Missouri Case Study 12 – Sparking Interest from Rural Missouri Hospitals on LGBT Health

andrew shaughnessyBy: Andrew Shaughnessy
Manager of Public Policy, PROMO Missouri

Upon concluding the review process for our Mid-Missouri and Southeast Missouri hospitals, health advocates were faced with the challenge of sparking interest among rural hospital officials on a review of their LGBT welcoming policies. Knowing the formula for sparking interest among urban hospitals, we knew that rural outreach would be considerably different. Putting on our strategy caps, advocates came up with a road map to engage these hospitals.

One issue that we felt needed to be overcome was the assumption that LGBT health is not an issue in rural Missouri – quite the contrary. We know that LGBT folks exist and live in every county in Missouri and across the Nation and we know that they utilize health and social service facilities – just like any citizen. But, disproportionately sexual minorities experience poorer health outcomes than our heterosexual peers according to the Missouri Foundation for Health.  Often times this is because of the invisibility LGBT rural folks feel within health and social service policies – it was our task to break our invisibility.

With this, advocates set out by utilizing the community, and the tools we learned from our outreach with urban hospitals. Through a series of strategic mailers that included a report of the hospitals LGBT welcoming policies as well as copies of local news articles that focused on LGBT health, advocates began to engage these officials.

In our outreach to rural hospital officials, advocates developed four points:

1. Create a sense of urgency – by highlighting local news articles that focus on LGBT health we were able to break our invisibility and create a sense of urgency. In developing these pieces, we also helped to start a community dialogue on LGBT health and the issues associated, including the lack of regional LGBT welcoming policies.

2. Highlight successes to create credibility– knowing this was the first time that these hospital officials would have likely been engaged by LGBT advocates, we wanted to create credibility from the begin by highlighting our past successes with urban hospitals.

3. Report along with methodology – to let officials know how we came to our conclusion on their LGBT welcoming policies, further establishing credibility.

4. Clear ask from the officials.

To review the packet of information sent to rural hospitals, please click here.

In the next case study, we will outline the work of the LGBT health advocates in outreaching to these officials along with lessons learned in moving forward with rural outreach on LGBT health.

Conferences · Tobacco Policy · Uncategorized

LGBT HealthLink Conference Commentary: Not So Straight

Jennablogphot (2)
LGBT tobacco researchers at SRNT

by Jenna Wintemberg, MPH

What: Society for Research on Nicotine and Tobacco Conference

Where: Philadelphia, February 25 to 28, 2015


The Society for Research on Nicotine and Tobacco (SRNT) conference in Philadelphia is the one I look forward the most each year, where the leading researchers in tobacco control come together to share their research. Session topics range from basic and clinical science, to behavioral and social science, to marketing and policy. I was proud to be there representing the Out, Proud and Healthy in Missouri project and LGBT HealthLink. I was also happy to share that this year I attended the conference as a travel scholarship award recipient for increasing diversity in nicotine and tobacco research. Of the 10 travel award scholars, representing many tobacco health disparate populations, I was the only LGBTQ research scholar.

Some of the LGBTQ presentations (titles and lead authors) that took place:

  • Is There a Relationship Between the Concentration of Same-Sex Couples and Tobacco Retailer Density? (Joseph Lee)
  • Rates of Tobacco Use Among Young Adult LGB Subpopulations (Amanda Richardson)
  • Minority Stress, Smoking, and Cessation Attempts: Findings From a Community Sample of Transgender Women in the San Francisco Bay Area
  • Sexual and Gender Minority Community-Based Tobacco Cessation Program: Tailored Recruitment and Evidence-Based Intervention (Jenna Wintemberg)

I always start the SRNT conference by looking through the program booklet for all of the LGBTQ tobacco presentations, but this year someone beat me too it. Joseph Lee, a graduate student at University of North Carolina Chapel Hill, emailed all of the LGBTQ researchers on the first day of the conference suggesting that we have lunch together and attend each other’s sessions. We were told to look for the rainbow flag tablecloth at lunch today to find each other. We may have been only 15 out of 1,200+ researchers at the conference, but the quality of LGBTQ tobacco research being done is outstanding and we can network in a very individual and personal way. For example, during our lunch meeting we workshopped the projects we are working on such as developing cessation interventions for LGBTQ couples who both smoke, enhancing cultural competency at state quitlines and marketing these services to our communities and addressing cancer disparities. I left with great new connections, new research avenues, and a renewed passion to tackle tobacco in LGBTQ communities.

