Creating an atmosphere of inclusion and acceptance for all people coming to an organization for help begins with the core values of that agency. Here, at ICL, we believe in and offer person-centered, recovery-oriented, trauma-informed, and integrated physical and behavioral healthcare. No matter a person’s history or circumstances, their story and their goals are important and listened to. When someone first comes to an ICL program, she or he is interviewed by a clinician during the intake process. The setting and the person conducting the interview are crucial components in this process. Is the physical environment fluid and diverse, or are reinforcements of heterosexism and gender-conforming norms the only things on display? Is the person asking me if I have a girlfriend or am I being asked about a partner? These are simple things we often take for granted but are factors that can create a safe space, if done right.
When “Danny” arrived at our downtown residence, he stated it felt like home. Not an easy task considering the place is eight stories high and accommodates well over 100 people. During his initial interview, he was made to feel comfortable. He was soon talking about the years of trauma he had suffered and he felt safe enough to disclose his sexual orientation as a gay man. Based on his story, the director assigned him to a Recovery Guide (formerly known as a case manager) she felt he could connect with the most. The Recovery Guide was around Danny’s age and was familiar with strength-based language. This helped Danny to feel that he was being put first, that his concerns and feelings would not be minimized. Positive, person-first language enabled Danny to not feel further stigmatized by his mental health diagnosis or his sexual orientation, even though both tended to set him apart from the “norm” of society.
His Recovery Guide continued to build a relationship with Danny. When exploring potential new treatment/social service providers, Danny requested an LGBTQ affirmative program. Fortunately, there was a nearby clubhouse, which offered support and advocacy for LGBTQ persons. Danny began to attend, which further improved his self-esteem and comfort level. The importance of being around others who understand your background and the experiences that help form you has been proven time and again to be of utmost importance in the recovery and acceptance process.
Eventually, Danny opened up even more and informed his residential Recovery Guide that he had a secret, which she encouraged him to share with her. Danny disclosed that he had been taking women’s clothing to the LGBTQ club and changing into them when he arrived. “Pam,” his Recovery Guide, responded in a neutral, nonjudgmental way, encouraging him to open up even more and explore what he was feeling. Taking an interdisciplinary approach, she asked Danny to share his secret with the rest of his residential team (program director, nurse, counselors, cook, etc.) so that everyone involved in Danny’s recovery would be on the same page and understand his thought processes. She also did her best to normalize what he was disclosing and so Danny was able to share more details and goals. Ultimately, Danny revealed that his true desire was that he wanted to transition and become “Wendy.” Pam showed genuine excitement and interest in assisting any way she could.
The road to Danny’s transition was smooth but didn’t happen overnight. Staff competencies were continually assessed during staff meetings, individual and group supervisions, as well as clinical trainings. Staff were also taught about the differences between one’s sexual orientation, their sex, and their gender. This was new to a lot of people. Staff showed great flexibility and person-centered care by using the proper pronouns and names that were preferred by Wendy. During the initial phase of the transition, when Danny was living at our downtown residence, Danny would fluctuate between wanting to be seen as Danny and wanting to be seen as Wendy. Staff took the time to recognize whether he was presenting as Danny or as Wendy and would address him accordingly in order to convey the utmost respect. And of course, when mistakes were made, Danny was understanding because of the relationship staff had built with him.
As Wendy became more present, staff had to constantly assess the residence as a whole to ensure that Wendy could self-actualize while remaining safe. This involved psychoeducation and celebrations around diversity as well as speaking to key informants within the residential community. Collaboration was ongoing with Wendy’s treatment providers and everyone worked together to help Wendy appear as she saw herself. How well a person can pass for the gender they identify with most can help overcome some of the barriers and discrimination felt in the broader community. It also increases safety.
Wendy is now ready for Supported Housing and is currently exploring different roommate options. In an effort to continue to be inclusive, staff are not limiting Wendy’s options. Wendy has recently identified a male friend she would like to room with and staff are working with her treatment providers to make it happen.
In residential settings, it is crucial for staff to be understanding of all the emotions residents go through as well as the traumas they’ve experienced, which can be overwhelming, both physically and emotionally. Residences must serve as safe spaces for all persons regardless of diagnoses or histories.
How is that accomplished? As we’ve seen in Wendy’s story, it happens through a mixture of engagement, inclusion, and relationship building. These aspects can be particularly sensitive when it comes to the LGBTQ community. There needs to be a level of acceptance and tolerance within both staff and fellow residents. Staff must face their own internal biases and learn how to work around them and grow from them. They must also be open to reaching out for help from others who might be more familiar with a particular area of concern.
Staff also works in partnership with each individual when and if s/he might be ready to reconnect with family. Many times, an individual might have been rejected or abandoned by their family because of his or her sexual orientation, making that person distrustful of sharing their true selves with other people.
Individuals may have long histories of trauma that include familial abuse and/or rejection. In working with individuals, staff creates a safe space where people can feel free to express their true selves. In essence, staff becomes like a family, creating an inclusive space for individuals to re-create the family experience and perhaps learn safe ways to approach and mend their pasts, if desired. Staff becomes the containers of each individual’s emotional distress, empowering them as they decide what emotions they want to face.
A collaborative approach to care ensures that everyone involved in a person’s recovery plan is supportive of that individual’s goals and path to achievement.