HomeMy WebLinkAboutItem 5 - Learning Session #2 - LGBTQ+City of San Luis Obispo, Council Memorandum
DEI-TF Agenda Correspondence
Date: September 23, 2020
TO: Diversity, Equity and Inclusion Task Force Members
FROM: Beya Makekau, DE&I Expert
SUBJECT: Item 5 - Learning Session #2: LGBTQ+ Community. Presentation and discussion.
Hi TF Members,
I hope your week is off to a good start. Please find attached a few documents our community
leaders sent over to support you in your work and the conversation for Thursday. Two of the
documents are fact sheets with important data and the other is the San Luis Obispo County
LGBTQ+ Mental Health Needs Assessment.
Best,
Beya
Packet Page 1
Health and Safety of Lesbian, Gay, Bisexual Youth (LGB)
in San Luis Obispo County
Central Coast Coalition for Inclusive Schools
Data are drawn from responses from students in 7th, 9th,
and 11th grades taking the California Health Kids Survey
(CHKS)
2013 SLO 2015 SLO 2017 SLO 15-17 California
LGB Non-
LGB
LGB Non-
LGB
LGB Non-
LGB
LGB Non-
LGB
285
4.5%
6079
95.5%
403
6.1%
6161
93.9%
586
6.3%
8733
93.7%
6.9%
93.1%
Attendance
How many times did you skip school or cut class in the past 12 months?
(more than once a week)
11.2% 3.0% 5.0% 2.8% 9.8% 3.1% 7.8% 2.6%
Missed school because you felt very, sad, hopeless, anxious, stressed,
angry? (past 30 days)
34.7% 11.0% 37.5% 10.8% 37.7% 10.2% 27.9% 8.4%
Missed school because you didn’t feel safe at school? (past 30 days) 7.7% 1.3% 8.2% 1.2% 11.8% 1.6% 6.7% 1.7%
Safety
How safe do you feel when you are at school? (unsafe or very unsafe) 14.7% 5.0% 11.7% 4.7% 18.3% 6.2% 15.5% 6.4%
Have you been in a physical fight? (past 12 months) 23.5% 10.4% 13.0% 9.3% 20.3% 11.0% 19.5% 11.1%
Have you carried a gun at school? (past 12 months) 6.0% 1.8% 2.3% 1.0% 7.7% 1.6% 8.3% 2.1%
Did you ever seriously consider attempting suicide? (past 12 months) 42.8% 10.8% 49.2% 14.4% 51.0% 14.9% 45.5% 13.5%
Did you ever feel so sad or hopeless almost everyday for two weeks or
more that you stopped doing some usual activities? (past 12 months)
66.5% 25.4% 61.5% 26.2%
Bullying and harassment
In the past 12 months on school property have you…
• Been pushed, shoved, slapped, hit, kicked by someone 1 or more
times
31.7% 22.1% 31.3% 20.1% 37.0% 22.4% 31.9% 20.9%
• Been afraid of being beaten up? 25.7% 12.9% 25.1% 11.9% 30.4% 13.1% 27.0% 12.8%
• Had rumors/lies spread about you? 57.6% 38.0% 54.6% 37.0% 58.1% 38.2% 51.5% 33.0%
• Had sexual jokes, comments, or gestures made to you? 60.6% 36.3% 55.3% 32.2% 58.3% 32.5% 54.3% 28.4%
Packet Page 2
• Been made fun of because of your looks or way you talked? 51.9% 32.2% 54.4% 30.1% 56.1% 31.0% 50.0% 29.5%
• Been threatened with harm or injury? 26.4% 10.4% 20.7% 7.7% 26.6% 8.6% 20.8% 8.5%
• Been made fun of, insulted, or called names? 57.3% 39.8% 59.0% 36.1% 61.1% 36.6% 52.3% 33.2%
• Were harassed or bullied for your race, ethnicity, or national origin? 19.9% 13.2% 17.0% 11.2% 24.5% 12.6% 24.6% 14.2%
• Were harassed or bullied for your religion? 17.4% 8.7% 12.0% 7.5% 19.0% 8.0% 15.1% 7.0%
• Were harassed or bullied for your gender? 22.1% 6.8% 24.7% 6.8% 30.1% 7.6% 25.8% 7.1%
• Were harassed or bullied because you are gay or lesbian or
somebody thought you were?
47.1% 6.2% 48.4% 4.6% 52.0% 5.2% 43.1% 5.9%
• Were harassed or bullied because physical or mental disability? 14.6% 4.3% 14.7% 3.4% 21.2% 3.9% 16.7% 3.8%
• Were harassed or bullied for any other reason? 35.8% 20.8% 36.6% 17.8% 39.4% 18.2% 35.4% 16.8%
2013 SLO 2015 SLO 2017 SLO 2017 California
LGB Non-
LGB
LGB Non-
LGB
LGB Non-
LGB
LGB Non-
LGB
Protective Factors
% responding “disagree” or “strongly disagree”
I feel close to people in this school. 18.4% 10.7% 20.1% 12.2% 24.3% 12.6% 23.3% 13.1%
I am happy to be at this school. 28.9% 12.4% 23.1% 12.4% 28.5% 14.3% 24.8% 13.6%
I feel like I am part of this school. 26.9% 14.3% 26.5% 14.1% 27.4% 15.0% 28.8% 15.7%
Teachers at this school treat students fairly. 20.7% 13.9% 17.2% 13.4% 20.1% 14.5% 24.3% 16.7%
I feel safe at my school. 16.1% 7.7% 13.5% 8.0% 15.6% 9.1% 20.7% 11.2%
I do interesting activities at my school. 23.5% 13.8% 21.6% 15.2% 24.6% 16.3% 25.5% 17.3%
I do things that make a difference at school. 39.7% 26.0% 34.2% 24.7% 34.8% 25.4% 39.2% 28.6%
Caring relationship
% responding “not at all true” to:
At my school there is a teacher or some other adult
…who really cares about me. 16.3% 9.6% 11.4% 8.4% 14.9% 9.3% 17.7% 11.2%
…who tells me when I do a good job. 16.6% 6.6% 8.4% 5.7% 13.6% 6.9% 15.5% 8.6%
…who notices when I am not there. 21.3% 11.9% 17.5% 10.4% 20.9% 11.7% 22.5% 13.8%
…who always wants me to do my best. 11.3% 4.3% 4.0% 3.8% 8.4% 4.6% 11.4% 5.7%
…who listens when I have something to say. 17.0% 8.1% 11.9% 7.5% 14.2% 8.3% 17.2% 9.6%
…who believes that I will be a success. 17.1% 7.9% 10.0% 6.2% 12.3% 7.1% 16.2% 8.5%
Packet Page 3
2013 SLO 2015 SLO 2017 SLO 2017 California
LGB Non-
LGB
LGB Non-
LGB
LGB Non-
LGB
LGB Non-
LGB
Lifetime Substance Use
Cigarettes 40.6% 14.3% 24.3% 10.1% 29.6% 9.9% 22.1% 7.3%
Tobacco 13.5% 7.4% 8.2% 5.5% 16.5% 6.1% 11.4% 4.1%
Alcohol 62.5% 36.2% 47.0% 30.1% 49.8% 28.7% 47.0% 25.2%
Marijuana 50.9% 25.1% 41.6% 21.3% 45.0% 20.4% 37.8% 17.5%
Inhalants 19.2% 5.7% 11.0% 4.5% 20.8% 4.7% 15.8% 4.7%
Cocaine/Methamphetamine 15.0% 5.2% 13.2% 3.6% 18.5% 5.7% 12.3% 3.9%
Ecstasy 19.3% 7.9% 14.1% 6.4% 21.1% 7.6% 14.8% 5.0%
Prescription Painkillers 37.5% 20.2% 24.9% 12.4% 31.0% 13.6% 23.6% 10.5%
Diet Pills 16.9% 5.9% 12.4% 5.0% 18.6% 6.0% 15.2% 5.6%
Ritalin or Adderall 15.5% 8.0% 14.7% 6.5% 21.4% 7.9% 14.1% 5.2%
Cold Medicine 44.0% 37.4% 36.8% 28.7% 41.4% 29.4% 38.0% 30.6%
Other Drug 28.4% 9.6% 15.4% 5.0% 23.1% 8.1% 26.8% 13.6%
Past 30 Day Substance Use
Cigarettes 23.2% 6.6% 10.4% 4.7% 17.0% 4.8% 12.9% 3.4%
Tobacco 6.1% 2.8% 1.8% 2.0% 10.7% 2.5% 8.1% 2.0%
Alcohol (One Drink) 37.3% 20.3% 26.2% 17.2% 32.4% 17.0% 28.7% 13.7%
Alcohol (Five or More Drinks) 26.0% 12.8% 15.4% 8.9% 22.6% 9.7% 17.6% 6.9%
Marijuana 31.0% 14.3% 23.6% 12.1% 29.9% 11.8% 24.7% 9.7%
Inhalant 7.3% 1.7% 4.2% 1.2% 12.8% 2.0% 10.0% 2.3%
Prescription Painkillers 12.0% 5.0% 10.0% 4.4% 17.2% 5.7% 13.5% 4.4%
Other Drugs 14.2% 3.0% 7.7% 2.2% 14.0% 3.2% 11.8% 2.9%
Two or More Drugs 16.8% 9.4% 13.2% 7.0% 20.3% 7.7% 14.9% 5.4%
Packet Page 4
SLO County Participant Demographics 2013, 2015, and 2017
N = 6623
M = 51.1%
F = 48.5%
7th grade = 2134 (32%)
9th grade = 2153 (32.3%)
11th grade = 1927 (28.9%)
White 3268 (54.2%)
Hispanic/Latino 2531 (38.8%)
Mixed 2198 (36.4%)
Am. Indian/Alaskan 177 (2.9%)
Asian 171 (2.8%)
Black or African American 145 (2.4%)
Hawaiian/Pacific Isl. 75 (1.2 %)
California Participant Demographics 2015 - 2017
2015 – 2017
N= 1,043,714
M = 50.6%
F = 49.4%
7th grade = 33.8%
9th grade = 33.7%
11th grade = 31.4%
N = 6564
M = 51.0%
F = 49.0%
7th grade = 2031 (33.8%)
9th grade = 2100 (35.0%)
11th grade = 1874 (31.2%)
White 3317 (54.3%)
Hispanic/Latino 2433 (37.7%)
Mixed 2284 (34.8%)
Am. Indian/Alaskan 147 (2.4%)
Asian 183 (3.0%)
Black or African American 109 (1.8%)
Hawaiian/Pacific Isl. 65 (1.1 %)
Asian/Pacific Islander 14.0%
American Indian 4.3%
Black .6%
White 32.5%
Multiracial 43.6%
Hispanic/Latino 51.1%
N = 9,319
M = 51.7%
F = 48.3%
7th grade = 3642 (39.4%)
9th grade = 3,81 (33.4%)
11th grade = 1992 (21.6%)
White 4561 (52.6%)
Hispanic/Latino 2751 (38.7%)
Mixed 3348 (38.6%)
Am. Indian/Alaskan 242 (2.8%)
Asian 242 (2.8%)
Black or African American 186 (2.1%)
Hawaiian/Pacific Isl. 99 (1.1 %)
Packet Page 5
Methods: The data presented in this fact sheet were collected as part of the California Healthy Kids Survey in the spring of 2013, 2015 and 2017 at middle and high
schools across San Luis Obispo County. The data were collected using a paper and pencil survey administered by school sites and reported to and compiled by WestEd.
The Central Coast Coalition for Inclusive Schools requested the dataset from WestEd and the data were analyzed running Chi-Square tests using SPSS statistical software.
All differences reported here are statistically significant.
The Central Coast Coalition for Inclusive Schools (CCC4IS) is a network of community partners actively supporting the development of safe and affirming school
communities.
Mission: The CCC4IS actively supports the development of safe and affirming school communities. We strive to celebrate diversity, advocate for social justice, and
transform educational cultures by empowering youth, families, professionals, and organizations. www.centralcoastinclusiveschools.org
Acknowledgements: The California Healthy Kids Survey was developed by WestEd under contract to the California Department of Education. This fact sheet was
prepared by John Elfers, PhD, Kris DePedro, PhD, and Matt Carlton, PhD. for the Central Coast Coalition of Inclusive Schools. These data were acquired through funds
provided by the San Luis Obispo County Community Foundation’s Growing Together Initiative.
For Further information about this Fact Sheet, contact:
John Elfers, PhD
Johnelfers52@gmail.com
Packet Page 6
Health and Safety of Transgender Youth
in San Luis Obispo County
Central Coast Coalition for Inclusive Schools
Data are drawn from responses from students in 7th, 9th,
and 11th grades taking the California Health Kids Survey
(CHKS)
2013 SLO 2015 SLO 2017 SLO 15-17 California
Trans Non-
Trans
Trans Non-
Trans
Trans Non-
Trans
Trans Non-
Trans
77
1.2%
6287
98.8%
69
1.0%
6875
99.0%
150
1.6%
9169
98.4%
1.5% 98.5%
Attendance
How many times did you skip school or cut class in the past 12 months?
(more than once a week)
18.2% 3.1% 4.4% 3.1% 23.0% 3.2% 19.6% 2.7%
Missed school because you felt very, sad, hopeless, anxious, stressed,
angry? (past 30 days)
20.8% 11.9% 39.1% 11.8% 38.0% 11.5% 27.1% 9.5%
Missed school because you didn’t feel safe at school? (past 30 days) 9.1% 1.5% 12.3% 1.5% 22.7% 1.9% 15.1% 1.9%
Safety
How safe do you feel when you are at school? (unsafe or very unsafe) 26.0% 5.2% 20.0% 5.0% 37.6% 6.5% 34.5% 6.6%
Have you been in a physical fight? (past 12 months) 29.9% 10.8% 20.0% 9.4% 42.6% 11.1% 38.9% 11.3%
Have you carried a gun at school? (past 12 months) 19.5% 1.8% 7.8% 1.0% 30.1% 1.6% 30.3% 2.1%
Did you ever seriously consider attempting suicide? (past 12 months) 26.0% 12.0% 46.0% 16.6% 57.9% 16.9% 48.7% 15.6%
Did you ever feel so sad or hopeless almost everyday for two weeks or
more that you stopped doing some usual activities? (past 12 months)
68.7% 27.4% 55.3% 28.3%
Bullying and harassment
In the past 12 months on school property have you…
• Been pushed, shoved, slapped, hit, kicked by someone 1 or more
times
40.3% 22.3% 41.5% 20.6% 54.4% 22.9% 45.9% 21.3%
• Been afraid of being beaten up? 24.7% 13.4% 26.2% 12.5% 43.0% 13.8% 40.7% 13.4%
• Had rumors/lies spread about you? 42.9% 38.9% 44.6% 38.0% 61.7% 39.1% 53.4% 34.0%
• Had sexual jokes, comments, or gestures made to you? 44.2% 37.4% 59.4% 33.4% 68.9% 33.6% 58.0% 29.8%
Packet Page 7
• Been made fun of because of your looks or way you talked? 44.2% 33.0% 61.5% 31.2% 65.1% 32.1% 54.5% 30.6%
• Been threatened with harm or injury? 31.2% 10.8% 24.6% 8.3% 47.3% 9.1% 38.4% 8.9%
• Been made fun of, insulted, or called names? 47.4% 40.5% 57.8% 37.3% 67.1% 37.7% 55.9% 34.2%
• Were harassed or bullied for your race, ethnicity, or national origin? 34.2% 13.2% 14.1% 11.5% 38.9% 13.0% 38.2% 14.5%
• Were harassed or bullied for your religion? 18.7% 9.0% 10.9% 7.7% 38.3% 8.2% 33.4% 7.2%
• Were harassed or bullied for your gender? 31.6% 7.2% 30.2% 7.7% 50.7% 8.4% 45.2% 7.8%
• Were harassed or bullied because you are gay or lesbian or
somebody thought you were?
