LGBTQ+: Challenges for OT
Despite the current support and the identified potential for furthering OTs role with the LGBTQ+ population, there are challenges present that impact the feasibility of providing services.
Education & Resources
Most healthcare providers receive no or very limited education pertaining to trans-health (American Psychological Association Task Force on Gender Identity and Gender Variance, 2008; Sanchez et al., 2006) and OT providers are no exception (Beagan et al., 2013). There is very little mention of LGBTQ+ client-based interventions within OT education, and even less on how OT can aid in trans-health (Beagan et al., 2013). This means that practitioners entering the field may often feel ill-prepared to address LGBTQ+ issues. Practitioners are required to seek out their own opportunities to develop and expand their knowledge in this practice area, but resources are scarcely available making it additionally challenging.
OT practitioners' access to individuals who identify as LGBTQ+ is mostly by happenstance which is dependent upon the individual entering a traditional setting such as a hospital or outpatient clinic and on the individual disclosing their association with the LGBTQ+ community. Serving this population can be done sporadically throughout these types of encounters; however, it can be difficult for OTs to make significant progress in assisting this population as a whole.
An OT hoping to make large gains in defining and implementing OT's role with this population will likely require initiatives to become involved in community centers that specifically serve LGBTQ+ individuals in need or to create outreach programs.
The needs and concerns of the LGBTQ+ community in regards to OT are still considered an emerging practice area for OTs. However, OTs must continue to advocate for clients to reduce minority stress and increase opportunities for those who identify as LGBTQ+. OTs are lacking in their approach towards treatment for the LGBTQ+ population by only focusing on issues related to sexual expression and relationships (Meach, 2017). Unfortunately, there is little research on LGBTQ+ needs related to OT. Research focused on OT and transgender individuals is nonexistent despite the increased awareness that transgender identity has a significant effect on occupations (Beagan et al., 2013).
In general, OT's role in advocating for and serving the LGBTQ+ community has yet to be defined. However, there is a network for lesbian, gay, bisexual, and transgender concerns in OT on the AOTA website (AOTA, 2019letter?). The network's primary purpose is to provide support to promote LGBTQ+ representation (AOTA, 2019letter?).
Openly discussing sex and intimacy is still somewhat taboo in American culture. Progress has been made with recent generational changes, but there is still significant progress to be made. Practitioners often fear to say the wrong thing that could be misinterpreted or is insensitive resulting in complaints or being reprimanded. Strong opinions influenced by religion on both the practitioner and the client side can also strongly influence the level of comfort discussing the topic.
LGBTQ+ individuals have less access to quality healthcare than the general population secondary to discrimination within the workforce and discriminatory policies within healthcare coverage (Healthy People, 2020; Kates et al., 2016; Operario et al., 2015; Shires & Jaffee, 2015). Without appropriate healthcare coverage, LGBTQ+ individuals are less likely to receive healthcare services, including OT services.
Biases & Discrimination
Just like the general public, OT practitioners carry their own biases and are capable of discrimination. As discussed on the LGBTQ+ background page, many healthcare providers struggle with strong opinions regarding LGBTQ+ lifestyles. Transphobia and concerns about a lack of knowledge regarding trans-care (Beagan et al., 2013) which has an effect on their transgendered clients. The same applies to those who sexually identify as something other than heterosexual. It's also been found that most healthcare providers do not discuss gender identity with their clients (Kitts, 2010). Although many healthcare providers aim to overcome their biases, implicit biases still exist and result in a lack of awareness. Cultural competency is critical, but not routinely taught.