Development and Evaluation of Training for Rural LGBTQ Mental Health Peer Advocates

Development and Evaluation of Training for Rural LGBTQ Mental Health Peer Advocates

Tania Israel University of California, Santa Barbara

Cathleen E. Willging Pacific Institute for Research and Evaluation,

Albuquerque, New Mexico

David Ley New Mexico Solutions, Albuquerque, New Mexico

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people in rural areas experience negative mental health consequences of minority stress, and encounter multiple barriers to accessing mental health and substance use treatment services. As part of a larger intervention study, we developed and piloted a unique training program to prepare peer advocates for roles as paraprofessionals who assist rural LGBTQ people with mental health needs. Thirty-seven people in New Mexico took part in either the initial training or a second revised training to improve their knowledge and skills to address LGBTQ mental health needs. Evaluation of this training consisted of self- administered structured assessments, focus groups, and open-ended interviews. Results for the initial training showed no significant increases from pre- and posttest scores on knowledge about LGBTQ people and their mental health issues, whereas significant increases were detected for the revised training. There also were significant increases in self-efficacy to perform tasks associated with the peer advocate role for all but a subset of tasks for the revised training. Qualitative data reveal that participants appreciated the opportunity to increase information and skills, especially concerning bisexual and transgender persons, and the opportunity to connect with others in the community who want to support LGBTQ people.

Keywords: LGBTQ, mental health, peer, rural, training

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people in the United States experience tremendous mental health and substance use disparities (Institute of Medicine, 2011). High rates of depression, anx- iety, and suicidality within the LGBTQ popula- tion may originate in “minority stress,” which comprises chronic stigma, discrimination, and

violence (Meyer, 2003). Minority stress oper- ates within cultural institutions and social struc- tures, including health care systems (Meyer, 2003; Meyer, Schwartz, & Frost, 2008), and may disproportionately affect gender noncon- forming individuals, people of color, and rural LGBTQ persons (Díaz, Bein, & Ayala, 2006; McLaughlin, Hatzenbuehler, & Keyes, 2010; Pinhey & Millman, 2004; Williams, Bowen, & Horvath, 2005).

With regard to rural communities, LGBTQ people may face social pressure to adhere to tra- ditional gender roles and norms (Barefoot, Rick- ard, Smalley, & Warren, 2015), as well as nega- tive attitudes related to lack of contact with sexual and gender minorities (Barefoot et al., 2015; El- dridge, Mack, & Swank, 2006; Herek, 2002; Sniv- ely, Kreuger, Stretch, Watt, & Chadha, 2004). Victimization—verbal harassment, property dam- age, and physical assault—is commonly reported by rural LGBTQ people (Barefoot et al., 2015;

Tania Israel, Department of Counseling, Clinical, and School Psychology, University of California, Santa Bar- bara; Cathleen E. Willging, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico; David Ley, New Mexico Solutions, Albuquerque, New Mexico.

The project described in this article was supported by NIMH R34MH095238.

Correspondence concerning this article should be ad- dressed to Tania Israel, Department of Counseling, Clinical, and School Psychology, Gevirtz School, University of Cal- ifornia, Santa Barbara, CA 93106-9490. E-mail: tisrael@ education.ucsb.edu

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