34.7% 7.7% 40.6% 7.0% 58.8% 7.5% 48.2% 7.9%
• Were harassed or bullied because physical or mental disability? 14.9% 4.6% 16.9% 4.0% 41.3% 4.5% 35.7% 4.2%
• Were harassed or bullied for any other reason? 33.3% 21.4% 44.6% 18.7% 53.5% 19.1% 45.8% 17.7%
2013 SLO 2015 SLO 2017 SLO 2017 California
Trans Non-
Trans
Trans Non-
Trans
Trans Non-
Trans
Trans Non-
Trans
Protective Factors
% responding “disagree” or “strongly disagree”
I feel close to people in this school. 16.0% 10.9% 24.6% 12.6% 40.0% 12.9% 34.4% 13.5%
I am happy to be at this school. 32.5% 12.9% 35.4% 12.4% 48.0% 14.6% 38.1% 14.0%
I feel like I am part of this school. 28.6% 14.7% 36.9% 14.6% 39.8% 15.4% 40.8% 16.2%
Teachers at this school treat students fairly. 24.7% 14.1% 24.6% 13.6% 33.3% 14.6% 39.5% 16.9%
I feel safe at my school. 23.4% 7.9% 25.0% 8.2% 31.8% 9.1% 36.3% 11.5%
I do interesting activities at my school. 24.0% 14.2% 21.9% 15.5% 36.1% 16.5% 35.3% 17.6%
I do things that make a difference at school. 34.7% 26.5% 39.7% 25.2% 42.7% 25.7% 46.1% 29.1%
Caring relationship
% responding “not at all true” to:
At my school there is a teacher or some other adult
…who really cares about me. 21.1% 9.7% 18.5% 8.5% 31.9% 9.3% 32.5% 11.3%
…who tells me when I do a good job. 18.4% 6.9% 13.8% 5.8% 29.7% 7.0% 29.7% 8.8%
…who notices when I am not there. 25.0% 12.1% 23.8% 10.8% 31.0% 12.0% 34.1% 14.1%
…who always wants me to do my best. 17.3% 4.4% 4.6% 3.8% 23.0% 4.6% 26.8% 5.8%
…who listens when I have something to say. 24.7% 8.3% 15.4% 7.7% 25.7% 8.5% 31.1% 9.8%
…who believes that I will be a success. 27.3% 8.0% 15.4% 6.4% 25.9% 7.1% 31.4% 8.7%
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2013 SLO 2015 SLO 2017 SLO 2017 California
Trans Non-
Trans
Trans Non-
Trans
Trans Non-
Trans
Trans Non-
Trans
Lifetime Substance Use
Cigarettes 27.3% 15.4% 21.5% 10.9% 43.9% 10.6% 37.3% 7.9%
Tobacco 13.2% 7.6% 9.2% 5.6% 41.2% 6.2% 32.3% 4.2%
Alcohol 51.9% 37.2% 46.2% 31.0% 61.1% 29.5% 54.2% 26.3%
Marijuana 38.2% 26.1% 40.0% 22.3% 57.1% 21.4% 48.3% 18.5%
Inhalants 18.2% 6.2% 10.0% 4.9% 43.2% 5.1% 35.1% 5.0%
Cocaine/Methamphetamine 9.1% 5.8% 15.4% 4.1% 40.6% 6.1% 35.1% 4.1%
Ecstasy 16.3% 8.5% 12.2% 6.9% 41.0% 8.0% 36.4% 5.2%
Prescription Painkillers 20.5% 21.2% 26.0% 13.2% 49.1% 14.3% 41.1% 11.1%
Diet Pills 16.3% 6.4% 4.1% 5.6% 33.7% 6.5% 35.1% 5.9%
Ritalin or Adderall 11.4% 8.4% 10.2% 7.0% 38.8% 8.3% 35.9% 5.4%
Cold Medicine 40.9% 37.7% 30.0% 29.3% 55.7% 29.8% 50.2% 30.8%
Other Drug 13.6% 10.7% 18.5% 5.5% 40.5% 8.6% 42.6% 14.1%
Past 30 Day Substance Use
Cigarettes 13.0% 7.3% 9.4% 5.0% 34.9% 5.1% 31.3% 3.6%
Tobacco 9.4% 2.9% 4.6% 2.0% 32.9% 2.6% 28.6% 2.0%
Alcohol (One Drink) 25.9% 21.1% 26.6% 17.7% 47.9% 17.5% 41.9% 14.3%
Alcohol (Five or More Drinks) 21.8% 13.4% 15.6% 9.2% 36.0% 10.2% 35.5% 7.2%
Marijuana 21.8% 15.0% 26.2% 12.7% 44.2% 12.5% 39.7% 10.3%
Inhalant 5.5% 1.9% 6.2% 1.3% 34.9% 2.1% 30.8% 2.4%
Prescription Painkillers 9.1% 5.4% 12.0% 4.7% 37.4% 6.0% 34.4% 4.6%
Other Drugs 7.3% 3.4% 9.4% 2.5% 32.1% 3.5% 32.3% 3.1%
Two or More Drugs 11.4% 9.8% 16.0% 7.3% 40.2% 8.0% 35.1% 5.6%
Packet Page 9
SLO County Participant Demographics 2013, 2015, and 2017
N = 6623
M = 51.1%
F = 48.5%
7th grade = 2134 (32%)
9th grade = 2153 (32.3%)
11th grade = 1927 (28.9%)
White 3268 (54.2%)
Hispanic/Latino 2531 (38.8%)
Mixed 2198 (36.4%)
Am. Indian/Alaskan 177 (2.9%)
Asian 171 (2.8%)
Black or African American 145 (2.4%)
Hawaiian/Pacific Isl. 75 (1.2 %)
California Participant Demographics 2015 - 2017
2015 – 2017
N= 1,043,714
M = 50.6%
F = 49.4%
7th grade = 33.8%
9th grade = 33.7%
11th grade = 31.4%
N = 6564
M = 51.0%
F = 49.0%
7th grade = 2031 (33.8%)
9th grade = 2100 (35.0%)
11th grade = 1874 (31.2%)
White 3317 (54.3%)
Hispanic/Latino 2433 (37.7%)
Mixed 2284 (34.8%)
Am. Indian/Alaskan 147 (2.4%)
Asian 183 (3.0%)
Black or African American 109 (1.8%)
Hawaiian/Pacific Isl. 65 (1.1 %)
Asian/Pacific Islander 14.0%
American Indian 4.3%
Black .6%
White 32.5%
Multiracial 43.6%
Hispanic/Latino 51.1%
N = 9,319
M = 51.7%
F = 48.3%
7th grade = 3642 (39.4%)
9th grade = 3,81 (33.4%)
11th grade = 1992 (21.6%)
White 4561 (52.6%)
Hispanic/Latino 2751 (38.7%)
Mixed 3348 (38.6%)
Am. Indian/Alaskan 242 (2.8%)
Asian 242 (2.8%)
Black or African American 186 (2.1%)
Hawaiian/Pacific Isl. 99 (1.1 %)
Packet Page 10
Methods: The data presented in this fact sheet were collected as part of the California Healthy Kids Survey in the spring of 2013, 2015 and 2017 at middle and high
schools across San Luis Obispo County. The data were collected using a paper and pencil survey administered by school sites and reported to and compiled by WestEd.
The Central Coast Coalition for Inclusive Schools requested the dataset from WestEd and the data were analyzed running Chi-Square tests using SPSS statistical software.
All differences reported here are statistically significant.
The Central Coast Coalition for Inclusive Schools (CCC4IS) is a network of community partners actively supporting the development of safe and affirming school
communities.
Mission: The CCC4IS actively supports the development of safe and affirming school communities. We strive to celebrate diversity, advocate for social justice, and
transform educational cultures by empowering youth, families, professionals, and organizations. www.centralcoastinclusiveschools.org
Acknowledgements: The California Healthy Kids Survey was developed by WestEd under contract to the California Department of Education. This fact sheet was
prepared by John Elfers, PhD, Kris DePedro, PhD, and Matt Carlton, PhD. for the Central Coast Coalition of Inclusive Schools. These data were acquired through funds
provided by the San Luis Obispo County Community Foundation’s Growing Together Initiative.
For Further information about this Fact Sheet, contact:
John Elfers, PhD
Johnelfers52@gmail.com
Packet Page 11
San Luis Obispo County
LGBTQ+ Mental Health
Needs Assessment
2019 Packet Page 12
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LGBTQ+ Mental Health
Needs Assessment
Report provided by:
Jay Bettergarcia, Ph.D., QCARES Principal Investigator
Emma Wedell, B.S., QCARES Lab Manager
Elissa Feld, M.P.P., QCARES Project Coordinator
QCARES Research Team
Executive Report
1
San Luis Obispo County
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Acknowledgments.................................................
Executive Summary...............................................
Key Terms.............................................................
Part 1: Introduction & Background..........................
Part 2: Method.....................................................
Part 3: Results.......................................................
Phase I: Quantitative Online Survey...................
Demographics..............................................
Barriers, Experiences, & Service Needs..........
Mental Health Distress..................................
Substance Use..............................................
Community Connectedness...........................
Minority Stress and Discrimination.................
Internalized Stigma.......................................
Phase II: Qualitative Focus Groups....................
Conclusion & Recommendations............................
References...........................................................
Appendix A...........................................................
Appendix B...........................................................
3
TABLE OF CONTENTS
6
8
10
13
15
17
17
18
28
34
40
44
46
51
52
62
70
73
84
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Figure 1: Age Demographics..........................................
Figure 2: Gender Demographics....................................
Figure 3: Sexual Orientation Demographics....................
Figure 4: Region Demographics......................................
Figure 5: Income Demographics.....................................
Figure 6: Education Demographics.................................
Figure 7: Employment Demographics..............................
Figure 8: Relationship Demographics..............................
Figure 9: Barriers to Seeking Mental Health Services.......
Figure 10: Support Services Most Needed.......................
Figure 11: Prevalence of Psychological Distress...............
Figure 12: Prevalence of Anxiety and Depression............
Figure 13: Percentage of Suicidal Ideation, Plan, and
Attempt by Age..............................................
Figure 14: Prevalence of Alcohol Misuse.........................
Figure 15: Prevalence of Drug Abuse..............................
Figure 16: Minority Stress Model.....................................
4
LIST OF FIGURES
18
19
20
21
23
24
25
26
28
33
36
37
39
41
43
46
Packet Page 17
Table 1a: Racial and Ethnic Identity Demographics..............................
Table 1b: Racial and Ethnic Identity - Hispanic or Latinx (Latino)..........
Table 2: Percent of Participants with Mental Health Experiences in
SLO County.........................................................................
Table 3: Reasons Why Participants Have Not Accessed Mental Health
Services..............................................................................
Table 4a: General Experiences with Mental Health Providers...............
Table 4b: Gender Identity-Related Experiences with Mental Health
Providers............................................................................
Table 4c: Sexual Orientation-Related Experiences with Mental Health
Providers............................................................................
Table 5: Psychological Distress Measurements..................................
Table 6: Frequency of Distress Due to Sexual Orientation & Gender
Identity..............................................................................
Table 7: Prevalence of Suicidality.....................................................
Table 8: General Community Connectedness....................................
Table 9: Gender Minority Community Connectedness........................
Table 10: Sexual Minority Community Connectedness.........................
Table 11a: Minority Stress - Gender Expression....................................
Table 11b: Minority Stress - Discrimination/Harassment........................
Table 11c: Minority Stress - Vigilance..................................................
Table 11d: Minority Stress - Vicarious Trauma......................................
Table 11e: Minority Stress - Family of Origin........................................
Table 11f: Minority Stress - HIV/AIDS..................................................
Table 11g: Minority Stress - Victimization.............................................
Table 11h: Minority Stress - Isolation....................................................
Table 12: Internalized Transphobia.....................................................
Table 13: Internalized Heterosexism...................................................
5
LIST OF TABLES
22
22
29
29
30
31
32
35
36
38
44
45
45
47
47
48
48
49
49
50
50
51
51
Packet Page 18
ACKNOWLEDGMENTS
2018-2019 QCARES Project Team
Emma Wedell, B.S.
Lab Manager
Karen Shoriz, B.S.
Research Assistant &
Previous Lab Manager
Bonnie Rose Thomson
Research Assistant
Amanda Shrewsbury, B.S.
Lab Manager
Bailey Arthur, B.S.
Research Assistant
Hayley Rostek
Research Assistant
Elissa Feld, M.P.P.
Project Coordinator
Sophia Renteria, B.S.
Research Assistant
Hannah Finn
Research Assistant
Access Support Network
Allan Hancock College
Cal Poly Pride Center
Central Coast Coalition for Inclusive Schools
Community Counseling Center
Community Action Partnership of San Luis Obispo
Cuesta College
Gay and Lesbian Alliance
House of Pride & Equality
LGBTQ+ High School Clubs
Peer Advisory and Advocacy Team
The Queer Crowd
Queer SLO
RISE
San Luis Obispo County Behavioral Health
Sierra Vista Regional Medical Center
SLO Bike Kitchen
SLOQueerdos
Transitions-Mental Health Association
Twin Cities Community Hospital
Tranz Central Coast
5 Cities Hope
#Out4MentalHealth Task Force
Thank you to the many QCARES alumni who have graduated but
contributed extensively
6 Acknowledgments
Community OrganizationsCommunity Liaisons
Anne Robin
Barry Johnson
Danielle Friedrich
Doug Heumann
Ellen Sturtz
Erica Andrade
Erika Duran
Frank Warren
Hilary Lawson
James Statler
Jane Lehr
Joe Stewart
John Elfers
Julie Baker
Kayla Wilburn
Meghan Madsen
Michelle Call
Nancy Sutton
Nestor Veloz-Passalacqua
Rob Diaz
Samuel Byrd
Susan Gaoiran
Trista Ochoa
Packet Page 19
ACKNOWLEDGMENTS
Primary funding for this project was provided by the County of San Luis Obispo
through the Mental Health Services Act and in collaboration with the County
Behavioral Health Department.
