Where’s the LGBT in Integrated Care Research? Rachel Hughes, MA, LMFT; Catherine Damin, MA, PLPC; and Katie Heiden-Rootes, PhD, LMFT

Disclosures We have no disclosures to report.

Learning Objectives Upon completion of this presentation, participants will be able to: Summarize the existing research on LGBT populations in integrated care settings Identify current benefits of using collaborative care with LGBT populations Recognize the benefits of expanding research of LGBT populations in integrated care settings

Content of Session Who we are Why LGBT issues in integrated care is important Research question Overview of search Findings and themes So, now what?

Why are population-based studies important? -Identifying health disparities -Identifying how to intervene Cultural-competency Talking about sexuality in a medical setting

Identifying health disparities in LGB populations through EHR (Katie’s study) -Higher anxiety and depression for same-sex partnered patients -Higher substance abuse (alcohol and smoking) for same-sex partnered patients -High clinical use for same-sex partnered female patients -Lower SES for same-sex partnered patients - 44% of the patients did not have any information about their sexual partnering Heiden-Rootes, et al. (in press). Prevalence of medical record diagnosis for same-sex and opposite- sex partnered patients. Journal of the American Board of Family Medicine.

Our inspiration for the study Our medical family therapy program University that doesn’t fund birth control research Background to LGBT interests

What are the current research perspectives of integrated care interventions for LGBT populations? 2. Do integrated care interventions promote positive outcomes in LGBT populations? The research questions

Our team Jane Gillespie “The Research Angel” Catherine Damin “The Muscle” Katie Heiden-Rootes “The Brains” Rachel Hughes “The Leader”

Our systematic review search terms Setting Integrated care, collaborative care, medical home, collocated care, team based care, federally qualified health center*, FQHC, interprofessional, biopsychosocial, family system* Population Sexual minorit*, gender minorit*, LGB*, GLB*, lesbian*, gay*, bisexual*, transgender*, transsex*, queer*, homosexual*, gender dysphor*, sexual orientation* Intervention Behavioral health*, medical family therap*, family therap*, MFT, mental health

Our review parameters To be included: To be excluded: LGBTQ+ identifying individuals Collaborative/integrated care services that received some sort of mental health US Residents Original research Since 2000 Non-LGBTQ+ identifying individuals Outside of the US Non-collaborative care/mental health setting Literature reviews/brief reports Social work and psychology only 1999 and earlier Solely heterosexual population (if not transgender)

The design and search process Three databases PsychInfo PubMed Cinahl How many articles do you think we found?

7 articles? Really?

The Articles Blank, Gallagher, Washburn, & Roger (2005) Explored the impact of holistic approach of STIs and mental health at social event for men who have sex with men. Carolan, Bak, Hoppe-Rooney, & Burns-Jager (2010) Case study of 30 undergraduate women with eating disorder diagnoses in outpatient, collaborative care. Sample included lesbian and transgender patients. Ferron, Young, Boulanger, Rodriguez, & Moreno (2010) Case study of one 68-year-old, transgender woman to examine concerns for older patients with multiple health issues.

The Articles (continued) Kauth et al. (2015) Provided training to 13 Veterans Health Administration (VHA) clinicians for treatment of transgender individuals. Proeschold-Bell, Heine, Pence, McAdam, & Quinlivan (2010) Examined substance use outcomes of HIV positive, substance-using patients at 3 integrated care clinics. Identified one participant as transgender. Woods, Samples, Melchiono, & Harris (2003) Addressed needs of at-risk, homeless, and HIV positive youth through collaborative care and outreach. Woods, Samples, Melchiono, Keenan, & Fox (2002) Evaluated role of outreach and HIV services for youth in Boston HAPPENS program

Themes of the articles Preliminary studies Nonexperimental STI testing Substance use and addiction

Implications of findings This research doesn’t really exist Emergence of MedFT and family-focused BHC Offers a population-centered approach to addressing gap in: Professional knowledge and sensitivity to sexual and gender minority persons Creates opportunities for accessing family-level interventions

So, now what? Research with LGBT populations and integrated care is in its infancy Community level and family level interventions needed to provide support and resources These interventions are significant because interconnected systems in health, mental health, and family Mental health and health disparities Connection of transgenderism and diabetes

Case study

How do you think increasing LGBT-focused outcomes research could impact healthcare for these populations?

Selected References Blank, S., Gallagher, K., Washburn, K., & Rogers, M. (2005). Reaching out to boys at bars: utilizing community partnerships to employ a wellness strategy for syphilis control among men who have sex with men in New York City. Sex Transm Dis, 32(10 Suppl), S65-72. Carolan, M., Bak, J., Hoppe-Rooney, T., & Burns-Jager, K. (2010). An integrated feminist approach to disordered eating intervention in a university campus outpatient setting. Journal of Feminist Family Therapy: An International Forum, 22(1), 43-56. Ferron, P., Young, S., Boulanger, C., Rodriguez, A., & Moreno, J. (2010). Integrated care of an aging HIV-infected male-to-female transgender patient. JANAC: Journal of the Association of Nurses in AIDS Care, 21(3), 278-282. Kauth, M. R., Shipherd, J. C., Lindsay, J. A., Kirsh, S., Knapp, H., & Matza, L. (2015). Teleconsultation and Training of VHA Providers on Transgender Care: Implementation of a Multisite Hub System. Telemed J E Health, 21(12), 1012-1018. doi:10.1089/tmj.2015.0010 Proeschold-Bell, R. J., Heine, A., Pence, B. W., McAdam, K., & Quinlivan, E. B. (2010). A cross-site, comparative effectiveness study of an integrated HIV and substance use treatment program. AIDS patient care and STDs, 24(10), 651-658. Woods, E. R., Samples, C. L., Melchiono, M. W., & Harris, S. K. (2003). Boston HAPPENS Program: HIV-positive, homeless, and at-risk youth can access care through youth-oriented HIV services. Seminars in Pediatric Infectious Diseases, 14(1), 43-53. Woods, E. R., Samples, C. L., Melchiono, M. W., Keenan, P. M., Fox, D. J., & Harris, S. K. (2002). Initiation of services in the Boston HAPPENS Program: Human immunodeficiency virus-positive, homeless, and at-risk youth can access services. AIDS patient care and STDs, 16(10), 497-510.