LGBTQ+ patients, however, continue to face significant barriers to care and acceptance in health care settings. Those who identify as LGBTQ+ in the United States are twice as likely to lack insurance as non-LGBTQ+ individuals (Baker and Durso, 2017). In a national survey, 8% of LGB respondents and 29% of transgender respondents indicated that a care provider had refused to see them based on their sexual orientation or gender identity (Mizra and Rooney, 2018). In that same survey, 9% of LGB respondents and 21% of transgender respondents indicated that a care provider had “used harsh or abusive language” with them in a care setting (Mizra and Rooney, 2018). These gaps and barriers are even more profound in rural communities. While all rural communities are different, when looking at national data it is clear that rural communities are significantly less support LGBTQ+ protections than their urban counterparts (MAP, 2019).
Cornerstone Whole Healthcare Organization (C-WHO) and partners – including Valor Health, Primary Care Development Corporation, Family Medicine Residency of Idaho, Dr. Neil Ragan, University of Utah and the Cambia Health Foundation – recognize that the LGBTQ+ community in Idaho and beyond face significant marginalization in health care, a context that should feel inherently safe and supportive. In response to these great inequities, C-WHO developed The Pride in Idaho Care Neighborhoods (PiICN) Project. The PiICN Project’s overall goal is to provide a scalable care model that will enhance health outcomes, increase patient and provider confidence in care encounters, lower the cost of care, and reduce the stigmatization and marginalization of the LGBTQ+ community in rural health care settings.
To date, The PiICN Project has facilitated a novel partnership between a community access hospital and local residency to provide access to gender affirming services in rural Idaho, trained over 80 staff in the tenets of the family acceptance project to promote services for LGBTQ+ youth, co-developed practice recommendations with the National Rural Health Association and, in just six months, doubled the number of local providers trained in management of PrEP.
Through this work, the PiICN Project has identified best practices as well as those to be avoided. The project team aims to share these findings with other rural communities of care across the state and country to promote the development of more inclusive, safe and culturally appropriate care environment for all marginalized rural community members. Available resources include:
- The Pride in Idaho Care Neighborhoods Roadmap (LINK) – An easy-to-follow guide with lessons learned and pitfalls to avoid.
- The Resource Library (LINK) – A great compilation of available resources for individuals, health care providers and systems, and non-clinical service providers.
Rachel Blanton is the Chief Officer of Innovation and Operations with Cornerstone Whole Healthcare Organization, Inc. (C-WHO), a 501(c)(3) private non-profit, serving rural and other vulnerable populations, dedicated to improving the conditions for health among all communities. Rachel has been recognized as an “Emerging Leader in Public Health” by the Kresge Foundation and as a Community Leader by the Federal Reserve.