Thank you to San Luis Obispo County Behavioral Health and the Growing Together
Initiative of the Community Foundation of San Luis Obispo for your generous
support of this important work. This project would not have been possible without
your contributions. We appreciate all you do to support our local LGBTQ+
community!
A very special thank you to all of the local LGBTQ+ activists, organizers, leaders,
community members, and participants who made this project possible. We
appreciate your willingness to be open and honest about your experiences as we
seek to make San Luis Obispo County a more welcoming, inclusive, and supportive
place, especially as it pertains to our communities’ mental health and wellness.
Thank you all for helping us make local change possible.
In solidarity,
Dr. Jay Bettergarcia & The QCARES team
Acknowledgments 7
Recommended citation: Bettergarcia, J. N., Wedell, E., & Feld, E. (2019). San Luis
Obispo County LGBTQ+ mental health needs assessment: Executive report. San Luis
Obispo, CA: County of San Luis Obispo Behavioral Health Department.Packet Page 20
EXECUTIVE SUMMARY
8 Executive Summary
To provide a thorough and current understanding of the mental health statuses,
experiences, and needs of LGBTQ+ individuals in San Luis Obispo County, the
QCARES program developed and conducted a mixed-methods research study,
consisting of a comprehensive online survey and a series of in-person focus groups
with individuals of differing identities. This study was carried out from 2018-2019 with
generous funding and support provided by the County of San Luis Obispo through
the Mental Health Services Act and in collaboration with the County Behavioral
Health Department, and the Growing Together Field of Interest Fund (GTI), a Fund of
The Community Foundation San Luis Obispo County.
The findings suggest that there are several barriers to seeking mental health support
services for LGBTQ+ people in SLO County, including several that were specific to
finding or accessing an LGBTQ+ affirming or competent provider, including:
Not knowing how to find an LGBTQ+ competent
provider (68%, n = 137)
Having no LGBTQ+ knowledgeable mental health
services in their neighborhood (60%, n = 119).
The barriers to accessing mental health care are
incredibly important to consider given the high
levels of psychological distress that many of the
participants report experiencing.
Approximately 87% of transgender and
nonbinary participants (n = 77) and 72% of
sexual minority participants (n = 245) reported
moderate to high levels of psychological
distress.
Approximately 74% of transgender and nonbinary (n = 67) and 56% of LGBQ+
participants (n = 186) reported that their distress is due, at least in part, to their
gender or sexual orientation.
Over half (51%, n = 45) of gender minority participants reported either moderate or
severe symptoms of depression and anxiety as compared to approximately one-third
(33%, n = 107) of sexual minority participants.
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EXECUTIVE SUMMARY
Executive Summary 9
It is particularly important to note that transgender and nonbinary
community members fare far worse than sexual minority
participants across various measures of distress, suicidality,
minority stress, internalized stigma, and community connectedness
in San Luis Obispo County.
Given the results of this needs assessment, a series of recommendations are
provided to better support the mental health and wellness of LGBTQ+
communities across San Luis Obispo County. Though the list is not exhaustive, it
should serve as a roadmap for organizations, agencies, and providers to better
serve the mental health and wellness needs of LGBTQ+ community members.
1. Organizations and agencies should attempt to identify areas for
growth and change to help support LGBTQ+ mental health and
wellness
2. Trainings are necessary to promote LGBTQ+ affirming practices for
mental health providers, agencies, and community organizations
3. Transgender and nonbinary community members, in particular, are
in need of more affirming mental health support
4. Suicide prevention efforts need to purposefully include LGBTQ+
community members
5. Increased support services for LGBTQ+ youth are necessary
6. LGBTQ+ affirming community spaces are needed to increase
feelings of safety and community connectedness
7. A database of LGBTQ+ affirming services and providers is needed
to reduce barriers to seeking care
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KEY TERMS
This list of definitions was drawn and adapted from UCSF LGBT Resource Center
(General Definitions, n.d.) to provide clarity on the meanings and usages of
some of the most frequently employed terms in this report. It is important to
acknowledge differences of opinion among academics, as well as among
members of any given identity group. Many of the terms below have evolved
over decades and are likely to continue changing to best represent the
identities, experiences, and expressions of future and aging generations.
Aromantic: A person whose primary romantic orientation is
characterized by not experiencing romantic attraction. Romantic
orientation is distinct from sexual orientation, as sexual
attraction and romantic attraction may or may not be congruent
within the individual.
Affirming: In the context of mental health care, affirming
practices involve LGBTQ+ cultural competence, including, but
not limited to, knowledge about LGBTQ+ identities, support for
clients' self-asserted gender identities and sexual orientations,
and awareness of the connections between mental health and
the different forms of societal stigma and discrimination
disparately affecting LGBTQ+ community members at the
intersections of multiple marginalized social identities.
Asexual: A person whose primary sexual orientation is
characterized by not experiencing sexual attraction. Asexuality
is distinct from aromanticism as well as from celibacy, which is
the deliberate abstention from sexual activity.
Bisexual: A person whose primary sexual orientation is toward
people of two or more genders or the same and other genders.
Cisgender: The prefix cis- means "on this side of" or "not
across." A term used to call attention to the privilege of people
who are not transgender, or those whose sex assigned at birth is
the same as their gender identity.
10 Key Terms
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KEY TERMS
Gay: A person whose primary sexual orientation is toward people of the same gender;
sometimes used as an umbrella term for sexual minority individuals.
Gender: A social construct used to classify a person as a man, woman, nonbinary, or
some other identity or identities. Fundamentally different from the sex one is assigned
at birth; a set of social, psychological, and emotional traits, often influenced by
societal expectations.
Gender Expression: How a person expresses their gender in terms of dress,
mannerisms and/or behaviors that society characterizes as "masculine," "feminine,"
“androgynous,” “gender neutral,” or something else.
Gender Minority: Traditionally used to describe people
who are transgender, including those who identify as
transgender men, transgender women, nonbinary,
genderqueer, agender, more than one gender, or
otherwise not cisgender.
Genderqueer: A person whose gender identity and/or
gender expression falls outside of the dominant societal
norm for their assigned sex, is beyond genders, or some
combination of these traits.
Heterosexual: A person whose primary sexual
orientation is toward people of a gender other than
their own. Also commonly referred to as “straight,” heterosexuality is not antonymous
with identifying as part of the LGBTQ+ community, as many heterosexuals may identify
as transgender, intersex, aromantic, or romantically attracted toward people of the
same or two or more genders.
Intersex: People who, without medical intervention, develop primary or secondary sex
characteristics that do not fit “neatly” into society's definitions of male or female sex.
Some but not all people believe that their intersex identities make them members of
the LGBTQ+ community. Additionally, some intersex people identify as sexual and/or
gender minorities and others do not.
Key Terms 11
Packet Page 24
KEY TERMS
LGBTQ+: An umbrella term collectively referring to those who identify as lesbian, gay,
bisexual, transgender, queer, questioning, and all others who identify as a sexual or
gender minority. The plus sign is used to explicitly include all sexual and gender minority
identities not represented in the letter portion of the acronym.
Lesbian: A woman whose primary sexual orientation is toward women, though some
lesbians may identify as nonbinary.
Nonbinary: A gender identity that embraces full universe of expressions and ways of
being that resonate with an individual. It may be an active resistance to binary gender
expectations and/or an intentional creation of new unbounded ideas of self within the
world.
Pansexual: A person whose primary sexual orientation is toward people of all genders
or toward people regardless of gender.
Queer: This can include, but is not limited to, lesbian, gay, bisexual, transgender,
intersex, and asexual people. This term has different meanings for different people and
many use the term to define their sexual orientation, gender identity, or both.
Historically, and sometimes still used as a slur, some find the term offensive while others
reclaim it to encompass the broader sense of history of the LGBTQ+ rights movements.
Queer can also be used as an umbrella term like LGBTQ+.
Sex: A categorization typically based on the appearance of the genitalia at birth, but
also includes the spectrum of internal and external physiology such as the natural
human variance in chromosomes, hormones, gonads, and secondary sex characteristics.
Sexual Minority: Traditionally used to describe those who identify as lesbian, gay,
bisexual, pansexual, asexual, queer, or otherwise not heterosexual. In this report, the
acronym LGBQ+ (lesbian, gay, bisexual, queer, questioning, and others) is used
interchangeably with sexual minority.
Sexual Orientation: A social construct and identity involving emotional, romantic, or
sexual attraction. Sexual orientation is often conceptualized as fluid.
Transgender: Used most often as an umbrella term, “transgender” is commonly
defined as someone whose gender identity or expression does not fit (dominant-group
social constructs of) assigned birth sex and gender.
12 Key Terms
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INTRODUCTION AND
BACKGROUND
(transgender and nonbinary) youth (Elfers,
DePedro, & Carlton, 2019b) report seriously
considering attempting suicide in the past 12
months. Additionally, a 2003 study conducted
with San Luis Obispo County LGBTQ+ communities
found that barriers to mental health care included
fear of being mistreated and insufficient services,
specifically transgender services, youth services,
and support groups (San Luis Obispo Community
Foundation, 2003). Further, LGBTQ+ community
members have identified supportive mental health
services and youth services as two of the most
important service needs in SLO County (Kenyon &
Elfarissi, 2015). To provide a thorough and current
understanding of the mental health statuses,
experiences, and needs of LGBTQ+ individuals in
San Luis Obispo County, the QCARES program
developed and conducted a mixed-methods
research study consisting of a comprehensive online survey and a series of in-person
focus groups with individuals of differing identities. This study was carried out from
2018-2019 with generous funding and support from the County of San Luis Obispo
through the Mental Health Services Act and in collaboration with the County
Behavioral Health Department, as well as the Growing Together Initiative (GTI), a
fund of The Community Foundation San Luis Obispo County.
Introduction 13
Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) identified individuals often
face health disparities due to social stigma and discrimination, both of which have
been linked to higher rates of psychological disorders, substance abuse, and suicide
(McLaughlin, Hatzenbuehler, & Keyes, 2010). In San Luis Obispo County, 51% of sexual
minority (LGBQ+) youth (Elfers, DePedro, & Carlton, 2019a) and 58% of gender minority
Packet Page 26
The Queer Community Action, Research, Education & Support (QCARES) program
was established in 2017 by Dr. Jay Bettergarcia, Ph.D., Assistant Professor in
Psychology and Child Development at California Polytechnic State University, San
Luis Obispo. QCARES was created to help bridge the gap between research about
the mental health and wellbeing of LGBTQ+ identified individuals, and the
application of these findings to support social change. QCARES conducts mixed-
methods research studies from a community-based participatory action research
(CBPAR) framework, in which researchers actively engage with individuals,
organizations, and other stakeholders in the local community throughout the
process of developing, conducting, and disseminating research.
To assess the mental health, wellness,
and related experiences in a sample
of lesbian, gay, bisexual, transgender
and queer (LGBTQ+) identified people
currently living in San Luis Obispo
County.
To provide recommendations about
the mental health and wellness needs
of San Luis Obispo County LGBTQ+
residents in an effort to create
positive change for LGBTQ+
community members across San Luis
Obispo County.
WHAT ARE THE MAIN GOALS
OF THIS PROJECT?
14 Introduction
WHAT IS QCARES?
Packet Page 27
METHODS
Participants
Participants included
self-identified LGBTQ+
youth (14-17 years old)
and adults (18+ years old),
who lived in either San
Luis Obispo County or
Santa Maria (Northern
Santa Barbara County) at
the time of participation.
Due to the nature of
Santa Maria being on the
cusp of the county line,
often residents live and
work in both counties.
Therefore, those who live
in Santa Maria were
included in the survey.
Methods 15
Overview
This mixed-method LGBTQ+ mental health needs assessment study included an
online survey and six focus groups held across San Luis Obispo County.
Recruitment
Participant recruitment was conducted via purposive and snowball sampling, and a
variety of tools were used for outreach, including: social media (e.g., Facebook,
Instagram, Twitter), posting flyers across the county, contacting potential
participants through email listservs, and speaking at community meetings and events.
Packet Page 28
Phase I: Quantitative Online Survey
The six focus groups included:
Lesbian women
Gay men
Bisexual, pansexual, queer, and asexual
adults
Transgender and nonbinary adults
LGBTQ+ Adults
LGBTQ+ Youth (14-17 years old)
Phase II: Qualitative Focus Groups
Survey items included:
Demographics
Experiences with mental health care
providers in San Luis Obispo County
Access to services, barriers to care, and
perceived areas of service needs
Psychological distress (e.g., depression
and anxiety)
Alcohol and substance use
Suicidality
Community connectedness
Minority stress and discrimination
Internalized stigma
Data collection occurred between Spring of 2018 and Spring of 2019. Data were
collected using a combination of online survey software and iPads.
Data collection occurred between Fall of 2018 and Spring of 2019. Adult
participants were offered opportunities to attend the focus group centering on the
identity of their choice. Focus groups were approximately 90 minutes long and
followed a semi-structured interview script (see Appendix A).
16 Methods
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RESULTS
Phase 1
Quantitative Online Survey
A total of 531 participants started the online survey.
However, data was only analyzed for 438
participants. Approximately 38 people started the
survey but were removed because they did not
meet the study criteria (i.e., not identifying as
LGBTQ+, not living in San Luis Obispo County or
Santa Maria, not consenting to participate). An
additional 55 participants were removed because
they made less than 10% progress in the survey.
However, all data was recorded for those who
completed at least 10% of the survey regardless of
whether they finished the survey. Many of the
questions differ in the number of respondents
because participants had the option to skip
questions that they did not wish to answer.
Results 17
The survey was translated into Spanish, with two
participants utilizing this version. The following
results are provided from the online needs
assessment survey.
Throughout this report, results are identified
separately for sexual minorities (LGBQ+) and
gender minorities (transgender, nonbinary, and
questioning). Many participants (n = 104) identified
as both a gender and a sexual minority.
Packet Page 30
Participants’ ages ranged from 14 to 89
with a mean age of 32. Youth (ages
14-17) made up 17% (n = 52) of the
sample. Approximately one-third of the
participants were between 18 and 24
years old (29%, n = 86) and another
third were between 25-40 years old
(29%, n = 86). Fewer were between the
ages of 41 and 64 years old (18%, n =
55), and older adults (ages 65 and
older) made up 7% (n = 20) of the
sample.
