Standards of Practice for the Provision of Quality Health Care Services
to Lesbian, Gay, Bisexual, and Transgender Clients
The Gay, Lesbian, Bisexual
and Transgender Health Access Project is a collaborative, community-based
program funded by the Massachusetts Department of Public Health
(MDPH). The Project's mission is to foster the development and implementation
of comprehensive, culturally appropriate, quality health promotion
policies and health care services for gay, lesbian, bisexual and
transgendered (GLBT) people and their families.
Research has indicated that fear of discrimination and stigma cause
many GLBT individuals to postpone or decline seeking medical care.
Others, once in care, sometimes withhold from their providers personal
information which may be critical to their well-being. Working closely
with consumers and clinicians across the state, the GLBT Health
Access Project works to confront the insensitivity and ignorance
that many GLBT people have experienced in accessing health care
and related services. Additionally, the Project seeks to support
GLBT individuals in understanding and acquiring the quality care
they need. The Community Standards of Practice contained here provide
a benchmark for both providers and consumers in the development
of and search for welcoming, culturally competent and responsive
The need for Community Standards emerged from several sources, including
a statewide provider survey and a 1997 GLBT Health Access Project
report, Health Concerns of the Gay, Lesbian, Bisexual and Transgender
Community. Among other things these reports detailed a serious lack
of GLBT awareness and understanding among health care providers
in Massachusetts. Some believed they had no GLBT clients or staff
in their facilities; many were unsure about what their role should
be in identifying and addressing GLBT issues; few had policies in
place to guide personnel or consumers.
To address these concerns, the GLBT Health Access Project convened
a community Working Group of over 60 consumers, providers, public
and private agency administrators and staff. Over the course of
a year, the group worked to develop a framework to improve GLBT
access to quality care and to assist clinicians and their facilities
in creating responsive environments. The working group's efforts
were guided by four principles: (1) the elimination of discrimination
on the basis of sexual orientation and gender identity; (2) the
promotion and provision of full and equal access to services; (3)
the elimination of stigmatization of GLBT people and their families;
and (4) the creation of health service environments where it is
safe for people to be "out" to their providers.
The resulting community standards of practice and quality indicators
outlined in this document will guide and assist providers in achieving
these goals. The standards address both agency administrative practices
and service delivery components, including the following areas:
Planning and Delivery
Outreach and Health Promotion
GLBT people live in and seek health care and prevention services
in every community in Massachusetts. Eliminating barriers to care
requires both an educated and empowered consumer base and a skilled,
culturally competent, sensitive and welcoming provider community
that is openly supportive of gay, lesbian, bisexual and transgendered
people and their families. These standards are one tool for achieving
greater health care for all.
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STANDARDS AND INDICATORS
Standard 1. The
agency shall establish, promote and effectively communicate an inclusive,
non-discriminatory work place environment for gay, lesbian, bisexual
and transgendered employees.
INDICATOR: Written policies, including
but not limited to non-discrimination, diversity and non-harassment
policies that explicitly include gay, lesbian, bisexual and transgendered
Inclusion of policies in all new employee orientation programs
and materials; inclusion of policies in employee handbook.
Written sign-off on policies by all employees.
Discussion of polices with job applicants during interviewing
Posting of polices in all of agency's facilities.
Annual review of all policies, and opportunities for ongoing employee
input and training.
2. The agency shall
support and encourage visibility of gay, lesbian, bisexual and transgendered
employment recruitment of gay, lesbian, bisexual and transgendered
employees, including outreach to GLBT organizations, and advertising
in GLBT media.
Development and implementation or revision of existing policies
to ensure effective procedures for dealing with employee complaints
of discrimination or harassment based on sexual orientation or
Written notice to all employees that discrimination or harassment
of other employees on the basis of sexual orientation or gender
identification is grounds for appropriate levels of discipline,
up to and including dismissal.
