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LGBT+Aging Immersion Experience: an innovative LGBT cultural competency course for healthcare professionals and students

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LGBT+Aging Immersion Experience: an innovative LGBT cultural competency course for healthcare professionals and students

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Content Running head: LGBT AGING IMMERSION EXPERIENCE HEALTHCARE 1
LGBT+Aging Immersion Experience: An Innovative LGBT Cultural Competency
Course for Healthcare Professionals and Students
Mario Espitia
University of Southern California
Suzanne Dworak-Peck School of Social Work
Doctor of Social Work Capstone Project
August 2020
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Table of Contents
Executive Summary ………………………………………………………………………. 4
Conceptual Framework: Literature Review ………………………………………………. 6
Health Gaps and Problems Experienced by LGBT Older Adults ………………… 6
Social Significance of Problem: Social Norm Hypothesis ………………………... 8
Problems of Practice and Innovative Solution ……………………………………………. 10
Contribution to the Close the Health Gap Grand Challenge ……………………… 10
Views of Key Stakeholders ……………………………………………………….. 11
The Current Landscape and Context for the Proposed Innovation ……………….. 11
Policies in California Protecting LGBT Older Adults ……………………………. 12
Senate Bill 219 ……………………………………………………………. 12
Assembly Bill 959 ………………………………………………………… 13
Opportunity for Innovation: Winning the Innovation Argument ………………… 13
Innovation as Process …………………………………………………….. 14
Innovation as Behavior and Social Change ……………………………...... 15
Innovation as Disruption …………………………………………………... 15
Theory of Change: ADKAR Change Model ……………………………………… 15
Logic Model ………………………………………………………………………. 18
Likelihood that the Problem will be Successfully Addressed …………………….. 19
Project Structure and Methodology ……………………………………………………….. 19
Description of Capstone Prototype ………………………………………………... 19
Comparative Market Analysis …………………………………………………….. 22
Project Implementation Methods …………………………………………………. 23
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ERIC Strategies …………………………………………………………… 24
EPIS Model ……………………………………………………………….. 25
Financial Plans and Staging ………………………………………………………. 29
Program Expenses ………………………………………………………… 30
Program Revenues ………………………………………………………… 30
Project Impact Assessment Methods ……………………………………………… 31
Research Design …………………………………………………………... 31
Sampling …………………………………………………………………... 32
Measures …………………………………………………………………... 32
Ethical Considerations …………………………………………………….. 33
Stakeholder Engagement Plan …………………………………………………….. 33
Communication Strategies and Products ………………………………………….. 34
Conclusions, Actions, and Implications …………………………………………………... 36
Summary of Projected Plans ……………………………………………………… 36
Projected Implications for Practice and Further Action …………………………... 38
Project Limitations ………………………………………………………………... 40
Resources …………………………………………………………………………………. 41
Appendix A: LGBT+Aging Immersion Experience Curriculum/Prototype ……………… 48
Appendix B: ADKAR Change Model ……………………………………………………. 58
Appendix C: Logic Model ………………………………………………………………... 59
Appendix D: GANNT Chart …………………………………………………………….... 60
Appendix E: Start-Up Budget …………………………………………………………….. 61
Appendix F: First-Full-Year-of-Operation Budget ……………………………………….. 62
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Executive Summary
The Close the Health Gap initiative was introduced by the American Academy of Social
Work and Social Welfare to address the social determinants of health and the disparities in
healthcare outcomes faced by marginalized and disadvantaged populations in the United States.
One disadvantaged and marginalized group with a long history of poor health and behavioral
outcomes is the LGBT older adult population. This population has high rates of high blood
pressure, diabetes, cancer, arthritis, depression, anxiety, and suicidal ideation. These poor health
and behavioral outcomes are impacted by gaps that exist within the healthcare world. Healthcare
professionals and students may have a difficult time treating this population due to gaps in
knowledge and lack of LGBT cultural competency training. In addition, these healthcare
professionals and students may hold unconscious biases and negative attitudes and beliefs toward
the LGBT older adult population that lead to discriminatory behaviors and practices.
To address the problems faced by LGBT older adults and healthcare providers, an
innovation has been developed called the LGBT+Aging Immersion Experience course. It is a
five module, two-hour course for healthcare professionals and students. It aims at providing
knowledge on the healthcare needs of the population and how their wellbeing is impacted by
discrimination and traumatic events throughout their lives. The course also aims to provide
healthcare professionals and students with tools that they can use to communicate more
effectively with LGBT older adult patients, as well as create safe spaces for this population. The
course is completed after a personalized action plan is developed, which also includes identified
community resources and a professional bio and message that is directed to LGBT patients.
A curriculum for the LGBT+Aging Immersion Experience course was developed through
different methods and tools. A Design Thinking process was completed to gain better
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understanding directly from LGBT older adults and healthcare experts themselves about their
mutual needs and gaps. Based on these recommendations, as well as those taken from a review
of journal articles, a curriculum was created. The Exploration, Preparation, Implementation, and
Sustainment (EPIS) model and a Logic Model were used to guide implementation efforts of this
innovative program. Research was done to also complete two different implementation budgets:
a Start-Up budget and a First-Full-Year-of-Implementation budget. Finally, a research design to
evaluate the effectiveness of the innovation was developed.
The goal is to eventually implement this innovation on a larger and grander scale. To do
so, a plan for the development of partnerships has been created. It will be essential to partner
with academic institutions that hold schools of social work, nursing, and medicine, healthcare
organizations, community businesses, and advocacy organizations. Through these partnerships,
it will be possible to recruit course participants, identify funders, and advocate for the need and
growth of the LGBT+Aging Immersion Experience course. Future next steps are to incorporate
the use of virtual reality and augmented reality technology into the various course components.
To do this, it will be vital to develop additional partnerships with schools of engineering,
computer science, and design. Through all these efforts, the LGBT+Aging Immersion
Experience course can be implemented locally and eventually on a larger scale.

