Research Brief:
Creating LGBTQ+ Affirming & Inclusive Crisis Center Cultures in Kansas
Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals face high rates of stigma,
oppression, and victimization, increasing their need for supportive mental health and crisis response services.1,2
It is essential that the agencies in which LGBTQ+ Kansans seek services are affirming and supportive and do
not inadvertently reproduce the stigma that creates mental health disparities. However, little research has
examined crisis agency cultures and climates for LGBTQ+ communities, especially in the Midwest and
predominantly rural states like Kansas. With the goal of providing ethical and competent crisis care for all
Kansans, it is important to assess how crisis agencies can create affirming and inclusive climates for LGBTQ+
people. Therefore, this project aimed to understand and identify strategies for promoting LGBTQ+-affirming
crisis center cultures in Kansas.
The Project: A team consisting of academic researchers, crisis counselors, LGBTQ+ Kansans, and community
leaders advertised focus groups and interviews for 1) crisis providers in Kansas and 2) LGBTQ+ Kansans. A
total of 64 people participated: 28 engaged in one of nine focus groups, 28 completed interviews, and an
additional 8 completed an alternate anonymous survey. Of the 64 participants, 24 were crisis providers (11 of
whom were LGBTQ+) and 40 were LGBTQ+ Kansans. Participants’ gender, sexual orientation, age, and
race/ethnicity are shown below.
Participants were spread throughout the state with 64% in the Northeast, 23% in the Southeast, 11% in the Middle, and 2% in the Southwest regions. About 16% lived and/or worked in rural communities. Crisis providers answered questions about their agency’s organizational culture toward LGBTQ+ people and any changes their agency had made to create a more LGBTQ+-affirming environment. Participants described affirming and non-affirming cultures; all of which were used to make the recommendations in this brief
Affirming vs Non-Affirming Cultures
Crisis providers discussed their agency cultures toward LGBTQ+ people, describing both affirming and nonaffirming environments. Importantly, some agencies included aspects of each.
Affirming Cultures
Providers discussed their agency cultures as LGBTQ+-affirming when they noted leadership, staff, and the agency as a whole working to promote LGBTQ+ inclusion. Specific aspects of agency cultures that were described as affirming included promoting authenticity among staff and volunteers, having affirming and visible signs of acceptance, creating opportunities for growth and development, and LGBTQ+ inclusive practices, all of which are discussed throughout this brief. Broadly, some participants spoke generally about the affirming nature of their agencies, describing the general sense of acceptance they felt.
“One thing I’ll say that’s positive about the agency I work for is that when I walked in on my first day, what I did notice is that everyone who works there…they’re welcome to be their authentic self…I was very concerned about walking in and not fitting in…If you understand the importance of being able to be yourself, then you can understand the importance of this.”
“But just the little things…no one has to say it, but you know you’d be accepted.”
Non-Affirming Cultures
Alternatively, some providers shared that their agencies cultures were not affirming toward LGBTQ+ people. These aspects of agency culture included using non-inclusive language, misgendering staff or clients, lack of visibility of LGBTQ+ communities, and lack of training. A few providers shared specific examples:
“I’ve had a client recently tell me, ‘I almost didn’t come back this time because the last time I was here, one of your lead case managers, I overheard them misgendering me and dead-naming me behind my back with staff.’ And this is a client who is a regular client, who everyone knows as their chosen name and…pronouns. Everybody knows this person by both, and this staff member wasn’t using them. That’s a matter of life and death, in that…situation.”
“When I first started working there, the staff were not respecting pronouns of client; maybe to their face, but then not behind closed doors with other staff, which is … Broadly, the services are very lacking and sometimes create unsafe conditions for clients.”
Include Visible Signs of LGBTQ+ Affirmation and Inclusion
Providers shared that one strategy for promoting an LGBTQ+-affirming culture at crisis service organizations is enhancing the visibility of LGBTQ+ affirmation and inclusion through signs and symbols. Participants described doing this in two key ways: displaying affirming signs and symbols and utilizing inclusive forms and medical records.
