Adapted from a presentation at ACOFP ’23 by Keri Griffin, LCSW, Orlando VA Healthcare System. Among other honors, Ms. Griffen received the national special contribution award in 2016 for her contribution after the Pulse tragedy.
In a 2022 poll in Central Florida, members of the LGBTQ community were asked, “Where do you feel most comfortable getting your healthcare?” The top two answers were two local LGBTQ-specific healthcare organizations, and the third answer was the Orlando VA.
Many people may not be aware of the LGBTQ supports and services available throug the VA. Some veterans were not treated well in the military and think they can’t come to the VA and be served openly. There are many veterans who hate the VA. The VA of the Vietnam era and the “Don’t ask, Don’t tell” era is not the VA of today. Today’s VA is committed to serving all veterans, with no asterisk. They have a long way to go, but they are always growing and changing.
The VHA now has national policies that apply to LGBTQ and trans and gender diverse veterans, and holds its staff accountable for following these policies. For staff who have a “conscientious objection” on religious grounds, the VA will do training to get them to a place where they’re comfortable, but they’re not allowed to say “Well, I’m not going to provide hormones to gender-diverse veterans.” When you walk through the door as a VA employee, you either adhere to policies or you could be out of a job.
Each VA facility has at minimum one Veteran Care Coordinator designated to understand policies related to LGBTQ veteran health and serve as a point of contact for veterans, etc. If you serve veterans who aren’t seeking care through the VA because of negative perceptions, please encourage them to reach out to their LGBT Veteran Care Coordinator.
The VA provides many services relevant to the LGBTQ+ community, including gender-affirming hormone therapy, speech therapy, PreP and PEP, and pre- and post-op care for transgender veterans. They do not yet provide gender-affirming surgeries, although they hope to in the near future. Their mental health care services include counseling for individuals, couples, families, and groups; presurgical clearance; and readiness evaluation/diagnosis. VA legal clinics can also assist veterans in accessing healthcare by applying to upgrade their discharge status. People who were discharged for being LGBT under Don’t Ask, Don’t Tell can have their discharge upgraded from “not honorable discharge” and thus be eligible for VA services.
Ms. Griffen had advice for all practitioners in creating a safe and welcoming environment for LGBT patients. She encouraged attendees to establish policies for their practice around treatment for LGBT patients, if they don’t yet have them. The VA also works to create a supportive environment for its LGBTQ employees. If employees don’t feel validated and affirmed and supported, they can’t create that environment for patients.
Some of Ms. Griffen’s tips for creating a safe space and welcoming environment for LGBTQ patients and staff:
- Use visual cues—rainbow lanyards, Pride flags, ally badges, Safe Space and ally cards on doors or in offices, pronoun pins. These safety symbols can make people feel more comfortable.
- Use “Patient” as a first name when calling people in.
- Share your own name and pronouns.
- Have a designated “champion” at each facility or site.
- In your EHR, have reminders to ask about sexual orientation (as an optional question) and pop-up reminders of which pronouns to use.
- Honoring special observances throughout the year can be very helpful. Putting that information out there to your patients and coworkers is affirming.
- Rainbow Christmas trees or other decorations for all holidays: “This sounds silly, but I can’t tell you how many patients and staff sent me messages about it. It registers with people, and it’s meaningful.”