Jenna Wintemberg

Jenna Wintemberg, MPH is a Health Education and Promotion doctoral candidate at the University of Missouri and works as a Graduate Research Assistant on the Out, Proud and Healthy Project. Her research interests are Tobacco-Related Health Disparities in Minority Populations, Tobacco Cessation, and Policy Change.



Tobacco Policy

Missouri Coalition Pushes State to National Leadership on LGBT Health

Missouri might not top many LGBT people’s lists of great places to live, but after today you might want to rethink the charms of the Show Me State. For the last year a local coalition has been pushing adoption of LGBT-welcoming policies at hospitals. In this week’s release of HRC’s Healthcare Equality Index, Missouri zoomed from 37th in the country to sixth in the number of local LGBT leader hospitals.

We don’t see policy changes this quickly very often, especially when they require many companies to adopt new policies. What’s the secret to this unlikely success? A few years ago Missouri Foundation for Health funded a partnership with the local Equality Federation partner, PROMO, and SAGE Metro St. Louis. My project, LGBT HealthLink, was also brought on board to provide them with technical assistance. With funding and staff and policy expertise all in place, the Missouri team got down to business to see what they could change to affect LGBT health disparities in their state.

If you just look at the situation today, you’d think they immediately stumbled on the equivalent of oil and a match for policy change, but, like many good projects, they started slowly. First they mapped the policy environment; then they tried a few different strategies for change. One of the things they identified was a big gap: While most hospitals were required to have LGBT-nondiscrimination policies by the agency that accredits them, they could find little evidence of those policies by searching. And if we can’t find them, then patients couldn’t either.

For a while the PROMO staff played nice with the hospitals, trying to build relations and seeing how to move the changes gradually. Some hospitals did respond, but the work was crawling forward. Eventually, we switched to a different tactic, blanketing many hospitals with letters pointing out that these policies were required. Then, of course, the PROMO staff person, Andrew Shaughnessey, was there following up with multiple phone calls offering to help them with policy resources. The new strategy, which we’ve taken to calling the “terrier approach,” worked. Eventually even the hospitals that said they weren’t interested started to call Andrew back. And if they needed LGBT-cultural-competency training as part of the new policy changes, Sherrill Wayland from SAGE was ready to step in to set up in-person trainings at a moment’s notice.

The upshot of all of this work was that, while in 2013 seven hospitals had LGBT-nondiscrimination policies in place, now 31 do. While seven hospitals protected LGBT status in employment, now 30 do. While two had achieved Healthcare Equality Index leader status in 2013, now 19 have. Today several of those hospitals are putting out their own press releases lauding their LGBT-welcoming policies. It’s a far cry from 2013, and that means much better access to health for thousands of LGBT people in Missouri.

What I want to see now is this amazing level of success replicated. I’ve worked in policy change for a very long time, and trust me, a model to change policies this fast comes extremely rarely. While they had a funder in Missouri giving them the time to experiment with different strategies, any other community center or equality organization in another state can take advantage of that work and just do what worked for them. Nicely, the PROMO team has documented their steps really clearly in the LGBT HealthLink blog. See the first post about it here.

Kudos to everyone in Missouri. From the amazing staff team at PROMO and at SAGE to Missouri Foundation for Health, who cared enough to invest, and the many hospital systems who jumped on board, this is an amazing job by all, and it’ll really affect the health of the LGBT communities in your state.

Now who else wants to do it for their states?

LGBT Policy · Show Me MO · Technical Assistance · Updates

Missouri Case Study 10 – Making LGBT Health Matter in Missouri Hospitals

Andrew Shaughnessy, Manager of Public Policy for PROMO

Andrew Shaughnessy
Manager of Public Policy, PROMO Missouri

This year has proven to be a monumental year for LGBT Missourians. Those monumental steps have been the recognition of out-of-state marriages by the State of Missouri, and the leadership of nearly 47 Missouri hospitals, who have included 105 new LGBT welcoming policies to their core values. As an LGBT Missourian it certainly gives me relief to know that I can access health care facilities and be me: my authentic self.

