My name is Nevaeh Anderson, so thank you all once again for coming. My name is Nevaeh Anderson. I specialize in simplifying complexities around race, gender, and sexuality through my consulting agency, simply the LLC, as well as with the OPR response network. So what we're learning today is we're going to learn how to implement what we learned in the first session in a clinical setting. So before we move forward, right, let's go over what we briefly learned. So in our last session, we covered the difference between sexual orientation and gender identity. We covered historical resilience and wins, as well as why it's relevant in today's work. We covered stigma and discrimination, and we also came up with solution-oriented ideas to make sure that our organization, or your organization, I should say, is an equitable organization for sexual and gender-diverse individuals. Next slide, please. So today we're going to explore the following. We're going to explore creating a safe space, affirming patients and client files. We're going to learn, affirm clinical settings, and separating core issues from personal biases. So this session, once again, is going to be a session where participation is encouraged. I know you've heard it a couple of times, but let me reiterate that. So as far as me, right, I'm bringing my experiences as a case manager and as someone who's worked in sexual health clinics. It's imperative that you all make the effort to participate for several reasons, right? Although I'm a subject matter expert when it comes to sexually and gender-diverse individuals and issues, as well as DEI issues, you all have been working clinically for years. So whether you're a behavioral health therapist, whether you're an intake specialist, whether you're a doctor or a doctor in training, whatever that practice looks like for you, or a substance use prevention specialist, there are years of experience in this room when it comes to working in clinical spaces. So long story short, this is the best way where we can all learn from each other. We can get some tips and tricks from each other. You might even teach me how to do my job better as a case manager, but not too much. But we can definitely all learn from each other. One of the things that I've learned from doing these trainings and presentations and workshops is that you learn more when you learn from each other and when we engage. So please keep that in mind. Next slide, please. So speaking of participation, here goes our first question. In your own words, what does a safe space look like? What do you think, guys? Safe space. You shout it out, I'll repeat it. Nonjudgmental. What else do we have? Nonjudgmental. Someone can be themselves. Someone can be themselves. Oh, yeah, these are good. Oh, one more, Emily. No retaliation. A space for someone who isn't afraid to come out and talk about anything they want to. Trust. I tried to give him the mic. He said no. Would you say a conducive atmosphere based on trust? Okay, he said that, yeah. Okay, so those are really good. Oops, and we look like we got some in the chat. So I'll read a couple and then we'll move forward. So one person says that I'm in the arms of my kid. So yeah, I guess that is a safe space personally, right? Another person says that you all do have a rainbow sign that says all is welcome here. That's definitely good, and we're definitely going to cover that throughout this training, but that's definitely good to know. Trust and acceptance, absolutely. And then one kind of said everyone is unbiased, nonjudgmental, full of love and trust. And another one states that they recognize differences openly. So these are all good examples, and thank you so much for that, y'all. Next slide, please. So in your own words, what does accountability look like? What do you think, guys? Accountability. Responsible. Doing what you say you're going to do. I like that. Dependable. Yes. Being humble if you make a mistake. Character default. So yeah, so when we say being humble, it just means owning up to your mistakes and rectifying it, right? Not to put words in anybody's mouth, but that's kind of what I gathered from it. So thank you for that. Yeah, and we had a couple of folks in the chat, too, that said actions and belief lining up and people being responsible for their own actions and dependable. Oh, this is perfect. So we're very familiar with accountability is. This is excellent. Next slide, please. So this one is a very important question because every organization, every company has a mission statement, right? So how can our views align with the mission statement of the organization? Or more so, how can your views align with the mission statement of the organization? I'm sure everyone is wondering what exactly our mission statement is. That was going to be the next question. I know, Carol Ann. Oh, you do? Go for it. I was going to. To provide the highest quality health care to those seeking alcohol and drug treatment services and to support ongoing recovery efforts. That is verbatim. Nice job. That's what I do. Thank you very much. I'll be here all week. So do no harm. That could be part of the mission statement. So you are just. Sorry. Well, I would say that our personal views don't necessarily have to align with the mission statement of the organization, but I think that we need to be able to have a certain level of ethical duty to then once we come into the workplace to then align our views with the organization. Did you guys catch that? Yeah. Beautiful. OK, these are all really good. So let's go ahead and go to the next slide. So, again, thank you all for participating, and I hope we can keep this energy throughout. We have an hour together. So let's make this go by smoothly. Yeah. So here's a few tips that can kind of make the process smoother within your clinical setting, right, especially when it comes to gender and sexual diverse individuals. So the