LGBTQ youth talk about healthcare experiences

By Communities Count in collaboration with Public Health Insider

Photographer, Ned Ahrens

In a first-of-its-kind effort, King County hospitals reached out to lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth and young adults to learn about their experiences with healthcare. King County Hospitals for a Healthier Community, which is a collaborative of 11 hospitals and health systems, joined with Public Health – Seattle & King County to identify the greatest needs and assets of the communities they serve and develop plans to address those needs. More than 1 in 10 King County youth identifies as lesbian, gay, or bisexual.

A series of listening sessions with LGBTQ youth and young adults age 13-24 living throughout King County, plus interviews with advocates who work with LGBTQ youth, revealed consistent themes that were also supported by survey data. The themes at the heart of the just-released LGBTQ Community Spotlight include:

  1. Lack of control of their own health

For many LGBTQ youth, lack of family support affected mental health, self-esteem, and their ability to effectively navigate the healthcare system. Youth who had stable and nurturing relationships with their families and trusted adults felt safe and supported. Those without these trusting relationships had extreme difficulty getting their health and healthcare needs met. One youth said, “… this is my body, this is my mental health, this is me; I feel like I’m not in control over any of it.”

Many youth would like more opportunities to speak privately with their providers, without family present, and feel strongly that providers should take the lead in suggesting this option. A listening session participant offered a positive example: “One thing my [provider] does to make me feel safe is asking me about telling my mom. He’ll always give me the option, ‘Do you want your mom to come along?’ or if she’s there [he’ll ask] if she should leave. He always leaves it up to me.”

  1. With providers, a need for safety, trust, and information

Youth said they needed to feel safe and develop trusting relationships with their providers before they could comfortably talk with them about their physical, mental, and emotional health needs – all topics that are broader than just sexual health. According to one participant, “[My pediatrician]’s really supportive of everything. Before she asks questions, she says ‘do you feel comfortable if I ask this?’ and it’s really nice.”

Participants also stressed the importance of a safe and supportive clinical environment where inclusive language on intake forms and behaviors from staff and providers acknowledge the possibility of gender diversity

Youth also said they needed more information – about diverse aspects of human sexuality and healthy interpersonal relationships, as well as patient rights, confidentiality, and the kinds of services that can be accessed without parental consent.

  1. Kudos for school-based health centers

Middle and high school students with access to one of the 23 King County School Based Health Centers  greatly valued the services and the privacy they provided. This is one of many enthusiastic endorsements: “They’re not only treating what’s wrong with you internally – they care about you all the way.”

  1. Safety concerns across multiple settings

In addition to explaining their need for “non-judgmental safe spaces” for healthcare services, youth expressed strong concerns about safety in their responses on a statewide survey of 8th, 10th, and 12th graders. Compared to students who identified as heterosexual, those who identified as lesbian, gay, or bisexual were significantly more likely to report feeling unsafe at school and on dates; they were also more likely to report that they had been bullied and that an adult had intentionally hurt them.

These safety concerns were echoed by the finding that more than half of LGBTQ+ respondents to the 2018 Count-Us-In survey of King County’s homeless population reported a history of domestic abuse or partner abuse.

Acknowledging the universal challenges of transitioning from childhood to adulthood, the report highlights the considerable variation in the ways this plays out with LGBTQ youth.  Findings from the report can raise awareness among the parents, teachers, healthcare providers, and other trusted adults whose support is important to these youth as they navigate a vulnerable stage of development. Check out the full report to learn more about the findings and to read more from the participating youth and advocates.

For interpreted data about LGBTQ youth in King County, click the “demographics” and “custom demographics” tabs on the following Communities Count indicators:  teen binge drinking, teen obesity, teen overweight, teen physical activity,  teen cigarette smoking and tobacco use, teen depression, teen substance use, and teen marijuana use.   The same information, without interpretation, is presented on King County’s Community Health Indicators website.