Display Affirming Signs and Symbols
Displaying affirming signs and symbols, such as rainbow and trans pride flags or ally signs, sent messages that LGBTQ+ people would be accepted at the crisis service organization. Several providers shared that their agencies had made intentional efforts to be more LGBTQ+ affirming by adding these signs and symbols to the agency.
Providers shared that one strategy for promoting an LGBTQ+-affirming culture at crisis service organizations is enhancing the visibility of LGBTQ+ affirmation and inclusion through signs and symbols. Participants described doing this in two key ways: displaying affirming signs and symbols and utilizing inclusive forms and medical records.
Display Affirming Signs and Symbols
Displaying affirming signs and symbols, such as rainbow and trans pride flags or ally signs, sent messages that LGBTQ+ people would be accepted at the crisis service organization. Several providers shared that their agencies had made intentional efforts to be more LGBTQ+ affirming by adding these signs and symbols to the agency.
“They provided stickers where it says you are welcome here with the (rainbow) colors that we were highly encouraged to put on our doors so that people just walking into the mental health center can feel comfortable and have at least a visual marker of a safe space…I think that’s important to have those visual cues.”
“This is such a little thing. I don’t know whose desk it was, but someone put up a little LGBTQ flag, and every time I see it, it always brings me a little bit of joy. No one said it had to be there…It’s just one thing. Something went up one day, and I’m like, ‘Okay, that makes me feel better that I’m in an environment that is supportive of that,’ because sometimes it’s not always the case.”
Utilize Inclusive Forms and Medical Records
Another strategy to promote inclusivity in the agency is through using LGBTQ+-inclusive intake or agency forms and medical records systems. For example, providers discussed the problems when their electronic health systems were not conducive to listing or finding chosen names or pronouns.
“We use a really old electronic health system and it’s awful. So there’s really not a place to…There is, and there isn’t. But catching someone’s (chosen) gender and name is hard…”
Other providers shared that their agency was working to improve their medical records and forms to allow for diverse genders and sexual orientations to be shared. Inclusive forms and medical record systems ideally include spaces for chosen name and pronouns, write-in options for gender and sexuality, and diverse representations of families or romantic relationships (e.g., using partner/spouse instead of husband/wife).
“We’re also doing an overhaul of our electronic medical record in our forms to be more inclusive. The statewide forms, we don’t necessarily have a lot of control over, but we are trying to make sure that all of our agency literature or advertising, all of that is more inclusive.
Develop an Environment of Learning and Growth
Providers discussed the need to develop agency environments that promoted learning and growth for a range of diverse identities and experiences. In regards to LGBTQ+ affirming environments, providers discussed a need for formal LGBTQ+ trainings and more informal education of staff without burdening LGBTQ+ staff unnecessarily.
Provide LGBTQ+ Trainings
Providers regularly discussed their training experiences, including the lack of training they received in providing competent crisis care to LGBTQ+ individuals and the important training they had received. Many participants discussed the lack of training in LGBTQ+ crisis care, specifically, noting that their training generally focused more on crisis response broadly or discussed marginalized communities occasionally, but not in a way that met their training needs.
“I’m not part of the queer community and I feel like I feel very not equipped with the necessary knowledge to do a better job…I would welcome more knowledge and more training and just to help me do a better job.”
“When you work at a CMHC or CCBHC you have to do these certain trainings on the Kansas website, to be able to bill. And none of them relate to different populations. They’re all very generalized, and I think that it would be beneficial to have that component of LGBTQ.”
Importantly, some providers shared that their agency and the training they received did a good job at promoting LGBTQ+ affirming agency cultures. These trainings tended to include a focus on understanding the experiences of LGBTQ+ communities and challenging one’s own biases.
“That’s something they really emphasize is, ‘hey, what happens if you’re talking to someone who maybe does something you don’t agree with or is part of the LGBT community or something like that, counseling through people who are maybe different than you or are going through different times, but just being able to focus on the emotions behind that and the counseling and the fact that the crisis itself, regardless of whether or not you and the person could be friends afterwards, are the crisis itself and the feelings are very real.’”
