On LGBTQ data, SF health department lags other city agencies
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When it comes to collecting the sexual orientation and gender identity data of San Francisco residents, most city agencies have made great strides since being required to collect the SOGI information in the summer of 2017. Yet the Department of Public Health continues to be a laggard.
It seems counterintuitive, as when LGBTQ advocates over a decade ago first began demanding that SOGI data be collected, a main focus was on having a better understanding of the health needs of the LGBTQ community. SOGI data has routinely been gathered among those living with HIV and AIDS, as well as those diagnosed with a sexually transmitted disease.
Yet, for the third year in a row, the city's health department has submitted a report about its SOGI collection efforts that includes no useable information about what diseases or health ailments are impacting San Francisco's LGBTQ community. The DPH report for the 2019-2020 fiscal year runs just six pages, whereas the report submitted by the Mayor's Office of Housing and Community Development runs 26 pages and includes a wealth of data about the 3,227 LGBTQ people it provided services to last fiscal year.
According to DPH's update, a main issue with its SOGI data collection stems from switching to a new records-keeping system called Epic during the 2018-2019 fiscal year. Just as it was ramping up work on converting tens of thousands of records and retraining thousands of clinical and non-clinical staff on how to use Epic, the COVID pandemic hit and a large portion of DPH's IT and analyst resources were rededicated to the health crisis.
The San Francisco Health Network, the city's public health care system, reported it did make strides improving SOGI data collection at such locations as its community oriented primary care sites, Laguna Honda Hospital, and its jail health services. The emergency department at Zuckerberg San Francisco General Hospital and Trauma Center was also set to begin collecting SOGI data last fiscal year, which was extended to September 30 from June 30 due to the COVID pandemic.
Once the various sites reach the threshold of having complete SOGI data for 75% of patients then they will start to examine health outcomes for disparities among minority orientations compared to heterosexual-identified patients and among gender expansive patients compared to cisgender patients. As stated in its SOGI report, DPH expects a process for data migration and validation will be possible perhaps as soon as late 2021.
In the meantime, DPH said it has arranged for an audit of its SOGI data collection to be undertaken by a researcher at UCSF.
"Armed with data for the first time, SFHN can begin to ensure health equity for LGBTQ patients," states DPH's SOGI report.
In an emailed response to the Bay Area Reporter's questions regarding its SOGI data collection efforts, DPH spokeswoman Veronica Vien stated the health department is committed to meeting its requirements for gathering the information and expects to be able to ramp back up the training of staff on how to use Epic once the COVID crisis ebbs.
"DPH supports tracking SO/GI data and sees it as a crucial step to addressing LGBTQ health issues. To date, DPH continues to collect and track SO/GI in Epic, with over 30,000 patients with completed SO/GI data," wrote Vien. "In light of the current pandemic and local health emergency, while DPH does not have the resources necessary to conduct a complete SO/GI data audit at this time, DPH has added SO/GI fields to COVID testing, case investigation, and vaccination records."
Such information will be collected when fields are incomplete as patients receive routine health care delivery, explained Vien, even throughout the COVID-19 emergency response.
"In future state, when quality improvement and reporting resources are available, we hope to rebuild reports that will help us monitor and improve SO/GI data completeness over time. Meanwhile, we will diligently balance the duty of emergency response and recording & validating data," stated Vien.
The ongoing problems with seeing DPH's various programs get up to speed on their SOGI data collection is to be expected due to COVID upending the health department's focus, said Clair Farley, a senior adviser to Mayor London Breed who, as director of the city's Office of Transgender Initiatives, is working with the city departments on their SOGI data collection efforts.
"Obviously DPH has been on the front line of leading the city's COVID response so it makes sense they have had barriers in collecting this data and with their implementation," said Farley. "We are hearing from providers that much more training is needed across DPH staff and programs."
As one example, Farley pointed to gaps in SOGI data in mental health programs and behavioral health. They are a specific focus area for her office this year in light of the impacts the COVID pandemic has wrought on LGBTQ individual's mental health.
"We have seen isolation in seniors, and mental health and anxiety continuing to be big issues for our community during COVID," said Farley. " I hope this can strengthen their resolve to prioritize and fund those community initiatives in years to come."
The SOGI department reports, filed at the end of 2020, were recently submitted to the Board of Supervisors for review. Gay District 8 Supervisor Rafael Mandelman plans to call for a hearing on the reports, likely before the board's government audit and oversight committee in June during Pride Month. It last held a hearing regarding the city agencies' SOGI data collection efforts in November 2019.
In an interview with the B.A.R. Mandelman expressed disappointment that DPH was not further along with its SOGI data efforts. But he said he understood that the COVID pandemic had pulled its focus and personnel away from other priorities for much of the past 12 months.
"The only thing to say possibly in their defense is there was a pandemic that occupied their time last year," said Mandelman, though he added, "yeah, I think their performance is unacceptable. But their performance was unacceptable a year ago. I would not have expected a ton of progress in the last year because of the health crisis."
Farley told the B.A.R. that her office has been asking DPH why it still has not been able to detail the findings from the SOGI data it has been able to gather. While understanding it has been "a big feat" for the health department to upgrade its record keeping systems and train its staff, and that COVID added to the complications, Farley hopes DPH will be able to accelerate its SOGI data efforts in the coming months.
"I agree DPH needs to examine and look where these gaps are and take strong steps forward on data collection and inclusion of services across their systems of care," she said.
