4 - (SYM 89) De-implementation Strategies to End Sexual Orientation and Gender Identity Change Efforts: Undoing a Harmful Legacy of Behavior Therapy

Background: Sexual orientation and gender identity change efforts (SOGICE) — commonly known as “conversion therapies” — are harmful practices that seek to change an individual’s sexual orientation (lesbian, gay, bisexual, queer, etc.) and/or gender identity (transgender or nonbinary; collectively known as LGBTQ+) to heterosexual, cisgender behaviors and identities. SOGICE lack scientific evidence, misreport efficacy, and have significant methodological failings that inflict serious harms (increased depression, anxiety, and suicidality) and stigmatize the already vulnerable LGBTQ+ community. In the US, some states have banned SOGICE while others offer alternative methods of protection through local legislative efforts. Given cognitive-behavioral professionals’ (CBPs) commitment to developing and implementing only evidence-based treatments, they have an ethical duty to stand against SOGICE, especially in a sociopolitical climate that is increasingly hostile toward LGBTQ+ people globally.

Methods: De-implementation is a systematic process focused on stopping routine use of an adverse – as in SOGICE – or otherwise low-value practice. Conceptual frameworks and theories for guiding de-implementation have been repurposed from implementation science, which focuses on efforts to scale up and spread beneficial, evidence-based practices. We analyzed and applied four key de-implementation phases that can aid in eliminating SOGICE. These include: selecting scope of SOGICE de-implementation efforts, assessing multilevel contextual barriers and facilitators to tailor de-implementation strategies, deploying active strategies, and evaluating selected strategies.

Results: Various examples of tailored strategies that addressed key barriers and facilitators to achieve maximum de-implementation success rates at the individual, organizational, policy, and social levels are outlined. For example, at the individual level, CBPs can engage families of LGBTQ+ youth and community members to reduce demand for SOGICE. At the policy level, CBPs can also partner with state mental health professional associations to advocate for legislative bans at the policy level.

Conclusions: Although strategies needed to eliminate SOGICE are complex, long-term, and multilevel, CBPs can help de-implement this practice. Through concentrated and coordinated efforts, we can address ethical injustice, repair historical harms, and enable healing by ensuring that affirmative care is available for every LGBTQ+ person who seeks it.