Educate Each Other and Avoid Putting Burden on LGBTQ+ Staff
While the majority of providers expressed a need for more training, a few also shared that education needed to continue outside of trainings, by staff educating each other or addressing challenges as they occur. They cautioned that often this type of education is left to LGBTQ+ staff or volunteers, which places an undue burden on them to do this work. As the following quote illustrates, some LGBTQ+ staff may welcome this type of work, but others may not.
“I’ve had individual conversations with people directly who have been misgendering people. I’ve had conversations with other non-binary trans people who’ve also noticed it…had conversations with supervisors…(I) shouldn’t have to…and 9 times out of 10, it does not bother me…I get a little frustrated because…you should know better. You make more than me. If you’re getting paid more than I am, I need you to do better.”
Demonstrate Inclusivity in Practice
Finally, providers shared how affirming organizations demonstrate inclusivity toward LGBTQ+ communities in their practice through the use of inclusive language and by hiring diverse and affirming staff.
Use Inclusive Language
Much like using inclusive forms, using inclusive language throughout the organization sends a message to LGBTQ+ people that they are welcome and will receive competent crisis care. LGBTQ+ inclusive language includes avoiding gendered language, normalizing the sharing of pronouns, and including LGBTQ+ terminology and images in agency materials. One participant shared how they did this on the crisis text chats.
“I think that diversity that we respect and understand that each and every one is equal, equal think is important. That’s there, I can say that the culture that is important in organization. Respect, understanding each person, and I think diversity, because I think there is each and every person is in organization, you’ll find people who are part of the LGBT community, people who are Black, people who are white, people who are disabled. I think there’s much diversity in my organization.”
“What I have control over is language that I use in chat…Someone was worried recently about a pregnancy scare, and so I was talking about Planned Parenthood and of course I was like, I said something like, ‘For folks whose child-rearing bodies.’”
Hire Diverse, Affirming Staff
Another strategy for promoting inclusivity is in who is at the agency providing crisis services or interacting with LGBTQ+ clients. Providers discussed the need for a diverse staff in terms of LGBTQ+ identities, but also race and disability, among other social identities. Providers discussed how having diversity among staff and volunteers was a way to send a message that the agency cared about inclusion.
“I think one thing that I kind of touched on earlier would be having a group of people that are specialized in working with that population…somebody that just knows options (for LGBTQ+ resources), they know every nonprofit in the area, they know shelter options, they know which churches are safe and which are not, they know about where places to get clothing or all these different things that… The information’s out there. But having somebody that works with that group day in and day out to being able to help navigate that would be, I think, such an improvement.”
Recommendations
● Crisis service organizations should adopt policies that mandate the use of all employee and client chosen names and pronouns regardless of legal name or insurance.
● It is important that staff and volunteers, including non-clinical staff, are trained in LGBTQ+-culturally responsive crisis intervention on an annual and ongoing basis.
● Crisis service organizations should ensure that forms, medical records, and the language people use in the agency are inclusive of diverse genders and sexualities.
● When crisis service organizations increase their affirmation of LGBTQ+ communities, they should display LGBTQ+ signs and symbols to promote their acceptance and affirmation of LGBTQ+ people.
● Leadership at crisis service organizations should model affirmation and inclusivity through their practices, including hiring, human resources, and other day-to-day practices.
Authors: Megan S. Paceley, PhD, MSW; Michael Riquino, PhD, MSW; Liz Hamor, MS; and Shana Green.
References:
1. Gower, A.L., Valdez, C.A.B., Watson, R.J., Eisenberg, M.E., Mehus, C.J., Saewyc, E.M., Corliss, H.L., Sullivan, R., & Porta, C.M. (2019). First- and second-hand experiences of enacted stigma among LGBTQ youth. The Journal of School Nursing, 37(3). https://doi.org/10.1177/1059840519863094
2. Katz-Wise, S.L. & Hyde, J.S. (2012). Victimization experiences of lesbian, gay, and bisexual individuals: A meta-analysis. The Journal of Sex Research, 49(2-3), 142-167. https://doi.org/10.1080/00224499.2011.637247
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