Figure 1: Age Demographics
18 Demographics
AGE
Note: n = 299
Packet Page 31
Participants were asked to select a term that
most closely describes their gender identity.
Nearly half of the participants identified as
female (48%, n = 209) and over one quarter
identified as male (27%, n = 117). Fewer partic-
ipants identified as genderqueer/gender non-
conforming/nonbinary (12%, n = 51), transgender
man (6%, n = 27), transgender woman (4%, n =
19), or questioning/unsure (3%, n = 13). Of all the
participants, 75% (n = 326) identified as cis-
gender and 25% (n = 110) identified as trans-
gender/nonbinary or questioning.
Figure 2: Gender Demographics
Demographics 19
12%
of participants identified as
nonbinary/genderqueer
GENDER IDENTITY
Note: n = 436 Packet Page 32
When participants were asked to
select a term that most closely
describes their sexual orientation,
about two-thirds of the sample
identified as either gay (23%, n = 102),
bisexual (23%, n = 101), or lesbian
(20%, n = 89). Fewer participants
identified as pansexual (16%, n = 70),
queer (8%, n = 36), asexual (4%, n =
17), questioning/unsure (3%, n = 12), or
heterosexual/straight (2%, n = 10). All
together, 98% (n = 427) identified as a
sexual minority or questioning.
Figure 3: Sexual Orientation Demographics
20 Demographics
SEXUAL ORIENTATION
Note: n = 437
Packet Page 33
Participants were recruited
from across San Luis Obispo
County, though some
recruitment occurred in Santa
Maria via groups and
organizations that are active
across these county and city
lines. The response rate from
across the county was strong.
Though most of the
participants reported living in
Figure 4: Region Demographics
Demographics 21
LOCATION IN SLO COUNTY
the city of San Luis Obispo (38%, n = 121), approximately two-thirds reported living
in either North County (e.g., Paso Robles, Templeton, Atascadero; 23%, n =
73), South County (e.g., Nipomo, Arroyo Grande, Shell Beach; 21%, n = 69), or the
North Coast (e.g., Los Osos, Morro Bay, Cambria; 16%, n = 53). Approximately 2% (n
= 6) of participants reported living in Santa Maria.
Note: n = 322 Packet Page 34
Participants were asked to select all
choices that apply from a list of racial
and ethnic identities that most
accurately describes their identity, with
a fill-in option if the provided options
did not accurately identify the
participants' race or ethnicity. The
percentages of participants who
selected one or more than one racial
or ethnic identity are seen in Table 1a.
Table 1a: Racial and Ethnic Identity Demographics
22 Demographics
(2%, n = 5), Native Hawaiian or Pacific Islander (2%, n = 8), or a racial/ethnic identity not
listed (2%, n = 7). The specific ethnic identities of participants who identified as Hispanic
or Latinx (Latino) are in Table 1b. The option to select all applicable racial and ethnic
identities diverges from the U.S. Census Bureau’s (2019) method of collecting data on
race and ethnicity and was offered to capture the nuance and complexity of
participants' identities. The racial and ethnic composition of participants is comparable
to current estimates of the racial and ethnic demographic data of San Luis Obispo
County at large.
RACE & ETHNICITY
Note: n = 324
Table 1b: Racial and Ethnic Identity - Hispanic or Latinx (Latino)
Approximately 20% (n = 65) of
participants selected more than
one race or ethnicity, with the
remainder choosing one selection.
Among other selections, 85% (n =
276) identified as White, nearly
one-fifth identified as Latinx
(Latino) or Hispanic (19%, n = 63),
8% (n = 26) identified as Asian, 6%
(n = 21) as Native American, and
fewer identified as Black (2%, n =
6), Middle Eastern or North AfricanNote: n = 63
selected more than one
option
20%
Packet Page 35
Participants reported a wide spread when
asked to estimate their combined
family/household incomes for 2017, ranging
from no income (2%, n = 5) to $150,000 or
more (12%, n = 30). At 19% (n = 45), the most
common estimated household income range
was $20,000 to $39,999 and the median
combined income was between $50,000 and
$59,999 (n = 18), below the median household
income in SLO County between 2013-2017 of
$67,175 (representing 2017 dollars; U.S.
Census Bureau, 2019). About 22% (n = 70) of
Figure 5: Income Demographics
Demographics 23
HOUSEHOLD INCOME
Note: n = 243
respondents to this item were unsure of their estimated household incomes and
therefore unrepresented in the former percentages.
Packet Page 36
Participants were asked about their highest level of education completed.
Approximately 22% (n = 70) reported that they were still in high school or had a
high school diploma or GED. The most common level of education, 36% (n = 114),
consisted of those who had completed some college, an associate's degree, or
Figure 6: Education Demographics
24 Demographics
an occupational degree. The high number of students in
the sample likely reflects representation of high school
students as well as college students enrolled at
California Polytechnic State University, San Luis Obispo;
Cuesta College; Allan Hancock College; and other
institutions of higher education. Approximately 42% (n =
133) had completed a bachelor’s degree or higher, with
nearly one-fifth of participants (19%, n = 60) having
earned a graduate degree.
EDUCATION
Note: n = 317
Packet Page 37
Participants were asked to indicate
their current employment status by
selecting all applicable options
from a list provided. Most of the
participants reported that they are
currently students (39%, n = 127).
The majority of participants
reported working in some capacity,
including working for an employer
full-time (33%, n = 108), part-time
(23%, n = 75), being self-employed
(10%, n = 34), or working as a
homemaker or full-time parent or
Figure 7: Employment Demographics
Demographics 25
EMPLOYMENT
Note: n = 324
caregiver (1%, n = 3). A larger percentage (15%, n = 50) reported being unemployed
when compared to the overall unemployment rate in SLO County of 3% as of July 2019
(Lee).
Packet Page 38
Participants were asked about their
current relationship status. A plurality of
participants reported being single (43%,
n = 138), one-fifth (20%, n = 65) reported
being in a state-recognized union (i.e.,
married, civil union, domestic partners),
and 30% (n = 96) reported being
partnered but not in a state-recognized
union. Fewer reported having another
relationship status (4%, n = 12), divorced
(3%, n = 8), or being widowed (1%, n = 4).
Figure 8: Relationship Demographics
26 Demographics
RELATIONSHIP STATUS
Note: n = 323
Packet Page 39
HOMELESSNESS
FOSTER CARE HISTORY
Participants were asked two questions about
homelessness: Are you currently homeless? and
Have you ever been homeless? Homelessness was
defined in the survey as living in a temporary living
arrangement (such as staying with a friend or at a
shelter); or with a primary nighttime residence that
is not ordinarily used as a regular sleeping
accommodation for human beings, including
but not limited to a car, park, abandoned building,
bus, or train station. Of 325 responses,
approximately 17% (n = 54) reported a history of
homelessness and nearly 2% (n = 6) reported being
homeless at the time of the study.
reported a history of
homelessness
17%
Participants were asked questions about their
experiences in foster care, identifying
whether they were currently in foster care or
group home and whether they had any past
experiences in foster care or group home. No
participants reported being in foster care or
living in a group home at the time of the
study, though 2% (n = 8) of 324 reported past
experiences in foster care or group homes.
Demographics 27
2%
reported past
experiences in the foster
care system
Packet Page 40
BARRIERS TO SEEKING
MENTAL HEALTH SERVICES
Participants who had accessed mental health services in SLO County were asked:
Please indicate the extent to which the following factors have posed a barrier to you
when seeking mental health services or support in San Luis Obispo County. If you are
not currently seeking services, please answer based on what would be a barrier if you
were seeking services. Participants were asked to rate each item, from a list provided,
across a 3-point scale which included always a barrier, sometimes a barrier, and never
a barrier.
The top three reasons that participants rated an item as always a barrier included that
participants did not know how to find an LGBTQ+ competent provider (29%, n = 59),
cannot afford the services I want or need (26%, n = 52), and cannot find provider I am
comfortable with who is also LGBTQ+ knowledgeable (26%, n = 53). Though some of the
most frequently-endorsed barriers were not specific to LGBTQ+ identities or
experiences, several of the top-rated barriers included those that were specific to
being LGBTQ+ (trouble finding an affirming provider, concerned about provider not
being LGBTQ+ affirming, or having no LGBTQ+ knowledgeable providers in their area).
28 Barriers, Experiences, & Service Needs
Figure 9: Barriers to Seeking Mental Health Services
Note: n = 198-202 Packet Page 41
EXPERIENCES WITH MENTAL
HEALTH SERVICES
When asked, Have you had any
experiences with mental health
services in San Luis Obispo County?,
55% (n = 238) of participants
responded yes. The 45% (n = 196) of
participants who responded no,
indicating they had not had any
experiences with mental health
services, were asked why they had
not had any experiences and to
select all that apply from a list of
Barriers, Experiences, & Service Needs 29
Table 2: Percent of Participants with Mental Health
Experiences in SLO County
However, common reasons for not seeking these services included being unsure
what services are available (48%, n = 60), feeling uncomfortable seeking services
(35%, n = 44), or not being able to afford services (29%, n = 36). There were also
64 participants who reported no need to seek services and no other barriers to
care. It is important to note that beyond general discomfort, cost of treatment,
and uncertainty about the services available, 15% (n = 18) of those who had not
accessed mental health services but felt a need to seek services reported that
they felt uncomfortable seeking services because of their LGBTQ+ identity.
Table 3: Reasons Why Participants Have Not Accessed Mental Health Services
possible reasons. The most common reason was that participants felt no need to
seek services (47%, n = 90).
Note: n = 434
Note: n = 124 Packet Page 42
EXPERIENCES WITH MENTAL
HEALTH PROVIDERS
Participants were asked about their experiences with mental health providers in San
Luis Obispo County. The prompt stated:
The following questions ask about experiences with your mental health care provider.
If you do not currently have a mental health care provider, please refer to your past
provider(s) when answering.
Four items were composed by QCARES and the remainder were drawn from previous
research findings about why sexual minority adolescents may not disclose their
identities to health care providers (Allen, Glicken, Beach, & Naylor, 1998) and a survey
assessing youths’ feelings of safety in health care settings (Ginsburg et al., 2002).
Tables 4a, 4b, and 4c identify the percentage of sexual and gender minorities who
agree or strongly agree with various statements regarding the competence of
mental health care providers in San Luis Obispo County.
30 Barriers, Experiences, & Service Needs
Table 4a: General Experiences with Mental Health Providers A significant percent-
age of sexual minori-
ties (67%, n = 134) found
their provider to be
open minded and non-
judgmental of LGBTQ+
individuals. However,
approximately half of
LGBQ+ (51%, n = 102)
and less than half of
transgender or non-
binary (42%, n = 29)
participants found their
provider to be aware
and educated about
LGBTQ+ people.
Note: Total transgender/nonbinary participants (n = 68-72) and total
LGBQ+ participants (n = 193-206) for tables 4a-4c
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EXPERIENCES WITH MENTAL
HEALTH PROVIDERS
Barriers, Experiences, & Service Needs 31
Participants who identified as transgender or nonbinary experienced therapists as
being accepting or very accepting less frequently (67%, n = 48) than sexual minorities
(85%, n = 174). Less than half (49%, n = 33) of transgender/nonbinary individuals felt
safe discussing their gender identity with their provider, and nearly 35% (n = 24)
reported feeling afraid that their mental health providers would think they are
mentally ill due to their gender identity.
Table 4b: Gender Identity-Related Experiences with Mental Health Providers
Importantly, over one-third (34%, n = 37) of transgender and nonbinary
participants disagreed or strongly disagreed with the statement that they felt safe
discussing gender identity with their mental health providers. With regard to more
general statements about the knowledge level of mental health professionals,
approximately one-third of gender minority participants (35%, n = 25) reported that
the mental health professionals they had seen were knowledgeable in discussions
about gender identity.
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EXPERIENCES WITH MENTAL
HEALTH PROVIDERS
32 Barriers, Experiences, & Service Needs
Table 4c: Sexual Orientation-Related Experiences with Mental Health
Providers
The majority of sexual
minority participants
(86%) reported that
therapists are accepting
or very accepting of
their sexual orientation.
However, only one-third
(34%, n = 69) of LGBQ+
participants reported
that their mental health
providers asked them
about their sexual
orientation. It is impor-
tant to note that more
than half (62%, n = 126)
of sexual minority par-
ticipants reported feel-
ing safe discussing their
sexual orientation with
their provider. However, 15% (n = 31) of LGBQ+ participants reported feeling afraid
that their mental health providers would think they are mentally ill due to their sexual
orientation. In terms of knowledge about sexual orientation, approximately half of
both sexual minorities (53%, n = 108) and gender minorities (47%, n = 33) agreed
or strongly agreed that their mental health providers are knowledgable in discus-
67%
found their provider to be open minded &
nonjudgmental of LGBTQ+ individuals
sions about sexual orientation.
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SUPPORT SERVICES
NEEDED
Participants were asked: What type of support
services are most needed to better serve the
LGBTQ+ community in SLO County? Please rate all
from no need to high need. Answer based on your
personal experience or general impression.
Of a list provided, the support service needs most
frequently rated as a high need for San Luis Obispo
LGBTQ+ communities were LGBTQ-focused sex
education (75%, n = 265), services for people
without insurance (70%, n = 265), transgender-
specific services (70%, n = 243), low-income
services (70%, n = 244), and LGBTQ-affirming
mental health providers (67%, n = 234).
Barriers, Experiences, & Service Needs 33
Figure 10: Support Services Most Needed
Note: n ranges from 348-354
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MENTAL HEALTH
DISTRESS
A series of measures and questions were used to assess
experiences of mental health distress, including general
psychological distress, anxiety, depression, alcohol use,
substance use, suicidal thoughts and behaviors, and self-
harm.
The majority of transgender and nonbinary participants had a
higher level of psychological distress (across the various
measures) than sexual minorities. At 65% (n = 58), gender
minority respondents were much more likely to report high
levels of psychological distress than sexual minorities (46%,
n = 156; see Figure 11), with about half of transgender and
nonbinary participants (51%, n = 45) experiencing moderate
or high symptoms of depression and anxiety (see Figure 12). In
contrast, sexual minority participants self-reported higher
alcohol consumption than gender minority participants (see
Figure 13) and similar levels of drug use and associated
problems (Figure 14).
34 Experiences of Mental Health Distress
of transgender and
nonbinary participants
reported high levels of
psychological distress
65%
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PSYCHOLOGICAL DISTRESS
The Kessler-6 (K6) Distress
Scale (Kessler et al.,
2002) measures general
psychological distress by
asking questions about
depression and anxiety
symptoms. The K6 is a 6-
item inventory that uses a
5-point Likert scale. It has
been widely established
that a score of 13 or
greater is indicative of a
diagnosable mental ill-
ness (Kessler et al.,
2003).
