Symposium 89 - Next steps for LGBTQ-Affirmative Care: Implementation and De-Implementation Efforts Toward Mental Health Equity for LGBTQ Clients

Chair(s)

• ZS

  Zachary Soulliard, Ph.D. (he/him/his)

  Assistant Professor
  Miami University
  Oxford, Ohio
• AH

  Audrey Harkness, PhD (she/her/hers)

  Assistant Professor
  University of Miami
  Coral Gables, Florida

Discussant(s)

• AD

  Alex Dopp, Ph.D. (he/him/his)

  Behavioral/Social Scientist
  RAND Corporation
  Santa Monica, California

Presenter(s)

• RS

  Rajinder Sonia Singh, Ph.D.

  Assistant Professor
  University of Arkansas for Medical Sciences
  North Little Rock, Arkansas
• ZS

  Zachary Soulliard, Ph.D. (he/him/his)

  Assistant Professor
  Miami University
  Oxford, Ohio
• AH

  Audrey Harkness, PhD (she/her/hers)

  Assistant Professor
  University of Miami
  Coral Gables, Florida
• BB

  Bharat Bharat, M.A. (he/him/his)

  Predoctoral Psychology Trainee
  University of Miami
  Coral Gables, Florida

Sexual and gender minority (SGM) individuals experience mental health disparities compared to their heterosexual and cisgender peers (e.g., King et al., 2008). Yet, for years, evidence-based interventions tailored to SGM clients did not exist (Pachankis, 2018). Some so called “treatments” were actively harmful to SGM clients (e.g., sexual orientation and gender identity change efforts; Haldeman, 2022). Recently, health care systems, including the Veterans Health Administration, have enacted policies related to LGBTQ-affirmative mental health treatment (Kauth & Shipherd, 2016), and researchers have developed evidence-based LGBTQ-affirmative interventions (e.g., Pachankis et al., 2022). To achieve equity, it is essential that affirming policies and practices reach SGM clients and are adopted and implemented. Meanwhile, harmful treatments must be de-implemented to eradicate harms.
Studying implementation of affirming evidence-based mental health interventions is critical for expediting translation of evidence to practice, and therefore addressing urgent mental health needs among SGM communities (Perry & Elwy, 2021). Implementation research can equip mental health clinicians with the resources and tools to implement identity-affirming treatments and de-implement harmful actions toward SGM clients. This symposium features current research on implementing LGBTQ-affirmative policies and practices, as well as strategies to de-implement sexual orientation and gender identity change efforts.
First, Dr. Singh will present determinants to implementing LGBTQ+ affirming policies in the VA system from provider and LGBTQ+ veteran perspectives. Findings underscore the need for multilevel collaborations to optimize affirming policy implementation. Dr. Soulliard will then present on determinants to implementing LGBTQ-affirmative CBT. LGBTQ+ community center providers identified implementation barriers (e.g., lack of content specifically for LGBTQ+ clients of color), but also deemed the intervention adaptable for diverse LGBTQ+ communities. Dr. Harkness will then describe implementation strategies considered essential for implementing LGBTQ-affirmative CBT across five clinical trials for different populations and contexts. These findings underscore the need for a package of core implementation strategies for implementing LGBTQ-affirmative CBT, and tailored strategies when implementing in specific contexts or populations. Finally, Bharat will describe the need to de-implement falsely claimed “treatments” (i.e., sexual orientation and gender identity change efforts) that actively harm LGBTQ+ people. This presentation will underscore the critical role of cognitive-behavioral professionals in de-implementation strategies to achieve this important goal.
Dr. Dopp, a clinical psychologist with implementation science expertise, will integrate themes across presentations. Aligned with the theme of cultivating joy with CBT, Dr. Dopp will discuss ways each presentation’s findings can be used optimize health and resilience, rather than just prevent disparities. Dr. Dopp’s remarks will also identify ways CBT professionals can participate in implementing LGBTQ-affirmative mental health care.

Presentations:

• (SYM 89) Moving from LGBTQ+ Affirming Policies to Healthcare Practice in the Veterans Health Administration: Preliminary Findings in the Southern United States
  

  Speaker: Rajinder Sonia Singh, Ph.D. – University of Arkansas for Medical Sciences

  Co-author: Sara J. Landes, Ph.D. (she/her/hers) – Central Arkansas Veterans Healthcare System

  Co-author: Traci Abraham, PhD (she/her/hers) – Clinical Outcomes Assessments, Clinical Outcome Solutions

  Co-author: Pamela McFrederick, DHA, MSHSA, MSW, LCSW (she/her/hers) – South Central VA Healthcare Network (VISN 16)

  Co-author: Michael Kauth, PhD (he/him/his) – LGBTQ+ Health Program (12POP3), Office of Patient Care Services, Veterans Health Administration, Department of Veterans Affairs

  Co-author: Jillian Shipherd, PhD – VA Central Office

  Co-author: JoAnn Kirchner, MD (she/her/hers) – Behavioral Health QUERI, Central Arkansas Veterans Healthcare System
• (SYM 89) Mental Health Providers' Experiences Implementing Lgbtq-affirmative CBT One Year After Training
  

  Speaker: Zachary Soulliard, Ph.D. (he/him/his) – Miami University

  Co-author: Eric Layland, PhD – University of Delaware

  Co-author: Nick Hatch, B.S. – Yale School of Public Health

  Co-author: Ellie Pickering, B.A. – Yale School of Public Health

  Co-author: Benjamin Eisenstadt, B.A. – Yale School of Public Health

  Co-author: Danielle Chiaramonte, PhD – Yale School of Public Health

  Co-author: Kriti Behari, MA – Syracuse University

  Co-Author: McKenna Freeman, B.A. – Miami University

  Co-Author: Shruti S. S. Kinkel-Ram, M.A. (she/her/hers) – Miami University

  Co-author: Audrey Harkness, PhD (she/her/hers) – University of Miami

  Co-author: John Pachankis, Ph.D. – Yale School of Public Health
• (SYM 89) Prioritizing Implementation Strategies for Lgbtq-affirmative CBT: Findings from Five Clinic Trials
  

  Speaker: Audrey Harkness, PhD (she/her/hers) – University of Miami

  Co-author: Steven A. Safren, ABPP, Ph.D. (he/him/his) – University of Miami

  Co-author: Bharat Bharat, M.A. (he/him/his) – University of Miami

  Co-author: Zachary Soulliard, Ph.D. (he/him/his) – Miami University

  Co-author: Eric Layland, PhD – University of Delaware

  Co-author: John Pachankis, Ph.D. – Yale School of Public Health

  Co-author: Brooke G. Rogers, M.P.H., Ph.D. – Alpert Medical School of Brown University

  Co-author: Kriti Behari, MA – Syracuse University
• (SYM 89) De-implementation Strategies to End Sexual Orientation and Gender Identity Change Efforts: Undoing a Harmful Legacy of Behavior Therapy
  

  Speaker: Bharat Bharat, M.A. (he/him/his) – University of Miami

  Co-author: Alex Dopp, Ph.D. (he/him/his) – RAND Corporation

  Co-author: Briana S. S. Last, Ph.D. (they/them/theirs) – Stony Brook University

  Co-author: Gary Howell, Psy.D. (he/him/his) – Florida School of Professional Psychology and Center for Psychological Growth

  Co-author: Erum Nadeem, Ph.D. – Rutgers University

  Co-author: Clara M. Johnson, M.S. – University of Washington, Seattle

  Co-author: Shannon Wiltsey Stirman, PhD – National Center for PTSD and Stanford University