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Heather Cobb

Sr. Director, Creative & Strategy, National Council for Behavioral Health

Passion and Sensitivity: The Cornerstones of Responding to Trauma in the LGBT Community

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Back in 1978 Chase Brexton Health Care was a small volunteer operation serving gay men affected by the just emerging AIDS epidemic. Now, it’s a Federally Qualified Health Center (FQHC) that provides integrated health care to all Baltimore’s underserved populations — services that include primary care, a pharmacy, OB-GYN, dental services and behavioral health and substance abuse programs.

But they haven’t forgotten their roots in the lesbian, gay, bisexual, transgender (LGBT) community and are passionate about responding to the special needs of this often-underserved population. Because trauma is so endemic among this population, the center’s participation in the National Council and Kaiser Permanente’s Trauma-Informed Primary Care Initiative is especially critical for their patients.

Despite great strides forward in some areas, LGBT people continue to be marginalized and endure a constant barrage of negative messages and threats of violence. Trauma manifests itself in addictions, self-harming behaviors, domestic violence, depression and anxiety. It is imperative that those of us working in health care don’t perpetuate the trauma inflicted on our patients who come to us for healing.

Trauma can begin early and have a long-term impact on the health and wellbeing of members of the LGBT community, according to Suzanne Linkroum, Chase Brexton’s site director of behavioral health. “Individuals who identify as LGBT deal with difficult and traumatic interpersonal issues like rejection from parents or bullying at their schools,” she explains. ”These early negative experiences, in combination with systemic homophobia, transphobia and classism perpetuated by communities and society at-large, can lead to internalization of these messages. When you add on another layer for individuals who have also experienced child abuse, you can see how this can lead to mistrust that can then translate into difficulties with personal relationships, self-care and engagement within health care.”

The damage isn’t just emotional. Chase Brexton strives to provide top-notch care for patients who are  HIV-positive and the physical toll of trauma on their health is evident. “If you look at the literature, there is a link between trauma and viral load such that individuals who are HIV-positive and have experienced trauma are more likely to have a higher viral load,” says Linkroum. “We want to be providing trauma-informed care to help alleviate that as much as we can. That’s something that we take to heart and are trying desperately to figure out how we can attenuate that.”

The critical nature of the problem is clear. The more difficult question is how can we best recognize and respond to this level of trauma. Are the “tried and true” responses enough? Are members of the LGBT community really that different from other clients? Do we need to rethink our whole approach?

According to Linkroum, the most powerful thing you can do is listen and be especially sensitive to non-verbal communication. The fact is that we all have some level of bias and need to be in touch with our own belief system and how it may affect our LGBT patients. Where did you sit in the room? Did you shake hands? Are you avoiding eye contact? Simple things that can make a world of difference.

And remember that every person is different. “It is very important to individualize treatment. Where is this individual in their own sexual identity development? What are their strengths? How do they view and identify their challenges, despite what you may identify as their challenge? It’s so important to be in tune with what the patient is saying, as this is the cornerstone of helping the individual trust you,” Linkroum says.

The National Council has already held two trauma-informed care trainings at Chase Brexton, as part of their participation in the initiative. Ultimately, all staff will train in trauma-informed care and meetings are already taking place to expand screening for trauma – probably to focus on domestic violence, which it is believed to occur at a higher rate in the LGBT community.

Ultimately, trauma-informed care will help Chase Brexton continue to fulfill their mission to provide compassionate, quality health care that honors diversity, inspires wellness and improves their communities.

The National Council, in partnership with and sponsored by Kaiser Permanente, selected 14 organizations, including Chase Brexton, to participate in the Trauma-Informed Primary Care Initiative as part of an ongoing effort to create a health care culture that recognizes and supports individuals dealing with the long-term impact of trauma. At the program’s halfway point, we reached out to some of the participants and are now sharing their stories.