Two King County cities designated Walk Friendly

Seattle and Bellevue are among 58 U.S. communities that have earned 2016 “Walk Friendly” status from the Pedestrian and Bicycle Information Center (PBIC).  According to PBIC, the Walk Friendly Community designation is awarded to applicant communities on the basis of “a comprehensive assessment tool that evaluates community walkability and pedestrian safety through questions related to engineering, education, encouragement, enforcement, evaluation and planning.”

 
SDOT photo showing reroute around work project that doesn’t force pedestrians to cross the street.

Seattle is the only Walk Friendly Community to reach Platinum-level recognition “due to top-notch planning and engineering, outstanding outreach and education, and strong enforcement and evaluation practices.”  Highlights noted by PBIC include:

  • Evaluation practices, including multiple pedestrian counts each year at almost 50 locations.
  • Web-based Pedestrian Master Plan with clear goals and performance indicators (for example, reaching out to 10 new schools each year).
  • Clear new directives for pedestrian mobility around work zones.
  • Installation of speed enforcement cameras at 14 schools.
  • Seattle Summer Parkways, free summer events that keep cars off several miles of city streets so people can walk, bike, dance, eat, and play in safety.
  • Adopting a complete streets ordinance that “directs SDOT to design streets for pedestrians, bicyclists, transit riders, and persons of all abilities, while promoting safe operation for all users, including freight.”
  • Reducing the speed of vehicles on city streets by: (a) installing thousands of traffic-calming devices and (b) starting in 2016, lowering speed limits on 10 arterial corridors, the central business district, and selected residential streets.
  • Managing parking by: (a) abolishing minimum parking standards in downtown and (b) providing parking-reduction incentives for large development projects.

Bellevue’s designation as a Silver-level community is based on its “excellent engineering practices, planning programs, and high mode share for transit and walking.”

For King County data on commuting by public transportation, walking or biking, see Community Health Indicators.  In its Transportation section, Communities Count posts data on commuting, neighborhood connections, and traffic safety (including traffic collisions and injury/fatalities in King County cities).

Is inequality a choice?

Yes, according to New York Times columnist Nicholas Kristof, who writes, “… while we broadly lament inequality, we treat it as some natural disaster imposed upon us. That’s absurd. The roots of inequality are complex and, to some extent, reflect global forces, but they also reflect our policy choices.” Kristof cites a recent report that 2014 Wall Street bonuses were about twice “the total annual earnings of all Americans working full time at the federal minimum wage” (see 3/23/2015 Communities Count blog).

For suggestions of ways to counter inequality, he turns to a new book, Inequality: What Can Be Done, by British economist Anthony Atkinson. Among Atkinson’s 15 steps to reduce inequality:
■ Government should be more concerned with monopolies and competition policy.
■ Trade unions should be bolstered to represent workers’ interests.
■ Government should provide public-sector jobs at minimum wage to those who want them, in areas such as meals-on-wheels, elderly care, child care and so on.•
■ In addition to a minimum wage, there should be a framework to restrain pay at the highest levels. Atkinson cites companies that have voluntarily decreed that executive pay should be capped at 65 or 75 times the average pay in the firm.
■ Personal income taxes should be made more progressive, with a maximum rate of 65 percent.
■ Every child should get a “child benefit” payment, to help keep kids out of poverty.

Finally, Kristof poses the following question about how Congress responds to inequality (more than one choice could be correct):

Congressional leadership is showing resolve to slash —
A) subsidies for private jets;
B) the carried interest tax loophole for billionaires;
C) food stamps;
D) the estate tax on couples with estates worth more than $10.9 million.

The answers: C and D — policies that “would hurt low-income children while offering a helping hand to billionaires.” Kristof asserts that “the problem isn’t inequality; the problem is us. We’re paralyzed.”

For examples of inequality in King County, see Communities Count data on health insurance, perceived safety, homicide by neighborhood poverty and race/ethnicity, and poverty trends.