Social Care Improves LGBTQ+ Health: Affirm at RUSH University Medical Center
This June, RUSH is celebrating Pride Month– a time to uplift LGBTQ+ voices, recognize the impact that LGBTQ+ individuals have had on our country’s history, and celebrate all individuals’ freedom to live authentically.
Though considerable progress has been made in the last 100 years, LGBTQ+ individuals still face a number of barriers to health and wellness in areas such as employment, housing, and health care. At RUSH, one small but mighty team is working to address some of these barriers and improve the quality of care for LGBTQ+ patients: Affirm! The Affirm team works across the RUSH system to bridge gaps in LGBTQ+ care by ensuring that providers understand how to care for LGBTQ+ patients while providing high-quality care and affirming services for everyone.
Affirm is a great example of how social care providers—including social workers and patient care navigators—can make a tremendous difference in a patient’s care experience and overall wellbeing.
What is Affirm?
Affirm: the RUSH Center for Gender, Sexuality & Reproductive Health is dedicated to ensuring that LGBTQ+ individuals receive the same high-quality healthcare as their cisgender and heterosexual peers.
Due to long-standing internalized stigma, trauma, and socioeconomic disparities, LGBTQ+ individuals face higher risk of conditions such as substance use, anxiety, eating disorders, mood disorders, suicide/suicidal thoughts, obesity, HPV infection, and chronic conditions. On top of that, significant gaps in the healthcare system—such as lack of provider knowledge about the needs of queer or trans individuals, stigma around disclosure of sexual orientation and gender identity, and lack of flexibility in medical records around gender pronouns—often lead to disparities in access to care. LGBTQ+ individuals have lower rates of health insurance coverage, are more frequently refused healthcare services and harassed by providers, are less likely to fill needed prescriptions, and are more likely to rely on emergency rooms and delay seeking care.
To combat these inequities, Affirm started in January of 2020 as “the fruition of dreams that people had long had about advancing LGBTQ healthcare within Rush, especially offering care for our transgender patient population,” says Affirm’s Manager of Social Work Services, Kenji Kuramitsu. Affirm works to advocate for and serve LGBTQ+ patients through patient navigation and social work services, as well as to observe and advocate for the changes in the system.
“It’s an organization that was well overdue for this population,” says Affirm Patient Care Navigator Willie Bassett. “And well-deserved.”
Which services are provided by Affirm?
Affirm provides a multitude of services to LGBTQ+ patients spanning across multiple departments, working with physician partners throughout RUSH who serve the LGBTQ+ patient population out of passion, interest, and experience. Services provided by Affirm include behavioral health, gynecology services and cervical cancer screenings, HIV care, primary care, specialty care (obstetrics, oncology, orthopedics, neurology), surgery, patient navigation, and many types of gender-affirming clinical specialties (endocrinology, voice therapy, and more).
“Patients are just amazed how many different gender affirming services we do offer,” says Affirm Patient Navigator Andre Pappas. “A lot of patients come to us just for one surgery—for example, breast augmentation—and then they leave knowing that we have body contouring, which many people don't even know about, or facial feminization, facial masculinization. I talk to them about non-surgical services like speech therapy, which is another thing people didn't even know existed, but they do want to change their voice. Many other people didn't know that you can find a primary care provider who's affirming.”
When people think of gender-affirming care, gender-affirming surgeries immediately come to mind—but Affirm staff know that it’s important for LGBTQ+ patients to have gender-affirming providers across ALL disciplines of their care. In one study, 15% of LGBTQ+ respondents and 30% of transgender respondents said that they postponed or avoided seeking medical care due to discrimination; and 1 in 3 transgender respondents reported that they needed to educate their providers about their sexual identity in order to receive adequate care. When patients don’t feel respected or understood by their doctors, they may have lower healthcare utilization, leading to worse health. That’s why Affirm works with providers across 18 disciplines: to make sure that LGBTQ and transgender patients get gender-affirming care, no matter what kind of care they seek.
Through Affirm, “patients can be referred to physicians to not only take care of their needs, but physicians who see them for who they are,” says Bassett. “They're not feeling uncomfortable or feeling judged when they go see a primary care provider or endocrinologist or OBGYN. They're met based on how they identify, not how they appear.”
Willie Bassett, Patient Navigator (left); Kenji Kuramitsu, Manager of Social Work Services (center); and Andre Pappas, Patient Navigator (right) staff a table for Affirm at a community event.
