Volume 73, March 2024, 101425Author links open overlay panel, , Highlights•

Sexual and gender minority youth face substantial health disparities and often seek care in a pediatric emergency department for mental health crises.

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When met with negative healthcare experiences, sexual and gender minority youth avoid healthcare in the future due to anticipated discrimination, which worsens both preventative and emergency health outcomes.

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A pilot quality improvement initiative for staff training on sexual and gender minority culturally sensitive care was devised and implemented at a large, urban pediatric hospital in the Southeast U.S.

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Staff demonstrated a statistically significant increase in clinical preparedness in caring for sexual and gender minority youth in response to the low-cost, flexible learning intervention.

AbstractBackground

Despite evidence of the impact of provider implicit bias and overt discrimination experienced by sexual and gender minority youth (SGMY), evidence surrounding sexual and gender minority cultural sensitivity training for pediatric emergency health professionals is limited.

No targeted training existed to improve the clinical preparedness of healthcare professionals serving SGMY by increasing providers' knowledge and attitudinal awareness in a pediatric emergency department at a large, urban pediatric hospital in the Southeastern United States.

Methods

The Institute for Healthcare Improvement’s [15] Model for Improvement informed the project and was completed in four Plan-Do-Study-Act cycles. A cross-sectional, pre-test post-test design was used to gather demographic data, administer the LGBT-DOCSS questionnaire, and collect participant feedback on the training session. The LGBT-DOCSS results were analyzed using an independent samples t-test.

Interventions

Evidence-based pedagogical strategies were utilized for a 60-minute staff training session. Staff (n = 25) had six opportunities to attend one of the training sessions over a period of 4 months.

Results

Self-selection and voluntary participation contributed to recruiting participants who demonstrated high baseline LGBT-DOCSS scores, particularly on the subscales that measure knowledge and attitudinal awareness. After the sessions, participants showed an increase in LGBT-DOCSS scores with a statistically significant increase in the clinical preparedness subscale.

Conclusions

This project was the first at the institution to focus on culturally sensitive emergency care for sexual and gender minority youth. The content was well received by staff, who demonstrated increased clinical preparedness after the training. Implementing the training as a required component of new nurse orientation and onboarding is the next step in creating a safety culture for SGMY in the PED setting.

Section snippetsBackground & problem statement

Suicidal ideation among sexual and gender minority youth (SGMY) was three times that of their sexual and gender majority-identifying peers, and SGMY were significantly more likely to have made a suicide plan or attempted suicide in 2019 and 2020 [1], [2]. The mortality risk that exists for SGMY who seek care in psychological crisis and are met with a system that reflects the anti-sexual and gender minority culture that has contributed to the crisis, or who avoid seeking care because of expected

Context

This project employed the Institute for Healthcare Improvement’s (IHI) Model for Improvement. The IHI’s iterative model accelerates movement by asking, “What are we trying to accomplish?” “How will we know that a change is an improvement?” and “What change can we make that will result in an improvement?” Plan-Do-Study-Act (PDSA) cycles are used to test and adapt changes to reach desired improvements consistent with project aims [13].

The project was implemented by an interdisciplinary team of

Data analysis & results

A total of 25 health professionals attended the sessions. Of these, 25 completed the pre-program survey, including demographic data, while 22 completed the post-program survey. The post-program survey contained 19 course evaluation responses; three participants failed to complete this portion. Sessions ranged from three to nine participants.

Participants’ average age was 36 (SD = 10.69). All participants identified as cisgender, and most were female. Participants’ roles included physicians,

Discussion

Health professionals in a large, urban pediatric hospital demonstrated a statistically significant increase in clinical preparedness after completing a 60-minute educational intervention. These results align with the program’s aim of increasing awareness of these topics and better-equipping staff to provide culturally sensitive care to this marginalized population in the pediatric setting. The program’s findings are consistent with existing evidence that dedicated staff education can improve

Research Methods

Limitations of the research within this QI project surround threats to internal validity, including the potential for selection bias through the voluntary sample, response bias on the attitude subscale of the LGBT-DOCSS, and imprecision in the statistical analysis. A paired t-test would strengthen the evidence of the increase in LGBT-DOCSS scores [26].

Staff participation

Voluntary participation by various health professionals in the PED was encouraging; however, there was less-than-expected nursing attendance.

Conclusion

This quality improvement project implemented a low-cost, effective intervention to improve pediatric emergency nurses’ awareness of the specialized needs of SGMY and to equip them to provide culturally sensitive emergency care. Staff demonstrated increased combined knowledge, attitudes, and clinical preparedness to care for this vulnerable population, with the increase in clinical preparedness being statistically significant. Evidence-based pedagogical strategies facilitated meaningful

CRediT authorship contribution statement

Kaysi R. Goodall: Writing – review & editing, Writing – original draft, Project administration, Conceptualization. Elizabeth Morse: Writing – review & editing, Writing – original draft, Validation, Supervision. Carolyn M. Howard: Writing – review & editing, Writing – original draft.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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