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Conceptual Framework: Literature Review
The American Academy of Social Work and Social Welfare (AASWSW) introduced the
12 Grand Challenges for Social Work, one of them being Close the Health Gap. This initiative
was developed with the purpose of tackling the social determinants of health that impact people
of color and other minority groups in the United States (Spencer et al., 2018). Examples of these
social determinants of health are race, ethnicity, economic status, education level, sexual
orientation, and gender identity (Emlet, 2016; Marmot, Friel, Bell, Houweling, & Taylor, 2008;
Mitchel, 2015). In addition, the Close the Health Gap Grand Challenge aims at addressing the
inequities in access to healthcare services and disparities in health outcomes faced by
disadvantaged and marginalized populations. Close the Health Gap is an invitation for social
workers to rise as leaders within healthcare and to develop innovative solutions for the health
gaps faced by many throughout the country.
Health Gaps and Problems Experienced by LGBT Older Adults.
The American Psychological Association (2013) estimates that there are approximately
39 million older adults 65 years of age and older in the United States and that close to 2.4 million
of them identify as lesbian, gay, bisexual, and transgender (LGBT). SAGE (n.d.), also known as
Services and Advocacy for LGBT Elders, reports that there are around 3 million LGBT older
adults 50 years and over in the United States and that this is projected to rise to 7 million in the
next 10 years. In addition, it is estimated that there are approximately 431,800 LGBT-
identifying older adults 50 years of age and older in the state of California (Bajko, 2019; Choi,
Kittle & Meyer, 2018).
LGBT older adults in the United States, first-order actors, face greater disparities in their
health and behavioral health outcomes. According to the innovation dynamics, actors are
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individuals or groups who have a first- or second-order relationships to a particular problem.
The Aging and Health Report brought shocking information about the healthcare outcomes of
this disadvantaged elderly population to the forefront (Fredriksen-Goldsen et al., 2011). From
the 2,560 LGBT older adults that participated in this study 32% were lesbian, 61% were gay, 2%
were bisexual women, 2% were bisexual men, and close to 7% identified as transgender. From
this study sample, it was revealed that about one in five older adults have had a cancer diagnosis
at some point in their lives. Bisexual men were the highest among the subgroups to ever have
received a cancer diagnosis (24%). It was also found that gay and bisexual men reported higher
rates of high blood pressure and human immunodeficiency virus (HIV); lesbian and bisexual
women reported higher rates of arthritis and osteoporosis. Transgender older adults are suffering
from health conditions at higher rates compared to lesbian, gay, and bisexual (LGB) older adults.
33% of those who identify as transgender struggle with asthma, 26% from obesity, and 47%
from high cholesterol.
Health problems are not the only source of concern for LGBT older adults. The same
study reports that high rates of behavioral health conditions exist within this elderly population.
It was reported that close to 30% of LGB respondents suffer from depression, 24% struggle with
anxiety, and 38% have considered suicide. The rates of these behavioral health conditions are
higher within the elderly transgender sample. Close to 48% of those who identify as transgender
report depression, 38% report anxiety, and 71% have planned or considered suicide. In addition,
health risk behaviors, such as smoking (9%), excessive drinking (10%), and drug use (12%) were
reported by the participants of this study. Once again, higher rates of health risk behaviors
existed among the transgender older adult sample. This study demonstrates that LGBT older
adults in the United States suffer from health and behavioral health conditions at high rates.
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LGBT older adults continue to experience poor health and behavioral health outcomes
due to two contributing factors. The first contributing factor is that healthcare academic
programs provide little or insufficient LGBT cultural competency education (Berg, 2018;
Kattari, 2018; Smith, 2017). In a study by Shetty et al. (2016), 77% of healthcare professionals
who participated agreed to strongly agreed that academic institutions need to include more
education and training on the health needs of the LGBT population. In addition, for a statement
that reads “I am well informed on the health needs of LGBTQI patients,” 35% responded they
disagree to strongly disagree and 31% responded don’t know. Healthcare professionals can
potentially miss opportunities to properly screen and treat LGBT patients if unaware of the
conditions that highly impact them. LGBT cultural competency training can potentially increase
awareness and knowledge of LGBT health issues among healthcare professionals (Schweiger-
Whalen, Noe, Lynch, Summers, & Adams, 2018).
The second contributing factor to the poor health and behavioral health outcome of
LGBT older adults are unconscious biases, negative attitudes and beliefs, and discriminatory
practices among healthcare professionals (Rossi & Lopez, 2017). This elderly population
continues to come across healthcare professionals who communicate in unpleasant and hurtful
ways (Aleccia & Bailey, 2019). For example, providers may make assumptions about a person’s
sexual orientation or gender identity and their preferred names and pronouns. At times this is
due to lack of training, but on other occasions, providers continue to engage in inappropriate
behaviors and microaggressions despite knowing a patient’s preferences. LGBT cultural
competency education has the potential of creating awareness of these biases and discriminatory
practices among the medical community (Berg, 2018).
Social Significance of Problem: Social Norm Hypothesis
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The disparities in health and behavioral health outcomes faced by LGBT older adults in
the United States reveals a social norm, one that continues to keep this social problem in place.
Social norms are informal rules that regulate behaviors of individuals within social settings
because they believe that most people in that setting – their reference network – conform to these
rules and believe that this reference network expects them to conform as well (Bicchieri, 2017).
The social norm that continues to keep the problem of poor healthcare outcomes amongst LGBT
older adults in place is as follows: it is okay for healthcare providers to continue to communicate
in disrespectful and inappropriate ways, as well as continue to neglect learning about the needs
of LGBT older adult patients. Providers of healthcare services belong to a reference network of
other providers. They may observe these microaggressions and lack of initiative to learn about
LGBT health in other providers and believe that these behaviors are expected of them. Due to
this, they may be inclined to engage in these types of behaviors as well. Ultimately, providers
are rewarded for continuing these behaviors; the social norm is validated and maintained.
This problem is socially significant, as well as the social norm that holds it in place.
Though this capstone focuses on the LGBT older adult population, this problem and social norm
impacts the larger LGBT community, first-order actors. It is important that this problem and
social norm be addressed as LGBT youth and young adults are also at risk of being discriminated
against by healthcare providers. This is known as parthood, which is the possibility of a problem
being part of another larger problem. For example, the Trump administration has made efforts of
overturning protections for LGBT individuals, such as the mandate to include sexual orientation
and gender identity in nondiscriminatory policies (Clymer, 2019). In addition, his administration
has promoted religious liberty exemption laws that would allow denial of healthcare services to
members of the LGBT community based on a provider’s religious beliefs (Mushovic, 2019).
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Problems of Practice and Innovative Solution
An innovation, or deviant, that aims at subverting the social norm that keeps the social
problem in place was developed. The LGBT+Aging Immersion Experience course is an
educational program for healthcare professionals and students of the fields of medicine, nursing,
and social work. Through this innovation, participants will gain greater understanding of the
healthcare needs of the LGBT older adult population. A panel of LGBT older adults will speak
on their life-long experiences of discrimination and oppression (due to sexual orientation, race,
and ethnicity), as well as how these experiences impact their health outcomes. Course
participants will be invited to participate in a facilitated conversation that aims at creating
awareness of unconscious biases and attitudes towards this vulnerable and underserved
population. In addition, essential skills for fostering positive relationships and safe environments
for LGBT older adult patients will be provided. Course participants will develop their own
personalized action plan that can be used instantly to enhance their practice when serving this
elderly population. The LGBT+Aging Immersion experience consists of five, two-hour
modules. A prototype – a course curriculum – has been developed and will be described in
greater detail in a later section.
Contribution to the Close the Health Gap Grand Challenge
The LGBT+Aging Immersion Experience course will make a significant contribution to
the Close the Health Grand Challenge. This innovation aims at addressing the following three
priorities areas highlighted by this initiative: 1) cultivate innovation in primary care, 2) promote
full access to healthcare and, 3) foster development of an interprofessional health workforce
(Spencer et al., 2018). Participants of the course will be able to implement the LGBT cultural
competency skills that they learned in their place of practice, whether it be primary care or a
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specialized clinic. They will be able to understand the unique needs of LGBT patients and
provide culturally sensitive and good quality care to address those needs. The participants will
be motivated to collaborate with professionals from other healthcare disciplines to provide
competent care to LGBT-identifying patients, which include the older adults.
Views of Key Stakeholders
Doctors, nurses, and social workers report that, despite being main sources or providers
of healthcare services, they have received insufficient or inadequate training on the healthcare
needs of the LGBT patient population (Emlet, 2016; Jablonski, Vance, & Beattie, E., 2013).
Nursing experts have openly recognized that the nursing profession has not prioritized the need
to explore the unique needs of elderly LGBT-identifying patients (Cloyes, 2016). The social
work profession is identified as the field who is most proactive in exploring the topics of sexual
orientation and gender identity. Biases and negative attitudes and beliefs towards those who
identify as LGBT remain unexplored and unaddressed among healthcare providers due to the
lack of LGBT cultural competency education (Erdley, Anklam, & Reardon, 2014).
The Current Landscape and Context for the Proposed Innovation
The Obama-era law, the Patient Protection and Affordable Care Act of 2010 (ACA),
aimed at addressing the numerous problems existing within healthcare in the United States that
impacted access to care and the health outcomes of many Americans. The ACA was developed
with the goal of expanding Medicaid throughout all the states (Andrews, 2014) and to respond to
the social determinants of health that impact disadvantaged populations (Browne et al., 2017).
Enhancing the quality of preventative services while maintaining affordability of medical
services through decreased costs were additional goals of the ACA (Andrews, 2014; Browne et
al., 2017; Nakra & Nakra, 2016). It also promoted and encouraged the development of policies
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within healthcare organizations that enhance interprofessional coordination and collaboration in
order to better meet the needs of patients (Brown et al., 2017).
Also included in the ACA are protections for members of the LGBT community. The
ACA made it illegal for insurance companies to discriminate against individuals based on their
sexual orientation and gender identity (Harley, 2016; SAGE, 2014). In addition, it became
illegal to penalize those with pre-existing conditions, such as transgender identity and human
immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), with increased
insurance premium costs. To tackle discriminatory practices towards the LGBT community, the
ACA made a recommendation that healthcare professionals undergo LGBT cultural competency
education and training (Harley, 2016).
Policies in California Protecting LGBT Older Adults
To protect the rights of LGBT older adults, a few bills have been introduced and made
into law in the state of California. These two laws are Senate Bill 219 and Assembly Bill 959.
Senate Bill 219. In 2017, California Senator Scott Wiener’s Senate Bill 219 (Long-Term
Care Facilities: Right of Residents) was signed into law (Bowers, 2017). This law, known also
as the Lesbian, Gay, Bisexual, and Transgender Long-Term Care Facility Resident’s Bill of
Rights, made it illegal for long-term care facilities, healthcare providers, and facility staff –
another group of actors – to discriminate against patients due to sexual orientation, gender
identity and expression, or HIV status (Wiener, 2017). In addition, those practicing and working
in these settings are mandated to use the patient’s preferred names and pronouns and to allow
patients to wear their clothing of preference. Long-term care facilities must allow patients to use
the restroom that best aligns with their gender identity and they must post their most up-to-date
nondiscrimination policy in a visible place.
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Assembly Bill 959. In 2016, Assemblymember David Chiu’s Assembly Bill 959 –
known also as Lesbian, Gay, Bisexual, and Transgender Disparities Reduction Act – was signed
into law (Chiu, 2015). This bill was developed to create awareness of the disparities in health
outcomes and experiences of discrimination faced by California’s LGBT population. In addition,
the bill highlights this population’s challenges with finding LGBT-affirming providers. This bill
also mandates that information and data on sexual orientation and gender identity be collected by
California’s Department of Health Care Services, Department of Aging, and Department of
Public Health. It is recommended that the information and data be used for improving
coordination of care, policy development, improvement of services and programs, and research.
Though laws such as the ACA, Senate Bill 219, and Assembly Bill 959 have contributed
to the effort of tackling the health disparities faced by the LGBT population in the United States
and in California, other actors have since then taken steps to reverse these efforts. Trump and
his administration have proposed and passed regulations that would overturn the healthcare
protections afforded to LGBT Americans by the ACA (Cole, 2020). Provisions that safeguarded
individuals from being discriminated against due to their gender identity were eliminated
contributing to the marginalization of transgender patients by healthcare providers and healthcare
organizations.
Opportunity for Innovation: Winning the Innovation Argument
Five categories of arguments are provided to demonstrate that a new or proposed project
is indeed innovative. Those five arguments are innovation as novelty, innovation as
advancement, innovation as disruption, innovation as process, and innovation as behavior and
social change (Benedict-Nelson, n.d.). The LGBT+Aging Immersion Experience course
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demonstrates that it wins the innovation argument in three of the categories: innovation as
process, innovation as behavior and social change, and innovation as disruption.
Innovation as process. The LGBT+Aging Immersion Experience course demonstrates
that it is an innovation as process as it was developed through the use of fun and creative
activities from Stanford’s Design Thinking. Tools from the human-centered Design Thinking
process were used to understand the views of the various stakeholders involved in the problem
and to design a capstone project that would meet those needs (Doorley, Holcomb, Klebahn,
Segovia, & Utley, 2018). During the empathize mode of the Design Thinking process, various
stakeholders, such as LGBT older adults, were interviewed to gain insights on challenging
experiences within healthcare and what they value and desire most from their medical providers.
Providers of healthcare services were interviewed as well. They spoke openly about not feeling
fully prepared or comfortable in their interactions with LGBT patients. They also shared being
unable to absorb LGBT cultural competency content provided by the healthcare organization’s
training, which consisted of PowerPoint-like slides.
This experience naturally flowed into the next modes of the Design Thinking process,
