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Building Inclusive Healthcare for LGBTQ+ Youth: Improving the Collection and Utilization of Patients’ Sexual Orientation and Gender Identity (SOGI) Information, Preferred Names and Gender Pronouns in a Pediatric Clinic

Authors:

Scott Jelinek ,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Fatima Toor,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Kristian Becker,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Kelly Smith,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Benjamin Schindel,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Nicholas Puoplo,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Camille Hebert,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Bari Winik,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Nicole Mann,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Lauren Ambler,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Carolyn Birbiglia,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Arnoldys Stengel,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Laura Nell Hodo,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Christopher Tenore,

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Cynthia Katz

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Abstract

How to Cite: Jelinek, S., Toor, F., Becker, K., Smith, K., Schindel, B., Puoplo, N., Hebert, C., Winik, B., Mann, N., Ambler, L., Birbiglia, C., Stengel, A., Hodo, L.N., Tenore, C. and Katz, C., 2020. Building Inclusive Healthcare for LGBTQ+ Youth: Improving the Collection and Utilization of Patients’ Sexual Orientation and Gender Identity (SOGI) Information, Preferred Names and Gender Pronouns in a Pediatric Clinic. Journal of Scientific Innovation in Medicine, 3(3), p.17. DOI: http://doi.org/10.29024/jsim.76
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  Published on 24 Jul 2020
 Accepted on 18 Jun 2020            Submitted on 18 Jun 2020

Background

Transgender and gender diverse youth are more likely than their peers to experience poor physical health and are at higher risk of depression, anxiety, self-harm and suicide [1]. They often have had negative healthcare experiences related to being transgender and gender non-binary (TGNB), including being refused treatment, verbally harassed, physically or sexually assaulted [2]. Fifty percent reported having to teach their provider about TGNB people in order to get appropriate care [3] and another study found that 80% of pediatricians did not ask about sexual orientation during a well visit [4]. Research shows LGBTQ youth value the opportunity to discuss their gender and sexuality with their healthcare provider [6] and addressing TGNB youth by their chosen or preferred name is associated with decreased rates of depression and suicide [5]. Therefore, asking questions about sexual orientation and gender identity (SOGI) is a vital step in the affirmation of a patient’s identity, building of rapport, and can be life saving. At the Mount Sinai Pediatric Associates clinic there is no standardized collection of SOGI information or gender pronouns. We set out to address this need by creating a standardized process for educating pediatric physicians and staff with the goal of increasing their knowledge, skills, and ability to collect, document, and utilize SOGI information.

Methods

The Mount Sinai Health System in New York City recently adapted our electronic medical record (EMR) to easily document patients’ SOGI information and to display patients’ preferred name and gender pronoun in the visit banner (Figures 1 and 2). Our planned interventions to educate pediatric physicians and staff on using the new EMR features include designing in-person and online training and holding staff roundtables to improve physician and staff comfort. As a means to enhance our clinical space to increase TGNB patient comfort, we will create culturally sensitive and inclusive demographic forms and signage within the patient waiting area, and distribute gender pronoun buttons for providers and staff. We will monitor progression of proposed interventions, including: 1) tracking staff completion of in-person and online training 2) measuring staff knowledge and comfort with post training surveys 3) percentage of pediatric patients 12+ years who have preferred name or SOGI documented in the EMR, with the goal of increasing the percentage from 0% to 50% within 3 months.

Figure 1 

SOGI Questions in Epic.

Figure 2 

Preferred Name and Preferred Pronoun in Epic Banner.

Results

Currently many providers express lack of comfort and familiarity with obtaining SOGI information. 21 pediatric residents and faculty were surveyed. Only 5% reported knowing how to document gender pronouns in the medical record and 0% knew how to document preferred names. Only 20% reported asking their patients “often” about gender pronouns and 0% “always ask.” The most common reason participants cited for not asking about SOGI information was lack of comfort, low level of confidence in their ability to properly obtain and document SOGI information from their patients, and minimal education and training.

Conclusions

Through a multi-faceted approach to educating providers and staff in our pediatric clinic, we hope to increase comfort, ease, and accuracy in obtaining SOGI information. Increased awareness about SOGI information will help to strengthen the patient-provider relationship and could positively transform the experiences of our TGNB youth. Additional study will aim to establish a sustained impact of our interventions and should address healthcare disparities among this population.

References

  1. Virupaksha H, Muralidhar D, Ramakrishna J. Suicide and suicidal behavior among transgender persons. Indian Journal of Psychological Medicine. 2016; 38(6): 505. DOI: https://doi.org/10.4103/0253-7176.194908 

  2. James SE, Herman JL, Rankin S, Kiesling M, Mottet L, Anafl M. The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality; 2016. 

  3. Grant, et al. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011. 

  4. Henry-Reid LM, O’connor KG, Klein JD, Cooper E, Flynn P, Futterman DC. Current Pediatrician Practices in Identifying High-risk Behaviors of Adolescents. Pediatrics. 2010; 125(4). DOI: https://doi.org/10.1542/peds.2009-0271 

  5. Hoffman ND, Freeman K, Swann S. Healthcare Preferences of Lesbian, Gay, Bisexual, Transgender and Questioning Youth. Journal of Adolescent Health. 2009; 45(3): 222–229. DOI: https://doi.org/10.1016/j.jadohealth.2009.01.009 

  6. Russell ST, Pollitt AM, Li G, Grossman, AH. Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth. Journal of Adolescent Health. 2018; 63(4): 503–505. DOI: https://doi.org/10.1016/j.jadohealth.2018.02.003 

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