Experiences of Mental Health Distress 35
Table 5: Psychological Distress Measurements
Of all participants in the survey, approximately 32% (n = 110)
had a score of 13 or higher. The K6 is commonly used in
practices and research within the psychological, medical,
and behavioral fields. The scale’s psychometrics have been
well-established (Kessler et al., 2002). The scale is scored by
summing together the six items for a possible range of 0 to
24. A score of 0 indicates no psychological distress, 1-5
indicates low distress, 6-10 indicates moderate levels of
psychological distress, and 11-24 indicates high levels of
psychological distress.
Participants who
identified as
transgender,
nonbinary, or
questioning
scored
significantly
higher across all
indicators of
psychological
distress.
Nervousness
Restlessness
Everything is an Effort
items that were frequently selected
by participants
Note: Total transgender/nonbinary participants (n = 89-90) and total
LGBQ+ participants (n = 340-343)
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DISTRESS DUE TO SEXUAL
ORIENTATION & GENDER IDENTITY
Figure 11: Prevalence of Psychological Distress
Table 6: Frequency of Distress Due to Sexual Orientation & Gender Identity
Participants were
asked, During the
past 30 days how
often has your
gender identity or
sexual orientation
been the cause of
these feelings? in
reference to psy-
chological distress
(see Table 6).
Approximately 57%
(n = 186) of LGBQ+
36 Experiences of Mental Health Distress
participants and 74% (n = 67) of transgender, nonbinary, and gender questioning
participants identified that their distress was due to their sexual orientation and/or
gender identity.
PSYCHOLOGICAL DISTRESS
All gender minorities reported
experiencing at least some
level of psychological distress
and approximately 65% (n =
58) of transgender, nonbinary,
and questioning individuals
experienced high levels of
psychological distress.
Note: Total transgender/nonbinary participants (n = 90) and total LGBQ+
participants (n = 332)
Note: Total transgender/nonbinary participants (n = 89) and total
LGBQ+ participants (n = 329)
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DEPRESSION AND ANXIETY
The Patient Health Questionnaire (PHQ-4; Kroenke, Spitzer, William, & Löwe, 2009) is a
widely-used, brief screening scale for depression and anxiety in psychological and
medical practice and research. It measures depression and anxiety by asking four
questions, the first two addressing anxiety symptomatology and the second two
addressing depression. It states: The following questions ask about problems you may
have experienced as a part of daily life. When answering, think about how often you
have been bothered by the following problems in the past two weeks.
Feeling nervous, anxious, or on edge?
Not being able to stop or control worrying?
Little interest or pleasure in doing things?
Feeling down, depressed, or hopeless?
Participants were asked to respond using on the following scale:
not at all = 0, several days = 1, more than half of the days = 2, nearly every day = 3
Experiences of Mental Health Distress 37
Figure 12: Prevalence of Anxiety and Depression
Note: Total transgender/nonbinary participants (n = 89) and total LGBQ+
participants (n = 327)
The values of the selected response options were summed and interpreted accordingly
(Kroenke et al., 2009; see Figure 12.) As shown, over one-quarter of gender minority (28%,
n = 25) and over one-third of sexual minority participants (39%, n = 127) indicated mild
symptoms of anxiety and depression. Over half (51%, n = 45) of gender minority
participants reported either moderate or severe symptoms of depression and anxiety, as
compared to approximately one-third (33%, n = 107) of sexual minority participants.
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SUICIDALITY
38 Experiences of Mental Health Distress
Table 7 shows approximate percentages of participants who responded yes to
various questions about suicidality. In reference to the past year, approximately 28%
(n = 94) of sexual minorities and 38% (n = 33) of gender minorities reported seriously
considering attempting suicide. Approximately half (51%, n = 44) of gender minorities
reported that they had made specific plans for suicide.
Table 7: Prevalence of Suicidality
The Revised Adolescent Suicide Questionnaire (ASQ-R;
Pearce & Martin, 1994) is a 5-item measure of suicidal
thoughts and behaviors. The measure asks questions in a
binary yes or no format. The questions cover the topics of
suicidal ideation, plans, threats, self-harm, and attempts.
The precise language of the ASQ-R was used to maintain
scale validity. However, it should be noted that some of the
language (i.e., commit suicide, made threats) is outdated,
stigmatizing, and contributes to the inaccurate and harmful
associations of suicidality with criminality and danger to
others (Beaton, Forster, & Maple, 2012). An additional item
n line with the California Healthy Kids Survey (California
School Climate, Health, and Learning Surveys, n.d.) asked
about thoughts of suicide in the past year.
The data indicate
that suicidal thoughts
are common, with
approximately three-
quarters
(74%, n = 249) of
sexual minorities and
85% (n = 74) of
gender minorities
reporting having
thought about suicide
at some point in their
lives.
Note: Total transgender/nonbinary participants (n = 87) and total
LGBQ+ participants (n = 334-335)
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SUICIDALITY
Experiences of Mental Health Distress 39
Although self-injurious behaviors are not
necessarily a component of suicidality,
participants were asked about self-
injury, Have you ever deliberately tried to hurt
yourself (self-harm)? Nearly half (47%, n = 157)
of sexual minority participants and about two-
thirds (66%, n = 57) of gender minority
participants reporting having engaged in self-
injurious behaviors.
Figure 13 : Prevalence of Suicidal Ideation, Plan, and Attempt by Age
of youth reported that
they seriously
considered attempting
suicide in the past 12
months
52%Approximately 85% of transgender and nonbinary
participants reported that they have thought about
killing themselves at some point in their life (n = 74), with
36% attempting to die of suicide at some point in their
life (n = 31). Youth and young adults reported higher
rates of suicidality across all measures.
Note: n = 296-297
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ALCOHOL MISUSE
The Alcohol Use Disorders Identification Test-C (AUDIT-C; Bush, Kivlahan,
McDonell, Fihn, & Bradley, 1998) is a brief, 3-question scale used to identify
consumers of alcohol who have risky drinking habits or potential alcohol use
disorders.
This test was used to guide the following questions asked on the survey:
How often do you have a drink containing alcohol?
How many standard drinks containing alcohol do you have on a typical day?
How often do you have six or more drinks on one occasion?
Scale totals for this measure of alcohol use were calculated for each
respondent by summing the values assigned to the response options selected
for a scale range of 0-12. Participants who responded never to the first item
were automatically directed to the proceeding set of questions and therefore
scored a total of 0.
The AUDIT-C risk group
designations of “low” use and
“mild” alcohol misuse—but not
moderate and severe misuse—
are typically dependent on the
test-taker’s self-reported sex
(Bradley et al., 2016), but
sex-differential scoring of
alcohol misuse scales is based
on research in which sex and
gender are incompletely
operationalized, thus rendering
unclear whether gender
identity, internal or external
physiological sex
characteristics, or sex assigned
at birth is most relevant to the
interpretation of alcohol misuse
measures
(Gilbert et al., 2018).
Given the inadequate guidance on the
interpretation of alcohol misuse scales for
transgender and nonbinary participants (Gilbert,
Pass, Keuroghlian, Greenfield, & Reisner, 2018),
the low use and mild alcohol misuse ranges
suggested for AUDIT-C scoring (Bradley et al.,
2016) were combined to create a single
category independent of participant sex and
gender.
Risk groups were defined as a score of:
0 = no alcohol misuse
1-4 = low use to mild alcohol misuse
5-8 = moderate alcohol misuse
9-12 = severe alcohol misuse.
40 Substance Use
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ALCOHOL MISUSE
Gender minority participants were more
likely to have abstained from alcohol use
(42%, n = 38 ) than sexual minority
participants (30%, n = 104; Figure 14).
Sexual minority participants were more
represented in the categories of low use
to mild alcohol misuse (61%, n = 207),
moderate alcohol misuse (8%, n = 27), and
severe alcohol misuse (1%, n = 3), with just
Substance Use 41
Figure 14: Prevalence of Alcohol Misuse
61%52%
LGBQ+Transgender
&
Nonbinary
reported low to mild alcohol use
&
Note: Total transgender/nonbinary participants (n = 90) and total LGBQ+ participants (n = 341)
over half (52%, n = 47) of gender minority
participants reporting low use to mild
alcohol misuse, 6% (n = 5) reporting
moderate alcohol misuse, and none
scoring in the category of severe alcohol
misuse.
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DRUG ABUSE
Participants were asked about using
drugs, blackouts, and withdrawal,
among other questions (see Appendix
A). Response options yes and no were
scored as 1 and 0, respectively, with
the exception of the third item, Are
you always able to stop using drugs
when you want to? which was reverse-
scored. Participants who responded
no to the first item asking, Have you
used drugs other than those required
for medical reasons? were
automatically directed to the
proceeding set of questions and
therefore scored a total of 0 on the
DAST-10.
The scale was scored by adding the values
assigned to each response option for a range
of 0-10. Scores were interpreted as a score
of 0 indicating no problems reported, 1-2 as
low level, 3-5 as moderate level, 6-8 as
substantial level, and 9-10 as severe level of
problems related to drug abuse (Drug Abuse
Screening Test, DAST-10, n.d.).
42 Substance Use
The Drug Abuse Screening Test-10 (DAST-10; Skinner, 1982) is a brief screening tool that
provides a quantitative measure of problems related to past-year drug abuse. It is used
to identify potential drug problems as well as provide information about the degree of
problems reported.
Over half of
participants
reported
no drug use
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DRUG ABUSE
Substance Use 43
Figure 15: Prevalence of Drug Abuse
Figure 15 demonstrates
comparable
representation of
gender and sexual
minority participants in
each category of drug
abuse-associated
problems. Nearly half of
both sexual minorities
(43%, n = 147) and
gender minorities (44%,
n = 40) reported using
drugs in the past 12
months.
Just over one quarter of both gender minority
participants (28%, n = 25) and sexual minority
participants (26%, n = 87) reported low levels
of drug use problems, with 16% (n = 15) of
transgender and nonbinary participants and
17% (n = 60) of sexual minority participants
reporting moderate to severe levels of past-
year problems associated with drug use.
Approximately 10% (n = 9) of gender minority
and 12% (n = 41) of sexual minority
participants scored a moderate level of
problems related to drug abuse.
Note: Total transgender/nonbinary participants (n = 90) and total LGBQ+ participants (n = 340)
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COMMUNITY
CONNECTEDNESS
Participants were asked a series of questions regarding how akin they felt to their
community (Flanagan, Cumsille, Gill, & Gallay, 2007) and about their
connectedness to others who share their sexual orientation or gender identity
(Testa et al., 2015).
Participants were asked about their connectedness to the community using the
prompt below.
Please select the most appropriate response for how well each statement
finishes the following statement:
44 Community Connectedness
Table 8: General Community Connectedness
Table 8 identifies approximate percentages of general community connectedness,
with less than one-third of participants (29%, transgender/nonbinary n = 25; LGBQ+
n = 94) responding that most LGBTQ+ people feel safe in their community and only
approximately one-quarter of gender minority participants (26%, n = 23) and one-
third of sexual minority participants (35%, n = 114) feeling that people are welcomed
when they move here regardless of their identities.
Note: Total transgender/nonbinary participants (n = 86-87) and total
LGBQ+ participants (n = 327-330)
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COMMUNITY
CONNECTEDNESS
A little over half (57%, n = 188) of
sexual minority participants felt
connected to others who share
their sexual orientation; however,
approximately one-quarter (26%,
n = 86) of respondents reported
feeling isolated from those that
share a similar sexual orientation.
Community Connectedness 45
Table 9: Gender Minority Community Connectedness
Table 10: Sexual Minority Community Connectedness
When examining community
connectedness specific to gender
(Table 9) and sexual (Table 10)
minorities, more than half (53%, n =
50) of gender minorities did not feel
like they are a part of a community
of people that shares their gender
identity, and approximately one-
quarter (25%, n = 22) felt isolated
and separated from others who
share their identity.
The Community Connectedness subscale of the GMSR (Testa, Habarth, Peta, Balsam, &
Bockting, 2015), a measure of transgender individuals’ affiliation and connectedness to
the gender minority community, was also included to assess identity-specific community
connectedness. Language for both the Community Connectedness subscale of the
GMSR Measure was adapted to create a comparable measure for sexual minorities.
These questions were included given the documented importance of community and
connection for mental health and wellness (Kertzner, Meyer, Frost, & Stiratt, 2009;
Meyer, 2003; Pflum, Testa, Balsam, Goldblum, & Bongar, 2015).
Note: n = 87
Note: n = 328-329
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MINORITY STRESS AND
DISCRIMINATION
46 Minority Stress
Figure 16: Minority Stress Model
The Minority Stress Model (Figure 17) demonstrates the pathway by which
discrimination and societal stigma culminate in mental and physical health
disparities between members of marginalized identity groups (e.g., LGBTQ+
community members and people of color) and people holding privileged social
identities (e.g., cisgender, heterosexual, and white people; Meyer, 1995, 2003).
The Daily Heterosexist Experiences
Questionnaire (DHEQ; Balsam,
Beadnell, & Molina, 2013) is a 50-
item, research-based assessment tool
with good internal reliability across
subscales (Cronbach's alpha ranging
between .76 and .87) and in its
entirety (α = .92) that is used to
assess the unique, intersectional
experiences of minority stress in
varying gender and sexual minority
individuals. Thirty-one items across
eight subscales (see Tables 11a-11g)
were selected for use to assess the
degree to which participants have
faced stressors specific to LGBTQ+
communities.
Reports of being sexually harassed
yielded significant percentages with
22% (n = 68) of sexual minorities and
34% (n = 29) of gender minorities
reporting that this experience
happens to them some or all of the
time (see Table 11g).
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Minority Stress 47
Table 11a: Minority Stress - Gender ExpressionGender minority participants
reported feeling significant stress
surrounding their gender
expression, with 78% (n = 68)
feeling misunderstood because
of their gender expression and
approximately half (48%, n = 42)
feeling invisible in the LGBTQ+
community. In terms of direct
discrimination, approximately 17%
(n = 56) of sexual minority
participants and almost one-
quarter (24%, n = 21) of gender
minority participants reported
that they have been verbally
harassed by strangers because of
their LGBTQ+ identity.
Additionally, 25% (n = 80) and 31%
(n = 27) of sexual and gender
minorities, respectively, reported
that they regularly hear
derogatory slurs directed toward
them. Large percentages of both
gender (79%, n = 67) and sexual
(62%, n = 201) minorities
reported feeling vigilant around
heterosexual people and
approximately one-third (35%, n =
112) of sexual minority participants
reported that they pretend to be
heterosexual and hide their
relationships from others
(see Table 11c).