which are define, ideate, and prototype (Doorley et al., 2018). The interviews allowed for the
opportunity to define and understanding the problems faced by LGBT older adults regarding
their healthcare outcomes, as well as the problems faced by healthcare professionals such as lack
of or insufficient LGBT cultural competency trainings that allow for biases and discriminatory
practices to continue. Defining the problem also allowed for ideation of potential solutions to the
problems shared within the interviews and the development of various prototypes. Activities
such as journey mapping provided opportunities to illustrate both negative and positive scenarios
experienced by LGBT older adults within the healthcare environment. Prototypes for LGBT
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cultural competency courses were also developed, which evolved over time as additional
information was obtained and discovered.
Innovation as behavior and social change. The LGBT+Aging Immersion Experience
course demonstrates that it is innovation as behavior and social change as it aims at tackling the
problematic behaviors of healthcare providers that maintain the social norm in place. The course
also promotes change within healthcare organizations. The course is an attempt to subvert the
current social norm by providing opportunities to gain new skills and to reflect on biases and
negative attitudes and beliefs that lead to discriminatory practices when serving the LGBT older
adult population. The new insights and skills gained through this course can allow healthcare
professionals to engage in new behaviors that will contribute to positive health and behavioral
health outcomes of elderly LGBT patients.
Innovation as disruption. Finally, it can be argued that the LGBT+Aging Immersion
Experience course demonstrates that it is innovation as disruption. The course promotes the
mindset of self-awareness, which can help healthcare professionals identify and challenge
unconscious biases and negative attitudes and beliefs towards LGBT patients that may arise
during the course and in the future. Through self-awareness and acquisition of LGBT cultural
competency skills, healthcare professionals will be able to disrupt old and unhealthy practices
that discriminate and marginalize this patient population within healthcare. LGBT older adult
patients may potentially sense that providers are safe, welcoming, and understanding of their
unique needs. This elderly population may potentially have increased trust towards healthcare
providers, which can lead to improved patient-provider relationships and improved quality of
care (Hoffman, 2017).
Theory of Change: ADKAR Change Model
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The Awareness, Desire, Knowledge, Ability, and Reinforcement (ADKAR) model for
change management was developed during the 1990’s by the founder of Prosci, Jeff Hiatt
(Lucidchart, n.d.). It is a tool that is used to implement change within organizations and changes
in practices among professionals. The ADKAR model will be used to motivate healthcare
professionals and students to engage in the process of changing their practices when interacting
with LGBT older adult patients (See Appendix B). They will be introduced to the LGBT+Aging
Immersion Experience course as the path for creating change and adopting a new set of skills,
tools, and resources to better serve this patient population.
During the first stage of the ADKAR model, Awareness, it will be important to
communicate the need for change in practices and the upcoming change process. Emails will be
sent out to healthcare professionals and students who belong to the healthcare organizations and
academic institutions that have partnered with the nonprofit that will be home to the
LGBT+Aging Immersion Experience. Within the emails, healthcare professionals and students
will be provided with information that details the need for change and the need to adopt new
skillsets. In addition, informational meetings through virtual platforms such as Zoom will be
hosted to provide a space for healthcare professionals and students to ask questions and obtain
additional information about the change process.
During the next stage, Desire, leaders and champions will motivate and instill a desire for
change among healthcare professionals and students. Leaders of the LGBT+Aging Immersion
Experience course, healthcare organizations, and academic institutions will monitor and identify
the reactions to change among healthcare professionals and students. They will identify highly
motivated individuals to become champions for the need for change and the adoption of new
skills. Resistance to change is anticipated. To address this resistance, additional Zoom meetings
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will be held to address and clarify concerns and doubts that remain. These meetings will also be
used to provide information on the personal and professional benefits of entering this change
process and the use of new skills.
During the third stage of the ADKAR model, Knowledge, healthcare professionals and
students will be provided and engaged in the LGBT+Aging Immersion Experience course.
Through the course, the participants will learn about the needs of the LGBT older adult
population and will be provided with opportunities to reflect on unconscious biases and negative
beliefs. Gaps in skills will be identified during this stage and support will be provided for
development of new skills. Course participants will develop a personalized action plan that will
contain new skills, tools, and resources that will contribute to the change process and to
providing high quality services to LGBT older adult patients.
During the next stage, Ability, course participants will have opportunities to implement
the new skills and experience the benefits of having engaged in this change process. Follow up
sessions will be held to monitor the change and the development of the new skills. In addition,
constructive feedback and input will be given to course participants to create awareness of
existing gaps and continued opportunities for growth. Adjustments will be made to the
LGBT+Aging Immersion Experience course along the way as well.
During the final stage, Reinforcement, support will be provided so that the practice
changes that are occurring among healthcare professionals and students will be the new norm.
Change will be monitored across time and steps will be taken to ensure that the desired outcomes
of the LGBT+Aging Immersion Experience are achieved. Positive praise, recognitions, and
rewards will be provided to those who demonstrate progress in making change and in adopting
the new skills that are being taught by the course.
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Logic Model
A Logic Model was developed to support the implementation efforts of the LGBT+Aging
Immersion Experience course (See Appendix C). Through the logic model, a set of goals for the
innovation have been identified, as well as the inputs, activities, and outcomes (short-, mid-, and
long-term goals). The purpose of this logic model is to demonstrate how behaviors toward
LGBT older adults will change among healthcare providers and students through the
LGBT+Aging Immersion Experience course.
Three goals have been identified for the LGBT+Aging Immersion Experience course.
The first goal is to increase access of LGBT cultural competency education for healthcare
students and professionals. The second goal is to decrease discriminatory practices and
microaggressions within healthcare settings. The third goal is to improve the health and
behavioral health outcomes of LGBT older adults. Inputs are the resources and materials needed
to implement a program. The inputs for the LGBT+Aging Immersion Experience course are the
development of a training curriculum, the training of course facilitators (an LCSW and an RN),
and the purchase of a Zoom business account that will be used to teach the course.
Part of the logic model is to describe the activities that will be provided through the
project with the goal of fostering change. The LGBT+Aging Immersion Experience will offer
the following activities: it will provide immersion experiences into the lives of LGBT older
adults through a panel discussion and skits, education on the history of trauma and
discrimination of this elderly population, opportunities for reflection on potential biases and
negative attitudes and beliefs, and promote effective communication skills. This course will
reach and be made available to students enrolled in medical, nursing, and social work academic
programs. It will be made available to healthcare professionals, administrators, and leaders.
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Outcomes, the results or effects of the activities, are also described within the logic
model. These outcomes provide information on why this project is being developed and are
described as short-, mid-, and long-term results. One of the short-term results is that course
participants will have an increased understanding of the healthcare needs of the LGBT older
adult population and their experiences in the healthcare setting. A mid-term result is that
participants will strengthen their LGBT cultural competency skills as they interact with LGBT
patients in the practice or work setting. Finally, a long-term result is that LGBT older adults will
report increased satisfaction levels with the services rendered by their healthcare providers.
Likelihood that the Problem will be Successfully Addressed
It is likely that the capstone innovation, the LGBT+Aging Immersion Experience, will
successfully address the problem faced by LGBT older adults and subvert the social norm that
holds it in place. Healthcare professionals have expressed concern over the lack of LGBT
cultural competency education within their academic institutions in order to better understand the
needs of the population (Berg, 2018; Smith, 2017) and are open to learning more in order to
provide good quality care (Mathias, 2018). It is likely that healthcare professionals and students
will be ready and willing to engage in the LGBT+Aging Immersion Experience course and
implement the skills that will be taught.
Project Structure and Methodology
Description of Capstone Prototype
A prototype has been developed for the capstone innovation titled the LGBT+Aging
Immersion Experience course (See Appendix A). The prototype comes in the form of a course
curriculum that consists of five modules. The curriculum begins with a description and overview
of the entire course, it provides five course objectives, and it lists the five modules. Each module
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has a module description, two to three module objectives, a module agenda, and questions for
reflection and discussion. A list of references and resources that are used throughout the
LGBT+Aging Immersion Experience course is also provided.
The first module is called Introduction of Minority Stress Theory and Intersectionality:
Impacts on the Health Outcomes of LGBT Older Adults. During module one, course participants
will be introduced to Minority Stress Theory and Intersectionality perspectives. This will be
done through a short-form video and a panel conversation featuring LGBT older adults. These
activities are provided with the goal of increasing awareness of the connection between the poor
healthcare outcomes and life-long experiences of discrimination and oppression due to sexual
orientation, gender identity, race, and ethnicity. This introductory review of Minority Stress
Theory and Intersectionality sets the stage for the following four modules of this course.
The second module of this course is called Developing Self-Awareness of Potential
Biases and Identifying Positive Mindsets. During module two, participants are given an
opportunity to learn mindfulness meditation exercises. These activities will provide mental and
emotional preparation for learning, reflection, and conversation. A series of questions will be
introduced. The goal is to foster a moment of reflection on unconscious biases and attitudes and
beliefs towards the LGBT and older adult population, as well as those belonging to other
minority and marginalized groups. Course participants will be invited to identify and adopt a
series of mindsets that will serve as tools for challenging their own potential biases and
perceptions of the LGBT population and that will support learning throughout the course.
The third module is called An Introduction to Trauma-Informed Care: A Path to Making
Positive Connections with LGBT Older Adult Patients. During module three, participants will be
given an overview of the key principles of Trauma-Informed Care applicable to this
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marginalized older adult population. Course participants will learn communication skills that
align with the Trauma-Informed Care approach that can enhance the patient-provider
relationship. Participants will learn that their communication styles and behaviors as healthcare
providers make a huge impact on the lives of patients. These communication skills will be
modeled through skits that depict interactions between healthcare providers and LGBT older
adults. An opportunity to reflect on possible obstacles and challenges for the implementation of
these skills will be facilitated by the course facilitators, who will also guide in problem-solving.
The fourth module is called Designing Safe Spaces and Crafting a Professional Message.
During module four, participants are provided with an opportunity to learn and adopt
recommendations made by the Joint Commission (2011) in their field guide called Advancing
Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the
Lesbian, Gay, Bisexual, and Transgender (LGBT) Community. Participants will be asked to
take pictures of their healthcare environments, such as waiting rooms, clinic rooms, and
consultation offices, and bring those to the session. Course participants will use the Canva app
on their phone or their computer to add elements to their pictures that will foster safe and
welcoming spaces for LGBT patients. Participants will also develop a personal bio and message
that can be used on websites and social media to positively appeal to the LGBT community.
The fifth module is called Bringing it All Together: Developing a Personalized Action
Plan. During module five, participants will complete the final component of their professional
action plan by developing a resource guide of services that exist for the LGBT population in their
community. Course participants will split into small groups to share their completed
personalized action plan with their course colleagues. They will reflect on the elements of their
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action plan that can be implemented in the short- and long-term within their current medical
setting. They will also reflect on the facilitators and barriers to implementing this action plan.
Comparative Market Analysis
Various organizations have made efforts to provide LGBT cultural competency education
by offering webinars and online training programs that aim at creating awareness of the
healthcare issues faced by the LGBT older adult population. The National LGBTQIA+ Health
Education Center, a program of the Fenway Institute in Massachusetts, is one organization who
provides training on LGBT-related healthcare issues. They offer a one-hour course recorded in
2017 that is title “LGBT Aging 101: What You Need to Know About Lesbian, Gay, Bisexual &
Transgender Older Adults and Caregivers” (Krinsky, 2017). In addition to providing a review of
general issues impacting heterosexual and LGBT older adults, the course does give insight on the
unique health and behavioral health challenges faced by the aging LGBT population. The
importance of LGBT cultural competency education and the need for macro-level engagement to
address the needs of this population is also addressed within this training.
The National LGBTQIA+ Health Education Center offers other pre-recorded trainings on
their website relating to LGBT older adults and healthcare. The center offers a training,
presented originally by Krinsky, Keuroghlian, Riedy (2019), titled “LGBT Aging: Change,
Challenge and Resilience.” It addresses topics on the problems faced by LGBT older adults
regarding their health and behavioral health care, social support, and end-of-life care. Another
two-part course originally recorded in 2020 is titled “Caring for the Sexual Health of
LGBTQIA+ Older Adults (Kass & Fleishman, 2020; Krinsky & Ard, 2020). This two-part
online course for healthcare professionals focuses on the LGBT older adult’s sexual health and
promoting a healthy sexual lifestyle within this population.
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Additional LGBT cultural competency courses with a focus on older adults are provided
by SAGE through its National Resource Center on LGBT Aging (n.d.). The resource center
offers the SAGECare Credential Program to organizations that provide services to the LGBT
population. Through this program, organizations can be awarded SAGECare Credentials that
vary in degree depending on the amount of staff trained within the organization. For example,
the silver credential is awarded if 40% of an organization’s employees are trained and the
platinum credential for those who train 80% of their employees. One-hour trainings on a variety
of topics, which can be conducted in-person, through live webinars, or other virtual training
platforms, are offered. They offer topics that touch on providing support and creating inclusive