first thing you want to do is ask for the client's new name, then take ID if required, right? Make sure that you document and that you know if the client's name, if their name is different from their legal name. Always or at least try to make it a practice to introduce yourself by using your name and your pronouns. Try to make a routine for every client. You want to try to normalize this as much as possible. That way it doesn't seem like you're singling anybody out. If you are corrected, don't ignore what the client is saying and don't make a big deal. Simply apologize and move forward with the correct names and pronouns if you need one. Make sure your forms are up to date as often as possible. So this should include assigned sex at birth, current gender identity, pronouns, and legal slash current name. And if possible, make sure you can look up preferred or current names in your system database. With that being said, though, I'm going to say a little thing about preferred names. I know that that is a clinical term that we have to use in, like, you know, any medical setting or any treatment setting, even in sexual health. I would just prefer, you know, name and legal name. And the reason why I don't like preferred name and there's been kind of arguments from, you know, other gender diverse individuals around preferred name is that preferred names make it seem like it's a preference. Like, okay, I don't have to call you by your name if I don't want to because your legal name says X, Y, and Z. I just want to reiterate that you have to. As long as you're dealing with transgender diverse individuals or sexual diverse individuals who have a different name or who go by a different name than their legal name, you have to address the message. That's not a debate. So please keep that in mind. And I say these things more so for your protection and just to ensure that, you know, you all are following the alignment of your mission statement. We'll go into that a little bit later, but, you know. Next slide, please. So here are some things that I have learned about, you know, case notes, right? A, I always say document current and legal name if they're different. If pronouns is something that you're having an issue with, document your pronouns as well as practice utilizing those pronouns. And you can always use someone's first name as their pronoun, as we discussed in the last training. And then highlight topics as needed regarding gender and sexuality. Make sure you document the relevance of these type of conversations, right? So one example that I'll always say is, like, if someone is noticing that their life is difficult because of discrimination that they experience as a trans person, right, that does not mean in your case notes you write down person is experiencing difficulties because they're transgender, because that simply isn't true. You can make a simple note where it says, you know, person did express gender identity has caused them a significant amount of discrimination, which resulted in several mental health issues as well as substance use issues. Something in my sales lines, don't quote me verbatimly, but you know, you can always stick with that format, right? Because you want to tell the whole story, and that's what case notes are. Include a standard of care as well as a follow-up schedule. Make sure you go over the standard of care with your client or your participant. After all, once again, they are the expert of their own lives, so they know what they need best. And most importantly, document all resources and collaborative efforts provided to the client. We all know being in this field, you have to leave a paper trail. Next slide, please. So this one is important, especially when you're dealing with sexual and gender diverse individuals. You must stay on topic. We must remember that problems do not come from someone solely because of their sexual or gender identity. There could possibly be a lingering amount of issues that weren't noticed because of the assumption that someone's sexual or gender identity is the root cause of their issues, right? So the reality of the situation is there could be some things that are deeper. So trauma, mental illness, navigating a cisgender, heterosexual, and may I dare say white society, even accepting the fact that sexuality and gender identity is independent from the root cause of someone's disparities. So it's important that you listen to the client and you understand where they're coming from, and you try to brainstorm solution-oriented ideas. If the issue is a sexuality or gender-related issue, unless you're a subject matter expert, it is ideal that you have an expert assist you. So this training would be one, but if you know of local LGBTQ organizations and you have a representative or a liaison or a case manager, you can always seek out their expertise. One thing that I can say in clinical settings or non-profit settings, especially around sexual health, we love collaborating, right? This is how we ensure that we get the clients the care that they need, as well as ensure that we're trauma-informed and that we're being equitable with our approach. At the end of the day, it's about the client's sobriety. And with that being said, we're going to watch a brief video of what not to do. So next slide, please. And action when you're ready. All right, I believe I have sound and everything shared, so we should be good to go. One moment, please. Okay. Hello, d***. Oh, that's my legal name, but I actually go by L. Oh, well, I don't see that on my chart. Well, I wrote it on the form right up top. Oh, there it is. Yeah. Okay, Mr. d***, what are we in for today? I've just had a sore throat for the last couple of weeks. Well, we don't want that. Yeah, no. No, I see it says here that you are currently on estrogen. Is that correct? Well, have you ever thought that might be the cause of your issue? No. No, I'm pretty