Patient navigation at Affirm: a “human touch” for LGBTQ+ patients
Once a patient is referred to Affirm, patient navigators assist the patient by sending referrals to gender-affirming providers within RUSH, in whichever discipline they may need. “There’s no department that we won’t work with,” says Pappas, who explains that patient navigators must be well-rounded and prepared to work with any department. “One day you're working with primary care, and then you're working with endocrinology, and then it goes to surgery, and then it goes to vascular medicine, and then it's someone looking for help with allergies. Being familiar with different conditions and diagnoses just really goes a long way.”
Patient navigators also assist patients with resources and services outside of the healthcare setting, addressing health-related social needs to enable patients to live healthy lives. Affirm connects patients to organizations outside of RUSH to help ensure their social needs are met, including local food pantries, housing support resources, benefits enrollment assistance, and more. When working with LGBTQ+ patients, addressing social needs may come with added challenges; for example, Pappas explained that many patients may avoid utilizing local food pantries if they’re not sure that the organization will affirm the individual’s gender identity. “This person is in a really bad bind because they're in need of food, but they don't want to be misgendered, they don't want to be judged for who they are. So they have two choices: either deal with discrimination or go hungry.” Affirm’s patient navigators have the resource knowledge to connect patients to gender-affirming organizations, such as referring patients to RUSH’s VeggieRX program, where patients know they can access healthy foods without fear of discrimination or misgendering.
But the navigation services don’t stop there! Affirm’s patient navigators use a person-centered approach, going above and beyond to help patients feel supported and comfortable. Bassett stresses the importance of meeting the patient where they are, always asking patients what they need instead of telling them what they need. Patient navigators will go as far as accompanying patients to their appointments if that helps the patient feel safer and more comfortable. “If they're going to surgery and they just want a friendly face to see when they come out, we'll be the navigator that's there when they come out,” says Bassett.
For many patients, this person-centered approach makes all the difference to their care. Bassett describes a phone call several years ago to help a transgender patient get an at-home Covid-19 test. “I just asked in the beginning, ‘What pronouns would you like me to use?’ And just that statement made their day.” Rather than calling the patient by the name listed in their medical record—which can often be populated with outdated information, like pronouns that the patient no longer uses—Bassett asked how the patient wanted to be addressed. “That young lady told me that was the first time anyone had ever cared beyond what they saw,” Bassett recalls. “So for me, that was really rewarding.”
Affirm’s patient navigators provide the empathy, openness, and human connection that can help LGBTQ+ patients feel comfortable and accepted in their medical care. “Having that human touch to help navigate really complex medical systems has made a big difference in the lives of our patients,” says Kuramitsu.
Sanjeev Singh, Affirm Program Manager (second from right) and Kenji Kuramitsu, Manager of Social Work Services at Affirm (far right) with Chicago Mayor Brandon Johnson at the Center on Halsted’s Human First Gala, where Affirm received the Community Spirit Award.
Impact and looking forward
In addition to one-on-one patient services, Affirm is working on top-down approaches to improve the care experience for LGBTQ+ patients. Affirm empowers providers to work with LGBTQ+ patients through education on sexual orientation and gender identity (SOGI), training and education around gender-affirming care, and individual consultation. From a process perspective, Affirm has worked on creating a Gender X legal marker integration within RUSH’s electronic health record system, as well as tracking SOGI and demographic data.
Since launching in January 2020, Affirm has provided care coordination to over 3000 individuals. In June 2023, Affirm was awarded the Chicago Proud Award by Chicago Mayor Brandon Johnson in recognition of their work in the LGBTQ+ community. Affirm also received the Community Spirit Award by the Center on Halsted at this year's Human First Gala for their combined efforts with the RUSH Congregate team around the Mpox vaccination, as well as for their continued commitment to provide gender affirming care.
Affirm is continuing to grow and improve their care for the LGBTQ+ population through efforts such as a strategic planning process, the formation of a patient advisory council, and expanding their involvement with other programs within RUSH. Affirm’s team also continues to learn about LGBTQ+ care, staying on top of what’s changing so that they can assist patients to the best of their capacity.
Through their tireless efforts and the invaluable services they provide, Affirm stands out as a prime example of the way that person-centered social care can support and improve care for patients. By addressing the unique challenges faced by the LGBTQ+ community, AFFIRM is making a profound impact on the lives of their patients and contributing to a more inclusive healthcare system.
Get in touch
Want to learn more about Affirm? Visit their website: www.rush.edu/affirm
For patients seeking gender-affirming care: Fill out Affirm’s patient intake form or call (833) 624-LGBT (5428). The Affirm team will get in touch within 2 business days.
For providers looking to host cultural awareness training sessions for your team: Reach out to affirm@rush.edu