Increasingly public health experts, researchers, healthcare providers and policymakers are aware of the health disparities and health needs of people across sexual orientations, gender identities, gender expressions, and differences of sex development.

Individuals with minority sexual or attractional orientations, gender identities, gender expressions, and sex development (referred to here as lesbian, gay, bisexual, transgender, queer people , people born with intersex variations, and asexual people) face barriers when accessing and receiving medical care, leading to health disparities and general mistrust of the medical system.

Numerous strategies are being developed to address these barriers at multiple levels of intervention. One strategy to improve how providers interact with individuals and families is cultural competence trainings.2 In a 2020 report on the health and well-being of people in the United States, the National Academies of Sciences, Engineering and Medicine noted: “Regardless of how care delivery is organized, providing cultural and clinical competency training about SGD [sexual and gender diverse] populations for the entire health workforce is critical to ensuring that SGD people can access high-quality care.”

At an individual level, culturally competent health care broadly refers to the knowledge, skills, attitudes, self-awareness, and abilities required to provide effective and ethical care to these populations.Cultural competence also extends to health and community organizations, systems, and institutions regardless of the specific healthcare specialization or individual staff role. Sets of competencies have been developed, ranging from individual competencies of medical and mental health staff to standards for hospitals and clinics.

This toolkit is intended to set standards, and recommend best practices, for cultural competence trainings of healthcare providers and staff, to enhance their knowledge of persons and communities; become more aware of their own attitudes and biases about these communities; to improve their skills in working with individuals and families; and to apply their learning in the delivery of healthcare. These recommendations are specifically intended for:

  • Healthcare institutions (including hospitals, clinics, healthcare systems, academic health centers, long-term care facilities, and networks of providers) and professional associations (such as state and local boards of medicine and hospital associations) that offer or sponsor trainings for their providers, staff, or members as part of continuing education, staff training, and professional development.
  • Other organizations and individuals who provide trainings for healthcare providers and staff.

The authors’ intent is to assist providers, support teams, and healthcare institutions to provide a more informed and welcoming environment for individuals and families, to improve the experience of care, and to enhance provider-patient relationships.

These recommendations aim to improve trainings in order to produce meaningful change in how health professionals, teams, and institutions serve the community – and ultimately, to improve the healthcare provided to individuals and families, and improve their health and wellness.

The recommendations presented here are based on expert consensus: specifically, those expressed by a group of healthcare providers, educators, researchers, and community advocates from across the United States. Health experts convened twice in-person to develop a framework for best practices in creating and implementing cultural competence trainings to improve the provision of healthcare to individuals and families (see How These Recommendations Were Developed for list of experts). Available peer-reviewed studies and training evaluations were reviewed and supplemented with the extensive practice-based experience of the summit participants and their institutions. The recommendations were also informed by review and detailed feedback from other experts and healthcare providers from a variety of institutions in different parts of the country. The recommendations that are provided are by no means exhaustive or representative of specific existing curricula, but rather reflect the collective best practice recommendations of experienced trainers. Read more about the limitations of our process and need for more work.

These standards recognize that competence is dynamic, not static. Maintaining competence requires incorporation of emerging research, refining one’s practice to reflect new learning and new experiences, and being aware of how facilities and institutions make healthcare more accessible, or less accessible, to all-individuals and families, including those with stigmatized or marginalized identities. A single training is unlikely to transform an individual provider or health care organization into “a culturally competent” provider or organization.7 Throughout this toolkit, cultural competence is defined as a process and a journey of increasing awareness, acquiring knowledge, changing provider attitudes and behaviors, and ultimately, transforming the overall systems, policies, and processes of care to be more responsive to the needs of individuals and families.

The importance of institutional reform as well as training of individual providers and staff.

Learning to work fairly, compassionately, and effectively with individuals and families requires an ongoing commitment not only by individual providers and other healthcare staff, but also by healthcare systems. While the recommendations in this toolkit primarily focus on trainings for individual providers and staff, cultural competence also involves an awareness of how systemic processes, and the behavior of colleagues, enhance or inhibit a welcoming environment that affirms the needs and concerns of individuals and families. In addition, cultural competence trainings are only one tool to address the barriers experienced by individuals and families in seeking and obtaining high-quality care. Other system-level interventions are necessary to create an effective and inclusive trauma-informed environment.