positive that my estrogen has absolutely nothing to do with my throat. And why are you on this medication, may I ask? On estrogen? Well, I am a trans person. Oh, okay. Well, that's interesting. Now, which way are you? Well, my medical history should be all on your chart. Oh, there it is. You're a man. Okay. Let me just take a few notes here. Mm-hmm. Do you take poppers? No, I do not. Okay, okay. Have you ever been to Thailand? No, I haven't. Oh, well, you just need to go. They have a lot of you over there. Well, I will keep that in mind. So here's the deal. Okay. I don't really feel comfortable treating you today because I don't have much experience with your kind. Okay. Then I'll just go. But I did notice from your last labs that your testosterone levels are really suppressed. So I recommend you start taking weekly T-shots immediately. I can send over a prescription today. Are you kidding me? Are you kidding me? I'd like to leave now. Okay, Mr. Whatever you need. Okay. Gosh, he is a moody. Must be all that estrogen. Okay. So although the video might be funny, I cannot tell you how often this has happened. This has happened to me several times before, right? And as a result of that, many sexual and gender diverse individuals forgo medical intervention and treatment, regardless of what kind of medical intervention or treatment it is. In some states, this could lead to a lawsuit, right? So even if you don't understand someone's gender or sexuality, remember that they are human and we all have the same organs. Next slide, please. Okay. So in your own words, can someone explain what HIPAA is, please? Thoughts on HIPAA? Y'all get emails all the time. Yeah, like if someone asked you to explain HIPAA, how would you explain it? Go ahead, Sarah. Hospital administration, privacy with records and, I mean, everything from the time you walk in the office, how your documents are stored, people calling, confidentiality. Yeah. Excellent. So we're all very HIPAA compliant, it sounds like, right? So thank you for that. So again, just to reiterate, HIPAA is a federal health insurance portability and accountability act of 1996, and their primary goal of the law is to make it easier for people to keep health insurance, protect confidentiality and the security of healthcare information, and help the healthcare industry control administrative costs, right? In short, this protects the client and their personal information. Although we're familiar with HIPAA, right? We're familiar with the policies, the procedures, the laws, the regulations. It's important to remember that disclosing someone's gender identity and sexual orientation is also a HIPAA violation if they're not open about their sexuality or their gender identity, right? So in short, outing someone is a HIPAA violation. I only say this because I've been in this field for over 13 years, well, 15 years, right? And I've been doing the EI work for about six, seven years. And there have been a few instances where there was either somebody, a trans woman who wasn't out, or a gay man who wasn't out, or somebody who didn't want people to know about their business as far as their gender and their sexuality went. And most of the clinicians or the case managers would openly discuss this person's information. Openly discuss this person's business to the point where one person found out about somebody's whatever. And before you know it, I'm having a conversation with them and they're bawling their eyes out because everybody knows that they're trans and they've been treated differently ever since. Or you know, sexuality or even HIV status. So when we talk about secrecy, please remember, or not secrecy but privacy, please remember that gender identity and sexual orientation is included in that. And unless that client or the member leads with the fact that they're open with their sexuality or open with their gender, you probably shouldn't even say anything, right? Even when it comes to note-taking, because everyone has ROIs or release of information, that should be the last thing that you address. That should be the last resort thing. When you are having these casings or these case staffings, addressing someone's gender or addressing someone's sexuality should not be at the front and center topic of discussion, unless it's absolutely relevant. And even then, documentation is everything because you don't want this to come back on you. So next slide, please. So this is why I wanted to push on participation and you all have been doing so wonderful. Today we're going to be doing case studies, right? I also have pictures of celebrities. The only reason why I have pictures of celebrities is that way we can get a visual representation of the clients and the clientele that we're dealing with. For full disclosure, not every client that identifies with these certain demographics are going to look or reflect like this, but we do need some familiarity. So you're going to see a couple of celebrities on here, right? But just letting you know that this is all practice. So first and foremost, I want you to meet Tasha. Tasha is a Black woman of transgender experience. She's been struggling with substance use as well as survival sex work as a way to make income. Her drug of choice is cocaine and meth, and she's been actively using for about a few years. Tasha has made up her mind that she wants to live a life of sobriety and inpatient treatment would be the best option for her. However, she reports that she's experienced discrimination from several agencies before she came to you. She has been misgendered, and she was informed that she had to be housed with men because of her assigned sex at birth. She was even told that her transition is the reason she is using. It is also important to note that the facilities Tasha has reached out to would require payment, and Tasha doesn't have much money to cover those expenses. Tasha wants to live a sober life and