Skip to main content
It looks like you're using Internet Explorer 11 or older. This website works best with modern browsers such as the latest versions of Chrome, Firefox, Safari, and Edge. If you continue with this browser, you may see unexpected results.

IC@N Project ECHO

Integrated Care at NEOMED (IC@N)

Equity and Justice

By Crystal N. Dunivant, MSW, LSW



How did I get here? I have been reading about the increased suicide rates in black youth. The results are alarming and demand our immediate attention. However, as I was reading, I was reminded that no one group is a monolith and many individuals have multiple identities. My initial reading led to additional reading about suicide and mental health rates in the LGBTQ+ community. The reality is that one can be a person of color and gay all at the same time.

Equity and justice have also been an interest of mine lately. I want to begin thinking beyond diversity and think about how we can provide the most equitable healthcare to all individuals. This led me to begin a discussion about how providers can effectively engage the LGBTQ+ community with a focus on multiple identities. This prompted a didactic presentation for the First Episode Psychosis ECHO. This past Friday I had the opportunity to present to the Integrated Care (IC@N) ECHO community.

What we know from the National Institute of Mental Health is that suicide continues to be the second leading cause of death for young people between the ages of 10-24. According to the Trevor Project, Lesbian, gay, bisexual, transgender, and questioning youth are four times more likely to attempt suicide compared to their straight peers. Individuals with rejecting families are eight times more likely to attempt suicide. Approximately 50 percent of transgender individuals have made a serious suicide attempt.Image of the pride flag flying against a blue sky

These statistics are stark but there is hope. Based on research that the Trevor Project has continued to expand, one accepting adult can help decreased the rates of suicide by 40 percent for LGBTQ+ youth. The one accepting adult was not tied to family members of school personnel. Healthcare providers were also part of the affirming adults identified by the youth. There is also new research that suggests access to puberty-blocking medication might lower the risk of suicide in transgender youth. Other resources have stressed the importance of identifying and addressing bias when working with racial and sexual to encourage and retention in healthcare services.

During both ECHO sessions, we spent a significant amount of time discussing shared decision-making. Shared decision-making is a framework that has been considered a foundation of patient centered care. In shared decision-making an individual is educated, provided with options, and with the input of the provider can make an informed health care decision. Shared decision-making works best when the burden isn't focused on provider and patient interaction. It is most effective when the framework is ingrained in the function and operations of the organization. One example is implementation of a shared decision-making philosophy for all staff members of the organization, including the front desk staff. Another example is pursuing commitment from leadership and develop of relationships with individuals from the LGBTQ+ community. The physical environment of the organization makes a first impression to the people coming through the doors. Welcoming cues such as, affirming pictures, educational materials, and restrooms that meet the needs of individuals with multiple identities. Again, an individual might be trans, Latinx, and a wheelchair user.

Time is of the essence for all healthcare providers. However, cultural humility is crucial when working with individuals with multiple identities. The American Psychological Association highlights that there are three core components of cultural humility. These components are a lifelong commitment to self-evaluation and self-critique, a desire to fix power imbalances, and an aspiration to develop partnerships with people and groups who advocate for others.

I shared during both sessions that I was at a Pride event about 18 months ago. I was with another organization and it was our first year having a table. The staff were excited to be there, and all the volunteers were excited. We had one volunteer who expressed that she felt very affirmed and comfortable in the that environment. As a result, she said she wanted to share with the group that she is pansexual. She was so open and gracious in answering all our questions. It was truly a memorable and enlightening experience.

I have been to cultural diversity trainings. I have read books and taught classes. No one was talking about pansexuality. This was a new opportunity for me to be quiet and listen. I allowed the individual to be the expert and she identified what her sexual identity meant to her.

I told this story during the ECHO sessions to stress the importance of having this conversation. However, this is only the beginning. I do appreciate the engagement of all participants. We had insightful conversation and questions about the next steps.

We have provided links to resources for future reading and discussion, but we would love to hear from you. What do you suggest for next steps for healthcare providers in providing affirming care for all individuals? What resources do you recommend to help providers best meet the needs of those receiving integrated care services in the community?


Contact our team with your thoughts at




Additional Reading

Image Attribution

"In Rainbows" by Jamison Wieser is licensed under CC BY-NC-SA 2.0