The ASHA LeaderLive Academics and Research September/October 2022

From My Perspective/Opinion: Creating a Safe Education Environment for Future LGBTQ+ Clinicians

Two faculty members offer ways CSD programs can bolster support for LGBTQ+ students in the face of threats to inclusion.

September 13, 2022
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Discrimination has a powerful effect on the LGBTQ+ community: It harms their mental and economic well-being, forces them to hide their personal relationships, and affects their access to housing, schooling, medical care, employment, and countless other critical services (see sources).

Unfortunately, many LGBTQ+ students in communication sciences and disorders (CSD) continue to experience such discrimination because not all CSD programs have joined growing efforts to embrace diversity (see ASHA efforts below). Results from a recent survey of LGBTQ+ students and professionals revealed continued discrimination, exclusion, and harassment experienced by LGBTQ+ graduate students in accredited university programs (see sources). Thus, we call on CSD programs across universities to create LGBTQ+ safe and inclusive environments for students.

Why support is essential

We will offer several suggestions about how programs can support marginalized students, but first let’s look at why LGBTQ+ students need this support.

  • Several states have recently passed anti-LGBTQ+ laws that legally sanction oppression, allowing those with discriminatory beliefs to speak or act on those beliefs. These laws can leave LGBTQ+ students feeling uncertain about their interactions with other students, faculty, supervisors, 
and clients.
  • Universities may have policies that discriminate against LGBTQ+ students. The ASHA-affiliated Council on Academic Accreditation (CAA) in Audiology and Speech-Language Pathology requires accredited programs to adhere to “laws, regulations, and executive orders” prohibiting discrimination. However, the CAA accepts federal exemptions for programs housed in universities that have been granted an exemption, such as those available under Title IX, or that are eligible for those exemptions.
  • Students may be paired with faculty or off-site clinical supervisors who discriminate against LGBTQ+ people.

LGBTQ+ students in CSD who confront these factors may feel isolated during their undergraduate and graduate programs (see sources). Some LGBTQ+ students hide their sexual orientation and gender identity as a way of protecting themselves, risking feelings of dissociation, inauthenticity, and isolation, as well as internalized homophobia, biphobia, and transphobia. The accumulation of these internal stresses may lead to invisible barriers to academic and professional success and other negative outcomes for students (see sources).

The alienation and disconnection of LGBTQ+ students can have negative consequences for the fields of audiology and speech-language pathology. Students may leave CSD entirely—despite their interest in the professions—to pursue other academic programs with greater LGBTQ+ representation and support. For some students, discomfort in living authentically during their academic programs can limit their success and growth as clinicians (see sources).

Ethical responsibility

For ASHA-certified professionals, discrimination “in the delivery of professional services or in the conduct of research and scholarly activities” violates the ASHA Code of Ethics, Principle I, Rule C). In addition, the code states that “Individuals shall not discriminate in their relationships with colleagues, assistants, students, support personnel, and members of other professions and disciplines on the basis of race, ethnicity, sex, gender identity/gender expression, sexual orientation, age, religion, national origin, disability, culture, language, dialect, or socioeconomic status” (Principle IV, Rule L).

These anti-discrimination policies protect people from harm; therefore, graduate programs need to ensure that students are also protected and educated in a way that allows them to practice ethically following graduation.

ASHA efforts

ASHA has been vocal in its support of diversity, including LGBTQ+ clients, students, and professionals.

Action steps

We encourage CSD programs to create LGBTQ+ safe/inclusive environments for students and to help them develop pride, self-acceptance, and connection to a wider community. To accomplish this, we urge them to educate themselves on LGBTQ+ current issues/events and:

Report discrimination. Clients, students, and faculty who have faced discrimination from a CAA-accredited program can report these incidents to the CAA (caa.asha.org/programs/complaints). Clients who have experienced discrimination from clinicians, or students who have faced discrimination from an ASHA-certified instructor or clinical supervisor can report ethical violations to the ASHA Board of Ethics.

Change policies that unfairly target or erase LGBTQ+ people. Though designed to ensure the system runs smoothly, these program policies—often written from the perspective of their framers—may create barriers for others. For example, consider removing gender references from dress-code policies. If some students are allowed to wear skirts that extend below the knee, then all students should be allowed to.

Hire faculty members and clinical educators who are openly LGBTQ+.  Representation matters. The presence of open faculty who are supported by fellow faculty communicates support for LGBTQ+ students as well.