be her authentic self, but is finding that it's getting more difficult to accomplish her goal to the point where she is experiencing depression. To her, maybe the headache isn't even worth the sobriety. So with that being said, what are some services you can offer? What are some barriers that she noticed, and how can you help her overcome these challenges to ensure she starts her road to sobriety? So I'm going to give you all like two or three minutes to, you know, strategize or brainstorm a few ideas. If you like to work together, you're more than welcome to do that. And let's say around 12.16, which is two minutes, we come back and we briefly discuss how will we take on Tasha's case. So let's go. Break. All right, so time is up. Let's go ahead and let's see what everyone has came up with. I know there's been a couple that was in the chat. So one stated that I would see if I can help her get state insurance by community care behavioral health, that insurance covers everything and it's for people with low to no income. So you already have your resources ready, it sounds like, Jody, that's excellent. Always have your resources ready. So I'm glad that you know, that was the first thing you thought of. Do you want the mic? I'm already naturally loud. Okay. Nicole, John and I were talking about how we would establish rapport and make sure that the resources available were talked about and discussed. Also we wanted to point out that we would treat her pretty much like any other patient client in that we would offer her support and services like anyone else, recognizing that her case is special and being understanding of what, you know, unique details of her life might entail and being sensitive to that. Yeah, absolutely. And which is excellent, right? You know, ensuring that she gets the same quality treatment, which is, you know, that's extremely important. And then also like with resources, the fact that, you know, you all will have resources available for her, you know, like the resources, that's amazing as well. Keep in mind though, when it does come to resources, especially with vulnerable populations, especially as they intersect, I remember we spoke about intersectionality the last time. Just keep in mind that there might be some research that you might have to do. As a case manager, I can go on and on about how much research I've had to do with certain clients and certain individuals just to ensure that we're sending them to the right spot. And that is a perfect fit for them, right? So there was another one that said, you know, start with the basic information gathering, ask what they feel are their most needed services, then start exploring options, treat them like any other case to build the services. Okay, so that's a recurring theme. And I'm glad that, you know, you all are there with, you know, treating folks the same and ensuring that, you know, they get equal treatment, right? But one of Tasha's needs or one of Tasha's requests is to seek inpatient treatment. So somebody already, you know, brought up insurance before, but how do we assure that we're sending Tasha into an affirming space? Or if you all, you know, I'm pretty sure, I think that you all have a recovery house. If Tasha stated that, you know, she wanted to stay, you know, because inpatient treatment was the best option for her and beginning her journey to sobriety, how can you ensure that Tasha gets proper treatment? How do you ensure that Tasha is affirmed? And how do you make sure that Tasha isn't triggered, you know, by any implicit biases or any overt or microaggressive transphobia? Does anybody have a response to that? For inpatient? Oh, yeah. I think definitely, like, as things come up, actually dealing with it appropriately and giving her a safe space to share throughout her stay. But I also think coming into play would be, like, aligning her with services that would be beneficial for her. She did have housing situations previously, you want to make sure that she's comfortable. And I know we have services available in Cleveland that would be beneficial for her to also have the case management and additional help, you know, and, you know, like, so there's a continuation of services throughout the whole thing, not just, you know, and also we do here. We house, if she's gender affirming female, we house with the female population. So we would support her in those endeavors and make sure that we're dealing with anything as it came up. And like, we have an LGBTQ plus group on the weekends that's really good and creates a safe space for people in allies, a community identifying in allies, you know, which also is a really good program for her. Okay, excellent. Excellent. And that's a tremendous start. So thank you for speaking up on that. As these things come along, you know, those are definitely things to consider. I also think that, you know, ensuring that there's a equality versus equity practice or thought process, I want to ensure that, you know, situations like with Tasha, more than likely she'll be successful, right? You know, you want to make sure that she gets like the same, you know, you want to make sure that you're treating her with respect, just like you would with anybody else. But you want to make sure that she's getting services that are tailor made to her because her background is so disparate, right? I shouldn't say so disparate, but she does come from a disparate background. So she is going to need certain accommodations and they're not special, right? It's just to make sure that she has the same footing as everyone else. So, you know, just something to think about, but everyone is definitely on the right path. And I thank you all for, you know, participating in this case study. We have two more to go though. So next slide, please. Okay. So this is, there are some ways that you can create a safe space clinically, right? First off, staff training and interaction. So