Component 1: Trainees

Trainees include behavioral health professionals; licensed and/or certified counselors; students enrolled in counseling education programs; conference and seminar attendees; staff at in-service training; primary, secondary, and tertiary caregivers; staff of health maintenance organizations (HMOs); case managers; primary care physicians; probation officers; and so forth.

Action Steps

• Recruit and select LGBT individuals of diverse ethnicity for counselor education programs and work settings.

• Develop students’ awareness of the need to understand LGBT issues.

• Provide counseling and other appropriate measures for students struggling with their own homophobia or negative attitudes toward LGBT persons.

Component 2: Faculty or Trainers

The faculty or trainers are members of counseling and social work departments responsible for curriculum development, course delivery, and practicum supervision. They prepare professionals and support staff for the behavioral health professions and provide training at seminars and workshops as well.

Action Steps

• Develop faculty and agency awareness of the need for improved understanding of LGBT issues.

• Attain and maintain a diverse faculty with theoretical and practical expertise in LGBT treatment and care.

• Recruit LGBT faculty and staff who can provide instruction, supervision, and services.

• Encourage and support all faculty and staff to continue their education in LGBT treatment areas.

• Support faculty and staff research in LGBT treatment.

• Assign decisionmaking roles to faculty who are knowledgeable about LGBT issues.

Component 3: Program

Managed care organizations, consumers, and quality improvement measures demand that health care be evidence based. Therefore, any training or educational program needs to be based on current research findings. Training elements should include assessment of need, attitudinal behavior changes, skills training, methods development, training and education program evaluation, and actions to implement change.

Action Steps

• Conduct an assessment of the current level of tolerance, sensitivity, and affirmation of the treatment agency staff.

• Gather and review pertinent research and theoretical material.

• Recruit skilled professionals as trainers and educators, and/or develop an interagency training alliance.

• Develop program materials and methods that are site- or client-specific.

• Determine methods for evaluating the effectiveness of the training or educational program.

Attitudinal Behavior Changes and Skills Training

• Utilize experiential exercises that uncover hidden biases in a safe manner (e.g., roleplay a 21-year-old coming out to his parent or ask participants to introduce themselves as lesbian, gay, bisexual, or transgender individuals).

• Encourage exploration of stereotypes and language, values, and behavior differences.

• Use various methods incorporating adult learning styles to increase skill development.

• Use additional resources available on videos and films.

Methods Development

• Make LGBT sensitivity and competency training a priority in the basic curriculum or in the inservice training schedule—an important first step in implementing this type of program.

• Redesign existing programs to include LGBT-related competencies. Use a team approach involving academic and clinical staff and, if possible, a team member from the LGBT community at large.

• Develop courses awarding continuing education units (for academic and/or professional credit) for professionals and support staff.


• Give pretests and posttests to evaluate training.

• If possible, make videotapes or audiotapes of clinical sessions before and after training to ascertain whether there have been changes in the ability to treat LGBT clients.

• Collect client satisfaction and followup data from LGBT clients treated at the same site over time.

• Conduct quality improvement studies focusing on the effects of LGBT sensitivity and competency training.

Component 4: Institutional Systems

For the purpose of this volume, the phrase “institutional or agency systems” refers to the individuals who serve as gatekeepers: administrators of organizations, departments, and schools who are responsible for the delivery of programs and services; boards of directors; and other staff.

Action Steps

• Gain administrative awareness of the need for improved understanding of LGBT issues.

• Create an administrative environment supporting LGBT care, treatment, and confidentiality.

• Require LGBT competency and sensitivity at all levels, including policy development.

• Institutionalize a policy for ongoing recruitment and selection of LGBT administrative, professional, and support staff.

• Encourage and support the use of LGBT staff and faculty to provide instruction and supervision.

• Institute administrative and clinical policies to endorse LGBT sensitivity and competency training, LGBT treatment, and unbiased care.

• Allocate curriculums, time, and resources for training.

Component 5: Professional Peers

Effective techniques for training and skills development and “what works” often are the subject of consultations among professionals. This important dimension of the training process plays a significant role in introducing important ideas to newcomers and improving practice by long-term practitioners as well.

Action Steps

• Increase professional peers’ awareness of the need for improved understanding of LGBT issues.

• Articulate the need for implementing programs at all levels of practice in professional associations.

• Convene conferences about LGBT treatment.

• Involve LGBT professionals in policymaking.

Component 6: Community

The family, neighborhood, town, city, State, and region in which LGBT clients are treated is their “home.” The response of the community to LGBT clients is a crucial factor in their care and treatment.

Action Steps

• Provide counseling services to the families of LGBT clients at all socioeconomic levels.

• Provide information on treatment and the special needs of LGBT clients to relevant parties in the community: government officials, police, and all criminal justice professionals.

• Create task forces to work directly with LGBT interest groups.