Title: “Home Away from Home”
Description: LGBTQ+ youth suffer from a greater burden of adverse mental health outcomes, including higher rates of depression, substance use, and suicidal behavior, compared to the general population (Liu & Mustanski, 2012; Day et al., 2017; Scannapieco, Painter, & Blau, 2018). Community-based services, such as LGBTQ+ specific organizations, are integral to supporting the well-being of LGBTQ+ youth and are often viewed as the frontline for service provision and support for community members, providing client-centered and affirming services (Allen et al., 2012). However, access to these organizations is contingent on one’s proximity to and comfort in entering LGBTQ+ spaces, leaving the majority of care provision to general practitioners. Unlike LGBTQ+ organizations, general practitioners frequently do not meet the same standard of cultural awareness and competency, creating undue burden on LGBTQ+ clients navigating the healthcare system (Shelton & Delgado-Romero, 2013). While training exists on affirmative language and the application of minority stress theory, truly inclusive cultural competency requires more than awareness of terminology and extends to both organizational policy and practitioner behavior (Boroughs et al., 2015; O’Grady, 2017).

Thus, this study sought to identify aspects of affirmative care that extend beyond current practice guidelines through a qualitative evaluation of service provision (e.g. types of services offered, staff background, approach to service delivery, participant experiences) and the service environment (e.g. agency policies, geographic location, interior décor) at four LGBTQ+ youth-focused agencies located in two large urban centers in the Northeast. In-depth qualitative interviews and focus groups were conducted with both service providers (staff) and service recipients (youth) at each organization. A template analysis approach was used to analyze data whereby an existing (a priori) theory was used to guide and organize qualitative data (Brooks et al., 2014). The affirmative practice guidelines developed by Hadland, Yehia, and Makadon (2016) were used as an overarching template to organize data. A total of (n=30) youth and (n=12) staff participated in focus groups and interviews across four agencies.

Results from the study found that all aspects of Hadland et al. (2016)’s affirmative practice guidelines were present in both agency and staff practices, however, there were differences in how agencies described the systems-level principles and practitioner behaviors in their practices. At the organizational level, staff and youth emphasized the importance of organizations offering “queer centric” programming that responded to youths’ intersectional identities and providing youth with referrals to meet their diverse needs (e.g., referrals to primary care, mental health services). At the practitioner level, youth and staff emphasized the importance of using trans+ inclusive language, collaborating with youth around decision making, using a non-judgmental stance, providing space for youth to explore their identities, and having “just for fun” activities. In addition to the findings from the template analysis, several other concepts were found to be integral to affirmative care including the development of community guidelines.

From the qualitative findings, affirmative care practice recommendations were identified, and a case example is provided to describe how one agency might consider aspects of implementation theory to evaluate readiness for and implement such guidelines in their practice. Findings from this study will increase knowledge of best practices in affirmative care for LGBTQ+ youth. These findings may be disseminated across practice settings to improve cultural competency among general practitioners.