communities for LGBT older adults and other specialized topics.
The National Resource Center on LGBT Aging also provides “on-demand” trainings at
no cost. They offer a course titled “Building Respect for LGBT Older Adults,” which is
intended for providers of healthcare services and employees of long-term care facilities. This
course is comprised of six, 10-minute modules, in which topics such as the history of
discrimination towards LGBT older adults within long-term care facilities and the importance of
using inclusive language are discussed. For healthcare professionals working in long-term care
settings whose states mandate annual LGBT cultural competency training, this course would
fulfill that requirement except for those practicing in the state of California.
Project Implementation Methods
Various methods exist that can be utilized to facilitate and guide implementation efforts
of new programs and evidence-based practices. The two methods that were selected to guide the
implementation of the LGBT+Aging Immersion Experience course are the Expert
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Recommendations for Implementing Change strategies and the Exploration, Preparation,
Implementation, and Sustainment model.
ERIC Strategies. To facilitate the implementation process of the LGBT+Aging
Immersion Experience course, it is important that multiple discrete implementation strategies
from the Expert Recommendations for Implementing Change (ERIC) project be used. These are
also referred to as multifaceted implementation strategies (Kirchner, Waltz, Powell, Smith, &
Proctor, 2018; Palinkas, n.d.; Powell et al., 2015). These strategies can potentially increase the
likelihood that innovative programs – such as the LGBT+Aging Immersion Experience course –
will be adopted, implemented, sustained, and scaled up (Kirchner et al, 2018). Three ERIC
strategies have been identified as vital strategies for this implementation.
A first strategy for implementation of the LGBT+Aging Immersion Experience course is
to develop academic partnerships. This strategy provides an opportunity to identify academic
institutions that have a common interest in the topic, are interested in forming a partnership, and
are available to co-lead in the implementation’s research and training components (Kirchner et
al., 2018). It would be ideal to partner with academic institutions that have schools of medicine,
nursing, and social work. This kind of partnership will make the course accessible to the
students enrolled in these schools.
A second implementation strategy is known as assess for readiness and identify barriers
and facilitators. Through this strategy, barriers that interfere with the implementation of the
course, as well as facilitators that support this process will be identified in advance (Kirchner et
al., 2018). This strategy also helps assess for readiness for implementation among the
stakeholders involved in the project. An example of this is to determine if the potential partner,
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an academic institution, is ready to take participate in the implementation of the LGBT+Aging
Immersion Experience course by identifying in advance any potential facilitators and barriers.
A third strategy for implementation of the course is develop and distribute educational
materials and make training dynamic. It is recommended that a manual or curriculum be
developed and shared with course facilitators so that they become familiar with the content of the
course (Kirchner et al., 2018). In addition, it is recommended that various learning styles and
approaches be used to better engage the course participants. The curriculum developed for the
LGBT+Aging Immersion Experience course incorporates the recommendations set forth by this
strategy. A variety of activities have been included to make learning dynamic and engaging.
Some of these activities include a panel discussion, group reflection, analyzing cases through
role plays, activities that involve art, and the use of technology that will assist course participants
with developing of a personalized plan of action for their practice with LGBT older adults.
Finally, create or change credentialing and/or licensure standards, is the third strategy that
will be used for the implementation of this course. In collaboration with partners and
stakeholders, it will be essential to advocate for the inclusion of LGBT cultural competency
education within a state’s licensure renewal requirements. Healthcare professionals will be
mandated by their licensing board to take courses related to LGBT health topics, such as the
LGBT+Aging Immersion Experience course, that will provide them with continuing education
units that will count for renewal of their professional license. An additional effort will be to
advocate for the integration of LGBT health and cultural competency courses within the
curricula of medical, nursing, and social work academic programs.
EPIS Model. The Exploration, Preparation, Implementation, and Sustainment (EPIS)
model is a four-stage framework that is used to facilitate and guide the process of implementing
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evidence-based practices and programs (Moullin, Dickson, Stadnick, Rabin, & Aarons, 2019).
The EPIS model is used to guide the implementation of the LGBT+Aging Immersion
Experience. This framework provides an opportunity to develop a timeline of tasks and
activities that need to be completed (See Appendix D). It is also used to identify potential
facilitators and barriers from the outer and inner context that may impact implementation efforts.
During the exploration stage, it was important to identify and complete certain tasks.
One important task was to identify potential sources of funding for the implementation of the
course. Potential funders are corporations and foundations that actively support causes that
improve the wellbeing of the LGBT community. Another task was to develop a curriculum for
the course. The five-module curriculum will serve as a toolkit and manual for the course
facilitators. It is also vital to identify and connect with stakeholders and partners. These can be
universities and academic institutions, especially those who have school schools of social work,
nursing, and medicine. Due to the COVID-19 pandemic and social distancing safety guidelines,
the course will be offered through virtual platforms such as Zoom rather than in-person.
Potential barriers and facilitators from the inner and outer contexts need to be considered
during the exploration stage. Organizational characteristics, such as leadership style and culture,
can either facilitate or be barriers for program implementation (Vinson, Stamatakis, & Kerner,
2018). To facilitate implementation of the LGBT+Aging Immersion Experience course, the
following mindsets will be adopted within the inner context: change agents, service, problem-
solvers, learners, and innovators. Barriers and facilitators for the implementation of the course
exist in the outer context, for example, the sociopolitical stage. While laws in California, such as
Senate Bill 219, promote and mandate LGBT cultural competency training for healthcare
providers and staff of long term-care facilities, there are no laws mandating this type of training
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for healthcare providers working in other settings, such as clinics and hospitals. This can be a
barrier for the implementation of the LGBT+Aging Immersion Experience course.
Certain tasks will also need to be identified and completed during the preparation stage.
During this stage of the EPIS model, the goal is to adapt evidence-based practices and to develop
a thorough implementation plan (Moullin et al., 2019). A task to complete during this stage is to
strengthen elements of the curriculum. For example, journey mapping activities can be utilized
to strengthen the role play skits and the panel conversation content. During this time, two course
facilitators will be hired and provided with an intensive review of the LGBT+Aging Immersion
Experience course. They will also receive training to further develop their facilitation skills. In
collaboration with the academic institutions and healthcare organization, the first cohort of
students will be identified, as well as the date and time for training.
Potential barriers and facilitators from the inner and outer contexts need to be considered
during the preparation stage. From within the inner context, it is important to consider individual
adopter characteristics. This is referring to the employees, in this case, the course facilitators.
They will need to believe and align with the values and mission of the LGBT+Aging course and
passionate about their ability to create behavioral changes among healthcare providers. This will
facilitate implementation of the course. There are potential barriers for implementation coming
from the outer context. One potential barrier could be the inability to obtain the funding that is
needed to implement the course. It will be important to seek funders who will align with the
vision and mission of the course, but competition to obtain funds for the cause of LGBT health is
a reality and can be a potential barrier.
During the implementation stage, it will also be important to identify and complete
certain activities and tasks. It is during this stage when programs and practices go live, are
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implemented, and then monitored (Moullin et al., 2019). One of the major tasks of this
implementation stage is to actually provide the LGBT+Aging Immersion Experience course to
the first cohort of students from beginning to end and as designed. Another major task us to
evaluate the program by obtaining feedback and input from members of the first cohort. This
feedback and input will be obtained through process and outcomes measures, which will be
described in greater detail in a later section. Feedback will also be obtained from professor and
administrators of academic institutions and leaders of healthcare organizations.
Potential barriers and facilitators from the inner and outer contexts need to be thought
through during the implementation stage as well. It is important that organizational
characteristics (from within the inner context) be considered again. A climate within the
organization that allows employees to be connected with the work that is being taken on, clarity
of roles among employees, and the ability to collaborative is central (Palinkas & Soydan, 2012).
This will promote good morale, loyalty to the mission and vision, and can facilitate
implementation of the course. Continued development of interorganizational networks (outer
context) during this stage is vital. Fostering partnerships with academic institutions and
healthcare organizations, as well as developing new ones, can facilitate implementation of the
course. In addition, partnering with advocacy organizations, such as SAGE, Equality California,
and the Human Rights Campaign, can also facilitate implementation.
Finally, the identification of tasks and activities during the sustainment stage is also
important. It is within this stage where adaptation of a program or practice can occur and where
partnerships continue to be strengthened (Moullin et al., 2019). After having received feedback
and input from the first cohort and other stakeholders during the previous stage, revisions and
updates can be made to the LGBT+Aging Immersion Experience course during this sustainment
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stage. The developer of the course and the course facilitators can work together to make
improvements to the curriculum and to continue to enhance personal and professional skills.
Partnerships with healthcare organizations and academic institutions will allow for the
identification of professionals and students who can be included in future cohorts. Fundraising
efforts can take full force, not only seeking funds from foundations and corporations, but
organizing major fundraising events (e.g. galas).
During this sustainment stage, it is also important to identify barriers and facilitators for
implementation of the LGBT+Aging Immersion Experience course. An important consideration
from the inner context is fidelity context of sustainment. In other words, ensuring that those
involved in providing and designing the course remain motivated and focused on providing the
course as intended and created. To facilitate implementation, training, continuing education
opportunities, ongoing support will be provided to the facilitators and those involved in
designing and developing the course. An important consideration from the outer context during
this stage is, once again, the sociopolitical context. In partnership with advocacy organizations,
efforts can be made to persuade elected officials and legislators of the need for LGBT cultural
competency education for all healthcare providers. In collaboration with these partners, efforts
to protect the healthcare rights of LGBT individuals can be made by supporting current
legislation and developing new policies and bills on the state and national levels. These efforts
can contribute towards the implementation of the course on a larger scale.
Financial Plans and Staging
Two budgets have been developed as part of the implementation process of the
LGBT+Aging Immersion Experience course: a Start-Up budget (See Appendix E) and a First-
Full-Year-of-Operation (FFYO) budget (See Appendix F). As the course will be implemented
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through a new nonprofit organization, the financial aspect of this effort will be under the
auspices of the nonprofit’s board of directors. Following is a description of the two budget’s
major categories and the line items within them: program expenses and program revenues.
Program Expenses. The Start-Up and FFYO budgets include program expenses, which
is split into two sub-categories. The first sub-category is personnel/staffing expenses. Expenses
are high within this subgroup as it is important to hire professionals that are highly talented and
qualified. The total personnel expenses and benefits are $290,000 during Start-Up and $657,000
during the FFYO. These include the salaries for the nonprofit’s chief executive officer (CEO),
finance officer, the two course facilitators, and an administrative assistant. The CEO will hold a
Doctor of Social Work (DSW) degree and a License in Clinical Social Work (LCSW). They will
be responsible to developing the curriculum, developing partnerships with other organizations,
and leading the implementation of the course. The finance officer will have years of experience
managing nonprofit budgets, the facilitators will hold an LCSW and Registered Nurse (RN)
license respectively, and the administrative assistant will have great organizational skills and
experience in the nonprofit sector. The second subsection in the expense category is other
operating expenses. The total other operating expenses are $112,000 during Start-Up and
$148,000 during FFYO. Line items under this subcategory include rental of office space,
utilities, computers and software, furniture and equipment, communication tools, training and
professional development, travel, professional services, and office supplies.
Program Revenues. The Start-up and FFYO budgets also include a category on
revenue. These revenue sources are foundation grants, corporate grants, and contributions. The
total amounts of revenue are $405,000 for Start-Up and $810,000 for FFYO of the LGBT+Aging
Immersion Experience course. As mentioned, foundation and corporate grants will be two
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important sources of revenue for this course. These potential foundations and corporations will
have histories of supporting LGBT causes and have a positive reputation amongst the
community. The Open Society Foundation and the Rainbow Endowments are examples of
potential foundations and U.S. Bank, Warner Bros., and Edison are examples of potential
corporations that can provide funding. Revenue will also be obtained from individual donors and
fundraising events. The nonprofit can partner with local LGBT-owned and LGBT-friendly
businesses to host fundraising events, such as galas. These businesses may also be open to, for
example, donating a percentage of night’s earnings to the nonprofit. In-kind donations will also
be accepted, such as furniture, technology, and office supplies.
Project Impact Assessment Methods
An evaluation of effectiveness research process will be conducted to assess the level of
impact that the LGBT+Aging Immersion Experience course has on the first cohort of course
participants. Following is a description of the evaluation’s research design, sampling, and
measures that will be used to demonstrate effectiveness of the course.
Research Design. The research design that was selected for the evaluation of
effectiveness of the LGBT+Aging Immersion Experience course is the nonexperimental design
(also known as pre-experimental), one-group pretest-posttest type. This design was selected as it
is the most accessible and cost-efficient design that can be used for the evaluation of programs
(Engel & Schutt, 2013). It can be used to evaluate if there were improvement through the use of
a program or treatment, the level of improvement, and how many participants showed
improvement. This research design is also cross-sectional in that the pre- and posttest data will
be gathered during one particular point in time. A mixed-methods approach (quantitative and
