Research Project
10488482
Project Summary: In the US, sexual and gender minority (SGM) older adults are disproportionately vulnerable on a number of health indicators and more likely to rely on long-term services and supports (LTSS) than their cisgender, heterosexual peers. SGM older adults share a common set of concerns and needs when using LTSS. Without training in culturally competent care of the LTSS workforce, SGM clients are vulnerable to receiving inappropriate and/or inferior care contributing to poorer quality of life and health outcomes. To address this, some states have recently mandated training of the LTSS workforce in the culturally competent care of SGM older adults. There are two major barriers to this approach being successful. First, we lack research on LTSS policies governing SGM care (in states where cultural care training is not mandated), which would inform whether state legislation is needed. Second, there are no scalable, sustainable, evidence-based training programs to train the LTSS workforce in SGM culturally-competent care. This application is focused on the Training to Serve curriculum which has trained over 12,000 LTSS workers in 12 states. This acceptable, feasible, and promising curriculum employs a multilevel approach to train management and frontline LTSS staff in SGM culturally competent care. But it has not been rigorously evaluated. This mixed methods study has three specific aims. In Aim 1, we will conduct a comprehensive policy analysis of 362 nursing homes and 362 assisted living facilities in Minnesota. Primary outcomes include the number and proportion of agencies in each setting which have explicit SGM affirmative policies in human resources, marketing, training and governance; and anti-discrimination policies guiding culturally competent care. In Aim 2, to address training challenges in an industry with high staff turnover, and to make Training to Serve more scalable nationally, we will design and develop an online version and pilot it with 30 LTSS management and 30 staff. In Aim 3, to assess the effects of training, we will conduct a 3-arm, management/staff stratified, group randomized, controlled trial of the in- person training versus the online curriculum versus a waitlist control group (in 62 agencies, with 310 management and 450 staff per arm). At the individual level, we will assess management and staff knowledge, attitudes, and skills providing care to SGM clients. At the agency level, at six months follow-up, we predict agencies who receive training will have more SGM explicit policies, more SGM welcoming environments, and staff with significantly greater knowledge, comfort, and skills in providing SGM culturally competent care.