Provide training for faculty and staff. These programs, which help participants become more accepting and affirming of LGBTQ+ identities, are available online and in-person through such entities as the Human Rights Campaign, The Safe Zone Project, and Transplaining. Many universities also offer trainings. 

Provide free, easy-to-access student academic and mental health support services.  

Provide access to CSD clubs/organizations that support LGBTQ+ students and allies, such as:

 Be loud and proud about supporting LGBTQ+ students. Allies constitute a larger portion of CSD faculties compared to those from underrepresented groups, so it is important that allies act on behalf of underrepresented and oppressed groups.

Identify yourself as a “safe space” with a sign in your clinic, classroom, and/or office.

Put your pronouns in email signature lines and introduce yourself with your pronouns (“I am Dr. Smith, and my pronouns are she/her”).

Work to always use people’s correct pronouns, regardless of whether they’re part of the conversation. Correct or model the correct pronouns for colleagues.

Provide LGBTQ+ representation in course content. Include information that disrupts assumptions that all families are cisgender and heterosexual. When providing case studies to students, for example, include situations that reflect the diversity of families in the community, including diversity of sexual orientation and gender. Challenge the notion that the gender of the case (“The client is a 25-year-old female”) is relevant: Does the fact that the client is a female matter in this case at all? If not, then why present gender as a prominent feature of the case in lieu of more relevant characteristics? 

Seek out student clinical experiences that serve the LGBTQ+ community. Placements that provide gender-affirming communication services help students gain skill in working with the LGBTQ+ community. Also consider providing speech-language and hearing screenings for support groups or community clinics serving the LGBTQ+ community.

Develop a crisis plan for handling discriminatory attacks from clients—before an incident happens. If faculty or administrators wait until students experience overtly racist, homophobic, misogynistic, or other oppressive abuse to determine a response, it is too late. These situations can be ethically complex because they may involve clients or patients with cognitive or other disabilities, making it even more critical to establish a carefully designed response plan. 

Much of this advice applies across all aspects of human diversity, and it all boils down to the platinum rule: Treat others the way they want to be treated. No one wants to be misgendered, called the wrong name, feel like they must hide who they are, or be punished for their gender or sexual orientation. Until there is more support for all aspects of human diversity, it is important for faculty and staff to actively support their LGBTQ+ colleagues, students, and clients, as well as those from other marginalized groups. With this vision, together we can build a more inclusive profession.

Charles Lenell, PhD, CCC-SLP (they/them), is an assistant professor in the Department of Communication Sciences and Disorders at the University of Northern Colorado. They are the initiator of the NYU LGBTQ+ Clinical Club and the national LGBTQ+ CSD Student Association; a L’GASP researcher/member; and an affiliate of ASHA Special Interest Groups 3, Voice and Upper Airway Disorders, and 13, Swallowing and Swallowing Disorders (Dysphagia). [email protected]

Gregory C. Robinson, PhD, CCC-SLP (they/them), is an associate professor in the Audiology and Speech-Language Pathology Department at the University of Arkansas for Medical Science. They are the director of the PhD program in communication sciences and disorders, the founder and director of the TLC: Gender Affirming Communication Group, and the chair of L’GASP: The LGBTQ+ Caucus of ASHA. [email protected]

Sources

ASHA. (2016). Code of Ethics [Ethics]. Available from www.asha.org/policy.

ASHA. (2021). Supporting and working with transgender and gender-diverse individuals. Retrieved 06-21-2022.

ASHA. (2022). ASHA statement on Brigham Young University administration decision to deny speech services for transgender clients. Retrieved 06-21-2022.

Bullington, E. K. (2022). Prevalence and experiences of LGBTQ+ speech-language pathologists and audiologists [Master’s Thesis, University of Arkansas for Medical Sciences].

CAA in Audiology and Speech-Language Pathology. (2020). Standards for accreditation of graduate education programs in audiology and speech-language pathology (2017). Retrieved 06-21-2022 from https://caa.asha.org/siteassets/files/accreditation-standards-for-graduate-programs.pdf

Gruberg, S., Mahowald, L., & Halpin, J. (2020). The state of the LGBTQ community in 2020: A national public opinion study. Center for American Progress. Retrieved from https://americanprogress.org/article/state-lgbtq-community-2020/.

Meyer, I. H., & Frost, D. M. (2013). Minority stress and the health of sexual minorities. In C. J. Patterson & A. R. D'Augelli (Eds.), Handbook of psychology and sexual orientation (pp. 252–266). Oxford University Press.

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