qualitative) will be used for this evaluation of effectiveness as well. In this nonexperimental
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one-group pretest-posttest design, one treatment group (or sample) will be identified to take a
pretest, go through the LGBT+Aging Immersion Experience course, and then complete a
posttest. There is no control group in this type of design.
Sampling. For this evaluation of effectiveness, the sampling method that will be used is
the nonprobability, purposive type. This means that the sample will not be selected randomly.
Instead, the sample is obtained in a non-random manner and by determining the kind of qualities
or characteristics desired of those who make up the sample (Engel & Schutt, 2013). For the
evaluation of effectiveness of the LGBT+Aging Immersion Experience course, the goal is to
recruit 30 healthcare professionals and students from the fields of medicine, nursing and social
work to be part of the sample. Healthcare professionals and students from organizations and
academic institution in the greater Los Angeles area will be invited to participate in this research
endeavor through an email that will sent by the researchers. They will be provided with a
website link where they can then register. Two additional email invitations will be sent to
potential participants two weeks apart until the sample size is obtained.
Measures. The instrument or measure that will be part of the assessment tools and used
for this evaluation of effectiveness is the Gay Affirmative Practice (GAP) Scale (Crisp, 2006).
The GAP Scale is a 30-item scale divided into two subscales. These subscales are intended to
measure a clinicians’ beliefs about providing treatment to LGBT individuals (items 1-15) and it
also measures the behaviors they engage in when serving this population (items 16-30). Each
item can be answered by selecting a number on a scale from one through 5. For items 1-15, the
answers range from 1 (strongly disagree) to 5 (strongly agree) and for items 16-30, the answers
range from 1 (never) to 5 (always). The total scores can range from 30 (low affirmative
belief/practice) to 150 (high affirmative belief/practice). Each participant of the LGBT+Aging
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Immersion Experience will take the GAP Scale at pretest and posttest. Crisp (2006) states that
the GAP Scale is valid (.93 Cronbach’s alpha for the belief subscale and .94 for the behavior
subscale) and reliable (Pearson’s r correlation of .624).
In addition to the GAP Scale, other items will be part of the assessment tools. There will
be a demographics section that participants will complete during the pretest. Participants will
provide information such as age, ethnicity, race, sexual orientation, and gender identity. It will
ask participants to disclose their profession affiliation, status as a professional or student, and if
their academic program included LGBT-related health content. At posttest, there will also be an
open-ended, qualitative portion. Participants of this evaluation of effectiveness will have an
opportunity to write their thoughts about what they learned about the LGBT older adult
community and how this will impact their practice with this population.
Ethical Considerations. There are ethical considerations to be mindful of. In order to
participate in the LGBT+Aging Immersion Experience, it will be important to obtain informed
consent from the course participants. They will be notified that their participation in this course
is completely voluntary. Institutional Review Board (IRB) approval to conduct this evaluation of
effectiveness may be needed if conducted through an academic institution, but not if conducted
through a healthcare organization (unless the particular organization requires it as well). It is
important to consider the emotional wellbeing of the participants, especially those who may be
more emotionally vulnerable, as the content in the course can be intense. Participants will be
informed of the intensity of the course content and will be provided with mental health resources
in the event that the content is emotionally triggering.
Stakeholder Engagement Plan
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Various stakeholders will be engaged. The first group of stakeholders to engage are
LGBT older adults from the Los Angeles community. They will be recruited to provide advice
and input on the content and activities of the LGBT+Aging Immersion Experience course.
These older adults will continue to have a platform where they can share their life stories to
ensure that the skits and panel discussions that are part of the course accurately reflect the life
experiences of LGBT older adults.
Another group of stakeholders that will be engaged are academic institutions and
healthcare organizations. They will be invited to also speak on the needs that healthcare
professionals and students have regarding their healthcare education, especially as it relates to
LGBT health and cultural competency knowledge. It will be important to collaborate with
leaders of these institutions and organizations so that there is buy-in and acceptance of this
course. If there is buy-in, they are more likely to promote the course within their institutions and
organizations so that potential participants are likely to register and attend the course.
Advocacy organizations, such as SAGE, Equality California, and Human Rights
campaign, are groups of stakeholders that will also invited to engage in the implementation
process of the LGBT+Aging Immersion Experience course. They have the ability to advocate
for the implementation and expansion of this course on a larger scale and have strong platforms
where the course can be promoted and endorsed. They can also be great connections to potential
funders who are interested in the issue of LGBT health and discrimination.
Communication Strategies and Products
A campaign to create awareness of the healthcare disparities and inequities faced by
LGBT older adults in the United States will be developed. This campaign will also integrate and
promote the LGBT+Aging Immersion Experience course. The beneficiaries and target group of
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this nation-wide effort will be healthcare professionals and students who are on the front line
providing direct services to patients, which include the elderly and those that identify as LGBT.
Examples of healthcare providers are those who belong to the fields of medicine, nursing and
social work. The campaign aims at enhancing the medical community’s knowledge on the issues
impacting the LGBT older adult population and raising awareness of the proposed innovation.
The LGBT+Aging Immersion Experience campaign will feature a short-form video or
public service announcement. It will feature and tell the story of two LGBT-identifying older
adults. They will be interviewed with a series of questions that will facilitate sharing of stories
that describe challenges they have experienced in their life due to their sexual orientation, gender
identity, race, and ethnicity. These may be challenges that they endured in setting such as their
families of origin, faith communities, schools, and in healthcare and that have negatively affected
their health and behavioral health. Ordinary, every-day older adults from the community will be
recruited for the short-form video interviews to increase the likelihood that their stories will be
reflective of the challenges faced by the general elderly LGBT population. It may be risky to
recruit celebrities as they may have certain privileges and advantages that may not be reflective
of the experiences of the general LGBT older adult population.
In addition, healthcare professionals from the fields of medicine, nursing, and social work
will be recruited and interviewed for the short-form video. The series of questions for the
interview will promote conversation on the kind of LGBT-related education received in their
academic programs, uncomfortable encounters with patients who identify as LGBT, and skills
they wish they had to make these encounters more productive. They will also be encouraged to
provide a message that expresses their commitment to becoming more competent in the area of
LGBT health. Healthcare experts will be recruited and featured in the short-form video in order
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to appeal to the campaign’s target group. Through the use of the social proof principle, the target
group is more likely to be persuaded to enhance their skills through the LGBT+Aging Immersion
Experience course being that the featured healthcare experts are taking the steps to do so.
The stories shared by the LGBT older adults and the healthcare experts will be edited to
provide two very important messages. The first message is that LGBT older adults, a forgotten
and underserved population, continue to suffer from poor health and behavioral health outcomes.
The second message is an invitation for healthcare professionals to accept the challenge of
learning about this population’s healthcare needs and improving LGBT cultural competency
skills. The campaign will appeal to the target group’s values and emotions, such as compassion,
empathy, service, hope, and altruism. Mindsets such as service, growth, learner, and change
agents will be promoted within this campaign.
The short-form video will be shared via the campaign’s social media channels, which
include Facebook, Twitter, Instagram, and YouTube. The campaign will partner with advocacy
organizations and academic institutions who are allies of the LGBT older adult population and
the short-form video will be shared via their social media channels as well. The developer of the
LGBT+Aging Immersion Experience course will appear as a guest speaker on social work,
healthcare-related, and LGBT-related podcasts to promote the campaign.
Conclusions, Actions, and Implications
Summary of Project Plans
LGBT older adults in the United States have a long history of poor health and behavioral
health outcomes. Despite these disparities in health outcomes, the elderly LGBT population is
largely neglected by society. Even within the LGBT community, focus is mostly placed on the
needs of the younger LGBT populations. The healthcare outcomes of this older population
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continue to be poor due to lack of training on LGBT health and unconscious biases and beliefs
among healthcare professionals and within healthcare organizations.
The Close the Health Gap Grand Challenges calls for innovative solutions to address
disparities and inequities in healthcare faced by marginalized and disadvantaged groups, such as
LGBT older adults. An innovation to address this problem has been developed and is called the
LGBT+Aging Immersion Experience course. This course is guided by a theory of change and
logic model that intends to create change in behaviors and social norms among healthcare
providers that, until now, continue to keep the problems faced by LGBT older adults in place.
The goals of this course are to increase access to LGBT cultural competency education, decrease
discriminatory practices among healthcare professionals, and improve the healthcare outcomes
of LGBT older adults.
The LGBT+Aging Immersion Experience course offers a curriculum that can be used to
provide essential knowledge and skills to healthcare professionals and students. This curriculum
has five, two-hour modules that address a variety of topics that lead to the development of a
personalized action plan by each course participant. The five modules are as follows: 1)
Introduction of Minority Stress Theory and Intersectionality: Impacts on the Health Outcomes of
LGBT Older Adults, 2) Developing Self-Awareness of Potential Biases and Identifying Positive
Mindsets, 3) An Introduction to Trauma-Informed Care: A Path to Making Positive Connections
with LGBT Older Adult Patients, 4) Designing Safe Spaces and Crafting a Professional
Message, and 5) Bringing it All Together: Developing a Professional Action Plan.
For successful implementation, the nonprofit that is home to the LGBT+Aging
Immersion Experience course will partner with various organizations, such as academic
institutions, healthcare organizations, and advocacy groups. These partnerships will assist in the
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implementation and scaling of the LGBT+Aging Immersion Experience course. These
partnerships will be avenues to recruiting course participants, potential funders, researchers that
will lead the evaluation of effectiveness, promoting the course, and advocating for legislation
that will update licensure requirements to mandate LGBT cultural competency training for
healthcare professionals.
Projected Implications for Practice and Further Action
The LGBT+Aging Immersion Experience course offers a variety of activities, which
include panel discussions of LGBT older adults that share their experiences of discrimination
and minority stress, roles plays and skits that model effective communication skills, and the use
of smartphone apps like Canva to design safe and welcoming healthcare spaces. These activities
are valuable and essential, but the way that these activities are executed will need to be updated
for a variety of reasons.
As this program continues to grow and expand, it may be challenging to recruit additional
older adults to be part of the panel discussion. It is important to consider their emotional and
psychological wellbeing as inviting them to be part of the panel discussion means that they will
be sharing their stories repeatedly and possibly becoming retraumatized. Similar considerations
apply to the activities that involve role plays and skits. As the program grows and is scaled,
additional actors will need to be hired to act out these role plays and skits. There is potential that
this can become expensive as, in the long-term, it would be just to provide a wage to the actors
and the panelists who participate.
It will be important to take the next step of embracing and integrating technology into the
activities provided through the LGBT+Aging Immersion Experience course. This step will add
on to the innovative element of this project and it will take advantage of the tools available
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39
during these modern times. A future plan for the course is to integrate virtual reality technology.
This technology can be used to replace activities such as the panel discussion during module one,
as well as the roles plays and skits during module two.
Virtual reality can create an experience of embodiment that can lead to a better
understanding of new situation and allow a person to have increased empathy levels (Nguyen,
2018). During module one, virtual reality can be used to tell the stories of LGBT older adults
and the challenging experiences in their lives. Course participants will be immersed in ways that
are not possible with just listening to a panel discussion. Virtual reality can now be used to
provide experiential opportunities during trainings, which can prepare participants to become
familiar with new or unfamiliar situations (Sibley, 2019). This applies to module 2, where
course participants will learn effective communication skills by immersing themselves in case
scenarios through virtual reality rather than through live skits and role plays. Virtual reality
technology can also be used to guide people through the mindfulness and meditation activities.
Another next step is to also include augmented reality technology into the LGBT+Aging
Immersion Experience course. Augmented reality can be used during module four to replace the
use of the Canva app to design safe and welcoming healthcare spaces. Through this technology,
course participants will be able to design spaces that look more realistic and take advantage of
360-degree feature. In addition to adding elements such as graphics, course participants will also
be able to add sound and video into their design.
In order to achieve this next step, partnerships with additional stakeholders will need to
be made. In addition to developing partnerships with schools of healthcare fields within
academic institutions, it will be important to also develop partnerships with schools that teach
computer science, design, and software engineering. Additional partnerships can be developed
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with professional associations in this field and with start-up technology companies that are
interested in healthcare education and LGBT health justice.
Project Limitations
There are a few limitations to the design of the curriculum and structure. Due to the
COVID-19 pandemic, the LGBT+Aging Immersion Experience course will be offered virtually
through Zoom rather than in-person in a training room. This can potentially impact the course
participant’s level of engagement. It can be easy to become distracted by other programs and
web browsers on the computer or by situations occurring in their environment. Due to this,
participants may miss out on the content that is being taught, which can impact learning and the
results from the evaluation of effectiveness. In addition, the five-day, two hours per day course
schedule can be a potential limitation. This schedule places the risk of participants losing
interest or possibly not attending all modules. This may give participants an opportunity to
absorb the information and education received in each module. The option of an all-day, eight-
hour course may not be appealing as well.