it can look like something, you know, like this, right? You know, you're making sure that you're creating a safe space. It's okay to have multiple trainings. It's okay to get the research on your own. It's okay to ensure that you're holding each other accountable the same way that you would hold yourselves accountable. All of that is ensuring that, you know, there is a common message and a common camaraderie that everyone is open regardless of religion, race, background, gender identity and expression, biological sex, and sexuality, you know? Posters and ringing materials reflecting LGBTQ patients. This is very important. We talk about, you know, representation, seeing ourselves on something. Staff and leadership representation. I don't feel like it's that much of a hot topic, but the staff should look like the clientele one way or another, and they shouldn't all be in frontline or entry-level positions. It's okay to have a queer person in a leadership role. It's okay to have a trans person in the leadership role. If you're going to have a trans person over a trans program, make sure that they have some kind of say. Make sure that they have some kind of control over that program. And, you know, and again, diversify it, because full disclosure, or not even full disclosure, but if you get a trans masculine person leading a group of trans women, that could be deemed problematic. A, because, and I want to be as nice about this as possible. A, because even though they're both trans, those are different experiences. So there could be some relatability, but there could also be a disconnect. And also for a lot of folks that I know that, you know, put trans masculine folks in positions or whoever, it's kind of like putting a, it's kind of like having a lesbian talk about the issues of gay men, right, where you're not looking for understanding or you're not looking for representation or leadership. You're just looking to be comfortable. And when it comes to these situations, sometimes you have to be uncomfortable. So if you are going to hire, you know, gender and sexual diverse individuals, make it a goal to hire multiple gender and sexual diverse individuals. So that way you do have that accurate representation and that you're able to interact with, you know, clientele from different backgrounds and different populations and in different parts of their journey, right? So that way you can be able to retain your clients and meet your deliverables, most importantly. I don't know where you all are with gender neutral restrooms. If you have them, great. If you don't, you can always create restroom, affirming restroom policies. It could be as simple as either creating all of your restrooms to be gender neutral or by just saying, you know, go into the restroom that you feel comfortable, the most comfortable way. You want to ensure that patient data is consistent, not only for auditing purposes, but if you all were to like look for grants, if you all were to look for specific programming around gender and sexual diversity, you have all your data right in front of you. And it's easy for you to create a story, to paint a picture, to tell your story, and most importantly, to get the funds, right? And, of course, relating back to HIPAA, reassuring clients that their patient data is confidential. So not only is it a HIPAA thing, but it's also to create a safe space. It's to create an affirming space. It's to create a space basically saying that, you know, you are welcomed here. Next slide, please. So here is our second case study. So I want you all to meet Connor. Connor is a non-binary individual who uses they, them pronouns. Connor has stated that they are looking for outpatient treatment as well as mental health services. Constantly being misgendered, Connor noticed that they might be at risk of resuming substance use, and they wanted to get into treatment that caters to their schedule. They are looking to engage in treatment that is affirming, trans and non-binary competent, and they feel like they're also looking for a therapist that has a sliding skill fee and someone who is familiar and has a track record of successfully working with non-binary clients. How would you navigate Connor's case? So we're going to do the same thing. I'm going to give you all two minutes to brainstorm, try to write down a few ideas, and then we're going to come revisit this, okay? So you all have, it's 1227. So I will meet you back here at 1229. Actually, just because I'm of time or what have you, let's give it like about five or 10 minutes, yeah? Let's say five minutes. So, 12.33, we'll come back. So, how are we doing? Are we good or do we need a couple more minutes? I think we're ready if you guys are. Okay. Excellent. Um, so what all did you come so what did you all come up with. Anyone from team Rita recall what was discussed. We're just brainstorming so there's nothing really to, you know, I think the psych today to see who'd be most appropriate. And I also said, check in with me Riley, to see what agencies that they use that will be helpful, because, and to see if your scholarship money because money is an issue. What is the Riley. Be Riley is for people. Yeah, it's a residential recovery house, or this specifically for the LGBT people. A whole lot of other things that are available, like, yeah, there's tons of resources, yeah they link to most of the Cleveland area community resources. Gotcha. So can I ask a follow up question if you don't mind, or, um, how would you go about ensuring that they're that they worked with non binary individuals, because we use them. I would probably just call and ask to make sure exactly. So that's what I was kind of getting to, and I am and the only reason why I'm, I asked that right is because there could be LGBTQ organizations that that is not familiar with working with non binary individuals, or they might have worked with a couple, but