Table 11b: Minority Stress - Discrimination/Harassment
MINORITY STRESS AND
DISCRIMINATION
Note: Total transgender/nonbinary participants (n = 84-87) and
total LGBQ+ participants (n = 313-335) for tables 11a-11h
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MINORITY STRESS AND
DISCRIMINATION
48 Minority Stress
Table 11c: Minority Stress - Vigilance
Participants reported high
percentages of vicarious
trauma, with notable
findings including 68% (n =
216) of sexual minorities and
84% (n = 73) of gender
minorities reporting that
they frequently hear about
LGBTQ+ individuals they
know being treated unfairly.
Table 11d: Minority Stress - Vicarious Trauma
Vicarious trauma has
been identified as
having a significant
impact on individuals
who identify as being
in a marginalized
group. Perry and Alvi
(2012) found that
being aware of
violence toward
others of the same
identified group
provoked similar
emotions of anger
and vulnerability.
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MINORITY STRESS AND
DISCRIMINATION
Minority Stress 49
Table 11e: Minority Stress - Family of Origin
Most gender minority (64%, n = 56) and sexual minority
(54%, n = 172) participants reported avoiding talking about
their identities with their families.
Table 11f: Minority Stress - HIV/AIDS
Seventeen percent of gender minority participants and 15% (n = 47) of sexual minority
participants reported worrying about getting HIV/AIDS.
40%
of transgender/nonbinary
participants reported
being rejected by their
families due to identifying
as LGBTQ+
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MINORITY STRESS AND
DISCRIMINATION
50 Minority Stress
Table 11g: Minority Stress - Victimization
About one-third (34%,
n = 29) of gender
minorities and one-fifth
(22%, n = 68) of sexual
minorities reported sexual
harassment due to their
identities.
Table 11h: Minority Stress - Isolation
of all participants
experienced difficulty
finding LGBTQ+ friends
53%
Significant percentages of
both transgender (74%, n =
63) and LGBQ+ (54%, n =
172) participants reported
having difficulty finding a
partner. Additionally almost
half of both gender
minorities (55%, n = 47) and
sexual minorities (46%, n =
145) reported having very
few people to talk to about
being LGBTQ+.
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INTERNALIZED STIGMA
Nearly one-fifth (18%, n = 14) of transgender or nonbinary
participants and one-tenth (9%, n = 28) of sexual minority
participants reported resenting their gender identity or
expression or their sexual orientation, respectively.
The most highly-endorsed
items of internalized stigma
across the two scales
pertained to feeling like an
outcast because of a
marginalized gender identity
or expression (55%, n = 44)
or sexual orientation (27%, n
= 88) and questioning why
one’s gender identity or
expression (43%, n = 34) or
sexual orientation (23%, n =
75) is not normal.
Table 12: Internalized Transphobia
Table 13: Internalized Heterosexism
Internalized Stigma 51
Overall, transgender
and nonbinary
participants selected
all items related to
internalized
transphobia at higher
rates than did
LGBQ+ participants
for each
corresponding item of
internalized
heterosexism.
Items from GMSR - Testa et al. (2015); Note: n = 80
Adapted from GMSR - Testa et al. (2015); Note: n = 325-329
Internalized stigma is a minority stressor involving the adoption of societal shame and
negative beliefs by those holding marginalized social identities into their self-concepts
and attitudes about their stigmatized identities (Meyer, 1995). Specifically, internalized
stigma of gender minority identities is termed internalized transphobia whereas
internalized heterosexism refers to internalized stigma of sexual minority identities.
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RESULTS
Phase 2
Focus Groups
A series of six focus groups were conducted in San Luis Obispo County to further
assess LGBTQ+ residents' mental health needs, experiences with care, and barriers to
care. Thematic analysis was used to categorize the data into six major themes with
sub-themes in various categories.
The themes are:
Barriers to Accessing Mental
Health Care
Conditional Feelings of Safety
Supportive Space and Community
Negative Experiences with Mental
Health Providers
Positive Experiences with Mental
Health Providers
Gender Identity-Specific
Experiences and Perceptions
52 Focus Groups
The series of focus groups included
groups of lesbian women; gay men;
bisexual, pansexual, queer, & asexual
adults; transgender & nonbinary
adults; LGBTQ+ adults; and LGBTQ+
youth (14-17 years old).
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THEME 1: BARRIERS TO ACCESSING
MENTAL HEALTH CARE
Focus Groups 53
"…regardless of, you know, the
orientation thing, I find it difficult
just to get any help. I tried through
[agency], I’ve tried through other
things, and I get anything from, they
don't return calls, to “Well, I’m not
taking clients right now,” you know?
Even if they take insurance or
whatever, they’re just...booked.
They’re full."
"I’ve had issues with
my family, like, I
know that my mom
doesn’t believe in
getting help for
mental health
things."
Financial Issues
"And it’s, like, you find these
therapists that look really nice
online, but again, it’s like—
they’re not lower-income
friendly or insurance-friendly or
anything like that, so it’s really
inaccessible."
"You’ll find a provider that is exactly what you
want and then you can’t go there because you
can’t afford it. And, you know, I’m on state
insurance and a lot of places that really
specialize in specific areas don’t accept that
insurance."
Mental Health Stigma
"I’m out at work, I’m comfortable
talking about being bi at work, but the
fact that I’m bipolar, oh no, nobody
knows about that secret."
"…because there’s
stigma about mental
health and then there’s
the whole stigma
around LGBTQ+, issues,
it’s like a double
whammy…"
"I think there needs
to always be more
information in
Spanish and other
languages."
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THEME 1: BARRIERS TO ACCESSING
MENTAL HEALTH CARE
54 Focus Groups
"…[we need] more
therapists and doctors who
know about queer stuff, who
are trained, who are queer
themselves; there’s like one
doctor in town who does
hormones."
"And mental health-wise, therapists are…not
known to the general community. I had to ask
many, many people, 'Who can I see? Who can I
talk to? Who is your recommendation for a
doctor?' And I strictly found out by word of
mouth through groups...there’s nothing
publicly."
Lack of LGBTQ+ Affirming Providers
"…just more
advertisement for
both therapists and
support groups in general,
just have it more common
knowledge [than] just
around the
town…"
Knowing How to Find and Access Mental Health
Care
"…my husband and I both have experiences with mental health providers
—it's not like anyone’s doing terribly…it’s just a lack of knowledge and it’s
really hard to find someone who is actually LGBT to work with."
"I’d say they’re
fine as people, but
when you take the
gay or trans part
then, like, they don’t
know what
to do."
Packet Page 67
THEME 2: CONDITIONAL FEELINGS
OF SAFETY
Focus Groups 55
"You still get
crawly creatures up your
back when you see some
people—you worry about
even walking downtown San
Luis Obispo after dark,
especially at bar
closings."
"Sometimes I'm a little
anxious about wearing my
skirt somewhere where it
seems very cis-expressive…
that’s a little nerve-
wracking."
Based on Location
"We don’t find
ourselves feeling super
comfortable to hold hands
walking down the street, really
anywhere in the county...that’s
definitely something I’d love to
see change or be a part of
that change."
Based on Identity and Presentation
"It’s kinda always on my mind, about making sure you
know where you are, your whereabouts, who your
audience is, if you’re paying for gas, going out to
lunch, or whatever it may be…"
"I think it has a lot to
do with your workplace. I mean,
that’s where you encounter so
much of the pressure to disclose or
not disclose, or talk about these
things or [wonder] am I going to
respond to that weird comment
or just let it go?"
"...but there’s also a difference between safety and comfort. Not in every circumstance
would I feel comfortable...making a loud declaration of bisexuality."
"I don’t feel the
same freedom to express
my love for my wife in
public the same as I might
feel in a city
environment…"
Packet Page 68
THEME 3: SUPPORTIVE SPACE AND
COMMUNITY
56 Focus Groups
"…to have a brick
and mortar place, you
know that might even be
government supported, or
county supported…where
you could go and belong,
and not fear for your
safety."
"I like GALA,
GALA’s pretty
cool."
Need and Want More Supportive Formal Meetings and Spaces
"…if there [was] just
one place in the town that
was like a coffee shop or a
clubhouse or some sort of
just LGBT central area where
you could just go at anytime
and...hang out and meet
people, you know?"
"I think teachers should know how much this
would mean if [they] could use the correct
pronouns, that would mean the world to
someone if [they] got called on."
"5 Cities Hope.
[Staff member at
5 Cities Hope] is
pretty cool."
"I would love
to see a support
group for women that
are just coming
out."
"…I want so badly [to have] a real life group of other trans
people, like 16 to, I don’t know, like, 25…I have that online…
and that’s great too, [I] talk to all of them, but I wish I had
that in real life."
"A support group!...that would be helpful, just to have
a place to go and have somebody mirror and reflect
back to me 'That’s okay that you feel that way,' or,
'Yeah, I’ve had that feeling, too. Here's how I’ve dealt
with it.' Just some kind of feedback."
Need and Want More Supportive Informal Hangout Spaces
"…if we had a community center...[or] a community forum like a bar, or
something like that, then, there [could] be a bulletin board...kind of like
where we saw the QCARES advertisements there could be something
there where everyone will see it."Packet Page 69
THEME 3: SUPPORTIVE SPACE AND
COMMUNITY
Focus Groups 57
"Something that
I’ve kind of noticed is a
lot of people just want to
find community...they
want to [find] people
who are like them."
Role of Social Support
"For me [social support]
has mostly been friends and
family members, but I also really
lucked out with my job, being super
open-minded. Like, as soon as I came
out to them, because I was getting
ready to start testosterone; they all
rallied around me. Like, they’ve
been amazingly
supportive."
Packet Page 70
THEME 4: NEGATIVE EXPERIENCES
WITH MENTAL HEALTH PROVIDERS
58 Focus Groups
Lack of LGBTQ+ Competence
"I’ve really struggled,
actually, to find someone to
open up to and talk to about
things that understands...I've had
a couple different therapists in the
past who have straight up told me
'Well, I don't really know how to
help you with your gender
thing because I don’t
understand it.'"
"It’s frustrating
sometimes because
I don’t want to be
the one to educate
you."
"I went to see a
therapist two or three years
ago. And I had an incredibly poor
experience—she made a few
comments about how it was too bad I
was using the employee assistance
program at my work to see her
because she wouldn’t be making as
much money as if I was
paying outright."
"I would probably prefer to be just
treated as a regular person, [rather]
than being, 'Oh, you’re trans, lemme
talk to you about these trans issues,'
instead, [ask] 'How are you doing
today?' 'What’s going on in your
life?' instead of 'How’s your
dysphoria doing?'”
having to identify as gay...asking that person, 'Are you okay with that?' And there’s always
that seven-year-old self in you that you always want to hear everybody be like, 'Oh, that’s
fine, that’s completely fine.' You know [that] you’re loved, you belong. And, [then] people
say to you, 'No, actually I’m not really comfortable with that, but thanks for calling.'”
"It was really hard…calling around
and realizing that you had to ask that
question, that if I was hetero I would
have never had to bring this up, but
Packet Page 71
THEME 4: NEGATIVE EXPERIENCES
WITH MENTAL HEALTH PROVIDERS
Focus Groups 59
Lack of General Mental Health Competence
"…it was more just finding
that I couldn’t really get deep
into any topics with people because
they just weren’t getting the basic stuff.
So if I was going to talk about
depression, I had to talk about it in
more of a general way. And sort of keep
transition related things out of it,
because they just weren’t gonna
be able to give me any
specifics on that..."
"I will say that my
experience with [agency] has
also been pretty poor. I would say
the [agency] is just terrible to
begin with—because it's not
helpful for long-term, and they
just basically tell you to go
somewhere else, which I
found really
frustrating."
"…as someone who used to receive their mental health care from [agency]...It’s
awful…It’s just substandard care at best, to begin with...so, I got out of there."
Packet Page 72
THEME 5: POSITIVE EXPERIENCES
WITH MENTAL HEALTH
PROVIDERS
60 Focus Groups
"I had one [therapist]
recently who was gay,
and who got it and I felt
like we had a shared
language there."
"I have a great
relationship with my therapist.
He's very nice. Definitely [does
not have] a whole of lot of
understanding about
specific...LGBTQ concerns or
issues, but he’s great and we
have a good relationship and he's
helped
me a lot."
Mental Health Providers Demonstrate Curiosity, Interest, and Humility
"…it was really
neat getting to work
with [provider] because
she totally understood
the intersection of faith
and spirituality and
sexuality."
"I feel like
everyone I saw in a
professional capacity who I
told I was bi was
overwhelmingly positive in their
reception. There was never a
moment’s hesitation with
whether or not that was an
okay way to be
a human."
LGBTQ+ Affirming Experiences
"I super lucked
out when I came out
in this community by
connecting with a
lesbian therapist."
"I think the biggest positive for me in recent years is just seeing that more minds are
opening and more people are willing to educate themselves."
"I haven’t had any negative experiences with [agency] either. Everybody’s been really
open to whenever I wanted to share, anything about my sexual orientation, so that was
pretty refreshing."
"I will say my psychiatrist currently is super, super
supportive and I have an acquaintance that sees her as
well, that I know is lesbian and she says she loves her, too.
She’s great! I can talk to her about anything and she’s
super supportive."
"I go to a therapist
and she’s actually one of
the few that I’ve found
that actually is open to
me being gay and that
becomes a topic of
conversation for me to
unload."
"The therapist that I
have is accepting and
completely embracing
of all my identities that
I have shared, and
helps me with working
through things…"
Packet Page 73
THEME 6: GENDER IDENTITY SPECIFIC
EXPERIENCES & PERCEPTIONS
Focus Groups 61
"…having people
straight-up tell you to your
face that they’re not willing
to respect your pronouns, to
me, immediately makes the
whole rest of the encounter,
no matter how positive it
might attempt to be, [it] just
sours it."
"Just my perception,
but I think that if you are gay,
lesbian, bi, but identify as
cisgender, that’s definitely more
understood, versus trans is such the
buzzword now, but I don’t feel like
there’s a lot of understanding of the
emotions and decisions and mental
health impact of
somebody coming
out as trans…"
"…when it comes to
gender identity I feel, like, that’s very
different. I identify as genderqueer and
that feels very, very invisible to me,
especially at work. We have gendered
bathrooms and I am the only person under the
age of 30 in my workplace…if I really wanted
to, I could say 'Hey, you all need gender-
inclusive bathrooms,' and they couldn’t
tell me 'No,' but I also haven’t because I
feel like that would put a target on me
as the only person in
the office."
"…sexuality-wise, I’ve had
a lot more luck with people being open-
minded and really understanding, but
unfortunately, at least in my case when it
comes to gender stuff, it's just been really
hard to find anyone to
talk to about it."
"I’ve had a lot of
luck with, in regards to
sexuality stuff, but as soon
as I bring my gender into
it it’s, like, completely
shut down."
