Voices of Inclusivity: Insights from Senior Leaders on How Acadia Creates a Welcoming and Safe Space for All
We brought together three Acadia leaders for an authentic, thoughtful and personal discussion about how we can best serve the LGBTQ+ community and foster an inclusive and welcoming space for everyone.
The discussion featured Peter Pennington, Chief Executive Officer at The Refuge: A Healing Place in Ocklawaha, Florida; Rachel Legend, Division President overseeing 11 facilities across Arkansas, Florida, Georgia, Indiana, Kansas, Missouri, and Nevada; and Mark Palmenter, Chief Marketing Officer on Acadia’s Executive Leadership Team.
Q: We know that members of the LGBTQ+ community often encounter a lot of stigma and have experienced unique challenges as a result of their identity. Peter and Rachel, how are you delivering a culture of support at your facilities?
Peter: It’s one of the reasons why I’m glad I moved to Florida and ended up at The Refuge. For us, it’s creating that safe space for our clients that come in. We are very strong especially at treating trauma – there’s so much trauma in working with the LGBTQ+ population.
We have process groups that are specific to this population as well as peer-led groups in the evening, where they can come in and have their own space to talk to each other. At any given point, we probably have between 5 or 10% of our clients who identify as LGBTQ+.
Whatever views people have, we do treat our clients with the dignity and respect they deserve, and that’s it. And we’ve had no problems with staff or anyone.
I also help conduct trainings that focus on supporting this community. I was in Austin, Texas, recently and spoke on creating a welcoming space in the clinical setting for the LGBTQ+ population.
I was speaking on everything from educating and understanding to making clients feel comfortable – either with safe space stickers that you put on doors or anything in the office, like a rainbow flag – just to let people know that it’s a safe space for you to be you. That’s very important: simply establishing that therapeutic bond and allowing the client to begin to feel like they can enter into this space of, “OK, now we can talk about the stuff that’s bothering me.”
This past June, I kicked off a three-part virtual webinar series focused on LGBTQ+ inclusion in behavioral health, which I presented alongside two other Acadia leaders: Laurie Stevens-Beck, Director of Clinical Services at Starlite Recovery Center in CenterPoint, Texas, and Dr. Robert Kincanon, Associate Clinical Director at Sierra Tucson in Tucson, Arizona. We will be hosting additional webinars in the future that will be open to everyone, and attendees will even be able to earn continuing education credits for participating.
Rachel: I am working with both clinical and nursing staff on a transgender-affirming policy, process and training right now. This will allow us to have standard processes and protocols for how we welcome and place trans patients into our facilities, provide best practice quality care for LGBTQ+ patients, and build even stronger relationships with our referral partners.
We’ve done a lot of training – five of my facilities have undergone the LGBT clinical best practices training which covers topics like, “What is gender-affirming care?” “How do we look at room placement?” and “How can our groups be inclusive for all families, including grandmothers, same-sex households and kids in foster care and state placement?”
When we focus on listening to the patient in front of us, affirming their identity and ensuring their safety, we affirm Acadia’s purpose to Lead Care with Light. We don’t put people in single rooms because we know that increases patients’ risk and then we work out how it looks on the unit, the same way we work out any other patient placement that may be difficult for a variety of other reasons, to ensure their safety and comfort.
But having those conversations from the lobby when we welcome a patient – to ensure we are getting pronouns and name right, then to the unit, from shift to shift and all the way to discharge – those are the things that can make us unique and provide quality patient care. How we’re doing this is not just best practice, but also creates unique patterns of referrals.
The LGBTQ+ community faces unique health challenges. Transgender people have a higher opioid rate than cisgender people, according to a study published on the JAMA Network. Lesbians have some of the highest cancer rates because they visit their primary care physician or specialists less frequently than straight women. And, suicide rates for LGBTQ+ adolescents are much higher than average.
The adolescent population is where we have the most room to grow, because adolescents are pushing our boundaries, pushing our language, pushing our expectations, making us ask a lot of questions of them around the self-identity language they use so that we can ensure our staff are informed and can have authentic conversations with these patients.
The last thing I’d say is having strong clinical programming that is inclusive, so that we are addressing alternative families whether with family tree exercises or any space where we speak about families. That means any caregivers for our adolescents – aunts and uncles, grandparents, two moms, two dads, state care, Department of Children and Families (DCF) care, it all needs to be inclusive.
