Faculty Take an Interprofessional Approach to LGBTQ Health Care

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By Laine Zizka

 

“[This] brought us together for the conversation that we’ve been trying to have for two years in the hallway,” said Tee Tyler, an assistant professor in the Department of Social Work, to Stephanie Evans, an assistant professor in TCU Nursing, as they sat down for a long chat.

Housed in two separate academic units of Harris College, Evans and Tyler have been working separately on research that looks to better the care for LGBTQ patients in the health care setting.

Dr. Stephanie Evans

Stephanie Evans, TCU Nursing assistant professor.

“I interviewed our LGBTQ students on campus that were self-identified,” Evans said. “I basically had focus groups so they were more comfortable…answering questions about what it was like for them.”

What she found was that these students lacked confidentiality in a lot of areas – or weren’t provided it at all. This led to a lot of secrecy, misinformation and tension as they grew up.

Tyler’s work focused on training social workers to walk the tight-wire between parent and child in navigating the identity shift of coming out.

Dr. Tee Tyler

Tee Tyler, Department of Social Work assistant professor.

“I think the one thing that has interested me in my qualitative work is not looking at the parent or the child as the client,” said Tyler. “When the conversation comes up, it’s not advocating for one individual to be heard, it’s advocating for both – which requires more of a balancing act.”

In essence, when a child comes out to their parent, they are leaving a perceived identity group they previously shared with their parent, while the parents are also changing identities as the parent of a child who identifies as LGBTQ. The biggest question comes when social workers look at how power is allocated in these counseling sessions.

“You can say that you’re advocating for the child, but if you lose the parent in the process, it’s not going to be the best outcome,” said Tyler.

Both Tyler and Evans said they found that LGBTQ patients were not being supported in the ways they needed to be in the health care setting – and they are determined to change that.

“I am a pediatric nurse practitioner,” Evans said. “I have worked in a pediatric care office since 2004. I have seen how many kids? And I know nothing about their sexuality. What am I missing? I started at that point then realizing that we have a big knowledge gap. If I didn’t know it, most people probably didn’t either.”

For Evans, the impetus for her research came when her oldest son came out to her as pansexual. She knew then that there had to be a support system in place for kids like her son.

“I would love us to have providers that realize that they need to provide confidential time so that if they have a question about it they can ask,” Evans said. “I’d like to know why we assume a negative connotation to LGBTQ still and I personally think it’s because it’s sexual in nature – which is taboo in society anyway.”

Tyler saw the knowledge gap grow as he sat in sessions watching relationships unfold in real time.

“The thing that became highlighted to me was that it was much more of a creative process than was a prescriptive process,” said Tyler. “What that means was that it had a lot more to do with the parent-child negotiating or deciding what they wanted to disclosure to mean for them and their relationship.”

He says relationships are based on what he calls ‘cultural dust’ that informs perceptions regardless of truth. Tyler notes that it’s not about mediation, it’s about conversation.

“It’s so easy to focus immediately on the relationship but it’s another thing to have a parent and child be open to this conversation and be critical about things they’ve heard,” Tyler said. “Doing that could save a lot of stress later when there’s tension.”

Evans notes that the knowledge gap is leaving many patients in the dust in terms of level of care – and that extends to the family and starts with education.

“The parent relationship is very different for each child, for each parent,” said Evans. “It’s not something that the child goes through by themselves because the entire family goes through it as a unit.”

Her solution is to create a health care system in which children can be seen by any number of specialists, from social workers to psychiatrists, in addition to their primary care doctor. It’s all part of a push toward interprofessional practice.

TCU is on the leading edge in terms of teaching interprofessional practice, bringing together students from across disciplines to assess how health care is administered. It starts with recognizing the gaps.

“I think that we’re just not educating the providers, we’re not providing the space the kids need, we’re not providing the space the parents need,” said Evans.

Instead, the two propose, practitioners need to be educating each other and create understanding across disciplines and scope of practice to be able to give the best care possible.

“I think the one thing that’s so clear is there’s so much work that needs to be done related to equality issues,” said Tyler. “That still manifests at broader civil rights level but that also manifests in health care. It just requires an integrated, holistic, full-frontal approach.”

That holistic approach looks like knowledgeable health care providers, inclusive intake forms and confidential time built into the framework of the system.

Beyond the confines of the health care system, Evans and Tyler know that care starts with the family.

“They’re still their child,” Evans said. “As a parent of a child who has a very strong faith-based belief, I don’t believe that God makes mistakes.”

Tyler advocates for patience – to take time.

“The burden to have stuff figured out quick doesn’t always help,” said Tyler. “Whenever parents are a little more compassionate with themselves that gives them a little more room to be passionate with their children. We’re told to go fast, but I think this isn’t a process where you can go fast.”