Standard 3. The
agency shall work towards ensuring that gay, lesbian, bisexual and
transgendered employees of all ages are subject to the same terms
and conditions of employment, including the same benefits and compensation,
as all other employees.
policies explicitly stating that the agency does not discriminate
on the basis of sexual orientation or gender identity in providing
compensation and benefits, including but not limited to family
and medical leave, bereavement leave, and such other benefits
as the agency offers its employees.
Written policies explicitly extending the same benefits to all
families, including the families of gay, lesbian, bisexual and
transgendered employees. Such policies may allow employees to
designate who shall be considered their "family" members.
If the agency offers health, life, disability insurance and pension
benefits to its employees, the agency shall work towards including
full and equal coverage for its gay, lesbian, bisexual and transgendered
employees and their families.
Comprehensive ongoing training of all human resource and other
appropriate personnel in sexual orientation and gender identity
issues with regard to employee benefits.
Mechanisms to appropriately convey GLBT-related policies and make
relevant training accessible to all employees at all levels, including
those with disabilities, and those for whom English is not their
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Standard 4. The
agency shall assure that comprehensive policies are implemented
to prohibit discrimination in the delivery of services to gay, lesbian,
bisexual and transgendered clients and their families. The agency
shall ensure that all staff use, and all written forms and policies
employ, culturally appropriate language when dealing with gay, lesbian,
bisexual or transgendered clients and their families. For the purpose
of these standards the terms "family" and "families"
shall be broadly construed, and shall include but not be limited
to relatives by blood, adoption, marriage or declaration of domestic
polices that explicitly state that the agency does not discriminate
on the basis of sexual orientation or gender identity in the provision
of services. Such policies shall specifically include families
of all clients.
Conspicuous posting of non-discrimination policies in all languages
appropriate to the populations served by the agency, and inclusion
of policies in agency brochures, informational and promotional
to ensure that non-discrimination policies and procedures are
appropriately conveyed to all clients, including those with disabilities
and those for whom English is not their primary language.
Explicit sign-off on policy by all employees.
Standard 5. The
agency shall ensure that it has comprehensive and easily accessible
procedures in place for clients to file and resolve complaints alleging
violations of these policies.
Designation of one or more persons responsible for ensuring agency
Written notice to all employees that discrimination in the delivery
of services based on sexual orientation or gender identity violates
standards of good care, and is subject to appropriate discipline.
Conspicuous posting of complaint procedures, inclusion of procedures
in informational materials given to agency clients and their families.
Translation of procedures into and provision of information in
all languages appropriate to populations the agency serves.
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Intake and Assessment
The agency shall develop and implement or revise existing intake
and assessment procedures to ensure that they meet the needs of
gay, lesbian, bisexual and transgendered clients of all ages and
INDICATOR: All reception,
intake and assessment staff are trained to use culturally appropriate
Development and implementation of intake and assessment forms
which provide for optional self-identification in all categories
of gender identity, sexual orientation, marital, partnership and
family status, and provide clients with the option and opportunity
for further written explanation.
Develop mechanisms to ensure that all reception, intake and assessment
staff are familiar with providers within the agency with expertise
in and sensitivity to gay, lesbian, bisexual and transgender issues,
and appropriately convey this information to clients.
Development and implementation of training for all intake and
assessment staff to assure medically and culturally appropriate
referrals for gay, lesbian, bisexual and transgendered clients
and their families to providers within and outside of the agency.
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Service Planning and Delivery
All agency staff shall have a basic familiarity with gay, lesbian,
bisexual and transgender issues as they pertain to services provided
by the agency.
and implementation or revision of agency training and programs
on diversity, harassment, and anti-discrimination to assure explicit
inclusion of gay, lesbian, bisexual and transgender issues.
Development and implementation of training for all intake, assessment,
supervisory, human resource, case management and direct care staff
on basic gay, lesbian, bisexual and transgender issues.
