A LGBTQ young person walking into a doctor’s office might feel more anxious than the average patient. In the past, they might have experienced stares and judgment in a waiting room, discrimination or misunderstanding in an exam room, and rejection when seeking to have their treatments covered by insurance. These traumas and systemic barriers can discourage LGBTQ individuals from seeking care and that challenge is often most pervasive for those with the greatest need and fewest resources.
The Ruth Ellis Center (REC) aims to turn that dynamic around. For nearly two decades REC has provided support services and safe spaces for homeless and at-risk LGBTQ young people in the Detroit area. More recently, in partnership with Henry Ford Health System (HFHS) and with support from the Health Fund, REC is helping their at-risk clients access physical and behavioral health services through a new integrated care clinic at their Highland Park location.
Previously, REC had one “medical room” and it was used exclusively for HIV counseling. Staff noticed that their clients often wouldn’t even try to access medical care because of stigma and past traumas. At the same time, there was an ever-growing need for medical care among their clients.
So how could they convince their clients to seek necessary medical care? Rather than pushing them toward traditional care settings, REC decided it would be more effective and more helpful to bring the care to their clients, in a space they already know and trust: the Ruth Ellis Center.
Beyond making it convenient, the new integrated care clinic means REC can ensure at-risk individuals are seeing medical professionals who understand their specific challenges and needs. For example, LGBTQ youth that experience family rejection due to their sexual orientation, gender identity, or gender expression face a higher risk of serious behavioral health challenges: they’re more than eight times likely to attempt suicide, almost six times more likely to report high levels of depression, and at least three times more likely to use illegal drugs and engage in unprotected sex compared peers raised in nurturing or accepting homes. The staff at REC’s clinic are well-versed in these facts, and trained to handle each patient with respect and acceptance.
Dr. Maureen Connolly, a HFHS pediatrician who serves as medical director for the collaboration with REC, describes the project’s approach as one of “radical harm reduction.” They’re not trying to steer patients’ behavior or prevent risky life choices, a significant distinction considering they work with young people who are often practicing sex work or dealing with substance abuse issues. Instead, the program is centered around the people they serve, helping them identify and achieve their own visions for health.
And that’s different for every patient, says Dr. Connolly. That’s why it’s so innovative to provide primary care in the same setting where patients can also access mental health services, family counseling, and other wraparound services. A teen seeking a STI check-up can also find someone to talk to about how to come out as transgender to their family, find stable housing, or leave an abusive relationship. In addition, REC staff will help patients navigate insurance coverage, a labyrinthine and altogether foreign process for many of their clients.
There’s truly “no wrong door” at REC. By upending the typical routine of ‘checkup, referral, repeat,’ REC is removing barriers to healthcare and transforming the way their clients think about their own health and safety.
It’s working: Dr. Connolly says she’s had weeks where 100% of her patients showed up, something that’s never happened before in her medical career. This speaks to the resilience of the young people REC works with, Dr. Connolly says, explaining that “when offered healthcare services in an environment that is welcoming and affirming, they will choose to access medical care.”
In addition to the medical care, they might also be showing up for the social aspect, or more simply, a place to belong. Monica Sampson, LMSW, directs behavioral health services at REC. She’s noticed that clients view the clinic in the same way they’ve always viewed REC: as a place where people can connect and feel safe. “There’s a ‘third-space’ aspect to it,” Sampson explains, using a term more often applied to coffee shops than doctors’ offices.
The picture painted by Sampson is a far cry from the traditional care environment—at least for now. Through their combination of support, services, and community, REC has created an innovative integrated model that’s bringing critical care to some of our most vulnerable neighbors. Part of REC’s Health Fund grant will support seminars for other care providers and hospitals to learn about culturally competent, trauma-informed care. Their hope is that inclusive, affirming healthcare will become the rule rather than the exception, and that every individual will feel safe and empowered to seek out the care they need.