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Appendix A
LGBT+Aging Immersion Experience Curriculum/Prototype
LGBT+Aging Immersion Experience Course Description:
The LGBT+Aging Immersion Experience is an LGBT cultural competency course tailored for
professionals and students of the healthcare field (e.g. physicians, registered nurses, and social
workers). Throughout the course, course participants will gain greater understanding on the
health and behavioral health needs of the LGBT older adult population. A panel of LGBT older
adults will speak on their life-long experiences of discrimination and oppression (due to sexual
orientation, race, and ethnicity), as well as how these experiences impact their health outcomes.
Course participants will be invited to participate in a facilitated conversation that aims at creating
awareness of unconscious biases and attitudes towards this vulnerable and underserved
population. In addition, essential skills for fostering positive relationships and safe environments
for LGBT older adult patients will be provided. Course participants will develop their own
personalized action plan that can be used instantly to enhance their practice when serving this
elderly population.
LGBT+Aging Immersion Experience Course Objectives:
1) Identify the life-long challenges faced by the LGBT older adult population through the
lenses of Minority Stress Theory and Intersectionality.
2) Identify unconscious biases and negative attitudes and beliefs towards the LGBT older
adult population and the sources of these biases and attitudes.
3) Identify key concepts of Trauma-Informed Care and communication skills that can be
used to improve engagement with LGBT older adults in your practice.
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4) Identify and use recommended techniques to communicate inclusivity and create safe,
welcoming spaces for LGBT older adults.
5) Identify useful strategies to develop a personal plan of action to implement in your own
practice and place of employment.
Course Modules:
• Module 1: Introduction of Minority Stress Theory and Intersectionality: Impacts on the
Health Outcomes of LGBT Older Adults
• Module 2: Developing Self-Awareness of Potential Biases and Identifying Positive
Mindsets
• Module 3: An Introduction to Trauma-Informed Care: A Path to Making Positive
Connections with LGBT Older Adult Patients
• Module 4: Designing Safe Spaces and Crafting a Professional Message
• Module 5: Bringing it All Together: Developing a Personalized Action Plan
Module 1
Introduction of Minority Stress Theory and Intersectionality:
Impacts on the Health Outcomes of LGBT Older Adults
Module Description:
Course participants will be introduced to Minority Stress Theory and Intersectionality
perspectives through a short-form video and a panel conversation featuring LGBT older adults.
Through these activities, the course participants will gain greater awareness of the connection
between poor health and behavioral health outcomes and life-long experiences of discrimination,
oppression, and rejection due to sexual orientation and gender identity, as well as race and
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ethnicity. This introductory review of Minority Stress Theory and Intersectionality sets the stage
for the following modules in this course.
Module Objectives:
1) Increase knowledge of concepts related to minority stress theory and intersectionality.
2) Identify the challenges experienced by LGBT older adults throughout their life spans.
3) Understanding the connection between the lived experiences of the LGBT population and
its impact on their health and behavioral health.
Module Agenda:
• Introduction of course, facilitators, and participants (20 mins.)
• Overview of module description, modules, and setting the stage (e.g. mindsets, promoting
a safe and nonjudgmental space for dialogue and conversation). (10 mins.)
• Introduction of minority stress theory and intersectionality concepts through the short-
form video and a panel conversation featuring LGBT older adults that will (60 mins.)
• Large group facilitated conversation and reflection (30 mins.)
• Closing
Questions for Reflection and Discussion:
• What is your understanding of minority stress theory and intersectionality?
• Was there a story shared by one of the panelists that caught your attention or struck you
the most? Why?
• Have you personally been impacted by experiences related to the concepts of minority
stress theory and intersectionality?
• What is something new you learned today about the LGBT older adult population that
you did not previously know?
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Module 2
Developing Self-Awareness of Potential Biases and Identifying Positive Mindsets
Module Description:
Module 2 provides course participants with an opportunity to center themselves through a
mindfulness meditation exercise that provides mental and emotional preparation for learning,
reflection, and conversation. Course participants will be provided with a series of questions that
will facilitate a reflection on perceptions, biases, and attitudes and beliefs towards the LGBT and
older adult population and those belonging to other minority and marginalized groups. Within
this safe space, course participants will be invited to identify and adopt a series of mindsets that
will serve as tools for challenge their own potential biases and perceptions of the LGBT
population and that will support learning throughout this course.
Module Objectives:
1) Develop basic skills that can increase your ability to focus and remain centered.
2) Increase understanding of personal perceptions, attitudes, and beliefs (and their potential
sources) towards LGBT and older adult populations.
3) Identify mindsets that will enhance your motivation and engagement in the learning.
Module Agenda:
• Overview of module 2 description, objectives, and agenda (10 mins.)
• Mindfulness/Centering meditation activity. (15 mins.)
• Small group reflection on questions that facilitate conversation on perceptions and
attitudes towards the LGBT and older adult populations. (45 mins.)
• Large group facilitated conversation. (35 mins.)
• Final mindfulness/centering meditation activity. (15 mins.)
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• Closing
Questions for Reflection and Discussion:
• If a close friend, classmate, or coworker who I assumed was straight told me they identify
as gay, lesbian, bisexual, or transgender, I would feel…
• Growing up, what were the messages that you heard or learned about members of the
LGBT community? At home? Your place of worship? School? Other?
• What messages did you hear or learn throughout your life about the elderly? People of
other races and ethnicities?
• In what ways have the messages that your heard and learned throughout your life impact
your practice and interactions with patients who belong to sexual, gender, racial, and
ethnic minority groups?
• What three mindsets will you adopt as you continue with this course?
Module 3
An Introduction to Trauma-Informed Care:
A Path to Making Positive Connections with LGBT Older Adult Patients
Module Description:
Our communication styles and behaviors as healthcare providers make a huge impact – negative
or positive – on our patients, especially with LGBT-identifying older adult patients. This module
will provide an overview of the key principles of Trauma-Informed Care applicable to this
disadvantaged and marginalized older adult population. Course participants will learn
communication skills that align with the Trauma-Informed Care approach that can enhance the
patient-provider relationship. These communication skills will be modeled through role
plays/skits that depict interactions between healthcare providers and LGBT older adult patients.
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An opportunity to reflect on possible obstacles and challenges for the implementation of these
skills will be facilitated by the course facilitators, who will also guide in identifying solutions
and a plan.
Module Objectives:
1) Identify the key principles of Trauma-Informed Care.
2) Identify basic LGBT terminology and the use of inclusive language for developing
rapport with LGBT patients as suggested by The Joint Commission.
3) Identify potential biases, attitudes, and obstacles that hinder the use of skills presented in
this module and steps/mindsets that can facilitate the use of these skills.
Module Agenda:
• Overview of module 3 description, objectives, and agenda (5 mins.)
• Mindfulness/Centering meditation activity. (10 mins.)
• Overview of Trauma-Informed Care and its key principles. (30 mins.)
• Review of LGBT terminology and the importance of gender-neutral, inclusive language
(20 mins.)
• Observation of Role Plays/Skits demonstrating interactions between providers and
patients using concepts and skills used in the course (20 mins.)
• Facilitated conversation on thoughts, attitudes, biases that arose from this module’s
content and the skills presented (30 mins.)
• Final mindfulness/centering meditation activity (5 mins.)
• Closing
Questions for Reflection and Discussion:
• Which Trauma-Informed principles did you identify with or catch your attention? Why?
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• Identify how you can implement Trauma-Informed Care principles into your current
practice?
• What questions do you have about the use of LGBT terminology and gender-neutral,
inclusive language?
• Why is it important (or not important) to use these communication skills?
Module 4
Designing Safe Spaces and Crafting a Professional Message
Module Description:
Module 4 is an opportunity to learn and adopt recommendations made by the Joint Commission
in their field guide called Advancing Effective Communication, Cultural Competence, and
Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT)
Community. Participants will bring pictures of their healthcare environments, such as waiting
rooms, clinic rooms, consultation offices that they have taken prior to attending the module.
Course participants will use the Canva app on their phone or computer to add elements to their
pictures that have the potential of creating safe and welcoming spaces for LGBT patients.
Participants will also develop a personal bio and message that can be used on websites and social
media to positively appeal to the LGBT community.
Module Objectives:
1) Identify strategies recommended by The Joint Commission to design a safe, welcoming,
and inclusive environment for LGBT patients.
2) Use the recommended strategies and recommendation to design a healthcare space
(through the use of technology) that is welcoming and affirming of the LGBT population.
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3) Develop a personal message that reflects inclusivity and universal values that can be used
to appeal to LGBT patients and to promote yourself and your practice.
Module Agenda:
• Overview of module 4 description, objectives, and agenda (5 mins.)
• Mindfulness/Centering meditation activity. (5 mins.)
• Overview of the Joint Commission’s Advancing Effective Communication, Cultural
Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and
Transgender (LGBT) Community: A Field Guide (15 mins.)
• Designing welcoming healthcare spaces using Canva (30 mins.)
• Overview of important elements to include in a personal message and bio (15 mins.)
• Craft a professional bio and message (30 mins.)
• Reflection on thoughts and experiences that arose from the module activities (20 mins.)
• Closing
Questions for Reflection and Discussion:
• Identify facilitators and barriers for designing safe and welcoming spaces within your
practice or healthcare facility.
• Identify facilitators and barriers for developing your professional bio and message and its
use on professional websites and social media.
Module 5
Bringing it All Together: Developing a Personalized Action Plan
Module Description:
During Module 5, course participants will complete the final component of their professional
action plan by developing a resource guide of services that exist for the LGBT population in their
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community. Course participants will split into small groups to share their personalized action
plan with their peers and colleagues. They will also reflect on the elements of their action plan
that can be implemented in the short- and long-term plan within their practice and medical
setting, as well as facilitators and barriers to implementing this plan.
Module Objectives:
1) Identify LGBT resources that exist within your community that will facilitate the
development of a resource guide.
2) Develop a personalized action plan that includes all the content in this course and that can
be used in your own practice with LGBT older adult patients.
3) Identify facilitators and barriers for implementing your personalized action plan.
Module Agenda:
• Overview of module 5 description, objectives, and agenda (5 mins.)
• Develop a resource guide that can be shared with LGBT older adult patients (25 mins.)
• Sharing of personalized action plan in small groups (60 mins.)
• Large group conversation and debrief (20 mins.)
• Final words and recognitions (10 mins.)
Questions for Reflection and Discussion:
• What elements of your personalized action plan can you implement in the short-term?
Long-term?
• What facilitators and barriers do you foresee in implementing your action plan?
References and Resources Used in This Course
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Dentato, M.P. (Ed.). (2018). Social work practice with the LGBTQ community: The intersection
of history, health, mental health, and policy factors. New York, NY: Oxford University
Press.
Eckstrand, K.L. & Potter, J. (Eds.). (2017). Trauma, resilience, and health promotion in LGBT
patients: What every healthcare provider should know. Springer.
Hendricks, M.L. & Testa, R.J. (2012). A conceptual framework for clinical work with
transgender and gender nonconforming clients: An adaptation of the minority stress
model. Professional Psychology: Research and Practice, 43(5), 460-467. doi:
10.1037/a0029597
Joint Commission (2011). Advancing effective communication, cultural competence, and patient-
and family-centered care for the lesbian, gay, bisexual, and transgender (LGBT)
community: A field guide. Oak Brook, IL. Retrieved from
https://www.jointcommission.org/lgbt/
Meyer, I.H. (2013). Prejudice, social stress, and mental health in lesbian, gay, and bisexual
population: Conceptual issues and research evidence. Psychology of Sexual Orientation
and Gender Diversity, 1(S), 3-26. doi: 10.1037/2329-0382.1.S.3
Substance Abuse and Mental Health Services Administration (2014). SAMHSA’s concept of
trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-
4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.