they're not necessarily familiar, nor do they have policies around pronouns or things like that. When we do talk about you know LGBT communities or organizations. It's also important to look at the demographic, because most LGBTQ organizations might cater to cisgender gay men and depending on the population, you know, white. But there's also a couple of black MSM agencies, black MSM dominated agencies here in Atlanta, who aren't really familiar with gender and sexual diverse ideologies, so they're kind of starting to acknowledge that and they're doing that restorative justice piece. So that's why I wanted to ask is definitely nothing about the resources that you all came up with. So I just, you know, I just wanted to throw that out there. I'm sorry. I said the reason why I said the Riley House is because it's a place that we use here at Glen Bay and that we're very familiar with, and they have awesome resources. Okay, excellent. So it's just about I'm doing your due diligence, but it sounds like you did. So now that's a great resource to have. Would anybody else like to speak or not speak but you know, come up with your ideas, like even if y'all wrote down a list of like, you know, some options. You're more than welcome to just kind of throw those out there as well. I do have somebody put something in the chat and have a Paula had said we would gather as much information from them as we would any other client that would call or come in asking for services, gain knowledge of their specific needs, talking through the services that we offer and help seek services for them that we may not have within our facility, including but not limited to insurance options and funding, private therapy, agencies, etc. She also noted that we would call and ask any outside resources to find out if they are familiar with and work with non-binary clients. Excellent, you know, yeah, so I guess I say all that to say that, you know, that that's like kind of the route that I would go as a case manager or just kind of a standard route because keep in mind in the case study, Connor did say that they wanted to go to somebody who had specific, you know, a specific expertise around non-binary individuals. So that's why I kind of, you know, ask, like, how would you go about, you know, doing your due diligence? Would you all create a checklist? What would your checklist look like? Because again, I think it's important to ensure that, you know, even though you do run across LGBTQ organizations or companies or what have you, that they're doing the work and that they're diligent and that they have, you know, worked with non-binary individuals and they do have that expertise within their organization. Otherwise, you could be causing that individual harm. So if it seems like, you know, if it's, I don't, I hope that what I stated earlier didn't seem invalidating because all of your responses are valid and you all are doing, you know, excellent jobs with that. But when it does, you know, there is no but. When it comes to certain populations like non-binary individuals, we also have to remember that, you know, this is kind of new for a lot of us, right? Pronouns are new to a lot of folks or at least paying attention to pronouns are new to a lot of folks. Even folks who are gay or trans or bi or what have you, using they, them pronouns for a singular person, that is new. So we have to assure that, you know, we have to see where they're at within their learning process. So that way we're not causing harm to this individual because after all, it is about their sobriety. So I just wanted to reemphasize that. So with that being said, next slide. So again, I want to thank you all for your responses, right? So when it comes to serving our clients, when it comes to assuring quality care, which improves prevention and treatment methods, it is important that we leave our personal beliefs at the door. This is especially true for gender and sexual diverse individuals. With the gargantuan amount of discrimination that the LGBTQ plus community faces on a daily basis, you and your organization can be the deciding factor if that person receives the medical care that they need. Remember to reflect on both explicit and implicit biases that you may have discovered to ensure that they're not dictating the care of the patient. So basically, always check in with yourself, make sure that your personal stuff isn't bleeding onto the client. So with that being said, how can we assure our own implicit biases are not dictating the care of the patient? Being in therapy? Excellent. I like it. Excellent. I mean, period. Right. Somebody said checking in with their peers. First, we have to know where. Absolutely. So can I ask what would checking in with your peers look like? Kind of like evaluating your assets or your liabilities with patients and seeing if, you know, like if anything you did was it looked like a microaggression or, you know, like staying up to date with continuing your own education and stuff. And we do get quite a bit of consulting questions here. I know I get a number of them asking about different situations and if what people did was ethical, okay, so on and so forth. And that opens the door for those conversations. Other thoughts? So somebody put something in the chat that I was actually going to say. But acknowledging any biases. Acknowledging any biases and addressing them. So that includes colleague feedback, additional education, therapy, et cetera. So that goes this goes into this accountability piece. We have to be honest with ourselves. We have to be honest with our own implicit biases. And we also have to be honest where they come from. So that way we know how to dismantle, you know, our own biases. Right? So it could come from a religious background. It could come from a cultural norm. It could come from, you know, your environment, where you grew up, how you grew up. It could come from negative