Packet Page 74
CONCLUSIONS AND
RECOMMENDATIONS
62 Conclusions & Recommendations
Overall, the data provide a nuanced view of the current state of LGBTQ+
mental health in San Luis Obispo County. The results provide important
information about barriers to seeking mental health care, experiences with
mental health care providers, and the support services that LGBTQ+ community
members see as most important to serve the needs of the community. Further,
this needs assessment provides a snapshot of the current state of mental
health and wellness for LGBTQ+ community members, including levels of
psychological distress, suicidality, alcohol, and drug use.
While one of the primary goals of the present needs assessment is to provide
recommendations to better serve the mental health and wellness needs of
local LGBTQ+ residents, this study also identified the strengths our community
possesses. Very few transgender and nonbinary (9%, n = 6) and sexual minority
(4%, n = 8) participants reported that their mental health providers made
distinct homophobic or transphobic remarks and most agreed that their
providers are open minded and nonjudgmental of LGBTQ+ people (see Table
4a). Further, at 86% (n = 177), most of sexual minority (see Table 4c) and 67% (n
= 48) of transgender and nonbinary (Table 4b) participants felt that their
providers were accepting of their sexual orientation or gender identity,
respectively. These positive experiences are not mutually exclusive to the
recommendations presented in the following pages, as both the areas of
LGBTQ+ mental health care that are doing well, and areas for growth, merit
recognition.
Packet Page 75
CONCLUSIONS AND
RECOMMENDATIONS
Conclusions & Recommendations 63
Organizations and agencies should attempt to identify
areas for growth and change to help support
LGBTQ+ mental health and wellness
Organizations and agencies should engage in a routine process of self-assessment in
order to better understand the current climate and needs of those they serve and
their employees aligned with national best practice in their respective fields.
Agencies should implement policies that protect and are inclusive of LGBTQ+
individuals in order to ensure equity for all and compliance with local state and
federal laws. See Appendix B for an adapted Organizational Self-Assessment.
Moreover, having an identified individual, liaison, or point person who is responsible
for proper implementation of affirming and culturally competent practices is strongly
encouraged. This person (or group of people) should be a source of support on
LGBTQ+ policies, practices, and inclusion efforts for those they serve and agency
employees. There are several examples of this best practice, including the City of New
York, Department of Corrections creating a director of LGBTQ+ initiatives (Tracy,
2019). Additionally, the Administration for Children's Services in New York, has
established a Provider LGBTQ Point Person Network (LGBTQ Children, Youth &
Families, n.d.). This is a crucial step to ensuring that LGBTQ+ affirming initiatives
continue to be considered, included, and implemented throughout and across
agencies and organizations.
67%
of participants reported
LGBTQ+ affirming
providers as a
high need
(n = 234)
Packet Page 76
CONCLUSIONS AND
RECOMMENDATIONS
64 Conclusions & Recommendations
It is important to note that being LGBTQ+ friendly
and supportive is an important first step; however,
providers, agencies, and community organizations
should also have knowledge about the broader
LGBTQ+ community (including specific gendered
identities and sexual orientations) and the health
issues and disparities the community faces. Finally,
providers often need to be trained with the skills to
provide affirming mental health care.
Trainings to promote LGBTQ+ affirming practices for mental
health providers, agencies, and community organizations
Community organizations and mental health agencies should provide training for
their staff about how to provide affirming services to LGBTQ+ community members.
Given participants’ experiences with mental health providers, specifically, provider
trainings are foundational to creating positive change for LGBTQ+ community
members. Though no data was collected directly from therapists, anecdotally, many
agencies, therapists, and local groups have requested training about LGBTQ+
affirming services. This recommendation is in line with past research suggesting that
therapists often do not feel confident in their ability to provide affirming services
(Anhalt, Morris, Scotti, & Cohen, 2003; Couture, 2017; Farmer, Welfare, & Burge,
2013). In this survey, only half (51%, n = 102) of LGBQ+ and 42% (n = 29) of
transgender and nonbinary participants reported that their providers were educated
about their unique identities and experiences (Tables 4a-4c).
Providers also need to develop an increased awareness of
their own beliefs and biases about sexual orientations and
gender identities, including heterosexist, binary, and
cisgender norms.
Packet Page 77
CONCLUSIONS AND
RECOMMENDATIONS
Conclusions & Recommendations 65
Transgender and nonbinary community members are in
need of more affirming mental health support
Throughout the needs assessment, transgender and nonbinary participants consistently
rated mental health provider experiences as less affirming and knowledgeable and
reported more disparities in most areas of mental health and wellness when compared
to sexual minority participants. Notably, less than half (49%, n = 33) of transgender and
Cultural competency trainings need to include emphases on
transgender and nonbinary identities and experiences, including at
the intersections of sexual orientation, racial and ethnic identity,
socioeconomic status, and nationality or documentation status.
nonbinary participants felt safe
discussing their gender identity with their
mental health providers (Table 4b).
Transgender and nonbinary participants
largely reported more negative mental
health outcomes, including higher levels
of psychological distress (Figure 11 &
Tables 5-6), depression and anxiety
(Figure 12), suicidality (Table 7 & Figure
13), lower levels of community connect-
edness (Tables 8-10), more frequent experiences of minority stress (Tables 11a-11h), and
higher levels of internalized stigma (Tables 12-13). These disparities highlight the need
for a substantial increase in gender-affirming mental health care in SLO County. All
efforts to support LGBTQ+ mental wellness, more generally, must take steps to ensure
that any deficits in provider knowledge, awareness, and skills in terms of working with
transgender and nonbinary clients are appropriately addressed so as to not
perpetuate the existing gaps in provider competence in serving clients with diverse
gender identities and sexual orientations.
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CONCLUSIONS AND
RECOMMENDATIONS
66 Conclusions & Recommendations
Suicide prevention efforts need to purposefully include
LGBTQ+ community members
In this study, approximately 28% (n = 94) of LGBQ+ and nearly 38% (n = 33) of
transgender and nonbinary participants seriously considered attempting suicide during
the past 12 months, with much higher percentages for youth and young adults. Kaniuka
et al. (2019) found that community connectedness was a significant moderator between
perceived stigma, depression, and suicidal behavior. In conjunction with concerted
efforts to create safe spaces, specific suicide prevention initiatives need to be directed
towards the LGBTQ+ community. Research has demonstrated that LGBTQ+ specific crisis
services have played an integral role in suicide prevention among the LGBTQ+
community (Goldbach, Rhoades, Green, Fulginiti, & Marshal, 2019). In addition to
common trainings such as Mental Health First Aid and Question, Persuade, Refer (QPR),
suicide prevention trainings should include a specific LGBTQ+ component.
Increased support services for
LGBTQ+ youth are necessary
In the present needs assessment, 92% (n = 48) of
youth participants have thought about killing
themselves and 52% (n = 27) of youth participants
reported seriously considering suicide in the past 12
months. Further, 35% (n = 18) of youth participants
have attempted suicide. Similarly, the 2017 California Healthy Kids Survey found that 51%
of SLO County LGB youth (Elfers et al., 2019a) and nearly 58% of trans youth (Elfers et
al., 2019b) had seriously considered attempting suicide in the past 12 months. Additional
research has identified that LGBTQ+ youth are at increased risk of drug and substance
use in comparison to their cisgender and heterosexual peers, leading to increased
suicide ideation and attempts (Hatchel et al., 2019). Notably, inclusive sex education
was rated as a high need by 75% (n = 265) of participants.
An increased focus on LGBTQ+ youth services is needed in San Luis
Obispo County, including LGBTQ+ affirming support groups and safe
spaces to connect with peers, particularly at school.
Packet Page 79
CONCLUSIONS AND
RECOMMENDATIONS
Conclusions & Recommendations 67
LGBTQ+ affirming community spaces are needed to
increase feelings of safety and community connectedness
Feeling a strong connection to a sense of community was of central importance and a
recurring theme throughout the needs assessment in both the quantitative and
qualitative portions of the study. Research has found community connectedness to be
a resilience factor associated with perceived social support (Testa et al., 2015) and
the belief that America is a just society (Flanagan et al., 2007). Given the role of
community connectedness as a buffer against the deleterious effects of minority
stressors on mental health in LGBTQ+ populations (Meyer, 2003), there is a
demonstrated need from participants for more accessible and supportive community
spaces (see Theme 3 from focus groups). With survey results finding that only 29%
(transgender/nonbinary n = 25; LGBQ+ n = 94) of participants agreed that most
LGBTQ+ people feel safe
in their community (see
Table 8), structural actions
fostering a stronger
connection to the local
LGBTQ+ community may
result in lower levels of
psychological distress and
increased mental wellness
in LGBTQ+ San Luis
Obispo County residents.
Packet Page 80
CONCLUSIONS AND
RECOMMENDATIONS
68 Conclusions & Recommendations
LGBTQ+ affirming community spaces are needed to
increase feelings of safety and community connectedness
The null environment hypothesis (Freeman, 1979) posits that explicit demonstrations of
support are necessary for marginalized communities to feel welcome and safe in a
given space. Because the absence of overt cis- and heterosexist hostility is insufficient
for promoting feelings of safety, organizations, businesses, and agencies can signal
LGBTQ+ affirming practices by flying pride flags (e.g. Philadelphia Pride Flag, Daniel
Quasar’s Progress Pride Flag, transgender pride flag). Such displays of support must be
accompanied by policies and practices that create actually LGBTQ+ affirming
environments. Other benchmarks for access, equity, and inclusion can be found in the
organizational self-assessment (see Appendix B).
The avenues of funding for and feasibilities of each previously-mentioned
recommendation to bolster community connectedness may differ, however, these steps
represent examples of concrete, structural-level actions that may lead to measurable
improvements in the mental health of local LGBTQ+ community members by way of
supporting community connectedness.
1) Increased funding, resources, and staffing is needed
for local LGBTQ+ organizations and for agencies that
disproportionately serve LGBTQ+ individuals. Funding is
also needed to support and increase LGBTQ+ affirming
initiatives across all agencies and organizations.
2) Provide funding to form new support, social, and
wellness groups or organizations, particularly where
these are lacking (e.g. North County) or a need has
been indicated.
3) Support for the LGBTQ+ community should be
displayed prominently and meaningfully in public and
private spaces.
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CONCLUSIONS AND
RECOMMENDATIONS
Conclusions & Recommendations 69
A database of LGBTQ+ affirming services and providers is
needed to reduce barriers to seeking care
Participants noted several barriers to seeking and receiving mental health care,
including many that could be remedied with an easy-to-access and searchable online
database of providers. Participants noted that finding affirming providers is largely
“word of mouth”, and many noted that it was difficult to find LGBTQ+ affirming services.
In fact, most participants reported not knowing how to find an LGBTQ+ competent
provider (68%, n = 137), and many believe that there are no LGBTQ+ knowledgeable
mental health services in their neighborhood (60%, n = 119).
There are some national online directories that help LGBTQ+ community members find
medical doctors or mental health providers, however, there are often very few, if any,
providers listed for San Luis Obispo County. Ideally, more affirming therapists might join
national directories that are LGBTQ+ specific. Unfortunately, when directories are not
LGBTQ+ specific, there are often questions from community members about how
knowledgeable and affirming the providers really are, or if they simply “checked a box”
on a form.
It may be advantageous to have more than one data base. These might be hosted by
different agencies and organizations, or a collaboration between agencies might
support the development of a more robust database, ideally focusing on various aspects
of health and wellness. The ability to search for providers online will likely enhance
community members’ ability to find the doctors, therapists, agencies, and organizations
that support and affirm their identities, thereby enhancing community connectedness.
There are several considerations when creating a directory
or database of providers, including which organizations will
host directories, the criteria for providers who are
interested in being placed on the list, the management of
the directory over time, and usability of content (i.e., being
able to search by geographic region, insurance, etc.).
Though these all need to be carefully considered, it should
not stop the progress of such a venture.
Packet Page 82
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70 References
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psychological distress. Psychological Medicine, 32(6), 959-976.
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., … Zaslavsky, A.
M. (2003). Screening for serious mental illness in the general population. Archives of
General Psychiatry, 60(2), 184-189. https://doi-org.ezproxy.lib.calpoly.edu/10.1002/mpr.310
Kroenke, K., Spitzer, R., Williams, J., & Löwe, B. (2009). An ultra-brief screening scale for anxiety
and depression: The PHQ-4. Psychosomatics, 50(6), 613-621. Retrieved from
http://search.ebscohost.com.ezproxy.lib.calpoly.edu/login.aspx?
direct=true&db=psyh&AN=2009-24222-009&site=ehost-live
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72 References
Lee, R. (2019, July 19). Immediate release: San Luis Obispo-Paso Robles-Arroyo Grande
metropolitan statistical area (MSA) (San Luis Obispo County). Retrieved from
https://www.labormarketinfo.edd.ca.gov/file/lfmonth/slo$pds.pdf
LGBTQ Access Project. (2016). Organizational self-assessment. Retrieved from
https://endgv.org/wp-content/uploads/2016/04/Organizational-Self-Assessment.pdf
LGBTQ Children, Youth & Families. (n.d.) NYC Administration for Children's Services. Retrieved
from https://www1.nyc.gov/site/acs/about/for-practitioners.page
McLaughlin K. A., Hatzenbuehler M. L., & Keyes, K. M. (2010). Responses to discrimination and
psychiatric disorders among Black, Hispanic, female, and lesbian, gay, and bisexual
individuals. American Journal of Public Health, 100(8), 1477-1484. https://doi-
org.ezproxy.lib.calpoly.edu/10.2105/AJPH.2009.181586
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social
Behavior, 36(1), 38–56.
Meyer I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual
populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–
697. https://doi-org.ezproxy.lib.calpoly.edu/10.1037/0033-2909.129.5.674
Pearce, C. M., & Martin, G. (1994). Predicting suicide attempts among adolescents. Acta
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org.ezproxy.lib.calpoly.edu/10.1111/j.1600-0447.1994.tb01601.x
Perry, B., & Alvi, S. (2012). ‘We are all vulnerable’: The in terrorem effects of hate crimes.
International Review of Victimology, 18(1), 57-71. https://doi-
org.ezproxy.lib.calpoly.edu/10.1177/0269758011422475
Pflum, S., Testa, R., Balsam, K., Goldblum, P., & Bongar, B. (2015). Social support, trans
community connectedness, and mental health symptoms among transgender and gender
nonconforming adults. Psychology of Sexual Orientation and Gender Diversity, 2(3), 281-
286. https://doi-org.ezproxy.lib.calpoly.edu/10.1037/sgd0000122
San Luis Obispo Community Foundation. (2003). Growing Together Initiative Focus Group
Project.
Skinner, H. A. (1982). The Drug Abuse Screening Test. Addictive Behavior, 7(4), 363–371.
