Template 8.3 (Appendix A) is useful for thinking critically about patient diversity concerning the recommendations for improving access to and quality of primary care for SGM patients. It will be helpful to review Chapter 4 when completing this template and draw on the organizational assessment results described in Chapter 5. Think about the specific disparities and structural vulnerabilities that may need to be addressed so that all SGM patients can benefit from the organizational change efforts taking place at the clinic. Consider what will need to happen to ensure that specific segments of the patient population can benefit from equitable care and any adaptations that may be required for the clinic or to specific recommendations to ensure that new policies and practices can be successfully implemented. This type of brainstorming will provide the Implementation Team with nuanced insight into possible action steps that can be integrated into Action Plans.
Template 8.3 Addressing Diversity Through Action Planning
Recommendation Area 4: Provide ongoing training for all employees in SGM cultural competency, including use of supportive language
Diversity Identity Category
Healthcare disparities and structural vulnerabilities
Ideas for equitable care
Adaptations to recommendation areas
Race and ethnicity
Mandate minority stress training for employees.
Integrate minority stress module in SGM cultural competency training.
People with disabilities
Mandate disability awareness training for all staff.
Include a focus on the disproportionate burden of disability among SGM people in the disability awareness training.
Religion and culture
Anti-SGM stigma, Islamophobia, and anti-Semitism, etc.
Prepare providers and staff to ask pertinent questions to understand patients’ religious and spiritual affiliations that may impact their health and well-being.
Maintain/distribute a list of questions to ask of patients who may be struggling with distress and isolation related to religion; use role-plays to increase their comfort in asking these questions; help them identify their own bias towards religion, so they can refrain from expressing judgment of patients’ beliefs.
Small towns and rural communities
Provider shortages, distance, and transportation
Prepare providers and staff to refer patients to SGM-friendly facilities and telehealth resources for SGM-relevant treatment.
Maintain/distribute inventory of facilities and telehealth resources verified as SGM-friendly; educate personnel about the resources and how they can be accessed.
Lack of insurance and cost barriers to health care (e.g., medication and transportation expenses)
Prepare staff to refer patients to clinic navigators to facilitate access to public coverage and local resources that provide access to financial support and basic needs.
Integrate information about insurance disparities among SGM people in SGM cultural competency training.
Maintain/distribute a list of local resources verified as SGM-friendly. for financial and basic needs assistance.
Discrimination in healthcare settings; exposure to violence, injury, or illness in everyday risk environments
Prepare staff to recognize the biases and assumptions they may bring to clinical encounters with persons experiencing homelessness and understand the relationship between SGM identity and homelessness, particularly among youth and transgender women.
Incentivize and reward staff to take part in in-person or online training in understanding homelessness and Trauma-Informed Care. Create a list of local resources for people experiencing homelessness verified as SGM-friendly (check particularly for the inclusion of transgender women in women’s shelters).
Structural barriers that create unique health-related needs and reduce access to care
Inform staff about the health issues, vulnerabilities, and barriers to access faced by SGM immigrants.
Incentivize and reward staff to take part in in-person or online training in the health issues, vulnerabilities, and barriers to access faced by SGM immigrants.
Maintain/distribute a list of local resources for undocumented individuals that are verified as SGM-friendly.
Children and youth
Lack of family support
Familiarize staff with access barriers for youth whose families are unsupportive and with local referral resources (e.g., PFLAG, SGM youth support groups).
Maintain/distribute inventory of local resources verified as SGM-friendly; educate staff about the resources and accessing them.
Limited social network; lack of specialty services
Familiarize staff with local referral resources (e.g., SAGE: Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders).
Maintain/distribute inventory of local resources verified as SGM-friendly; educate staff about resources and accessing them.
Other (specify) Returning citizens
Mistreatment in jail or prison
Develop staff skills in Trauma-Informed Care.
Incentivize and reward staff to take part in in-person or online training in Trauma-Informed Care.