The LGBTQIA+ community is at greater risk for health disparities in the United States than many other demographics. The result of this can manifest in poor health outcomes related to physical and mental health, access to qualified medical providers, and preventative medicine. Promoting improved health outcomes through the provision of culturally competent care is critical to closing the LGBTQIA+ health disparity gap.
Dr. Brian Masciadrelli is a dual-licensed clinical social worker with almost two decades of experience in human development, therapy, and academic instruction. Dr. Masciadrelli, one of Premiere’s expert course creators, developed Anti-Discriminatory Practice as Cultural Competence with LGBTQIA+ Patient Populations, a course offering insight for all healthcare professionals into the detrimental impact discrimination and stigmatization has on the LGBTQIA+ community.
Premiere: Tell us about your background and your work with Premiere.
Brian: For 15 years I was a professor in a traditional academic job for an undergraduate social work program, and spent 13 of those years as either program director or department chair. I had taken a course for one of my licenses through Premiere for child abuse reporting, and decided to apply for a position.
Premiere: What kind of content have you focused on in your role?
Brian: I specialize in LGBTQIA+ content. It became a focus early in my career early on when I became familiar with Erik Erikson’s theory of human development, which is both a human development theory and a psychoanalytic theory in ego psychology. I wrote my dissertation on the achievement of generativity in the lives of non-metropolitan lesbian women and gay men living in downstate Illinois.
Premiere: How would you define generativity?
Brian: In the Eriksonian model, it’s the act of establishing and guiding the next generation, and it goes far beyond just being a parent and raising children. Generative activities include helping any group of people live in and experience a better world.
For instance, if you are an environmentalist, pursuing environmental causes and helping the next generation understand and appreciate how caring for the planet can make their lives better and more fulfilling is a generative act.
Premiere: How does generativity tie into the content you create for Premiere?
Brian: My courses are directed toward a broad range of healthcare providers, whether they are social workers or in nursing or dentistry, and a lot of it deals with how you’re engaging. It’s particularly important in those fields because, in both healthcare and generativity, the virtue is care.
Caring for someone else means you’re not just telling them the answer to their problems is to be like you. That’s the narcissistic trap according to Erikson. Rather, you have to meet them where they are, understand their experience of the world, and then guide them to better outcomes through that lens.
This is of particular concern when you’re attempting to address health disparities that exist within particular subsets of the population. Discomfort and distrust that arise because of cultural, social, political, institutional, and spiritual dissonance between patients and providers can result in a community being reluctant or unwilling to engage with the care they need. The end result is worse health outcomes.
The fact is, from a generativity perspective there’s no difference between a person who can’t get care and a patient who won’t seek it because of a bad experience. The outcome is the same, and it’s the opposite of what anyone in healthcare is trying to achieve.
By developing a more nuanced, inclusive approach to care, doctors and nurses can meet their generative goals by providing better health outcomes for more people.
Premiere: When it comes to a member of the LGBTQIA+ community seeking healthcare, what makes an experience go right or wrong?
Brian: When a person initially presents to a healthcare worker, they don’t necessarily know how that patient identifies; you can’t just look at them through the lens of your own socialization and assume they must fit the mold. It’s better to engage from a point of curiosity, which can include things like using the name they give you rather than repeating what’s on their ID or chart.
There are many other examples, and meeting them where they are rather than making assumptions and judgements can have immediate and severe consequences in a healthcare environment. For example, it might not matter that much in a care-recipient sense if someone at the DMV misgenders a trans person, but patients have to be comfortable with extremely intimate and vulnerable interactions with healthcare workers who are often perfect strangers. If they don’t trust a doctor to treat them like a human being, why would they trust them to treat their human body? They’ll walk out and never come back no matter how sick they are, and that’s where health disparities begin.
Everyone understands that intuitively, and creating a welcoming, open, and informed environment is at the core of providing optimal healthcare services.
Premiere: What have you enjoyed about your time with Premiere?
Brian: Premiere has been an exceptionally supportive environment. They really care about creating a positive culture, and that energy translates into creating courses that make a positive difference in people’s lives.
It’s also a very satisfying part of my professional life. Premiere gives me an opportunity to research and explore topics that will empower professionals to improve outcomes for themselves and for their patients, so the experience is rewarding front to back. I’ve liked two things in my adult working life: one is therapy, and the other is teaching. Premiere allows me to do both.