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Enablement zone

Engagement zone

Awareness

• Email will be sent out
to healthcare
professionals and
students from partnering
healthcare organizations
and academic
institutions indicating
need for change and
offering a new course
opportunity.
• Provide reasoning and
explanation for need to
make change by
obtaining new skills
through this course.
• Hold informational
meetings through Zoom
to provide a space where
healthcare professionals
and students can ask
questions and obtain
additional information.
Desire

• Identify reactions to
change among
healthcare
professionals and
students.
• Identify potential
champions that are
motivated to engage in
the change process and
motivate others.
• In cases where there
is resistance, hold
additional Zoom
meetings to clarify
concerns and doubts.
In addition, provide
information to
demonstrate how the
course will benefit
them personally and
professionally.
Knowledge

• Provide
LGBT+Aging
Immersion Experience
course to assist course
participants.
• Assist course
participants with
developing a
professional action plan
with skills, tools, and
resources needed to
serve the patient
population.
• Identify gaps in skills
and provide additional
feedback and support.
Ability

• Provide an
opportunity for course
participants can begin
practicing and using the
skills taught during the
course.
• Hold follow up
sessions for course
participants to monitor
change and use of the
new skills.
• Provide constructive
feedback and input to
course participants to
create awareness of
opportunities for
growth.
• Make adjustments to
course as needed.
Reinforcement

• Monitor change that
occurs over time after
course participants
begin using skills, tools,
and resources learned
through the course to
ensure desired outcomes
are being achieved.
• Provide positive
praise, recognitions, and
rewards to course
participants who
demonstrate ability to
change practices and
adopt new skillset.
Appendix B
ADKAR Change Model

LGBT AGING IMMERSION EXPERIENCE HEALTHCARE

59

Project: LGBT+Aging Immersion Experience

Goal: 1) Increase access of LGBT cultural competency education for healthcare students and professionals. 2) Decrease discriminatory
practices and microaggressions within healthcare settings. 3) Improve the health and behavioral health outcomes of LGBT older adults.
INPUTS ACTIVITIES OUTCOMES
What we invest What we do Who we reach
Why this project: short-
term results
Why this project:
intermediate results
Why this project: long-
term results

• LGBT cultural
competency
training
curriculum.