In 2013, only two Missouri Hospitals, Children’s Mercy in Kansas City and the VA in St. Louis, qualified as leaders in the Human Rights Campaign Care Equality Index (HEI). In the coming days the health sector will see the launch of the 2014 HEI, where several of Missouri’s top hospitals have been reviewed on their lesbian, gay, bisexual and transgender (LGBT) welcoming policies.  This year, Missouri will see several hospitals both in rural and urban areas that have been working to ensure their facilities are welcoming to all.

To learn more about the policies of Missouri Hospitals, click here for a map detailing their LGBT welcoming policies.

We have truly made LGBT health matter among Missouri’s top hospitals, but the work of the LGBT health policy project does not stop there. Through the technical assistance of Dr. Scout, Director of LGBT HealthLink, we will continue to work with health and social services organizations in Missouri to ensure that we are creating spaces free from discrimination. Through our collaboration with Sherrill Wayland, Executive Director of SAGE Metro St. Louis, we will be training Missouri’s health and social service professionals to understand the unique needs of LGBT patients.  And we will continue to advocate for the health of LGBT families and our families of choice.

As we begin to look at the legal future for the LGBT community, we must be concerned with the growing disparities we find in LGBT health. Our next frontier is on the borders of health and making sure that we are a strong and healthy community. I’m humbled to be a part of this work. Having experienced discrimination in a health care setting myself, I assure you your voice is not going unheard.


Huffington Post LGBT Wellness

LGBT Wellness Roundup: October 5

As published on Huffington Post’s new LGBT Wellness blog, see original at: http://ow.ly/DhVNO

Each week HuffPost Gay Voices, in a partnership with bloggers Liz Margolies and Scout, brings you a round up of some of the biggest LGBT wellness stories from the past seven days. For more LGBT Wellness, visit our page dedicated to the topic here. The weekly LGBT Wellness Roundup can also now be experienced as a video — check it out above.

Conferences · Feature · Philly Trans health conference

Revolutionary: Asking the Hard Questions

Pride Center Staff Photo



Bishop S.F. Makalani-Mahee

Minister. Performing Artist. Community Organizer




One of the blessings I receive from attending conferences such as Philly Trans Health is the intentional creation of space for dialogue, dialogue  that not shares experience, strength, and hope; but dialogue that challenges our thoughts, assumptions, and bias.  Here the keynotes addresses serve as family gathering/meeting where we affirm one another and remind each other we are not alone; discuss how to function more healthily as a family, and we can hold  each other accountable in love.

I was sitting in a workshop where a trans woman of color was cautioning us to have the conversations that shines a light on our shame so that our youth know we haven’t always been who we are today, and there were times when we made choices (for whatever the reason maybe) that we were not always proud of.  However, we realize that we don’t have to carry the shame of those choices with us for the rest of our lives.   When we engage each other in conversations, and ask each other the hard questions we create a space of truth, trust, respect, and non-judgment.

I left that session asking myself  “Where am I not being honest, about owning my own shame based experiences?” This was a hard question that I would not have been able to ask myself had there not been the intentional creation of the space to have conversations that ask the hard questions, and the strength, boldness, and courage of people to show up and share their shame  spoken in truth that becomes warrior marks and the bridges to our destiny.

I also feel that these conversations and asking the hard questions provide a lifeline for those of us who live in places where there is not large trans communities, or visible people of color communities, or resources for them; and as such there is not an ongoing dialogue that addresses living in a world impacted by micro-aggression, and confronting an oppressive white supremacist –capitalist-patriarchy that doesn’t want us to engage with or empower each other; which really makes me think that having conversation and asking the hard questions may be one of the most revolutionary things we can do.


Continue To Walk In The Light, Redefine Your Faith, and Remember It’s All The Rhythm.




Missouri Case Study 3: The Hospital That Wants To Stay In the Closet

Tracey PROMOTracy McCreery
Manager of Public Policy, PROMO
The Closeted Hospital Lobby
The Closeted Hospital Lobby

A targeted hospital, when we researched online, was discovered to have what appeared to be a perfect score on the Human Rights Campaign (HRC) Healthcare Equality Index (HEI). How exciting, right? Now I just needed to find someone inside to complete the survey. I didn’t know anyone on the management team, but from my days in the legislature I’d met and worked with the hospital’s lobbyist. He had some checking to do and what he reported to me was a bit shocking but maybe not really surprising, this is Missouri after all. This hospital did not want anyone to know about their policies and so were not going to complete the survey.  No explanation was given so I can only speculate. Are they worried about anti-LGBT protesters outside their hospital? Obviously, executives at the highest level think it is important to have policies that are friendly to both LGBT patients and employees. But until those policies are promoted to patients they won’t really create any change. Our job in the next year will be to convince them that the public supports workplace fairness and an LGBT patient’s right to health care free from discrimination.

