VA Maryland Health Care System
Improving the VA Experience for LGBT Veterans
On the surface, it's about bathrooms. In reality, it's about more than bathrooms. It's about discomfort, uneasiness, and fear juxtaposed against a strong, unrelenting human drive to be one's true self. Just ask Jovan Bess, a Marine Veteran, a longtime government employee, a transgender man at the beginning of his transitioning process, and a VA Maryland Health Care System employee. "The one issue that keeps coming up among my coworkers, the one question that I'm repeatedly asked about is what bathroom I intend to use," he said. "The question doesn't surprise me, but it's a matter of allowing me to be who I am without the question."
Bess is not alone. An estimated one million Veterans identify as Lesbian, Gay, Bisexual or Transgender (LGBT). The VA is committed to providing high quality care to all Veterans, including LGBT Veterans. Because the LGBT population has historically experienced social stigma and discrimination that have contributed to health disparities in terms of access, engagement and quality of care, the VA established LGBT Veteran Care Coordinators at all VA medical centers throughout the country to meet the unique needs of this Veteran population. At the VA Maryland Health Care System, Jillian Silveira serves as the LGBT Veteran Care Coordinator.
In this role, Silveira is charged with educating the health care system's clinicians and administrative staff about how to deliver culturally-competent care to LGBT Veterans. She is also responsible for conducting outreach to local LGBT Veterans who are not enrolled for VA health care because they are unaware of the cultural shift throughout the organization. By establishing a formal point of contact for LGBT Veterans, they can find support when issues arise as patients and/or as employee because there is a collaborative working relationship between the coordinator and the Equal Employee and Opportunity (EEO) office to resolve concerns and take corrective action as necessary. As the LGBT Veteran Care Coordinator, Silveira also serves a Veteran advocate for LGBT related health care issues throughout the VA Maryland Health Care System.
"In the past," Silveira said, "some Lesbian, Gay, Bi-Sexual, and Transgender Veterans simply did not seek VA health care because they felt unwelcomed at VA facilities due to the level of discomfort and misunderstanding. I'm here to engage Veterans who are part of the LGBT community but who are not yet receiving health care at the VA to educate them about the programs and services available to meet their special needs."
VA's mission is to deliver patient-centered health care to all eligible military Veterans, regardless of their sexual orientation or gender identity. "With LGBT rights awareness growing, the VA is keeping pace," said Silveira, whose goals as the LGBT Veteran Care Coordinator include educating staff about fostering a welcoming and inclusive environment.
"We're not here to change anyone's personal belief system or religious views," said Silveira. "My role is to educate staff that regardless of their personal beliefs we are all here to deliver safe, compassionate and quality care to all Veterans, including the LGBT Veteran population."
LBGT Veterans can suffer an increased risk for high levels of stress that can increase the potential for certain mental and physical health conditions. "This can be exacerbated when they encounter people or policies that are insensitive to their unique needs and that can create barriers to accessing health care," Silveira added. As a result, her top priorities include simple lessons that promote a welcoming environment for LGBT Veterans and employees. Silveira provides guidance and education to clinicians about unique LGBT health issues and best practices. She says that a welcoming environment means that employees use the proper pronouns and preferred names when interacting with LGBT Veterans and coworkers. It also recognizes that family structures can be diverse and non-traditional, and that equal visitation rights allow any person the patient chooses, including same-sex partners, to be present during an inpatient stay.
Silveira has already begun reaching out to community-based organizations and service providers to network and connect with Veterans who identify as LGBT, but who are not accessing VA health care. "I've provided information to help educate community partners about the unique health risks and relevant services offered to LGBT Veterans at the VA Maryland Health Care System," she said.
In the next few months, Silveira will be working with clinical and administrative leaders to advance staff education. In addition, she will also help to plan LGBT observances, such as Pride Month, LBGT Health Awareness Week, and Transgender Awareness Month, among other activities.
As a Veteran and an employee, Bess agrees and feels hopeful about the future of the VA enhancing connections with the LGBT Veteran community thanks in part to the LGBT Veteran Care Coordinator positions.
The VA Maryland Health Care System has been on the forefront of providing LGBT Veterans with culturally-competent patient care. In 2013, the Human Rights Campaign (HRC) Foundation, the educational arm of the country's largest LGBT civil rights organization, named the Baltimore VA Medical Center as one of eight facilities in Maryland that is leading in delivering explicit LGBT-inclusive care in a survey of 309 different hospitals, community health centers and VA medical centers.
This distinction will make Silveira's outreach to LGBT Veterans a lot easier and gives Veterans and employees something to be proud of.