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Collecting Baseline Data
Quality improvement programs measure performance against baseline data. This means adding appropriate data fields for recording one’s transgender identity, sexual behavior or identity, and information about significant same-sex relationships to forms used to collect client demographic data. Coding this information will require programs to respect consumers’ wishes about confidentiality but also provide information on one’s sexual orientation and gender differences, issues, and concerns.
Many people feel that this is personal information, that asking about it is awkward and inappropriate, and/or that people’s right to privacy must be protected. Providers should be mindful that the guiding rationale for collecting sexual orientation and transgender identity information is to determine whether these communities are being properly served and what health problems they are experiencing. On this last point, confidentiality should always be of concern. Clients can never be forced to provide any demographic information, but policies to preserve privacy rights should not keep people from communicating and recording their sexual orientation or transgender identity if they choose to do so.
The ability to elicit baseline demographic data about their LGBT client population is an important measure of competency for LGBT care providers. Many, if not most, staff members will need formal training on how to ask the necessary questions. Training relating to collecting this information will need to consider a variety of factors (e.g., age, culture, ethnicity, and individual consumer differences). Self-administered questionnaires could be used. By providing a blank space where they can identify their gender if they choose, the items on such questionnaires can be posed to clients so it is not necessary for them to commit to being either male or female. Eli Coleman’s assessment tool (1987) shown in chapter 1 is an example of an effective form. It will be important to explore how to collect these data later in the treatment episode if they are not volunteered at intake or during assessment.
The initial staff training on data collection will provide agency leadership with an important gauge of the attitudes and comfort level of staff working with LGBT clients. The close attention and expressed commitment of leadership is, therefore, of critical importance. Because staff competency and comfort are important, baseline data on this issue should be collected at the start of training and throughout training/performance improvement efforts.
Once baseline information is gathered, the percentage of LGBT clients using the facility should be compared to the best available estimates of the percentage of LGBT individuals in the community at large. Comparing the two numbers will provide important information on how well the facility is meeting LGBT clients’ needs. Even if the proportion of LGBT clients matches or exceeds the proportion of LGBT individuals in the community at large, there may be considerable room for improvement in working with LGBT individuals considering that clients may hide their identities because of lack of support or fear of persecution, especially in areas where there is no visible LGBT community. Ironically, those who are uncertain about disclosures or reluctant to disclose that they are (or might be) LGBT individuals may likely require the most support concerning these issues.
The key questions that every program should address are:
• How well does the program or staff elicit information regarding clients’ sexuality? Is the atmosphere uncomfortable?
• Are LGBT outreach efforts effective?
• Are there actual disincentives for such clients to seek care at the center?