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

2. Disclosures
We have no disclosures to report.

3. 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

4. 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?

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

6. 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.

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

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

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

11. 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

12. 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)

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

14. 7 articles? Really?

15. 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.

16. 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

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

18. 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

19. 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

20. Case study

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

22. 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),
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),
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), doi: /tmj
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),
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),
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),