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Testa, R. J., Habarth, J., Peta, J., Balsam, K., & Bockting, W. (2015). Development of the Gender
Minority Stress and Resilience Measure. Psychology of Sexual Orientation and Gender
Diversity, 2(1), 65-77. https://doi-org.ezproxy.lib.calpoly.edu/10.1037/sgd0000081
Testa, R. J., Sciacca, L. M., Wang, F., Hendricks, M. L., Goldblum, P., Bradford, J., & Bongar, B.
(2012). Effects of violence on transgender people. Professional Psychology: Research and
Practice, 43(5), 452-459. doi:10.1037/a0029604
Tracy, M. (2019). LGBTQ point person named at NYC Corrections. Retrieved from
https://www.gaycitynews.nyc/stories/2019/17/elizabeth-munsky-lgbtq-dept-of-
corrections-2019-07-25-gcn.html
U.S. Census Bureau. (2019). QuickFacts San Luis Obispo County, California. Retrieved from
https://www.census.gov/quickfacts/fact/table/sanluisobispocountycalifornia/
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APPENDIX A
Appendix A 73
Phase I Survey Questions
Eligibility Questions and Demographics
What is your current age (in years)?
If you agree to voluntarily participate in this research project as described,
and are at least 14 years old, please indicate your agreement by completing
and submitting the following questionnaire.
Do you identify as part of the lesbian, gay, bisexual, transgender, queer,
questioning, intersex, or asexual (LGBTQIA) community?
Do you currently live in San Luis Obispo County?
Are you 14 years old or older?
What term below would most closely describe your gender identity? (Note: -
You will have the opportunity to mark all gender identities that apply to you
towards the end of the survey)
What term below would best describe your sexual orientation? (Note: You will
have the opportunity to mark all sexual orientations that apply to you towards
the end of the survey)
Barriers, Experiences, and Services Needs in San Luis Obispo County
Have you had any experiences with mental health services in San Luis Obispo
County?
If you have not had any experiences with mental health services, please select
all that apply:
Please check any of the following mental health services that you have had
any experiences with:
Provider Ratings
Respond to the following statement: In general my experiences at ______
were:
Please explain any positive or negative experiences (if applicable):
Are you still receiving treatment at ________?
If no, why were your treatments ended? Please select all that apply.
How satisfied would you say you are with the therapy you are receiving?
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74 Appendix A
Provider Ratings Continued
Please rate the therapists (all together) who have treated you on the following
scales.
In general, the mental health professionals I see or have seen are
knowledgeable in discussions about sexual orientation.
In general, the mental health professionals I see or have seen are
knowledgeable in discussions about gender identity.
My mental health care provider asked me about my sexual orientation.
My mental health care provider asked me about my gender identity.
I felt safe discussing sexual orientation with my provider.
I felt safe discussing gender identity with my provider.
My provider said they would be willing to discuss sexual orientation.
My provider said they would be willing to discuss gender identity.
I assumed that my health care provider was against homosexuality and/ or
gender identity noncomformity.
I was afraid my mental health care provider would think I was mentally ill due
to my sexual orientation.
I was afraid my mental health care provider would think I was mentally ill due
to my gender identity.
I was afraid my mental health care provider would send me to a psychiatric
hospital.
My mental health care provider made distinct homophobic or transphobic
remarks.
The provider is open-minded and nonjudgmental of LGBTQ+ people.
The provider is aware and educated about LGBTQ+ people.
Staff are discreet; they are sensitive to the issue of being LGBTQ+ or closeted.
I have a choice of having an LGBTQ+ provider.
The site offers services that focus on LGBTQ+ youth.
The provider does not assume that I'm heterosexual or straight and/ or
cisgender.
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APPENDIX A
Appendix A 75
Barriers
Please indicate the extent to which the following factors have posed a barrier to you
when seeking mental health services or support in San Luis Obispo County. If you are
not currently seeking services, please answer based on what would be a barrier if
you were seeking services.
I cannot afford the mental health services I want or need.
I was not eligible for the services I want or need.
The wait time to be seen by a mental health service provider was too long.
I feel ashamed to seek out mental health services.
I had a harmful or traumatic experience in the past with mental health services.
I am concerned that my mental health care will not be kept confidential.
The mental health services I have been using have been cut.
The provider hours did not work with my schedule.
There were no couples or relationship counseling services offered.
I have chronic physical health problems which limit my ability to access services.
My culture (e.g., racial, ethnic, religious) does not support mental health services.
I was only offered group services instead of individual services.
I do not have transportation to mental health services.
There are no mental health services in my neighborhood.
I am concerned that the mental health provider will mistreat me due to my race
or ethnicity.
I do not know how to find a mental health provider that is LGBTQ+ competent.
I cannot find a provider I am comfortable with who is also LGBTQ+
knowledgeable.
I am concerned that my provider would not be supportive of my LGBTQ+ identity
or behavior.
There are no LGBTQ+ knowledgeable mental health services in my neighborhood.
I am afraid that my sexual orientation or gender identity will not be kept
confidential.
Several of the LGBT providers I would visit are in the same social circle as me
(e.g., attend the same social events).
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APPENDIX A
76 Appendix A
Service Needs
What type of support services are most needed to better serve the LGBTQ+
community in SLO County? Please rate all from no need to high need. Answer
based on your personal experience or general impression.
What do you feel is needed in San Luis Obispo County to improve LGBTQ+
mental health services? Please include as many suggestions, comments, and
ideas as you would like.
Mental Health
General Distress
The following questions ask about your recent thoughts, feelings, attitudes, and
behaviors about yourself and everyday life. Please select the answer that most
accurately describes you.
Select all that apply:
During the past 30 days, about how often did you feel...
Nervous?
Hopeless?
Restless or fidgety?
So depressed that nothing could cheer you up?
That everything was an effort?
Worthless?
The following questions ask about how your responses to feelings in the previous
question may have affected you in the past 30 days.
During the past 30 days how often has your gender identity or sexual
orientation been the cause of these feelings?
During the past 30 days, how many days out of 30 were you totally unable to
work or carry out your normal activities because of these feelings?
During the past 30 days, how many times did you see a doctor or other health
professional about these feelings?
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APPENDIX A
Appendix A 77
Mental Health
General Distress Continued
The following questions ask about problems you may have experienced as a part
of daily life. When answering, think about how often you have been bothered by
the following problems in the past two weeks.
Feeling nervous, anxious, or on edge?
Not being able to stop or control worrying?
Little interest or pleasure in doing things?
Feeling down, depressed, or hopeless?
Suicidality
During the past 12 months, did you ever seriously consider attempting suicide?
Have you ever thought about killing yourself?
Have you ever made specific plans to commit suicide without carrying them
out?
Have you ever made threats to others that you will kill yourself?
Have you ever deliberately tried to hurt yourself (self- harm)?
Have you ever tried to kill yourself?
Substance Use
Alcohol Use
The questions use the term "standard drink." When answering, you can consider a
standard drink to be: 12 ounces of regular beer, 5 ounces (a standard glass) of
wine, or a 1.5 fluid ounce shot of spirits (gin, rum, tequila, etc.).
How often do you have a drink containing alcohol?
How many standard drinks containing alcohol do you have on a typical day?
How often do you have six or more drinks on one occasion?
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APPENDIX A
78 Appendix A
Substance Use
Drug Use
When answering the following questions, please think about the past 12 months.
When the words “drug use” are used, they mean the use of prescribed or over -
the- counter medications and/or drugs, in excess of the directions, and any non -
medical use of drugs. The various classes of drugs may include: cannabis (e.g.,
marijuana, hash), solvents, tranquilizers (e.g., valium), barbiturates, stimulants
(e.g., speed, cocaine), hallucinogens (e.g., LSD), or narcotics (e.g., heroin). This
does not include alcohol or tobacco.
Have you used drugs other than those required for medical reasons?
Do you use more than one drug at a time?
Are you always able to stop using drugs when you want to?
Have you had "blackouts" or "flashbacks" as a result of drug use?
Do you ever feel bad or guilty about your drug use?
Do your spouse/partner, friends, or parents ever complain about your
involvement with drugs?
Have you neglected your family because of your use of drugs?
Have you engaged in illegal activities in order to obtain drugs?
Have you ever experienced withdrawal symptoms (felt sick) when you have
stopped taking drugs?
Have you had medical problems as a result of your drug use (e.g., memory
loss, hepatitis, convulsions, bleeding, etc.)?
Community Connectedness
The following questions are about your connectedness to the community.
Please select the most appropriate response for how well each statement
finishes the following statement:
"In my community..."
There are people I can ask for help when I need it.
Most people try to make this a good place to live.
People trust each other.
Most LGBTQ+ people feel safe.
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APPENDIX A
Appendix A 79
Community Connectedness Continued
The following questions are about your connectedness to the community.
Please select the most appropriate response for how well each statement finishes
the following statement:
"In my community..."
In general, people from my town work to solve our problems.
In general, I have found that people pull together to help each other.
When someone moves here, people make them feel welcome regardless of
their identities.
You can meet others of different sexual orientations/gender minorities.
Sources of Support
Where do you feel you get the most support for your gender identity (please
select all that apply)?
Where do you feel you get the most support for your sexual orientation (please
select all that apply)?
Internalized Stigma and Identity-Specific Community Connectedness
Internalized Transphobia
Please indicate how much you agree with the following statements.
I resent my gender identity or expression.
My gender identity or expression makes me feel like a freak.
When I think of my gender identity or expression, I feel depressed.
When I think about my gender identity or expression, I feel unhappy.
Because of my gender identity or expression, I feel like an outcast.
I often ask myself: Why can’t my gender identity or expression just be normal?
I feel that my gender identity or expression is embarrassing.
I envy people who do not have a gender identity or expression like mine.
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APPENDIX A
80 Appendix A
Internalized Stigma and Identity-Specific Community Connectedness Continued
Internalized Heterosexism
I resent my sexual orientation.
My sexual orientation makes me feel like a freak.
When I think of my sexual orientation, I feel depressed.
When I think about my sexual orientation, I feel unhappy.
Because of my sexual orientation, I feel like an outcast.
I often ask myself: Why can’t my sexual orientation just be normal?
I feel that my sexual orientation is embarrassing.
I envy people who do not have a sexual orientation like mine.
Gender Minority Community Connectedness
Please indicate how much you agree with the following statements.
I feel part of a community of people who share my gender identity.
I feel connected to other people who share my gender identity.
When interacting with members of the community that shares my gender identity, I
feel like I belong.
I’m not like other people who share my gender identity.
I feel isolated and separate from other people who share my gender identity.
Sexual Minority Community Connectedness
I feel part of a community of people who share my sexual orientation.
I feel connected to other people who share my sexual orientation.
When interacting with members of the community that share my sexual orientation, I
feel like I belong.
I’m not like other people who share my sexual orientation.
I feel isolated and separate from other people who share my sexual orientation.
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APPENDIX A
Appendix A 81
Minority Stress and Discrimination
Respond to the statements according to the scale.
Feeling invisible in the LGBT community because of your gender expression.
Being harassed in public because of your gender expression.
Feeling like you don't fit into the LGBT community because of your gender
expression.
Being misunderstood by people because of your gender expression.
Watching what you say and do around heterosexual people.
Pretending that you are heterosexual.
Hiding your relationship from other people.
Avoiding talking about your current or past relationships when you are at work.
Hiding part of your life from other people.
Being called names such as “fag” or “dyke."
People staring at you when you are out in public because you are LGBT.
Being verbally harassed by strangers because you are LGBT.
Being verbally harassed by people you know because you are LGBT.
People laughing at you or making jokes at your expense because you are LGBT.
Hearing about LGBT people I know being treated unfairly.
Hearing about LGBT people I don’t know being treated unfairly.
Hearing about hate crimes (e.g., vandalism, physical or sexual assault) that
happened to LGBT people you don't know.
Hearing other people being called names such as “dyke” or “fag”.
Hearing politicians say negative things about LGBT people.
Hearing someone make jokes about LGBT people.
Your family avoiding talking about your LGBT identity.
Being rejected by relatives because you are LGBT.
Worry about getting HIV/AIDS.
Worrying about infecting others with HIV.
Other people assuming that you are HIV positive because you are LGBT.
Being punched, hit, kicked, or beaten because you are LGBT.
Being sexually harassed because you are LGBT.
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APPENDIX A
82 Appendix A
Minority Stress and Discrimination Continued
Respond to the statements according to the scale.
Difficulty finding a partner because you are LGBT.
Difficulty finding LGBT friends.
Having very few people you can talk to about being LGBT.
Feeling like you don't fit in with other LGBT people.
Demographics
Where do you live in San Luis Obispo County?
How many years have you lived in San Luis Obispo County?
In this study, homelessness is defined as living in a temporary living arrangement
(such as staying with a friend or at a shelter); or with a primary nighttime residence
that is not ordinarily used as a regular sleeping accommodation for human beings,
including but not limited to a car, park, abandoned building, bus, or train station.
Are you currently homeless?
Have you ever been homeless?
What is your age?
What is your current employment status? Check all that apply.
What is the highest level of school or degree you have completed?
What is your current relationship status?
How much was your total individual income in 2017 in USD?
How much was your total combined family/household income in 2017 in USD? (If
living alone, please indicate your individual income.)
The following question asks about experience with the foster care system. Which of
the following best applies to you?
The choices below may not encompass your entire racial/ethnic identity, but for the
purposes of this survey, please select the choice(s) that most accurately describes
your identity: (Mark all that apply)
You marked that you are Hispanic or Latinx. Which of the following do you most
closely identify with?
What sex were you assigned at birth?
Please mark all gender identities that apply to you:
Please mark all sexual orientations that apply to you:
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APPENDIX A
Appendix A 83
Sample of Phase II Focus Group Questions
What are your general perceptions of being a member of the LGBTQ+ community in
San Luis Obispo County?
Drawing from your perceptions or your experiences, how knowledgeable are mental
health providers in San Luis Obispo County about the needs of LGBTQ+ people?
How skilled are the mental health providers in San Luis Obispo County in serving
LGBTQ+ clients?
Where do LGBTQ+ community members in San Luis Obispo County seek mental
health services and support?
What are some of the negative experiences you have had with mental health
providers in San Luis Obispo County?
What are some of the positive experiences you have had with mental health
providers in San Luis Obispo County?
What might be the barriers to seeking or receiving mental health care in San Luis
Obispo for the LGBTQ+ community?
What can San Luis Obispo County do to better support the mental health and
wellness of the LGBTQ+ community?
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APPENDIX B
84 Appendix B
Organizational Self-Assessment. Adapted from "The
LGBTQ Access Project," Copyright 2016.
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APPENDIX B
Appendix B 85
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APPENDIX B
86 Appendix B
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APPENDIX B
Appendix B 87
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88 Appendix B
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