| dc.description.abstract | Background:
The Twenty-Ten Association Incorporated (Twenty-ten) is a New South Wales (NSW)-based not-for-profit organisation. This service provides housing, case management, psychosocial support, counselling, mental health, health, family and domestic violence and legal services for young people (aged 12-25 years) of diverse genders and sexualities, and those born with innate variations of sex characteristics, for their families and communities who support them. Lesbian, Gay, Bisexual, Transgender, Intersex, Queer/Questioning, Asexual, and other diverse gender and sexual identities (LGBTIQA+) young people can experience significant stigma and discrimination, leading to higher rates of mental health conditions compared to their heterosexual, cisgender and endosex peers. Healthcare systems that are cisgender-heteronormative and that privilege endosex individuals often exclude LGBTIQA+ young people. As a result, these young people may disengage from healthcare systems, resulting in poorer health and wellbeing. Some may turn to social media and online communities to help address their healthcare concerns.
Effective and culturally safe LGBTIQA+ healthcare requires incorporating lived experiences of stakeholders, understanding health disparities, and practising respectful communication. Mental health professionals too often lack confidence and skills in providing affirming and culturally safe care to LGBTIQA+ clients. Connection to the community and access to culturally safe healthcare are critical protective factors for these young people. LGBTIQA+ affirming practice training is essential for reducing discrimination and improving care. Studies show that while healthcare professionals benefit from LGBTIQA+ training, there is limited access to such programs, and evidence weighing the effectiveness of that training is scarce. Improving culturally safe care and inclusivity through targeted training can significantly enhance the mental health and wellbeing of LGBTIQA+ young people.
Aim and objectives:
The overall aim was to evaluate the knowledge of mental health professionals about culturally safe healthcare for LGBTIQA+ young people pre- and post- the Safe and Affirmed program, presented through professional development workshops. Our objectives were to evaluate the program to determine if participants have (1) gained knowledge and skills to enhance clinical practices supporting LGBTIQA+ young people in managing family, carer, school, and social relationships, (2) improved system responsiveness and care experiences for LGBTIQA+ young people in mental health care settings, and (3) applied their learnings to clinical practice, advocacy, and affirmative care for LGBTIQA+ young people.
Methods:
A pre- and post-evaluation was conducted to assess the Safe and Affirmed LGBTIQA+ program for mental health professionals in NSW. The evaluation included pre- and post-surveys administered on the same day as the professional development workshop, and a follow-up survey conducted three to six months later. A sub-sample of consenting participants were invited to take part in semi-structured interviews, which were conducted online three- to six-months post-training.
The professional development, provided by Twenty-ten, comprised face-to-face and online education sessions and was implemented across all NSW government and several private health services (i.e., not-for-profit organisations and private healthcare organisations). This program was designed to primarily support Child and Adolescent Mental Health Services (CAMHS). Eligible participants were mental health professionals (e.g., medical practitioners, nurses, social workers, occupational therapists, and peer workers) working in youth mental health services in NSW who completed the training. Recruitment strategies included engaging CAMHS services and disseminating flyers to potential participants.
Quantitative data were analysed using paired t-tests to assess average changes in pre- and post-training survey scores. Descriptive statistics summarised demographic and professional characteristics, and the study was designed to detect score changes with statistical significance (p<0.05). All interviews were audio-recorded with participant consent and transcribed verbatim to ensure accuracy. Transcripts were then analysed thematically using both inductive and deductive approaches. This involved a systematic coding process to identify, analyse, and interpret key patterns and themes, drawing on both data-driven insights and pre-identified areas of interest related to the training objectives.
Key findings:
Three hundred and thirty-four (n=334) participants completed the pre-evaluation survey, and 271 completed the post-evaluation survey; thus, 18.9% (n=63) were lost to follow-up. Participants completing the post-evaluation survey were predominantly social workers (25.4%, n=66), psychologists (23.1%, n=60) and registered nurses (18.5%, n=48). Most participants practised in regional or rural locations (n=171, 65.8%), compared to metropolitan (30%, n=78) or remote (3.5%, n=9) locations. An insufficient number of participants completed the three- to six-month follow-up survey; therefore, this data could not be included in the analysis.
The pre- and post-evaluation surveys highlight the significant improvements in participants' knowledge and confidence following their completion of the professional development. Participants reported significantly improved confidence in their knowledge and skills to provide gender affirming approaches for children, adolescents, and young people. Further, there was a marked improvement in participants' confidence in providing culturally safe mental health care to gender and sexuality diverse young people and those with innate variations of sex characteristics.
Participants indicated an increased understanding of the co-occurrence of gender diversity with diagnoses such as eating disorders and neurodivergence. They also reported a better understanding of the co-occurrence of sexuality diversity with conditions like anxiety, depression, and post-traumatic stress disorder (PTSD). Participants demonstrated a significant improvement in their confidence in supporting and advocating for young people with an innate variation of sex characteristics. Pre-training 36.7% (n=95/260) of participants could name three unique needs of LGBTIQA+ young people when accessing mental health care services, compared to 94.2% (n=244/259) post-training. The ability to identify three barriers to accessing safe and equitable mental health care for LGBTQIA+ young people increased from 53.1% (n=138/260) pre-training to 97.7% (n=254/260) post-training. Awareness of the NSW LGBTIQ+ Health Strategy increased from 30.8% (n=80/260) pre-training to 96.5% (n=251/260) post-training. Awareness of the NSW Specialist Trans and Gender Diverse Health Service for young people under 25 increased from 48.1% (n=125/260) pre-training to 95.4% (n=248/260) post-training.
Fifteen participants were interviewed three to six months after attending the workshop. Most identified as cisgender female (n=12, 80%), followed by cisgender male (n=2, 13.3%) and trans woman (n=1, 6.7%). Eleven participants identified as heterosexual (73.3%), three as gay or lesbian (20%), and one as bisexual (6.7%). The majority were working in regional or rural settings (n=10, 67.7%), with the remainder based in city or urban areas (n=5, 33.3%).
Interviews underscored the importance of inclusive documentation in creating affirming healthcare environments for LGBTIQA+ young people. Participants highlighted small changes, such as including chosen names and pronouns on forms, that can significantly affirm identities and influence broader team culture. However, structural barriers, such as electronic medical records with binary gender options, were noted. In response, staff employed local solutions and emphasised the importance of team communication, training, and leadership. While the Safe and Affirmed professional development promoted inclusive values and critical reflection, participants emphasised the need for systemic reform, noting that lasting change requires a whole-of-setting approach that extends beyond individual efforts.
Conclusion:
These findings underscore the effectiveness of the Safe and Affirmed program in enhancing the participants' capabilities to support and provide culturally safe care for LGBTIQA+ young people. Continued investment in targeted and tailored professional development for mental health professionals providing care to LGBTIQA+ young people is required to build the knowledge and capacity of the health workforce. Quality training with a face-to-face component delivered by experts with lived experience enhanced the learning experience. Regional and rural health professionals must be included in quality face-to-face LGBTIQA+ culturally safe training opportunities. | en |
