PIRE is conducting a community-engaged implementation science study to support New Mexico school-based health centers (SBHCs) in implementing and scaling up practices that will enhance their care, services, and supports for student patients that identify as lesbian, gay, bisexual, transgender, queer or questioning, and other diverse sexual orientations and gender identities (LGBTQ+).
SBHCs are at the frontlines of healthcare delivery and prevention services for young patients across the United States. SBHCs provide vital services to school-aged youth, including behavioral and sexual and reproductive healthcare, often regardless of patients’ insurance status or ability to pay. Young LGBTQ+ patients are far more likely to suffer from adverse health outcomes than their cisgender and heterosexual peers. Structural or societal-based factors (e.g., stigma, discrimination, low awareness of and insensitivity toward their health needs) contribute to greater unmet needs and poorer quality of care for LGBTQ+ youth. Structural competency addresses the upstream factors (social determinants of health, inadequate and fragmented treatment, inequities in care) that affect LGBTQ+ students.
Enhancing structural competency within SBHCs will improve the care received by LGBTQ+ students and, therefore, their health. Nationally recognized recommendations for nurturing structural competency include (1) adoption, dissemination, and enforcement of LGBTQ+ supportive policies and procedures; (2) creation of welcoming physical environments for LGBTQ+ patients; (3) systematic documentation and use of sexual orientation and gender identity (SOGI) information to inform and improve clinical services; (4) ongoing training for all employees in best practices for interacting with LGBTQ+ patients; and (5) clinical workforce development to encourage delivery of high-quality services to LGBTQ+ patients.
We are enrolling 24 SBHCs in this stepped-wedge trial to examine how implementation processes informed by the Dynamic Adaptation Process impacts the adoption and effect of structurally competent changes on SBHC, patient, and implementation outcomes.
As part of supporting and examining SBHCs’ implementations we will conduct mixed-method readiness assessments to determine the role of key inner- and outer-context determinants, bridging factors, and associated mediators and moderators influencing implementation processes and enhanced outcomes for LGBTQ+ students. These outcomes include reduced barriers to care and greater satisfaction and engagement in care. This study represents a key steppingstone to achieving our long-term goal of high-quality care and reduced physical and behavioral health disparities for LGBTQ+ youth.
SBHCs interested in participating should contact Daniel Shattuck, PhD, at dshattuck@pire.org or 505-765-2331.