experiences. Right? Which is, you know, which all of that is fine. Excuse me. Our traumas look different. And the best way for us to assure that our own implicit biases isn't dictating the care of the patient is to be honest with ourselves and to actively pluck the root of those said traumas or those said implicit biases. So you are kind of right on the money. And even if you have to do a self, you know, evaluation or if you do go to a colleague. One thing that I'll do, of course in a professional manner, right, is I'll go to, you know, like a coworker and I'll be like, was I wrong at explaining the situation? And, you know, again, ask, you know, was there anything that I could have done to improve anything? Did it seem like I was being negative towards that person? Et cetera, et cetera. So all those things that you said are wonderful. That goes back in. And of course, Paula says speak with peers. We need to keep ourselves accountable just as we keep accountability with our clients as well. Excellent. Thank you so much for stating that, Paula. So the second question is, how can we assure that our colleagues are navigating in a space where patient care is affirming? So in other words, how can you assure that everybody is on the same accord with the mission statement as well as the equitable, as well as being equitable towards gender and sexual diverse individuals? Any thoughts, guys? Annual trainings. I like it. All right, so training. I know I'm not afraid to do this, but I'm in a different spot from some people just who I am as a person. But I call it out in a kind and caring, compassionate way, like, hey, I'm sure you didn't mean it, but that was really rude or that was extremely inappropriate or it could have been taken this way. And they may not always like what I have to say, but they hear it. Supervision. Yeah. Maybe if you're not I was going to say maybe if you're not sure how to navigate a situation with a client or, you know, there's something that's new to you, you can always ask for a third party to step in. Like a moderator. I mean, not to necessarily step in, but to kind of help support you. So if you do case notes with somebody and you're not sure how to take that person because they're trans and that's new to you, have somebody who is familiar sit in with you and do your intake. Camille also states for patients, we can add it to our patient handbook to acknowledge acceptance and inclusion. Absolutely. For those of you who all have groups, do you all reiterate that your groups or your support groups are a safe space for everybody? We were just chatting about that and how our group rules. We do read them. Oh, I'm sorry. Go ahead. I didn't mean to cut you off. I'm sorry. No, I was just saying we do remind everybody and I think our counselors do a really good job of making it a safe place for people and stopping any situations where somebody might be knowingly or unknowingly inappropriate or leading in a direction that's not acceptable. Oh, this is great. And then of course, there's nothing wrong with reiterating every group or every meeting. Of course, your clients will probably roll their eyes or be annoyed or whatever, but just assuring that you do it each and every time. There's nothing wrong with that as well. I'm glad to know that you're earning the money with that one. Go ahead. So, say that you all come across a staff member or you overhear a staff member having their usual water talk or whatever, and this person states that they're not going to make an effort to learn pronouns because it's too much for them. What would you do? A coworker is not going to make an effort to learn or use appropriate pronouns. Is that right? Right. I would just casually stand near them. You would just do what? I'm sorry? I would casually just walk over and stand near them. I'm pretty out here, so they would probably look at me and probably chat kindly. Right. But no, what would you guys do? Would you stand there silently? Would you come tell me about it later? Would you tell your boss? I would ask why. Why? Ask why? Some people might be afraid to say something. Other people wouldn't. It's not like it's who they are and they have a human right and that should be reiterated no matter who we are or who we're talking to. That's the code of ethics, and that's not an option for us. We're counselors. That's what we're supposed to be doing. And even if it's not a counselor, I know that when I've been in those situations and I have casually come to stand next to someone that has happened, I just remind them that their views are their own and they can have those, but while they're at work, they will respect certain things, and abiding by pronouns is one of those. Yeah. So, yeah, no, thank you all for that, right? If anybody took a picture of it, of this slide, please feel free to continue to use this throughout your meetings or throughout yourself or even with a colleague where you all can ask yourself these questions. It's totally okay with me, right? Next slide, please. So, this is our final case study, and I want you all to meet Timothy. Timothy is a gay man who found out he was living with HIV almost a year ago. As a result, his life has spiraled out of control. He has engaged in substances heavily, which resulted in him losing his home, his job, and has caused a strained relationship with his family members and friends, in which he hasn't disclosed his recent diagnosis to. He wants help, and he wants to get into care, but he doesn't know where to start. And when I say care, both substance use treatment as well as HIV medical adherence care. With that being said, how would you navigate Timmy's case? And I'm going to give you all, let's say, five minutes. Today? Yes. Could we do two minutes? Our counselors have group in about 20, and I want to make sure we get through it. Okay, so let's do two minutes. Yeah, because this is going to be like the last slide