Excerpted from Chapter 2 of Improving Emotional and Behavioral Outcomes for *LGBT Youth, edited by Sylvia K. Fisher, Ph.D., Jeffrey M. Poirier, M.A., PMP, *& Gary M. Blau, Ph.D. Copyright© 2012 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

## Providing Culturally and Linguistically Competent Services and Supports to

## Address the Needs of LGBT Youth and Their Families

Cultural and linguistic competence (CLC) is a core principle for enhancing policy and practice within mental health services organizations and communities. CLC provides a conceptual framework for systems, agencies, and practitioners to develop their capacity to effectively respond to the preferences, needs, and identities of youth from diverse cultures. For lesbian, gay, bisexual, and transgender (LGBT) youth, CLC provides a rationale and framework for examining and improving organizational policies, structures, procedures, practices, behaviors, and attitudes toward LGBT youth in youth-serving systems. This chapter applies CLC to LGBT cultures in a manner similar to other recent literature (e.g., Planned Parenthood Mid-Hudson Valley, Inc., et al., 2007; Poirier et al., 2008) to help ensure that LGBT youth receive culturally and linguistically appropriate services and supports in systems of care. Services and supports that are not culturally and linguistically competent are apt to be less responsive, not fully inclusive, and perhaps less efficacious than services and supports that are. Throughout this book a CLC lens is used to discuss and integrate strategies that can help ensure that youth-serving systems become more responsive to the multifaceted cultural identities of LGBT youth. Furthermore, CLC should be one basis for continuous quality improvement (CQI) and research efforts related to this population in systems of care. This chapter briefly reviews the evolution of CLC, including emphasis on cultural responsiveness, and related key literature and its growing application to mental health services and supports. The chapter discusses the implications of CLC for providing effective, appropriate services and supports, and presents recommended strategies and practices. It also shares community examples, including two in-depth descriptions of how systems of care in Michigan and Minnesota have worked to enhance CLC and improve supports and services for LGBT youth in their communities.

## WHAT IS CULTURAL AND LINGUISTIC COMPETENCE?

*Culture has many definitions, which reflects the diversity of culture itself. It can* be defined as learned and shared knowledge, as well as patterns of human behavior such as communication styles, customs, and values (Cross, Bazron, Dennis, & Isaacs, 1989). Culture is complex, dynamic, and shapes our views of the world and our communities. Culture includes our beliefs and how these influence our behaviors, as well as how we interpret our experiences and interact with others and our social environments. Furthermore, cultures can and do evolve (as is true with LGBT cultures). Culture has multiple influences: the various contexts within which we live (ecology), important people and communities in our lives and in society, and what we learn. Together, these shape our values, beliefs, traditions, roles, and rituals, as well as our biases and prejudices, which are part of each person's cultural roots. Culture deeply affects our perspectives, interpretations, and experiences. Although some systems of care may use the term culture interchangeably with race/ethnicity (Goode & Jackson, 2005), it is important to acknowledge the broader scope of culture, including LGBT cultural identities, among others. *Competence pertains to individual, organizational, and system capacity to* effectively address individual preferences and needs. Specific knowledge, skills, behaviors, and experience are needed to build this capacity and implement effective policies, procedures, practices, and CQI efforts (National Association of Social Workers [NASW], 2001). To be competent, individuals need sufficient proficiency of a particular topic. Many professions (e.g., social workers) require certifications to demonstrate competence, but competence is a minimum standard. Developing competence is a lifelong learning process that requires a unique path for each individual, a personal commitment to growth, and openness to diversity. CLC self-assessments can facilitate personal reflection about one's level of competence related to particular groups or topics. They are short surveys that ask an individual to respond honestly to a series of questions about self-perceived prejudice, discrimination, stereotypes, and other related biases (see Chapter 3). Historically, culture and competence were not usually linked. During the last 20 years, however, the health and behavioral health care fields, in particular, have linked these concepts, including in a landmark monograph (i.e., Cross et al., 1989). Cultural competence involves valuing the worth of individuals, families, and communities and is a process through which individuals, organizations, and systems effectively and respectfully interact with and support others from all cultural backgrounds (NASW, 2001). NASW (2001), for example, issued 10 standards for cultural competence in social work, including self-awareness of one's values and beliefs, as well as development and application of cross-cultural knowledge and skills. In addition, cultural competence has evolved over time to include concerns related to language and communication.

## WHY A CULTURAL AND LINGUISTIC COMPETENCE STRATEGY FOR

## LGBT YOUTH AND THEIR FAMILIES?

Systems of care initially focused on children and families of color who were "un- served, underserved or inappropriately served" by most behavioral health delivery systems (Isaacs, 1998, p. 9). Resonating throughout this book, though, are the many challenges that LGBT youth may experience, often at disproportionately greater rates compared with non-LGBT youth (e.g., depression/anxiety, suicidal ideation, homelessness, harassment/assault). To address these behavioral health disparities and challenges, professionals in youth-serving systems should work to enhance their CLC efforts for LGBT youth and their families. This requires a cohesive strategy for providing more culturally and linguistically responsive services and supports through organizational change and work force development. A CLC strategy can help to address barriers to accessing and appropriately utilizing care, including inadequate provider knowledge and stigma. Inadequate knowledge of providers, regardless of their attitudes, and insufficient training contribute to structural barriers to culturally responsive services and supports at institutional levels (Institute of Medicine [IOM], 2011).