Q: Are there any memorable or unique patient stories that come to mind about how you’ve been able to serve the LGBTQ+ community?
Peter: I just had to fill out a form for my child yesterday and the form had father and mother, and I had to cross out “mother” and write “father” because it’s heteronormative. Like, “Who are your parents? Your mom and your dad.” Well, my kids happen to have two dads.
But I think of two things, in particular, because misgendering happens and pronoun usage is so important.
We have a system where our clients tell us how they want to be referred to. We have clients that try on different names sometimes. We had a client that identified as transgender after admission and said, “I always hated my name,” and we just said, “Well, tell us how you’d like us to refer to you,” so it went from one name to another name. Giving them that space to be able to do that and to be accepted during that process is very, very important to us and the client.
Then, another one that’s actually the opposite of what we’re talking about: right at the end of June last year, we admitted a female client. When she got out of the car, she saw we had Pride flags in the community areas and said, “Y’all need to take this stuff down right now.”
Our clinical team met with the client and said, “This is who we are. This is what we do. We celebrate everybody.” But the client didn’t like it, so we were able to transfer her to a different place to receive the care she needed. We’re going to keep our clients safe and supported as to who they are and stay true to who we are. And if the client doesn’t like that, then The Refuge might not be the best place for them, because we don’t want to cause more harm to our current clients because of one client.
Rachel: Some of my best moments have been when we identified opportunities to improve. I asked one of our trans patients, “How’s your experience been?” and he responded, “Horrible.” And he told me every way we failed him, and it started with admission, when they asked about his gender in a very insensitive way.
But I took that back to my senior leadership team, and I said, “This is it – this is our opportunity to do better and be better; our call to action to serve patients better.”
And so, we went out and found a trans-specific endocrinologist and therapist and PCP system for discharge planning, we changed our policies internally; we trained every staff member. We became a best practice facility. One patient interaction spawned great change.
Q: What advice would you give for developing your career, as an LGBTQ+ leader?
Mark: There are a couple things that I would share. One is that everyone brings a unique perspective to the work that they do. Research shows that LGBTQ+ employees often exhibit high Emotional Intelligence – particularly empathy for those who may have gone through or are currently going through similar struggles.
Again, no matter what your background is, one of the most authentic things that someone can bring into the workplace – acknowledging that all of us are in behavioral health for various reasons – is our fundamental desire to help people who oftentimes may not be in their best place.
Going back to our purpose to Lead Care with Light, anything that we can do to make sure that we are listening, being authentic, looking for ways to share experiences like Rachel is saying and helping to be that catalyst for convening conversations that help to advance the care of any number of communities will continue to be a focus of Acadia.
Importantly, all of us can do that – we don’t need to be a leader in the nominal sense, but that is what leaders do. They introduce new ideas, bring people together and drive change. That’s what I would offer in terms of what each of us can do at Acadia and beyond.
Peter: I like the authentic self that Mark is talking about. You definitely want to be yourself. There’s so much more to me than just my sexual identity. And so, I tend to not lead with it a lot, but I don’t hide from it, either. It’s kind of there and when people ask, I’m up front. When people ask who my wife is, I just correct them that my husband’s name is Tommy and just move forward.
I think modeling that and being able to align yourself with facilities and companies that meet that for you is important – just like we don’t want clients to not feel safe in their clinical environment, we don’t want employees to not feel safe in their occupational environment. Don’t be afraid to ask questions – even in the interview process – about how facilities handle these types of things.
Rachel: I think part of it goes back to not settling for a role at a company where you don’t feel accepted – this isn’t the 1950s where we’re forced to take jobs and be in the closet, although most assuredly that can happen in certain segments.
I think we can normalize our uniqueness by sharing that we all know what it feels like to come out. We can come out as being LGBTQ+, we can come out as being a sexual assault survivor, we can come out as being an adult child of an alcoholic, we can come out as being in recovery, we can come out as being a domestic violence survivor. We can come out for a lot of things. We all know what it feels like to sit in that moment of fear: to look and decide, to hear what people say about it before we feel comfortable telling our story. And so, if we understand what that feels like, I think that level-sets us to be able to create some space for alternative identities in a several different ways. And it can also create space for people to come out in different spaces. I would encourage all to bring their full selves.