• Training
facilitators (LCSW
and RN).

• Zoom virtual
platform.

• Provide immersion
experiences through
panel discussion and
skits.

• Education on
history of trauma and
discrimination faced
by the LGBT
population.

• Opportunities for
reflection on potential
biases.

• Promote effective
communication skills.

• Students enrolled
in medical,
nursing, and social
work academic
programs.

• Providers of
healthcare
services (e.g.
physicians,
nurses, social
workers).

• Healthcare
administrators and
leadership.

• Course participants will
learn LGBT cultural
competency and
communication skills.

• Participants will have an
increased understanding
of the healthcare needs of
LGBT older adult patients
and their experiences in
healthcare settings.

• Participants will develop
awareness of personal
biases.

• Participants will
strengthen LGBT
cultural competency
skills as they interact
with LGBT-identifying
patients in their
practice or work
setting.

• Participants will
have increased
perceived level of
comfort when
working with this
population.

• LGBT older adult
patients will report
increased satisfaction
levels with services
rendered by their
healthcare providers

• Improved health and
behavioral health
outcomes amongst
LGBT older adults.

• Increased levels of
trust toward healthcare
providers and
organizations.

Assumptions
• The training program will provide a safe space that
facilitates learning and conversation
• Training will be easily accessible to healthcare students
and professionals

External Factors
• (+) Collaboration and partnerships with academic institution,
professional organizations, and LGBT advocacy groups can
strengthen and validate the need for this training program
• (-) Lack of policies that mandate this type of training and competition
for funding can impact ability to provide training

Appendix C
Logic Model

LGBT AGING IMMERSION EXPERIENCE HEALTHCARE

60
EPIS Stage Task Name
Identify barriers and
facilitators
Search for funding
Develop training curriculum
Identitfy and connect with
partners
Obtain office space
Recruit talent
Train facilitators
Enroll course participants
Exploration
Preparation
Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21
Appendix D
GANNT Chart

EPIS Stage Task Name
Conduct initial training
sessions
Obtain evaluation/input
from participants
Refine facilitator skills and
curriculum
Continue to seek funding
Continue to foster
partnerships
Continue to enroll course
participants
Update and edit curriculum
(ongoing)
Implementation
Sustainment
Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21
LGBT AGING IMMERSION EXPERIENCE HEALTHCARE

61
Name: LGBT+Aging Immersion Experience
FY 2020-21 Start Up Budget
Category ------------ $'s (000's) ------------ ---------------- Comments ---------------
REVENUE
Foundation Grants 120 Open Society Foundation, Rainbow Endowment.
Corporate Grants 105 US Bank, Warner Bros., Edison.
Contributions 180 Individual/local donors, fundraising event.
Total REVENUE 405
EXPENSES
Personnel Exp
Wages/Salaries
CEO 75 1 full-time (6 month)
Finance Officer 62 1 full-time (6 month)
Course Facilitators 56 2 full-time licensed clinicians: LCSW and RN (4 months)
Admin. Assistant 30 1 full-time (6 month)
Sub-Total 223
Benefits (@ 30%) 67
Total Pers. Exp 290
Other Operating Exp
Facility/rent 18 $3k/month
Curriculum development 15
Tel/Utilities 3 Telephone/fax service, Wi-Fi, light, gas.
Computers/software 27 8 computers (16), Software (10), Zoom platform (1)
Furniture/equipment 6 Desks, chairs, etc.
Communications 4 Telephones, fax machine, other equipment.
Trng/Prof Dev 4 Professional development for 6 employees.
Travel & Enter. 15 Travel reimimbursement for employees.
Prof Srvc's * 15 Consultants as needed.
Office Supplies 5
Total Other Op Exp 112
Total EXPENSES 402
SURPLUS/DEFICIT +3
Appendix E
Start-Up Budget

LGBT AGING IMMERSION EXPERIENCE HEALTHCARE

62
Name: LGBT+Aging Immersion Experience
FY 2021-22 First Year of Operation Budget
Category ------------ $'s (000's) ------------ ---------------- Comments ---------------
REVENUE
Foundation Grants 380 Open Society Foundation, Rainbow Endowment.
Corporate Grants 280 US Bank, Warner Bros., Edison.
Contributions 150 Individual/local donors, Gala event.
Total REVENUE 810
EXPENSES
Personnel Exp
Wages/Salaries
CEO 150 1 full-time
Finance Officer 125 1 full-time
Training Facilitator 170 2 full-time licensed clinicians (85x2 employees)
Admin. Assistant 60 1 full-time
Sub-Total 505
Benefits (@ 30%) 152
Total Pers. Exp 657
Other Operating Exp
Facility/rent 36 $3k/month
Tel/Utilities 6 Telephone/fax service, Wi-Fi, light, gas.
Computers/software 28 8 computers (16), Software (10), Zoom platform (2)
Furniture/equipment 6 Desks, chairs, etc.
Communications 4 Telephones, fax machine, other equipment.
Trng/Prof Dev 8 Professional development for 6 employees.
Travel & Enter. 25 Travel reimimbursement for employees.
Prof Srvc's * 30 Consultants as needed.
Office Supplies 5
Total Other Op Exp 148
Total EXPENSES 805
SURPLUS/DEFICIT +5
Appendix F
First-Full-Year-of-Operation Budget

Abstract (if available)

Abstract The Close the Health Gap initiative was introduced by the American Academy of Social Work and Social Welfare to address the social determinants of health and the disparities in healthcare outcomes faced by marginalized and disadvantaged populations in the United States. One disadvantaged and marginalized group with a long history of poor health and behavioral outcomes is the LGBT older adult population. This population has high rates of high blood pressure, diabetes, cancer, arthritis, depression, anxiety, and suicidal ideation. These poor health and behavioral outcomes are impacted by gaps that exist within the healthcare world. Healthcare professionals and students may have a difficult time treating this population due to gaps in knowledge and lack of LGBT cultural competency training. In addition, these healthcare professionals and students may hold unconscious biases and negative attitudes and beliefs toward the LGBT older adult population that lead to discriminatory behaviors and practices. ❧ To address the problems faced by LGBT older adults and healthcare providers, an innovation has been developed called the LGBT+Aging Immersion Experience course. It is a five module, two-hour course for healthcare professionals and students. It aims at providing knowledge on the healthcare needs of the population and how their wellbeing is impacted by discrimination and traumatic events throughout their lives. The course also aims to provide healthcare professionals and students with tools that they can use to communicate more effectively with LGBT older adult patients, as well as create safe spaces for this population. The course is completed after a personalized action plan is developed, which also includes identified community resources and a professional bio and message that is directed to LGBT patients. ❧ A curriculum for the LGBT+Aging Immersion Experience course was developed through different methods and tools. A Design Thinking process was completed to gain better understanding directly from LGBT older adults and healthcare experts themselves about their mutual needs and gaps. Based on these recommendations, as well as those taken from a review of journal articles, a curriculum was created. The Exploration, Preparation, Implementation, and Sustainment (EPIS) model and a Logic Model were used to guide implementation efforts of this innovative program. Research was done to also complete two different implementation budgets: a Start-Up budget and a First-Full-Year-of-Implementation budget. Finally, a research design to evaluate the effectiveness of the innovation was developed. ❧ The goal is to eventually implement this innovation on a larger and grander scale. To do so, a plan for the development of partnerships has been created. It will be essential to partner with academic institutions that hold schools of social work, nursing, and medicine, healthcare organizations, community businesses, and advocacy organizations. Through these partnerships, it will be possible to recruit course participants, identify funders, and advocate for the need and growth of the LGBT+Aging Immersion Experience course. Future next steps are to incorporate the use of virtual reality and augmented reality technology into the various course components. To do this, it will be vital to develop additional partnerships with schools of engineering, computer science, and design. Through all these efforts, the LGBT+Aging Immersion Experience course can be implemented locally and eventually on a larger scale.

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Asset Metadata

Creator Espitia, Mario (author)

Core Title LGBT+Aging Immersion Experience: an innovative LGBT cultural competency course for healthcare professionals and students

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 10/16/2020

Defense Date 08/07/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag aging,biases,close the health gap,cultural competency,design thinking,Discrimination,health disparities,healthcare,immersion experience,implementation,LGBT,logic model,minority stress theory,OAI-PMH Harvest,theory of change

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Rank, Michael (committee chair), Orras, George (committee member), Wind, James (committee member)

Creator Email espitia.dsw@gmail.com,espitia@alumni.usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-383045

Unique identifier UC11666553

Identifier etd-EspitiaMar-9042.pdf (filename),usctheses-c89-383045 (legacy record id)

Legacy Identifier etd-EspitiaMar-9042.pdf

Dmrecord 383045

Document Type Capstone project

Rights Espitia, Mario

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA