LGBTQ+: Support for OT

Although there are recent increased efforts for equal care such as recommendations for culturally competent care, policies are still not widely implemented and gaps exist between research and clinical care (Kano et al., 2016). 

Calls for Change

The Joint Commission suggests hospitals and other healthcare establishments should offer training sessions that focus on the LGBTQ+ community (Bristol et al., 2018). This has yet to be implemented in most facilities. Healthy People 2020 has identified LGBTQ+ individuals as a U.S. national health priority (Healthy People, n.d.). Improvements need to be made regarding the safety, health, and wellbeing of individuals who identify as LGBTQ+ (Bristol et al., 2018).

Healthcare Provider Standards

Support for OTs advocating for LGBTQ+ individuals and addressing their specific needs is primarily based on our role as healthcare providers and the responsibility that comes with it. As healthcare providers, OTs have the obligation of being client-centered and placing their client's needs above all else. Legally, an individual cannot be refused healthcare services due to a provider's beliefs or opinions about their identified sexuality. However, this is not a guarantee for quality care and many LGBTQ+ individuals face significant obstacles to receiving appropriate healthcare services. It is imperative that healthcare providers aim to gain cultural competence as it relates to various populations to better understand and accommodate their beliefs and values. Bias, discrimination, and neglect have the potential to significantly impact an individual's health outcomes. Healthcare providers can cause further isolation of LGBTQ+ individuals by choosing to neglect an individual's association with the LGBTQ+ community (Moone et al., 2016).

OT Code of Ethics

The Occupational Therapy Code of Ethics and Ethics Standards (AOTA, 2015) calls on OTs to make ethical and moral conclusions while caring for their clients. It aims to promote a high standard of conduct that members of the public can expect from OTs and should be applied to all components of practice (AOTA, 2015). 

  • The core value of altruism calls on OTs to put the concern and welfare of others above their own. An example of an OT lacking altruism is one who avoids or refuses to partake in discussions about LGBTQ+ matters while placing their own discomfort or beliefs above the needs of their client. 
  • The core value of equality sets an expectation of OTs to treat all clients without bias and to practice impartiality. Although a total lack of bias and impartiality is nearly impossible, it is an OT's responsibility to address their biases as much as possible and to actively promote fairness. An OT rushing through a session or having a negative attitude toward an LGBTQ+ client due to their opinions or perception of LGBTQ+ individuals while providing adequate time and positive attitudes towards other clients is an example of inequality.
  • The core value of freedom promotes the idea that OTs should allow a client's desires and choices to guide their interventions. An example of an OT failing to reach this standard is one who redirects or discourages ADLs, such as grooming or dressing activities that are incongruent with gender norms despite a client's preference. 
  • The core value of justice advocates for OTs to adhere to applicable laws and to the standards of their practice in an effort to allow individuals from diverse communities to participate. An OT discriminating towards an LGBTQ+ individual or failing to ask about client factors due to suspicion that LGBTQ+ matters may arise are not adhering to the justice standard. 
  • The core value of dignity endorses OTs treating all clients as unique individuals and with respect while supporting engagement in meaningful activity. An OT who chooses to refer to a client with pronouns that are not preferred by the client is an example of not treating a client with dignity. 
  • The core value of truth requires that OTs provide accurate information in both oral and written forms. An OT who provides inaccurate information regarding sexual health risks of homosexuality as a way to discourage such practices is failing to meet the standard of truth. 
  • The core value of prudence is the use of clinical reasoning, ethical reasoning, judgment, and reflections to make decisions. An OT who chooses to only promote a long-term residential care facility for an elderly LGBTQ+ client that will not allow their same-sex partners to reside with them while LGBTQ+ friendly facilities are available is at risk of failing to uphold prudence as an OT is aware of the impact that social participation, role fulfillment, environmental, and other client factors can have on a client's health and wellbeing. 

It can be challenging to uphold all core values at all times, especially when some actions are unintentional. However, it is imperative that OT's actively strive for these core values to their utmost ability.

Those who aim to the address and advocate for LGBTQ+ specific healthcare needs may be confronted by other healthcare providers who argue that treating all their clients equally is enough and they do not need to ask about or address their client's association with the LGBTQ+ community. However, equity, rather than equality, should be the highest aspiring goal for all healthcare providers as that is how gaps in healthcare services can be reduced. Afterall, an OT wouldn't treat a client with a spinal cord injury in exactly the same manner as someone with schizophrenia because their needs are different. Many LGBTQ+ individuals also have needs that are different than those who are not and, OT's should be making sure those needs are met to the best of their ability. 

Occupations, Health, & Wellbeing

The Occupational Therapy Practice Framework (OTPF) by the American Journal of Occupational Therapy encompasses the overall constructs that define OT practice (2017). OTs are responsible for exploring all contexts of a client's life, including cultural, personal, and temporal contexts (AOTA, 2015). This is especially important in working with the LGBTQ+ population because OTs can assess how adverse events such as discrimination and stigmatization can harmfully influence clients' occupational performances.

There are varying occupations listed in the OTPF that may be of unique concern to this marginalized group. Dressing, grooming, medication management, and toileting are particularly important to address, specifically with transgender individuals. Dressing and grooming tasks are vital ways to project identity for transgender individuals (Beagan et al., 2013). OTs can assist transgender clients with form-changing clothing, such as breast forms for transgender females and binders for trans males (Sharber, 2018). OTs can aid clients with a process known as transitioning, which may require hormone therapy and prescriptions by a physician (Beagan et al., 2013). This can be addressed during OT by managing medication routines for proper health management (AOTA, 2014). Toileting is an occupation that may also be focused on during interventions with transgender or non-binary clients. One study revealed that the lack of safe public restrooms causes health concerns to this marginalized group, such as increased risks of urinary tract infections and dehydration (Herman, 2013). To mitigate these issues, OTs can help through advocating for gender-neutral restrooms and safe spaces for the LGBTQ+ population.

Health promotion and disease prevention is another aspect that OTs may address with LGBTQ+ clients. It is estimated that gay and bisexual males make up 2% of the population in the United States, but makes up nearly 55% of all HIV cases in the country (Human Rights Campaign, n.d). According to the OTPF, OTs can promote education on safe sex practices and HIV/AIDs prevention (AOTA, 2014). OT health promotion also includes the advocacy of mental health for clients. OTs can contribute to preventing bullying in school-based settings (AOTA, n.d). A study reveals that of the individuals interviewed, 33% of LGBTQ+ youth report that they were bullied on school property (U.S Department of Health and Human Services, n.d). Assisting LGBTQ+ in finding appropriate and supportive housing options is another way that OT's can practice health promotion and disease prevention for this population.

OTs can also provide advocacy and self-advocacy for this marginalized group. According to a study published in 2018, healthcare professionals who take LGBTQ+ cultural competency training courses can improve the overall health of LGBTQ+ individuals (Radix & Maingi, 2018). The findings of this study stress the importance of OT clinicians on improving knowledge and understanding about this specific population in order to provide client-centered, occupation-based care. OTs working with LGBTQ+ clients can also aid in self-advocacy, such as helping individuals find LGBTQ+ safe spaces and welcome centers in the community to address social participation in the community (AOTA, 2014).

OT addresses all factors of a person's wellbeing, including aspects of sexuality (AOTA, 2019). OTs can support LGBTQ+ individuals by advocating for equal rights and opportunities. They can also bring cultural awareness to healthcare providers and work establishments to facilitate education on LGBTQ+ individuals and their needs (Sharber, 2018). OTs are also able to assist individuals within the LGBTQ+ who are seeking to project, portray, construct, or affirm their gender identity through occupation. For example, an OT may assist a person who is transitioning genders with dressing and grooming occupations in order to live more successfully in their identified gender. OT's assisting an LGBTQ+ individual who has a disability with sexual participation may assist by providing education and suggesting sexual aides or positioning devices that are specific to their preferred sexual practices.