## LGBT YOUTH CULTURE

Although individuals may have a personal definition of self, others, including the systems and professionals with which they interact, also have preconceived notions about groups of individuals that may be quite divergent. Discrepancy and divergence between self and others may lead to stereotyping, bias, prejudice, and discrimination. Youth may identify with any of a host of cultural identities, including youth culture or their own ethnic, racial, religious/spiritual, or LGBT culture. These multiple overlapping identities that many youth experience can both enrich and sometimes complicate youth development, depending on the presence or absence of supportive families, peers, or other allies. The "jagged edges" around these overlapping identities can present challenges to youth as they attempt to reconcile aspects of their identities that do not complement each other as a result of nonacceptance by significant others or an inability to successfully integrate these identities in a way that benefits youth as they achieve developmental competencies. Historical or current trauma may also affect the development and health of youth navigating their LGBT identity. Progressing through this delicate and formative period in youths' lives can be challenging, but effective efforts to foster CLC for these youth and their families can provide opportunities for successful integration or, at least, a satisfactory conjunction of these identities that can support and strengthen youth and their families. LGBT youth are especially vulnerable to societal and dominant culture biases that may judge, discount, and stigmatize them, but CLC can play a central role in helping youth successfully integrate the strengths of their multifaceted identities into a stronger and integrated whole.

## INCREASING CULTURAL AND LINGUISTIC COMPETENCE WITHIN ORGANIZATIONS

Because of the stigma related to LGBT identity and marginalization of youth with mental, behavioral, and emotional health needs, communities should carry out specific CLC strategies to support LGBT youth. For organizations to develop their CLC capacity, they should 1) value diversity; 2) engage in cultural and linguistic self-assessment; 3) address dynamics of difference (e.g., by acknowledging the effects of historical experiences among different populations due to trauma or discrimination); 4) institutionalize cultural knowledge; and 5) adapt to diversity by making the appropriate policy, hiring, program, training, coaching, evaluation, and other infrastructure changes. Organizations should sustain their CLC efforts so that they become a part of daily operations and organizational culture.

## STRATEGIES TO MOVE CULTURAL AND LINGUISTIC COMPETENCE FORWARD IN YOUR COMMUNITY

CLC activities can be challenging, and related results have tended to be disappointing in systems of care (Isaacs, Jackson, Hicks, & Wang, 2008). Strategies presented throughout this book and the following key recommendations, however, can help advance the effective implementation of CLC approaches within systems of care. In particular, although LGBT culture is as heterogeneous as other diverse cultures, it is important to be as knowledgeable as possible about LGBT cultures through training, technical assistance, and culturally appropriate inquiry of those who have knowledge and experience. Professionals supporting LGBT youth do not need to be LGBT themselves (although it may help), but they need to be open to learning, engage in an authentic self-assessment process, and be able to speak as an authentic ally of LGBT youth. Insensitive, biased systems can frustrate LGBT youth trying to access mental health services and affect the quality of these supports. As system of care professionals improve their CLC for LGBT youth and their families, they will actively address heterosexism and transgender bias. Communities can frame bias and stigma as conditions to be ameliorated through active interventions. Conditions can improve over time as system of care staff and constituencies develop more culturally and linguistically competent attitudes, enhance their knowledge base, and expand their experience with LGBT youth and their families. Communities can then identify constructive steps to address these needs and improve individual and organizational competence.

## Assess Strengths and Needs

Individual and organizational assessments are another important strategy for moving CLC forward in systems of care. The information gathered from these assessments can inform strategic planning (e.g., development of CLC plans), decision making (e.g., service delivery), and, among individuals, a deeper awareness of their personal commitment and ability to meet the needs of LGBT youth and their families.

## Develop, Support, and Implement an Inclusive Cultural and Linguistic Competence Plan

Some system of care communities have struggled to establish responsibility and accountability among much-needed stakeholder groups, particularly for LGBT populations. A community's CLC plan, which should include LGBT youth as a priority population, is an important tool for communities to guide CLC development and implementation. For those engaged in the process, the CLC plan can help raise awareness, create a sense of urgency for action, and manage progress. For example, most state child-serving systems, such as juvenile justice, are mandated to address disparities that exist in their systems, and these efforts should include disparities encountered by LGBT youth and their families. It is important to develop a CLC plan, supported by a CLC committee that provides meaningful infrastructure and serves as a community leadership group, while clearly documenting a community's vision, mission, and goals. A focus on LGBT, questioning, intersex, and two-spirit youth should be part of the broader organizational CLC plan.

## Provide Safe, Welcoming Environments

It is critical to foster and sustain a safe, welcoming environment for LGBT youth and their families. This recommendation cannot be overstated—the implementation of nondiscrimination policies, procedures, and practices is just one approach to fostering a safe, supportive environment. Maintaining a physical environment that promotes safety and security for these youth and families is also important.