5 Principles of Affirming and Inclusive Care: Poster

1. Ensure patient safety and comfort

Many LGBTQIA+ children and youth have learned to read subtle signals of whether an environment is safe or unsafe to come out. Intentionally providing overt signals of affirmation will help them to feel safe being honest about their health. 

Affirm names and pronouns. Use the words someone uses for themself.

Use inclusive language. Ask questions in ways that are open to gender and sexual diversity: Are you attracted to anyone? instead of Do you have a boyfriend?

‍Ask for consent before examining a patient and use gender-inclusive language when referring to body parts.
May I examine your chest?

‍Explain why you're asking questions about sex, sexual orientation, and gender.
This information is relevant to your health because...
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2. Build and maintain trust 

LGBTQIA+ communities, especially Black, Indigenous and communities of color, have long histories of experiencing systemic harm by the medical community. These histories are passed on through families. Patients may enter the clinic with mistrust; it is our job to earn their trust.

Uphold privacy and confidentiality, including LGBTQ+ identity if necessary. Where needed, explain the limitations of privacy and confidentiality for youth.

Don't make assumptions based solely on identity.
Within any specific identity there is great diversity in health needs and experiences; assumptions make people lose confidence or trust in our ability to care for them.

When we make a mistake, apologize briefly and move on.
I'm sorry, I should have said [Sean]. [Sean], these are some options I see…
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3. Respect patient experiences & priorities

LGBTQIA+ children and youth enter the clinic with knowledge about what is most important for their wellbeing, and how their experiences impact their health. Yet they are routinely patronized and pathologized as being  too young to know, confused, or inherently unwell.

Address patient priorities first and with meaningful time. Don't wait until there are only a few seconds left in the appointment to ask if they have something they'd like to discuss. Spend time based on their agenda first. 

Acknowledge the impact of trauma on health outcomes and behaviors. Don't assume a patient has trauma, but do affirm experiences if they share.
Your depression, anxiety, and symptoms are a common outcome of experiencing systemic discrimination; having these symptoms doesn't mean there's something wrong with who you are. 
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4. Participate in shared decision-making

LGBTQIA+ young people enter the clinic with essential information about their health, the circumstances that will make interventions effective or ineffective, and how interventions will impact them. Due to discrimination, they may not have the same or safe access to resources or support available to straight, cisgender youth. 

Actively involve youth in decision-making about their health. Provide all the information and discuss which options are possible for them.

Involve family when appropriate; understand that LGBTQIA+ youth may not be supported by their family of origin and "family" may not be who you expect.

Affirm the healthcare practices that are culturally meaningful to the patient.
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5. Provide useful information and accessible care 

Many sources of health information use gendered language, assume heterosexuality, and relate information to dominant cultural norms. LGBTQIA+ youth are looking for information that they can access without parental support and that speaks to them directly. Consider how recommended interventions may lead to interaction with additional systems: law and immigration enforcement, welfare oversight, segregated health systems.

Provide access to information that is relevant and accessible to the populations being served.  

Increase knowledge about additional health considerations for Black and non-Black POC, transgender, nonbinary, and gender nonconforming youth.