People need to know this information, so why am I being mysterious?  Because I prefer the carrot (versus the stick) approach.  I will be working with this hospital to encourage them to complete the 2014 HRC HEI.  I’m hopeful they will do it willingly this year.  Why?  Because if they don’t, HRC is going to include this hospital in the HEI 2014 anyway.  HRC staff will evaluate them vis-a-vis the Core Four criteria for LGBT patient-centered care even if they choose not to actively participate.


Missouri Case Study 2: The Nurse Who Changed A Whole Hospital System

Icon_2011 Headshot
Sherrill Wayland
ED, SAGE of Metro St. Louis
Cochran VA
John Cochran VA Medical Center

In 2011, when “Don’t Ask, Don’t Tell’ was repealed, the Veterans Health Administration (VA) looked at ways to optimize healthcare for LGBT veterans. The VA medical centers were encouraged to participate in the HEI.  In the past, SAGE has consulted with local Veterans receiving care at the VA and helped them navigate the system. We reached out to VA and invited them to be a part of our LGBT Health Access Roundtable.

Sometimes all it takes is one person to champion a cause.  The nurse in charge of the VA LGBT Diversity Council learned of the trainings being conducted by SAGE and invited us to join the VA LGBT Diversity Council.  This Council interacts with all levels of the VA to help ensure that the local VA is meeting all requirements set forth at the federal level to ensure LGBT health access.

A critical change was recognizing that LGBT patients may have concerns related to fair treatment and access. The VA created an LGBT liaison who is available to help LGBT patients navigate the system and request a new doctor if they are not comfortable with the care being received. Over the past year, the work at the VA in St. Louis has grown to include a robust offering of LGBT Health Cultural Competency Trainings provided by VA employees and SAGE. We are currently in the process of developing a schedule of trainings for SAGE to present on a monthly basis.

SAGE recognized the VA with the first SAGE excellence in community care award at our 5th Anniversary celebration.  SAGE presented them with a plaque and asked all Veterans in the audience to step forward so the VA could see those impacted by LGBT care.

2014 is shaping up to be another good year for the VA.  They’re making plans to attend their 2nd Pride Festival, continuing to identify things they can do  to be more LGBT inclusive, and are offering ongoing LGBT health trainings.


Missouri Case Study 1: The Almost-There Hospital

Barnes-Jewish Hospital in St. Louis
Barnes-Jewish Hospital in St. Louis

Tracey PROMOTracy McCreery

Manager of Public Policy, PROMO

Barnes-Jewish Hospital (BJH) was the single Missouri entity that filled out the Human Rights Campaign (HRC) Healthcare Equality Index (HEI) the year before. But according to the HEI, they only had two protections out of 7, yet when we looked online, we could find evidence of 5 protections out of 7. But before we go further, let me explain the seven different HEI components for 2012 (they added one more in 2013).

Healthcare Equality Index from Human Rights Campaign

1a. Patient Bill of Rights and/or nondiscrimination policy includes “sexual orientation”?

1b. Ditto “gender identity”?

1c. [added in 2013] Nondiscrimination is conveyed to patients in at least two accessible ways?

2a  Explicitly inclusive visitation for same-sex couples?

2b. Ditto same-sex parents?

3a. Equal employment opportunity policy includes “sexual orientation”?

3b. Ditto “gender identity”?

4.   Provide cultural competency training?

Luckily BJH has an office on diversity, inclusion and equity- so since the new HEI survey was open, we started calling this office to see who could fill it out, and hopefully add the additional protections we found online in the mix too. The process took longer than we’d thought. We found a liaison in the office who could fill out the HEI survey, but HRC reported that they’d filled out the same responses as the year before (thanks Shane!). It took several meetings and a series of calls, and even then, the HEI deadline almost passed and they still hadn’t entered their updates. To make things even more complicated, we were looking up protections assured by their parent company, BJC HealthCare, which had a great LGBT nondiscrimination policy which initially appeared to apply to all subsidiaries… but after meeting with Barnes-Jewish Hospital — they said it did not apply. (And to make things even more complicated, now the page with the parent corporation protections has been taken down. ← were we imagining it?)

Eventually our persistence paid off and BJH filled out the survey reporting five of the now eight categories as yes. They might have been a different five than we first thought, but the point was now one hospital system in the St. Louis region was firmly establishing itself as a leader among the pack for LGBT protections!

But at the same time PROMO was working with BJH, a private hospital, SAGE was working diligently with the largest public healthcare system in the area, Cochran VA Medical Center. Read more about that journey in our next case study.

Netroots Nation · social media

Announcing: Network Restarts at CenterLink – The Community of LGBT Centers


Scout, Ph.D.
Director, CenterLink’s Network for LGBT Health Equity

We are more than pleased to be announcing the following news right now!



CenterLink Awarded New Five-Year CDC Grant

Becomes New Home for The Network for LGBT Health Equity

Ft. Lauderdale, FL – October 28, 2013 – CenterLink: The Community of LGBT Centers today announced that The Network for LGBT Health Equity has joined CenterLink and will become an official program of the organization.

“We are thrilled to have The Network for LGBT Health Equity joining CenterLink,” said Terry Stone, Executive Director of CenterLink.  “The work that Scout and his staff have done over the past eight years in creating healthier LGBT communities is so impressive, and we have high expectations that by using our organizations’ shared strengths we can provide even more focus on LGBT health through community centers across the country.”

Funding for The Network comes from a new five year $3M cooperative agreement from the United States Centers for Disease Control and Prevention (CDC) for operation of the LGBT tobacco & cancer disparity network. “We look forward to continuing to work with the CDC to ensure that all of the state departments of health they fund have access to the latest best practices in LGBT wellness,” said Dr. Scout, Director of the Network for LGBT Health Equity at CenterLink.

All operations will be headquartered in CenterLink’s offices in Ft. Lauderdale, FL, with remote staff on the east and west coasts.  This union broadens CenterLink’s service lines for LGBT community center leaders, including health and wellness information resources, access to LGBT cultural competency training for state health departments and policymakers, and access to health advocacy resources.

The Network will continue to partner with The Fenway Institute, its former organizational home. “We look forward to continuing our work with The Network for LGBT Health Equity and helping to identify and end health disparities for the communities we serve,” said Dr. Judy Bradford, co-chair of The Fenway Institute. As part of a new focus on cancer, the Network will also be starting a major new partnership with the National LGBT Cancer Network.

“The Network’s business has always been linking people with information. That includes providing information to organizations around the country about taking care of our health, especially the role of tobacco and healthy living in eliminating our cancer & other health disparities” said Dr. Scout.  “We’ve had such a productive relationship with CenterLink over the years, and as we focus more on changing community norms about wellness it became clear — becoming an official part of CenterLink will let us have more impact than ever before.”

The Network’s move to CenterLink comes at a time when the federal Department of Health and Human Services has pledged to continue its work to ensure equal treatment for members of the LGBT community. The Department continues to implement changes reflective of the June Supreme Court ruling that invalidated Section 3 of the Defense of Marriage Act (DOMA). Additionally, HHS is continuing outreach to the LGBT community to ensure they are aware of new consumer protections under the Affordable Care Act – including a ban on health insurance companies’ ability to deny or limit coverage because of sexual orientation or gender identity – starting in 2014.

# # #


CenterLink was founded in 1994 as a member-based coalition to support the development of strong, sustainable LGBT community centers.  Serving over 200 LGBT community centers across the country in 46 states and the District of Columbia, as well as centers in Canada, Israel, Mexico, China, Italy and Australia, the organization plays an important role in supporting the growth of LGBT centers and addressing the challenges they face, by helping them to improve their organizational and service delivery capacity and increase access to public resources. (www.lgbtcenters.org)

The Network for LGBT Health Equity is a community-driven network of advocates and professionals looking to enhance LGBT health by eliminating tobacco use, and reducing cancer risk through enhancing diet and exercise. The Network, one of six CDC-funded tobacco and cancer disparity networks, directly trains state health departments and other policymakers in LGBT cultural competency and forges bridges between those agencies and local LGBT health specialists. The Network also actively monitors national and state health policymakers and urges community action when there is an opportunity to enhance LGBT wellness. (www.lgbthealthequity.org)