Mental health provider training to improve LGBTQ competence and reduce implicit and explicit bias: A randomized controlled trial of online and in-person delivery.

Abstract

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals in most countries face strong stigma and often rely on affirmative mental health care to foster coping and resilience. We tested an LGBTQ-affirmative mental health training for psychologists and psychiatrists by comparing in-person versus online modalities and the added benefit of supervision. Participants were randomized to a two-day training either in-person (n = 58) or via live-stream online broadcast (n = 55). Outcomes were assessed at baseline and 5, 10, and 15 months posttraining. Optional monthly online supervision was offered (n = 47) from months 5 to 15. Given the substantial need for LGBTQ-affirmative expertise in high-stigma contexts, the training took place in Romania, a Central-Eastern European country with some of the highest LGBTQ stigma in Europe. Participants (M age = 35.1) were mostly cisgender female (88%) and heterosexual (85%). Trainees, regardless of whether in-person or online, reported significant decreases from baseline to 15-month follow-up in implicit and explicit bias and significant increases in LGBTQ-affirmative clinical skills, beliefs, and behaviors. LGBTQ-affirmative practice intentions and number of LGBTQ clients did not change. Participants who attended at least one supervision session demonstrated greater reductions in explicit bias and increases in LGBTQ-affirmative behaviors from baseline to 15-month follow-up than participants who did not attend supervision. LGBTQ-affirmative mental health training can efficiently and sustainably improve LGBTQ competence and reduce provider bias in high-stigma contexts. Future research can identify additional ways to encourage mental health providers’ outreach to LGBTQ clients in need of affirmative care.

Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers.

“…Because the training tested in this study was delivered synchronously online and during work hours to the centers in which participants were affiliated, these results support a cost-effective, efficient means to ultimately enhance the mental health care available to LGBTQ individuals. Indeed, an existing study finds no difference in online versus in-person delivery of LGBTQ-affirmative provider trainings (Lelutiu-Weinberger et al, 2021), further supporting the future broad implementation of this training.…”

“…Motivated by this background, the present study employed a wait-list-controlled trial of mental health providers working across LGBTQ community centers to test the efficacy of an 11-week training in LGBTQ-affirmative CBT. Based on previous evidence that training in LGBTQ-affirmative approaches is equally efficacious when delivered in-person and remotely (Lelutiu-Weinberger et al, 2021) and to ensure broad reach to diverse geographic settings while overcoming access barriers (i.e., provider cost, time, and travel), we delivered the training synchronously (i.e., in real time) online. Outcomes included self-reported LGBTQ-affirmative competency, cultural humility (i.e., a clinician’s openness to accepting how their own identities and experiences may bias their awareness of their clients’ intersecting identities and experiences), and knowledge of the minority stress theory and practice skills underlying LGBTQ-affirmative CBT.…”

Transgender-Specific Adolescent Mental Health Provider Availability is Substantially Lower in States with More Restrictive Policies

“…Intervention and policy efforts are needed to alleviate these trans-specific adolescent mental health provider shortages. Trans-specific provider training interventions, which increase mental health providers' competency and comfort working with transgender adolescents (Case & Meier, 2014), may increase provider availability in states with more restrictive laws/policies (Lelutiu-Weinberger et al, 2022). Reducing barriers to mental healthcare delivery across state lines (e.g., teletherapy) may have similar benefits.…”

“…More specifically, existing trans-specific policy climate measures comprise a relatively narrow range of state laws/policies (Clark et al, 2022;Goldenberg et al, 2020a;Goldenberg et al, 2020b;Hughes et al, 2022), and analytic techniques (e.g., exploratory factor analysis) have yet to be employed to enhance their reliability (i.e., minimizing unique variance in state law/policies to reduce measurement error) and/or to provide evidence of their construct validity (i.e., demonstrating that state laws/policies load onto the same factor; Hatzenbuehler, 2017).…”

Future Directions in Mental Health Treatment with Stigmatized Youth

“…Taken together, this evidence suggests that existing training curricula in culturally responsive practice does not adequately address the mental health needs of stigmatized youth. This problem stems from both insufficient curricula (e.g., it is often developed solely by researchers, rather than by, or with, the client populations we seek to serve) and limited dissemination (i.e., the extent to which the curricula is distributed; Brownson et al, 2021;Lelutiu-Weinberger et al, 2022;Pachankis, Clark, et al, 2021). Moreover, there is a dearth of research on the efficacy of such training.…”