During the 2019 hearing DPH had said no locations had met the 75% threshold it had set for the SOGI data. But department staff predicted there would be marked improvements in the coming years so the information could be used to better tailor services to the LGBTQ community.
"We will be looking at the data to look for health disparities," said Ashley Scarborough, a member of the public health department's SOGI steering committee. "We will develop goals for improving health outcomes based on what we find in this data."
Wealth of info in reports
Advocates have long argued that without the SOGI information the city cannot adequately address the needs of the LGBTQ community. It is why, as of July 1, 2017, the city has required SOGI data to be collected not just by DPH and the mayor's housing office but also by the Department of Human Services; the Department of Disability and Aging Services; and the Department of Homelessness and Supportive Housing.
The Department of Children, Youth and their Families is also required to have its grantees ask the SOGI questions of the youth they are serving. And each fiscal year the departments are required to file reports detailing their SOGI data efforts and the information they have been able to collect.
DCYF found higher than expected numbers of LGBTQ youth are using the programs offered by its grantees. Among its transitional age youth program participants, 3% are transgender compared to trans adults accounting for roughly 0.24% of San Francisco's adult population. While estimates suggest the city's lesbian, gay and bisexual population is 6%, 11% of youth in DCYF programs identify as LGB.
"DCYF can state with confidence that we remain committed to monitoring SOGI data in FY20-21 to ensure that DCYF-funded programs are accessible by LGBT individuals," it stated in its report.
The departments continue to fine-tune the types of SOGI questions being asked. For instance, the mayoral housing office received a waiver in 2018 not to have to ask people the sex they were assigned at birth. Last July 1 the office added two new questions to ask respondents, what gender pronouns they use and what name they wish to be called.
It also translated the SOGI-related questions into traditional Chinese, Spanish, and Filipino. An orientation and training was held for all of its grantees last September 11 and, in October, Farley's office conducted an interactive workshop with the grantees.
In FY19-20, the mayoral housing office funded 318 projects that provided services to over 37,000 clients, of whom nearly 9% identified as LGBTQ. A little more than 1% of the office's public service program clients identify as transgender or genderqueer/gender non-conforming, with trans female clients representing the greatest number (258), followed by genderqueer/gender non-binary (169).
Slightly under 9% of clients identify as LGBQ, with the greatest share of clients (5%) identifying as gay/lesbian/same gender-loving. MOHCD reported it served the greatest number of LGBTQ clients through its Sustainable Housing program area (889), followed by Eviction Prevention (701), and then Legal Services (565).
According to the city's homelessness department, it is hiring a chief equity officer so that its Homelessness Response System and all of its work is centered around equity. It had to delay planned data integration into the system it uses due to COVID and its homeless outreach team suspended collecting client information last March. It plans to resume its client data collection sometime this year depending on the health crisis waning.
"The historic and continuing impact of anti-blackness and white supremacy, and of homophobia and anti-trans bias, have led to disproportionate levels of homelessness for communities of color, LGBQ+ and transgender and gender-nonconfirming (TGNC) persons experiencing homelessness," the department stated in its report.
All of its contractors and grantees are now required to collect SOGI data for clients accessing direct services. The department is also working to better train its staff to improve its SOGI data collection efforts.
Of the 8,176 new households seeking its services last fiscal year, 1,274, or 16.60% were LGBTQ+. It was an increase of 88 LGBTQ+ households from the previous fiscal year ending June 30, 2019.
A review of the data showed that trans and nonbinary households were "significantly more likely" to need housing referrals than cisgender people experiencing homelessness. It also concluded that LGBTQ+ people are prioritized in a representative rate, according to its report.
"HSH is pleased that the prioritization method of focusing on chronicity of homelessness, barriers to housing, and vulnerability is leading to a significant prioritization of LGBTQ+ people experiencing homelessness being identified for Homeless Response System housing assistance," the department stated.
As of May 1, the city's homelessness department will have as its leader Shireen McSpadden, a bisexual woman who is the executive director of the Department of Disability and Aging Services. Her department, which falls under the auspices of the city's Human Services Agency, has been a leader on SOGI data collection efforts.
It was able to gather SOGI data last fiscal year on 65% of its adult protective service clients, with 17% choosing a response other than "Straight/Heterosexual." Of the 98% who provided their gender identity, roughly 0.7% identified as either transgender, gender nonbinary or another gender identity besides female or male.
As for In-Home Supportive Services clients, of the 82% who provided their sexual orientation, all but 3% were straight or heterosexual. Of the 88% of clients reporting their gender identity, 0.3% reported being transgender or a gender identity not listed.
The Human Services Agency reported making "great strides" in the quality and completeness of its SOGI data. And while the COVID pandemic did not disrupt those efforts, it did delay the agency's efforts to determine how to present and analyze its SOGI data in its annual reports.
"HSA wholeheartedly supports the City's SOGI data collection ordinance and has committed significant resources to comply with it over the past four years. The complexity of the agency and the fact that SOGI data is collected by around 140 programs or contracts and is stored in 11 different computer systems has translated to a heavy implementation lift," it noted in its report.
The overall takeaway from the SOGI annual reports, said Farley, is there continues to be a need for training service providers on the importance of asking the SOGI questions. In the first half of 2020, her office was able to train 1,500 city employees and has continued to provide online training regarding SOGI data collection.
Without good, accurate SOGI data, knowing what sort of service gaps need to be addressed and funded remains a challenge, Farley noted.
"It shines a light on the fact there is still so much more work to do," she said.
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