Living out Loud, Laughing out Loud: Best Practices of an LGBT Veteran Support Group

Background/Purpose:Increasing numbers of LGBT veterans are accessing the Veterans Affairs following repeal of Don’t Ask, Don’t Tell however most social workers have not been trained to care for this previously invisible and diverse population. This lack of training is due in part to the nascent state of the literature on LGBT veterans, with the majority describing the population’s health disparities and few describing individual or group level interventions. Additionally, most social workers received little if any training in tailoring existing interventions (e.g., Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Motivational Interviewing) to LGBT veterans including those who have multiple marginalized identities (e.g., LGBT people of color, LGBT people living with disabilities, LGBT people living with serious and persistent mental illness [SMI]). This paper discusses the challenges and successes of a group level intervention for LGBT Veterans at the VA Palo Alto Health Care System (VAPAHCS).

Methods:This paper describes intake and follow-up assessments completed by LGBT Veterans who attended at least two of the LGBT Veteran support groups since its establishment in 2011. These assessments include areas of interest for group discussions, what participants hope to receive from the group, what they find most helpful about the group and how they would like the group to be changed to better meet their needs. Group participants (N=86) range in age from 22 to 86 years old, include men, women, and transgender people, and all branches of the military. Military Eras span from the Korean War to current military efforts, with a few on medical leave from active duty while receiving health care at VAPAHCS. Group participants identify as lesbian, gay, bisexual, queer, and/or transgender and intersex and have a variety of health concerns including military sexual trauma, PTSD, depression, anxiety, SMI, obesity, heart disease, vision and hearing impairment, cancer, fibromyalgia, diabetes, traumatic brain injury, and substance abuse among others. Assessments are analyzed with a mixed method approach of qualitative analysis of veterans’ written responses and simple descriptive statistics of their health challenges, discussion topic interests, and group satisfaction.

Conclusion and Implications: The success of this group is largely due to the group’s ground rules created by group members and facilitators (e.g., racist, sexist, ableist comments are not tolerated), thorough intake assessment process (clinical consultation with referring providers, chart review, and interviews with veterans), socializing veterans to the group (e.g., while the group is for sexual and gender minorities, it is not a place to find a date), and organized extramural activities (e.g., marching in the San Francisco Pride Parade, holiday parties, producing a film about LGBT Veterans, and publishing a peer reviewed journal article). Additionally, the theoretical orientations of the Minority Stress Model, Harm Reduction, Critical Race, Queer, and Feminist Theories, and Psychosocial Rehabilitation have been used successfully to tailor the group to LGBT Veterans and build and maintain a diverse group membership. Suggestions are provided for logistic considerations that increase diverse participation (e.g., group accessibility for people living with disabilities, location, outreach, and closed versus open group models).