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Active Duty LGB Service Members: Research, Assessment, and Clinical

Training in a Post-DADT MilitaryNCCOSC

Capt. Scott L. Johnston, PhD, Jagruti P. Bhakta, PhDPalo Alto UniversityPeter Goldblum, PhD

Disclaimer

The opinions expressed in this article are the author's own and do not necessarily reflect the view of the United States Government, the United States Department of Defense, The United States Navy, or The United States Navy Bureau of Medicine and Surgery. 

The study protocol was approved by the Naval Medical Center San Diego Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects.

I am an employee of the U.S. Government. This work was prepared as part of my official duties. Title 17 U.S.C. §105 provides that ‘copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C §101 defines U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

Introduction• On September 20, 2011 DADT

was repealed

• 1 million LGB service members and veterans may seek access to care

• Need to develop a better understanding to ensure successful integration of LGB service members

• What are the clinical, ethical, and organizational implications after DADT?

After DADT: Implications for Service Members• Persistence of sexual stigma &

prejudice

• Potential spike in sexual orientation-based harassment and victimization

• Complicated decisions about revealing sexual orientation

• Military mental health professionals may be unprepared

Presentations • Examining the Experiences of Active Duty LGB

Service Members in a Post-DADT Military

• Development of an Evidence-Based Clinical Assessment Protocol for LGB Military Clients

• Risk Factors, Health Care Disparities and Culturally-Competent Care for LGB Individuals

www.nccosc.navy.mil

Examining the Experiences of Active Duty LGB Service Members in

a Post-DADT Military

Jagruti P. Bhakta, PhD, Jennifer Webb-Murphy, PhD,

Theodore Morrison, Phd, Peter Goldblum, PhD, & Scott L. Johnston, PhD

Background• Limited scientific knowledge exists

regarding active duty LGB service members

• As the U.S military adjusts to the repeal of DADT, it is imperative to understand the needs of LGB individuals

• More research is strongly warranted to guide clinical practice and educate policy makers

Survey of LGB Service Members

Demographic Questions

LGB Specific Measures & Military Questions

Outcome Measures

Preliminary Results – Demographics

n = 41

Preliminary Results – Demographics

n = 41

Branch of Service Pay Grade

Preliminary Results – Post DADT Experiences

Preliminary Results• 15% currently receiving medical treatment for

chronic health issues

• 21% currently receiving mental health treatment

• 15% feel it is unsafe to discuss LGB issues with a mental health provider at a military treatment facility

• 43% have been threatened with physical violence

• 15% have been sexually assaulted

• 25% have been blackmailed/threatened with being “outed,” 1 person denied a promotion in rank

Preliminary Results – Suicidal Thoughts

n = 32 n = 10 n = 10 n = 10

Novel Contributions of Study• Findings will help health care providers, civilian

organizations and the military community better understand the needs of LGB service members

• Valuable information to educate policy makers, guide clinical practice and advance research.

• Ongoing study with plans to recruit 400 service members

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Risk Factors, Health Care Disparities and Culturally-Competent Care for

LGB Individuals

Scott L. Johnston, PhD, Jagruti P. Bhakta, PhD, Jennifer Webb-Murphy, PhD,

Theodore Morrison, Phd, & Peter Goldblum, PhD

LGB in the Military• An estimated 71,000 active

duty service members, reservists and retired force members who are LGB

• 870,000 veterans estimated to be LGB

• After DADT, 1 million service members and veterans may seek access to culturally sensitive health care

MPFC Survey – Coming Out Risk

MPFC Survey – Comfort with Provider

Health Care Disparities• LGB rate their health as poor, have more chronic

conditions, and a higher prevalence and earlier onset of disabilities

• Asthma, headaches, allergies, osteoarthritis, gastro-intestinal problems, smoking

• LGB are at greater risk for problems with mental health• Depression, anxiety, substance abuse, suicidal ideation,

sexual violence

• Differences between subgroups within LGB

Eliminating Health Care Disparities• Professional health organizations have created policies

and guidelines promoting LGBT health education

Training in LGB Health• Research indicates that medical schools seldom offer

planned curricula on comprehensive LGBT health

• Survey of medical schools reported an average of five hours dedicated to LGB-related curricula

• Medical students do not feel adequately prepared to address sexuality in a clinical context

• Psychologists also report a lack of formal training on working with LGB individuals

Health Education Initiatives• Studies show promising results

• 3-hour seminar resulted in students feeling more prepared

• 2-hour UCSF course demonstrated improvement in LGB knowledge and related care

• No published studies with military treatment providers

Are Psychologists Prepared?• LGB clients report many

clinicians are biased, insensitive & unhelpful

• Military providers have less experience with open LGB clients

• Competence concerns

• Wide heterogeneity in competence

MPFC Literature Review• NCCOSC is collaborating with Military Partners

& Family Coalition • Evaluate availability and quality of culturally-

sensitive LGB training

• Preliminary findings • Strong need for standardized, evidence-based

trainings and implementation

• More research is needed

Recommendations• Avoid assuming: repeal = “all is well”

• Be affirmative versus tolerant

• Follow client’s lead regarding disclosure

• Collaboratively address victimization

• Use maximal caution in record keeping

• Make good use of referrals

• Explore pros and cons of military service

• Pursue competence in work with LGB clients

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