring the fluidity of people’s gender identities and sexual orientations with respect and without assumptions
“Our clinicians are specifically trained to work with people in the LGBT community,” Williams says. “We make no assumptions about who you are, and we don’t assume your needs based on your gender identity or sexual orientation.”
It’s an affirming space. It’s a happy space. It’s not a place of fear.
Williams provided this specific example of how that philosophy may play out for a transgender patient: “First, we would ask about your pronouns and the name you prefer to be called – and we’d make sure that information was carried through the entire organization so the next person you engaged with wouldn’t have to ask you again. Also, we would know how to ask you questions relevant to your current anatomy in a way that respects your identity while ensuring that your health care is appropriate and comprehensive. In addition, we would help you navigate any insurance-related issues that may be tied to a gender marker that differs from your gender identity.”
Having the ‘right vocabulary’ is only part of the puzzle for these providers – the real goal is to be asking relevant questions and creating a sense of trust so that all identities can speak openly to their health care provider.
Integration of multiple services
One of the reasons why HELP opened the Corktown Health Center was to reduce the fragmentation of health-related services offered to the LGBTQ community. According to Williams, support services and clinical services were often at different locations – requiring patients to not only juggle multiple appointments, but also to feel comfortable in multiple settings.
“Often times, patients just weren’t making it to their clinicians,” Williams says. “We opened Corktown with the idea of having one location where people could come in to see their provider and also access other services.”
Ruth Ellis was serving about 500 unique youth and young adults annually out of our drop-in center, and it was incredibly scary to find out that almost 40% of those young people were already living with HIV – and not connected to any care whatsoever,” Erwin-McCormick says. “We knew we had to respond to this, and we knew we had to do so sooner rather than later because literally there were lives at stake.
The other services offered at Corktown include not only mental and behavioral health providers, but also wrap-around supports related to food insecurity, housing insecurity, or even help paying utility bills.
Howard Brown Health and Ruth Ellis also emphasized the importance of integrating physical health with other services under the same roof.
Howard Brown Health offers mental health services at the same location as its physical health clinics because, as Ducheny explains, “it’s all so interconnected – no matter what health condition you’re dealing with, it’s so much more difficult to manage if you’re also struggling with mental health.”
Ruth Ellis’ clinic is an integrated behavioral and primary health care model and is in the same building as its ‘drop-in center,’ which provides basic safety-net services including hot meals, a clothing closet, shower facilities, and youth leadership programming.
“Ruth Ellis was serving about 500 unique youth and young adults annually out of our drop-in center, and it was incredibly scary to find out that almost 40% of those young people were already living with HIV – and not connected to any care whatsoever,” Erwin-McCormick says. “We knew we had to respond to this, and we knew we had to do so sooner rather than later because literally there were lives at stake.”