and then just a wrap up. So, let's do two minutes. Let's respond back in three, and then we'll wrap this up, yeah? Okay, so out of respect for time, let's go ahead and let's dive in real quick. What are some things you all came up with? One of the big things that was said for most of us here in the lecture hall was the Ryan White Foundation out of Cleveland, they kind of helped, oh, okay, so you've heard of that, I don't need to explain, okay. Oh, yeah, no, Ryan, yeah, Ryan White, I mean, even though it's different in Atlanta, but Ryan White is very significant. Oh, but go ahead and continue, please. That was like the big thing as I was listening to everyone chat about what that they were saying. Anybody have anything else they wanted to add? No, I got shy again. Okay. But what would be the purpose of Ryan White? Like, we all know what Ryan White's used for, right? Like, you know, that way we can get this person into care. We can get this person insurance. We could find an agency where they're supporting newly diagnosed individuals. Maybe we can talk about what, you know, what their substance use will look like, both inpatient and outpatient. Yeah, all of that. How often would y'all follow up with this person? Regularly. Regularly. What's regularly for you, Rita? Weekly. Weekly, bi-weekly, sometimes monthly. So they said start out weekly and then kind of move out forward for more, depending on how they're doing. Now, would this be a situation where you all are prepared to do client advocacy? I think we're prepared for that in almost any situation. Okay, excellent. So, you know, advocating on the client's behalf, letting, supporting or sister agencies know what this person needs. If housing would be an issue, we've talked about that. Which I don't know what Ohio's HOPWA funds look like or how that's implemented, but that's definitely an option. I see lots of heads shaking. Anything online? I think everything with the live audience kind of covered it. But yeah, let's go ahead and let's go to the next slide so we can wrap this up, because I don't want to, you know, disrespect anybody's time. So first off, I just want to say thank you all for participating, right? You all learned from each other. I learned some things from you all. You know, this training went by faster than it would have if nobody would have participated. So for all those things, I definitely appreciate that. And I hope that you all, like, learn something or gain a new perspective from this training, whether it was from myself or from each other or from Caroline. So just to wrap up, we went over gender-affirming case notes. We also looked up, went over how to navigate names and pronouns. Spoiler alert, write everything down. Acknowledge the name of the pronouns if the client, you know, tells you that their name or pronoun is. We also emphasized that HIPAA protects gender and sexual diverse individuals. And the funnest thing that we did was we went over case studies. And if there's any exercises or anything that you take from this that you want to implement within your own agency, please feel free to do so. I would recommend especially doing case studies just so you all can be comfortable with that. That way when, you know, a trans or a non-binary person does come in, regardless of where they're at within their journey, it's not new to you all. It's not foreign. In fact, you're very familiar with it and you know how to navigate those situations. So I just want to emphasize that you all are doing amazing work. Thank you for wanting to come in and get more knowledge from me. Thank you for participating. And please continue to do the work. Pat yourselves on the back whenever you get a chance to, or sorry, pat yourselves on the back whenever you get a chance to. And please be kind to yourself. Next slide, please. With that being said, what questions do you all have for me? I've got nothing in the lecture hall. Okay. Um, it looks like we're good on the virtual world to so. Next slide please. So this is kind of how you would claim your credits, as well as your evaluation. And the last slide. And then, of course, if you would like to ask any questions or submit a request, you can reach out to the response network. I was also going to say, Carolyn, not to put you on the spot, but if any of the folks have any follow up questions that they wanted to ask, or they didn't feel comfortable asking out loud, can they send it to you and we can kind of go over that. 100%. That would be awesome. Okay. Well, you definitely got an option there. Well, it looks like you all are getting 15 minutes of your time back. Thank you so much, Paula. And Nevaeh and Jess, I just wanted to take a moment and thank you guys and your time. They put all this together for free. So I just really want to point that out. They took their time out of their day jobs to do this and my other training for us and for our agency. So I really do want to thank you guys. It's been very enlightening. And it really has started some conversations here that have led to some positive things. So thank you for that. Excellent. Of course. Thank you all so much for letting me take up your lunchtime. I'm pretty sure y'all could have been anywhere in the world, McDonald's, Applebee's, all the good stuff, but y'all are here with me. So I appreciate that. And I just hope that y'all continue to have these conversations. And if y'all ever need any other trainings around anything, whether it's like just strictly pronoun training or strictly intersectionality training or anything of that nature, please feel free to reach out to us or have Caroline reach out to us. But y'all are wonderful. And thank you again. And I hope this is the last time. All right.

Nevaeh Anderson

gender-affirming clinical settings

LGBTQ+ individuals

patient data confidentiality

implicit biases

safe spaces

equitable care

transgender individuals

HIV

client advocacy

training