Standard 8. All
direct care staff shall routinely provide general care to gay, lesbian,
bisexual and transgendered clients. All direct care staff shall
be competent to identify and address, within the scope of their
field of expertise, specific health problems and treatment issues
for gay, lesbian, bisexual and transgendered clients and their families,
to provide treatment accordingly, and to provide appropriate referrals
ongoing training provided for direct care staff to identify and
address basic health issues within their field of expertise that
may particularly or uniquely affect gay, lesbian, bisexual and
Creation and implementation of mechanism for identification of
staff with special expertise in and sensitivity to gay, lesbian,
bisexual and transgender issues.
Provision of training for direct care staff on how, when and where
to make appropriate referrals for gay, lesbian, bisexual and transgendered
clients and their families.
Development of a comprehensive resource list for appropriate referrals
for special gay, lesbian, bisexual and transgender health concerns.
Outreach to and development of relationships with other agencies
and providers with expertise in gay, lesbian, bisexual and transgender
Evidence of agreements or other appropriate mechanisms to ensure
cooperation with other agencies and providers to whom gay, lesbian,
bisexual and transgendered clients and their families may be referred
for specialized care and treatment.
9. All case management and treatment
plans shall include and address sexual orientation and gender identity
where it is a necessary and appropriate issue in client care.
of training for all case management and direct care staff on gay,
lesbian, bisexual and transgender health, treatment and cultural
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The agency shall ensure the confidentiality of client data, including
information about sexual orientation and gender identity issues.
Gay, lesbian, bisexual and transgendered clients shall be informed
about data collection that includes references to sexual orientation
and/or gender identity, including in what circumstances such information
may be disclosed, whether it may be disclosed as aggregate or individual
information whether personal identifiers may be disclosed, and how
and by whom such information may be used.
confidentiality policies which explicitly include sexual orientation
and gender identity, indicating that such information is to be
considered highly sensitive and treated accordingly.
Designation of sexual orientation and gender identity is at client's
option on forms and records.
Comprehensive training for appropriate staff on data collection
and reporting issues as they relate to confidentiality.
Written disclosure to clients explaining when information may
or must be disclosed to third parties for payment or other reasons,
and in what circumstances such disclosures may include information
regarding sexual orientation and gender identity.
11. The agency shall provide
appropriate, safe and confidential treatment to gay, lesbian, bisexual
and transgendered minors, unless the agency's services are inappropriate
for all minors. All clients who are minors shall be informed of
their legal rights, and advised of the possibility and possible
consequences of any statutory or otherwise mandated reporting.
training regarding the legal rights of minors.
Development and implementation of procedures for intake, assessment
and treatment of minors that is sensitive to gender identity and
Written and oral notice to minors of various mandated reporting
laws and their implications, and of the minor's rights regarding
confidentiality and treatment without parental consent.
Reception staff trained to be sensitive to issues of gay, lesbian,
bisexual and transgendered youth.
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Relations and Health Promotion
Standard 12. The
agency shall include gay lesbian, bisexual and transgendered people
and their families in outreach and health promotion efforts.
advertising and promotional materials clearly indicate nondiscrimination
policies regarding sexual orientation and gender identification.
Agency outreach efforts to social service, medical and other providers
promote services to gay lesbian, bisexual and transgendered clients
and their families.
Agency outreach and promotional efforts accurately reflect the
level and quality of services available to gay lesbian, bisexual
and transgendered clients and their families.
13. The composition of the agency Board
of Directors and other institutional bodies shall encourage representation
from GLBT communities.
INDICATOR: The process
for electing or appointing members of the Board of Directors and
other institutional bodies includes outreach to and inclusion
of gay, lesbian, bisexual and transgendered candidates.
14. Agency community benefits programs
shall include gay, lesbian, bisexual and transgendered people in
the communities the agency serves.
of criteria for community benefits programs that provide for inclusion
and promotion of issues of concern to gay lesbian, bisexual and
transgendered people and their families.